HomeMy WebLinkAbout17622 (46) ----_�!— C1TY OF DIAMOND BAR C./ `
DEPARTIvIENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��%��� BUILDINGPERMITAPPLICATION FIRMLY '
� JOBSITE �� I EC�v'' C'�/�(J//E � l_ �C/—" I���
/ ,./�� APPLICATION PERMIT P/C I
o ADDRESS Y DATE NUMBER
� APN LOAT�y�— TRACT ISSUE TYPE OCC
p OWNER E/u'v�i� - /yJEI1 DATE CONST. GROUP
p ADDRESS l��: ZONING SETBACKS
z CITY n'!'O TEL. �/JS FRONT q�/y p
o APPLICANT TEL. ' S DE/SIDE STREET RW ❑
� CONTRACTOR �-� oL • SIDE p
ADDRE Lt/k+
� CITY LW ZIP TEL' 0 PROPOSED USE
oARCWENG/
�z DESIGNER NO.DWEL. NO. NO.
� ADDRESS
cn UNITS STORIES BEDROOMS
N CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT 1 AM EXEMPT FROM THE CONTRACTORS L4 Gerage/Carport
W CENSE UW FORTHE FOLLOWING REASON(SEC.7031.6 BUSINESSAND PROFESSIONS CODE:ANY CITV OR (n
C-� COUNTVWHICHRE-0UIRESAPERMITTOCANSTRUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS ll�
g CENSE LAW(q1APTER p(COMMENCINO WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO� � POOUSPB
� FESSIONSCODE�ORTHATHEORSHEISEXEMPTiHEREFROMAND7HEBASISFORTHEALLEGEDE%EMP� �
TION.ANV VqLAT10N OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roo1
A CIVIL PEN�LTY OF NOT MOFE 7HM1 FNE HUNDRED DOLLARS(5500).):
p OI,ASOWNEROFTHEPROPER7Y,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1rt18fCIflI
Z WILL DO THE WOHI�AND THE STRUCTURE IS NOT IMENDED OR OFfERED FOR SALE(SEC.70u,BU51� J �
� NESS AND PROFESSIONS CODE:THE CONTRACTOFS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NTiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSEIF OR HERSELF OR
� THROUGHMISORHERONTJEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
� OFFEREDFORSALEIFHOWEVER7NEBUIIDINGORIMPROVEMENTIS50LDWITTIINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SAL�.
w ❑I,AS OWNEROFTHE PROPERTV,AM EJ(CLUSIVELV CONTRACTINO WfTH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.70td,BUSINESS AND PROFESSIONS CODE:7NE CONTRACTORS ll- V8I118SIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONMER OFA PROPERTY WFIO BUILDS OR IMPROVES THEREON.AND
� WFIOCANTRACTSFORSUCHPRQIECTSWITHACON7RACTOR(S)LICENSEDPURSUMITTOTHECONTRAG QUANTITY DESCRIPTION FEE '
TORS LICENSE LAW.).
� ❑I AM E%EMPT UNDEf7 SEC. 8.8 P.C.FOR THIS REASON Q
� U
� DATE OWNER F-
Z U
� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRAI UNDER PENALN OF PERJURV THAT 1 AM UCENSED UNDER PROVISIONS OF CHAPTER y-- ��}.��
� o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF iHE BUSINESS AND PROFESSIONS CODE,ANO Z �/ T��/� G b .
