HomeMy WebLinkAbout15092 (17)CITY OF DIAMOND BAR
DATE �-. {
NUMBER—
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
DATE CONST. GROUP
21660 E. Copley Drive Suite 190
FRONT RW ❑
(909)860-3195 Fax(909)861.3117
SIDEISIDE STREET RW ❑
BUELDING PERMIT APPLICATION
PROPOSED USE
JOBSITE
ADDRESS F0�
APN LOT TRACT
O'.VNER (IJ
CITY OfJ2I-r —AF ,C'iL3 ZIPr l CC TEL. n
APPL CANT C(I! ;1Cl_+_ t C' J'0 TEL_ ll 1J e- C 'SC
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCW'ENG/
DESIGNER
ADDRESS
CITY ZIP TEL..
OWN"EI-BUILDER DECLARATION
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I HCnEBY AFFIIIM INOER PENALTY Or PCR.UnY THA' 1 AM EXEMPT FROM THE 0001TRAL:OnS LI.
CCNSC LAW FOR THE FOLLOWING RLASCFI (SEC. 7671 6 BLSWESS AND PRCFESS<X 5 COLEA.:Y CITY On
COUNTY WHICH REOUNESAPCRMr7 TO OOHS-. nLICT. ALTCFL NPPOVE.00MCLISI L OR M PAA ANY STUC•
T1FIE. PRIOR TO Ii915SUANCE, A:50 REOLASES THE APPLICANT F041 SUCH PERMIT TO FILE A S:GKED
STA'EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVIS'ONS OF THC CONTRACTORS LF
CENSE LAW (CHAPTER S (COMMENCING WITH SECTION 700C) OF D:VISION 3 OF DHE EUSINESS AND PRO.
FISSIONS ODDE)OR TIHATHE OR SHE IS EXCIA T THEREFPCMAND TIE BASIS FOR 7HC ALLEGED EXCIAM
TION. ANY
VIOLATION OF SECTION 7031.5 BY ANY APPLX.ANT FOR A PE RMI i SUBJECTS THE APPLICAN I TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUI DnED DOLLARS (115x; )
O L AS OWNER OF DHE PROPCnTY. OR MY EMPLCYEES W'TH WAGE S AS DHEA SOLE COMPC45ATCN,
VALL DO TMC WORK. AND TMC STRUCTURE 13 NOT INTENDED 014 OFFERED FOR SALE (SEC. 7344. BUS:
NESS AND PROFESS*KS COO, TIC CCW TRACTOnS LICENSE UN DOES -.or APPLY TO AN OWNER OF
PROPERTY IM10 BUILDS On IMPROVES THEREON, AND WHO DOES SUCH WORK H'MSCLF Ori H.( RSCLF Ori
TNF100011 H'S Cin HER OWN EMPLOYEES. PROVCCD THAT SUCH IMPROVELIC%TS Ani AAT N' ENDED On
OFTERED fORSALEIf,fVCIL THE BUILDING IXLMPFIOV[MCNiIS SOLD WI: Nil ON=YEAR OF WNP:E-
TICN. TIE OWNER M=ER WILL FIAVE THE BURDEN OF PnCY.NG THAT FF. OR SHE DID NOT BL:P.D Oil
IMPROVE FOR THE PURPOSE OF SALE).
O LAS OWNEROF THC PROPERTY: AM EXDLUSIVELYCONTRAOt1NO WITH LICC%EED CONT^
RAORS
TO CONSTRUCT THC PRDIECT (SEC. 7544. BUSINESS AND PROFESSIONS 00,.1 TIE CON'RACTOR i LF
CC NSE LAW DOES NOT MPLYTOAN OWNER OFAPROPERTY wHocJA.CS on MPnO.'E5 T11ERrON AND
VA
HOOON7RAC7S FOR SUCH PROJECTS WITI A CONTRA--TOnIS) LCCNSCO A.'RSUAN- TO THE CONTRACT
TORS LICENSE LAW).
Ell UNDER SEC. U. A PC. ICA l".* RCA)ON
[�Fl• —
WE =Fid, OW+:En
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFJN UNDER PENALTY OF PERJURY THAT IAM LICE.NSrD UNDER PRO:'ISIONS CF CHAPTER
S(COMMENCNG W:THSMI)N 7000) OF DPF5ION 7 OF THE D'U5:NCS5 ANaD PFICFESS ONS COSC.AND
MY LICENSE IS N FULL FCnCC AI13 EFFECT.
LICENSE CUSS LIC. NO
DATE CONTRACTOrI
WORKERS' COMPENSATION DECLARATION
I HCREDY AFFIRM LNOCn PENALTY OF PEIL,T:FY/ ONE OF THC FOL LOWING DECLARATIONS
—I HAVE AND WLL UAN7A.T A CERTIr•G:E OF CONSENT TO SELF-IN3URE FOn WORKS RS'
COMPCN5ATnN, AS PROVICED BY SECTION ST DO Or THE LABOR OCCE. Eery TIL PEn-ORMANCE
OF THE
WOnIC FOR M41CH THIS PERMIT IS ISSUED
_I HAVE AND W.U. MAN'Atl WORKS. RS' COMPEl3A-gY INS::RAnCC. AS RECUR ED BY 3CCRON
57000r THE LAnan CODE. FOR THE PCITrCRMANCE OF THC WORK FOn W^ -CN DrS PE PMIT IS
ISSUED. MY WDMCRS' COM PE NSATCN INSJRA%CE CAP n:rn ANO POLICY NUMEL It APC.
