HomeMy WebLinkAbout18260 CITY OF DIAMOND BAR
---�-��` — DEPARTMENT OF COMMiJNITY 8c DEVELOPIvfENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
I ��'�»��� BUILDING PERMIT APPLICATION FI RM LY
Q DDRESS ��7 � / �I�e� C�. 'APPLICATION PERMIT T.P/C ���
p DATE ����-�� �NUMBER �.� #
� APN -�LRT TRACT D TEE ��v�O ST. GROUP �
p OWNER � �! �/�'�J
p ADDRESS � ZONING SETBACKS
Z CITY � � ZIP 9 EL.
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zd SIDE/SIDE STREET RW ❑
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� CITY l7%P�Q/o��- ZIP % � PROPOSED USE � /
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
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I HEREBV AFFlRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f89B/CBfPOff
W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:MlVCITYOR (n
C-� COUNTYWHICHRC-0UIRESAPERMITTOCONSTFiUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG w
W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w P0fI0/DBCK
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- .
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTpN 7000)OF DIVISION 3 OF THE BUSINESS AND Pq0- � PooUSpa
FESSION9 CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOED EXEMP- (�
TION.ANVVIOLATIONOFSECTION7071.6BVANVAPPLICANTFORAPEFMITSU&IECTSTHEAPPUCANTTO Z Re-Roof
A CIVIL PENALT'OF NOT MORE THAN FNE HUNDRED UOLURS(f500).):
� ❑I,ASOWNEROFTHEPROPERTV.ORMVEM7LOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial �
Z WILL DO THE WORI(AND THE STRUCNFE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7W�,BUSI- J
� NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO/W OWNER Of �
PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR '
. � THROU(iHHISORHEROWNEMFLOVEES,PROVIDEDTHATSUCNIMPROVEMENTSARENOTINTENDEDOR m
0 OFFEREDFORSALEIF,HOWEVERTNEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,AS OWNER OF THE PROPERfY,AM EXCLUSNELV CONTRACTINO WI7H LICENSED CON7RACTORS
� TO CONSTRUCT hIE PRQIECT(SEC.70b/,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V01U9fiOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWYIOBUILDSORIMPROVESTHEREON,MID '
� WF�OCANTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDVURSUANTTOTHECONTRAG QUANTITY DESCFIPTION FEE �
Y 70RS LICENSE UW.).
0 ❑1 AA1 EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� DA7E OWNER �
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�Q LICENSED CONTWICTORS DECLARATION w
2 I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT 1 AM LICENSED UNDER PROVISpNS OF CHAPTER � .
� o(COMMENqNO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS IN FULI FORCE AND EFFECT. " � �j m
� IICENSE CLASS ���, � LIC.NO. / �/-.�/�.7 r �
V DATE e�' �O�LjI'Q� CONTRACTOR�-LLt�AN �dD LY d
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� WORKERS'COMPENSATION DECLARATION Q
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N I HEREBY AFFIfiM UNDER PENAL7V OF PERIURV ONE OF THE FOLLOWINO DECLARATKKJS: Z
� _I HAVE M1D WILL MAINTAIN A CERTIFICATE OF CANSEM TO SELF-INSURE FOR WORKEHS' a
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Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOH CODE,FOR 7HE PERFORMANCE U
E WORK FOR WHICH THIS PERMIT IS ISSUED. W
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATqN INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF TNE WOR)(FOR WHICH 7HIS PERMIT IS
ISSUED.MY WOR�KER.�S'—CyQ�M—PE�NS-ATION INSURANCE CARRIER AND POLICyVpt��eEa nnE: CONSTRUCTION
jCARRIER u'/wlF� L�111'yl.P• �/ PLAN REVIEW �
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
C� SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE '
[/� WORKERS'COMPENSATION LAWS OF CALIFORNIq AND AOREE TH F I SFqULD BECOME INSPECTION FEE
= SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFS TI0137o00FTHELABOR I �•
CODE.I SHALL FORTHWITH COMPLV WITH THOSE PR/�/ISIONS. ISSUANCE
1p DA � '� �O�APPLICANT: �J SMIP '� O
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J WARNING:FAIIURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C -
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� SUfl1ECTANEMPLOYERTOCRIMINALPENALTIESANOCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f t 00.000).IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. �' �n
OC RETENTION FEE: i V
OCONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDWO AOENCY
� FOR THE PERFORMANCE OFTHE WORK FOR WHIp1 THIS PEHMIT IS ISSUED(SEC.309'!,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARFECT. TOTA L FE ES ��� +9 � , V
� I A�REE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES M!D STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO EIiTEH UPON THE
Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PUFPOSES. COMMENTS ��
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m PERMI EE NAME(P T) �
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� SIONATU MI DATE
� RECPT.NO. PAID BY � VALIDATION
WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENFO�File Copy,GREEN—P.pplicanYs Copy
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FTGS/FORMS/STEEL �-5•oL ,� FHA REQMTS
ELECTRIC GROUND a�OL � UNDER FLOOR DUCT �
GROUND PLUMBING ` g.s.�� UNDER FLQOR CUt�IDUIT
SLAB GRADE FIREPLAGE FOUNDATION �
TEMP POWER � � FIREPLACE BOND BEAM
WATER SERVICE MID HT. BQND EsEAM �
ROOF SHEATHItVG � 8 FT. B�ND BEAM
FRAMINGNENTILtATIOP! FINAL BOND BEAM
ROOF COVER PRE-GRADlNG �
ROUGH HEATING �BENCNING W
ROUGH ELECTRIC q•s•Ot, �! ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWERrCUB TEST POOL ELECTRIC /�
EXT. LATHFSIOING � POOL FENCING (� � ,�,�/�--
�'VALL IPVSEILATIOIV � POOL FIt�lA,L � ' � ��v
CEILIf�lG IN�ULATION � OFF SITE IMPS.
DRYWALL' lJAILING DEDICATIONS �
SEWER �iNAI.ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITIL.L. � ' URI SITE lMPS.
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FlNAL COIVST. /�� _ , _.,.-' FlRE DEPT. FINAL
FIN,4L HEATING ��i� —'F HEALTH DEPT. FINAL
FINAL EL�CTRIC ' " •��! DEV. FEES PAID
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