X`� MY UCENSE IS IN FULL F E AND E5F ECT. m
LlJ [/� 7/ O
� LICENSE CLA55 � � `— LIC.NO. �" � � �
V DATE �^I YaL-- CONTRACTOR � a
W
� WORKERS'COMPENSATION DECLARATION Q
N I HEREBV AFFlRM UNDER PENALTY OF PEqJURV ONE OF THE FOLLOWING DECLARATIONS: V
C!) Z
�Z _I HAVE AND WI MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' ¢
Q
COMP N,AS PROVIDED BV SECTION 37o00F THE LABOP CODE,FOR THE PERFORMANCE U
Q WORK FOR WHICH THIS PERMIT IS ISSUED. � � �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MY WORICERS'COMP NSATION IN URANCE CAR/R—IER AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER �JA'��� _L_/9 S. PLANREVIEW
Z� POLICVNUMBER ��_��,��Q� 1 ELECTRIC
Q (n+ssEcraNr�r+oreE�rmoFn-e�w.n�swaor�Erti.r�E000unicsgiaoloa�ss} PLUMBING 1��
w
Z I CERTIFV THAT IN hIE PERFORMANCE OF hIE WORK FOR WHI THI ER IS ISSUED.1 MECHANICAL
C} . SHALL NOT EMPLOV ANV PERSON IN ANV MANNER AS TO CA U&1 T TO THE
(n WORKERS'COMPE SATqN LAWS 0F CALIFOR A THA I I SH LD BECOME INSPECTION FEE
SU&IECTTO T E RKERS'COMPENSATION 3� OFTHELHBOR
OCADE,I SH F THWITH COMPLV WITH TH p ioN . ISSUANCE (�
p DATE: PLICANT. SMIP
w ENERGY P/C ��Fx'�^�--ri�--�.�____
J WARNINO:FAILU SECURE WORKERS'COMPENSATIO G WFUL,AND SHALLBE (
J ���ll `..rA .��\ �I 1 r ._'`
� SUBJECTANEM L ERTOCRIMINALPENALTIESANDCNI�FINESUPTOONEHUNDREDTFIOUSAND ENERGYPERMIT � � � ��
D011ARS(f100. .IN ADDI710N TO THE COST OF COMPENSATKKJ,DAMAGES AS PROVIDED FOR IN
J SECTqN37oeOFTHEUBORCODE.INTEREST,ANDATTORNEI"SFEES. ---
aC � RETENTION FEE: I I I [ ' ' •
O CONSTRUCTION LENDING AGENCY "�� �/ ^
PRE-ALT FEE: � I � U -
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A Cq4STRUCTION IENDWG AGENCV � ; �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�. � .y�
Z �.��.1;;�.T.
w
� LENDER'S NAME ��. "''_.. � --�--""'���
F— LENDER'SADDRESS
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATbN IS CORRECT. TOTAL FE ES R
p_ I AOREE TO COA/PlV WITM ALL qTY AND COUNTV ORDINANCES AN�STATE LAWS PELATING TO BUILDING ��'S V
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED P TV FOR IN N puaaosEs. COMMENTS
� � ,
�
m PERMITTEE NAME �
� Z./-ol
� SIGNATUREOFPERM EE OA7E
� RECPT.NO. PAID BY VALIDATIO
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROP—File Copy,GREEN—ApplicanYs Copy
(���� �[� �OQ6�fli��R'1� [�/�lf�
O�S�[���""��� l�f���9��9
� �C. u o � a �5� , D�C�itt�G3 0 ° �� DGJ`tr� O��p
SET BACK ���1�������� � � FLOOR JOIST •
FTGS/FORMSJS7EEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING � UNDER FLOOR CU�IDUIT �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPI�ACE BOND BEAM
WATER SERVICE MID HT. BOtVD BEAM
ROOF SHEATHING 8 FT. BOND BEAAfl
FRAMINGNENTfUATfON ` FINAL BOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATING SENCHING
ROUGH ELECTRIC RUUGH GRADfNG
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATHJSIDING � POOL FENCING
WALL I�ISULATI�(d POOL FINAL
CEILING IN�U�ATiON � OFF SITE IMPS. __ _ _
DRYWALL NAIUNG DEDICATIONS
SEWER FINAL ENG.
SEPT(C TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. u
GAS AIR TEST FINAL ZONlNG -
FlNAL CONST. : �lRE DEPT. FINA"
FINAL HEATING HEALTH DEPT. FINA�
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
�Ai�.c �¢.�R� z�xilm2. �. �iL
r � .��o .
COiVlMEiVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE "
. �
� � �.
c� _