HomeMy WebLinkAbout17165 CITY OF DTAMOND BAR
`-----��� --- DEPARTIvIENT OF COMMUNITY&DEVELOPMENT SERVICES I
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 �RES$
"`%���� BUILDING PERMIT APPLICATION I�ORMLY
o AODDRESS�� l.SS P�rN,�,Nprn �� DATECAcf �17��1 NUMBER��I�S #/Cvly -t��/
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER"- AG.�nC W 6iS�' N t'$t S
o ADDRESSoZO�1SS /�i4 T Hl=�rD�rz ZONING SETBACKS
Z CITY D�l�►MMwD B!�/L ZIP9i7G�TEL. FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
z
Q CONTRACTOR / SIDE ❑
� ADDRESS /[Z/�S �lLZS �
� CITY�/�� /�I/1irL ZIPq3.�0/ TEL7� ' -F/� PROPOSED USE
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
� ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f0(JB/CBfpOR
W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
U COUNTYWHICHREOUIfiESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG �
� W TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w Patio/Deck
STATEMENT THAT HE OH SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAN7RACTORS LI�
� CENSE LAW(CHAPTER 8(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- � POOUSPB
FESSIONSCADE)ORTHATHEOHSHEISEXEMPTTHEREFROMANDTHEBASISFOHTHEALLEGEDEXEMP- (J
� TION.ANVVIOLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5ao).): �
❑I,ASONRJEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, �
Z Commercial -
WILI DO THE WORN,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7044,BU51- J
N NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� QOFFEREDFORSALE.IF,HOWEVERTNEBUILDINGORIMPfiOVEMENTIS50LDWI7HINONEVEAROFCAMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OH SHE DID NOT BUILD OR
� IMPROVE FOR THE PUHPOSE OF SALE).
❑I,AS OWNER OF THE PROPERTV,AM E%CLUSIVELY CANTRACTING W ITH LICENSED CONTRAC70R5
� TO CANSTRUC7 7HE PR0.1EC7(SEC.70�1,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� VelUet� O� � ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� NMOCANTMCTSFORSUCHPRQIECTSWITHACANTRACTOR(S�LICENSEDPURSUAN7TOTHECONTRAG pUANTITY DESCRIPTION FEE
Y TORS UCENSE UW.�.
� ❑I AM EJ(EMPT UNDEFi SEC. B.8 P.C.FOR THIS REASON Q
� U
� �
DATE OWNER U
Z W
¢ LICENSED CONTRACTORS DECLARATION w -
OC I HEREBV AFFIRM UNDER PENALTY OF PERJURV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER lI' {�
d B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z DS / �+O •�
`X MY LICENSE IS IN FULL FORCE AND EFFECL m
� UCENSE CLASS LIC.NO. j I
� J
U DATE CONTFACTOR 0-
W
� WOAKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIfiM UNDER PENAL7Y Of PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ '
¢ COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFOflMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � I
�
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION }�'„��� f�
Q 37oa OF 7HE UBOFi CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS � ��+�I ] d v
ISSUED.MY WORK 5'/C.A..MPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ���
Q
CARRIER S /q�b �D�P F1�{IVn PLAN REVIEW �•
> I1
ZPOLICY NUMBER O Y.�^ O' ELECTRIC I
Q
0 (fHLSSECiIONNE�NOTBE00MPLEfEDOFTHEPERANTISFORONEHUI�DREDD0I.LARS(E100�ORLESS). PLUMBING
W ' i
Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKFORwHICHTHISPERMITI5155UED,1 MECHANICAL
�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE � '
N WORKERS'COMPENSATION LAWS OF CALIFO IA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&IECT TO THE WORKERS'CAMPENSATIO VISIONS OF SEC710N 37 OF 7HE LABOR
CAD I SH FORTHWITHCOMPIY WITH OS PROVISION� ISSUANCE � x
� ' SMIP � •.cOV
p DATE: G APPLICANT:
J WAflNING FAILU TO SECURE WORNEHS'COMPENSATION COVERAGE IS UNLAWFl1L.AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f10o.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �'l/� �
� SECTION370BOFTHELABOFCODE.INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: • �111 'I
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� 1 HEREBV AFFIqM UNDEH PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION IENDING AGENCV �
�- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
Z
W
� LENDER'S NAME �i
I-= LENDER'SADDRESS /�
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARFiECT. TOTAL FE ES ��) 'O D f,
w I AGREE TO COMPLV WI7H ALL CI7V AND COUNTY ORDINANCES AND S7ATE LAWS REUTING 70 BUILDING ��
� CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE �
� ABOVE�MEN710NED PROPEf77V FOR INSPEC710N PURPOSES.
Z COMMENTS
� � �y� ELLE
m PERMI E E(PRINT) �{
C/) ` 7 V
� SIGNA7UR EFIMITTEE DAT �.
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A IicanYs Co
P PY� PY, PY. PY, PP PY
� - ------- - -. _ . .. _ .
�fl�� �� ������� ��(�
�(��pL�G��c�6� G��C�Cc�I��
�G�pC U o DQ� 0 ° �� � ' �C��rI10�� DGJ r� �� Q ' �
SET BACK � FLOOR JOIST !
-- ----- ---_._ .-- - -----__ - ---- -
___...._ _..._._ -___
_._
FTGS/FORMS/STEEL � ; FHA REQ�ITS ;
_ ____ _ _ _..__.- --- .. _._._�_-- .._. _..._ � _ ___
_ ___-----
ELECTRIC GROUND _i UNDER FLOOR Dl1CT � �_
_._ .._— .__ - —. -- = ------ _.---
GROUND PLUMBING I _ _____ � UNDER FLC?OR CUMQUIT ;
- — � —r------.._._._.._...._.
SLAB GRADE FIREPLACE FOUNDATION _ ' "__
TEMP POWER FIREPLACE BOND BEAM ____
WATER SERVICE ' MID HT. B�ND BEAM ' _
ROOF SHEATHING , 8 FT. BOND BEAM • _ i • __
----- -- . .
---- -
FRAMINGNENTILIATION FINAL BC�NB BEANI �
- -- --- - --....-- -------.._._---
---......._....__.
ROOF COVER { __ _ PRE-GRAL�iNG ,i i _ ----------
ROUGH HEATING� BENCHII�lC� j
ROUGH ELECTRIC ROUGH GRAdING � �
- ----- ____ ------ - ------
ROUGH PLUiViBING i FINISH GRADING ___ _
SHOWERrfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCIh1G
WALL INSULATIOiV POOL FINAL
CEILIIVG IPVBULATION OFF SITE IMPS.
- --- --.....----...._..__.
DRYWALL fVAILING DEDICATIOiVS
-- --- ---- --_..__ _.__.___._____
SEWER FINA�E�l�a:__.._ -1.-._______.__
SEPTIC TANK � LANDSCt�PE/IRRIG. �� �
SEEP PIT/L.L. � � ON SITE IMPS. i
GAS AIR TEST FINAL.ZONING
FIfVAL CONST. �!RE dEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
FIMAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING • � ENERGY ,
. -- -- ------------ -----......_.
�
�
--- ---
�
I --- C�f��:�� o- �
-------- �— --_---
CU�/iiViENTS
SEPTIC TAiVK SIZE
SEEP PIT/U SIZE ---� --- -----
� �� - -- ___. — �_._____
� � --
� , . .