CAFLRIER
PCLICY MJUDEn
rMSE-IONNEEDNO'BCOCMIFrEDCrTE PCF/d: IS FOROW.. HUNDIMDOUXIS war; OR LC55,
1 CERP.rY THAT N THE PERFORMANCE Or THE WORK FOR WHICH THIS PERM:' IS ISS ED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNEn SO AS TO BECOF.R' S'UB:ECT TO DIE
WORKS RS' COMPENSATION LAWS OF CAA rFORNIA. AND AGREE TKA' IF I SHOULD BECOME
SUDJCCT TO THE WORKCnS'COM^ENSATXN PRO':IS,Ghs Or SECTION ]7030: THC LADOn
COOF.1 SRALL FDRTHW:THCOUPLY VAnH THOSE PRCrIlSK)NS
DATE. APPLICANT
WAM:NG' FALUr,C TD SECL:nE WORK(nS GOhIPENSATKX4 COYCn AGE IS LKUWrJL.AN) SHALL BE
SUEUECT AN (MPLOYCn TO CR'U'NALPCNALTIE S Aho C.V.L FMCS UP TO OK C HUNDRED IPM'SA4D
DOLLARS 13100 0(X., N ACG;TION TO T E CO;T OF CCUPCNrA'ION. DAMAr:S AS Pn0'nOED FO(I IN
SECTION ]DCF OF DIC LABOR CODE. N7ERCST-AND A'Ton%En FEES.
CONSTRUCTION LENDING AGENCY
1 F4RCBY AFFIRM UNOrn PL MALTY Or PETLV nY THAT THERE IS A CONSTRUCTION LEND_Nr.. AGENCY
FOR T2 PERFORMANCE OF T2 WORK FOR W 1%101 TH•5 PERMIT IS ISSUED (SEG 33FT. C:V C.).
LENDERS NAME
LEHJCRSADORCSS
I
CER :FY THAT I FIAVE READ TIOS APPUCA70N ANO STATE THAT 7HE ABOVE NX4 FORMA'KIS CORRECT.
I AGREE TO COMPLY WITH ALLCITY AND COUNTY OPOWANCES ANS) STA -11 LAA-. RELATING 70 BUILDING
CONS iRUCTION. AND Y HER11 A:.:74Qn:ZE REPRCSE NIA: IVES OF T IIS COUNTY 10 EN. CII UPON DIE
ABOVE MENTIONED PROPERTY Fon INSPECT ON PURPOSES
PERMITTEE NAME IPR;NT, — rt
(y4F.IF/�%=(-;f %�o — l 1 —0 Q.
SIGNArUI i— I: OF PLFOdlr iii IIA'L
PRESS
FIRMLY
APPLICATI N I PERMIT I P/C
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DATE �-. {
NUMBER—
ISSUE
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DVJEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. ARE.AIVALUATION
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Valuation ADJ.ARCA
QUAINTITI DESCRIPTIOPJ FEE
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INSPECTION FEC
ISSUANCE
SN.Ir
ENERGY P,'C
ENERGY PERMIT
RETENTION FEC:
PRE -ALT FEE:
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TOTAL FEES
OCOMMCNTSQV--(?LL— )Q/J�e
COMMENTSQV--(?LL— 1-0
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NO. _�A
PAID BY VALIDATION V
YJHITE—Department Ccpy, YELLOW- fna..we Copy. PINK—Assessor Copy, GOLDENFIOD—Fila Ccpy, GREEN—A;p:.cant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
.SET DACK
FLO-,A JOIST
Fl GS.!F0R.l.lS.,STEEL
Fl 11A RE07.1,TS
ELECTRIC GROUND
-U-ND-EPFL-6-6 R- D -LJGT
GROUND PLUMBING
UNDER FLOOR
SLAI: GRADE
I FIREPLACE FOU.NDATIO.Nl
TEM.P rOVV'ER
I FIREPLACE BOND BEAN1
WATER. 8 E R V I C 71 FIT. DOND BEAM.
Sl ]EATHING -1-or-T.130NDBE
ROOT A'
ROOF COVE -'R
FINAL POND B-7AM
PRE -GRADING
RIOIJIGH Hr ATI
-ICHIN-
ROUGH ELECTRIC
-
ROUGH GRADING,
7
PI ULIEING
FINISH GRADING
BTEST
POOL ELECTRIC;
::X T. LA-- H,"SIDING
POOL FENCING
POOL FINAL
0'--- IL! NS 17-1. U L AT 1 O'N'0.
- CF SITE l,'A.PS.----
D E 1) 1 GAT 1 ON S
FINAL ENG.
LANDSCAPE/IRM-11.
OBJ SITE PS.
':'::ST
FINIAL ZONINS
FIRE DEPT. FINAL
1 HEALTH DEPT. FUNIAL
i -ECTr-l?.:";
i DEV. FEES PAID
PLUMBNG
EFi 0.1 Y
IMENTS
SEP TICTANK S!-,.=
SEEP PIT/U SIZE