HomeMy WebLinkAbout10742CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21660 E. Copley Drive Suite 190
(909) 860.3195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
JITE
ADDRESS./ A/. PIA71R 41 o D r.
APN LOT TRACT
OWNER PiI S
ADDRESS 0
CITY D. ZIP9170C'_ TEL.$4/-777
APPLICANT 641Y&OL TEL.5sbsle
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CIN ZIP TEL.
OWNER•BVILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERAUnY THAT I AM EXEMPT FROM THC CONTRACTORS LI
CENSC LAW FDR TME FOLLCWNG REASON IS CC. 7071.5 BUSINESS ANO PMFESSONS COC[ ANYCJTY OR
COUNTY WHICH REOARES A PERMIT TO CONSTRUCT, ALTER IMPROVE. DEMOLISH. OR nEPA:R ANY STnUC.
TORE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUQI PEM4T TO FILE A SIGNED
STATEMENT THAT NC OR SHE IS LICENSED PURSUANT TO THE PROVISI.NS OF THE CONTRACTORS LP
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION TOM) OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEOC.D E%EMP.
TION. ANY VIOLATION OF SECTION 7071 S BY ANYAPPLICANT FOR A PERMIT SUBICCTS THE ATPOCX47 TO
A CK.L PEI:ALTY OF NOT MORE TITAN FIVEM:NDRCD DOLLARS ({5001 )
LAS OWN ER OF THE PROPCR'Y OR MY EMPLOYECS WITH WAGES AS THC. R SOLE COMPENSATION,
WILL DO THE WORK.
AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SATE (SEC 70N, B:lSI-
NESS AND PROFCSSIONS OTC. THE CONTRACTORS LICENSEE LAW DOES NOT APPLY TO AN OWNER Or
PROPERTY VA.0 BUILDS On IMPROVES THEREON. AND IMO DOES SUCH WORK HIMS E LF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOY ECS. PROVCED THAT SUCH IMPROVEMENTS ARE NOT N'E MDED OR
OFFERED FOR SALE. W. HOWEVER THE BUILDING OR IMPROVCMCNT IS SOLO WITH40NE YEAR OF COMPILE.
7ION• THE OWNER-BUMDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT 6ULD On
IMPROVE FOR THE PURPOSE OF 9ALEL
O LASOWNER or THC PROPERTY. AM EXCLUSIVELY CONTRACTING Vr.TH LICENSED CONTRACTORS
TO CDNSTRUCT THE PROJECT (SEC. 7344, B'JS'NESS AND PROFESSIONS CODE THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY 70 AN OWNER OF A PROPERTY MK) BUILDS OR IMPRCVC S THEREON. AND
VRIO CONTRACTS FOR SUCH PROJECTS WI TH A CONTRACTONS)LOAN
ENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW).
O 11AAM EXEMPT UNDER SEC. e L PC. FOR THIS REASON
DATE _/ �! 6-9 % OWNCR
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PCrW M THAT IAM LICENSED UNOE R PROVISIONS OF CHAPTER
9 ECOMME%CNG WITH SECTION 70x) OF DIVISION 3 O THE BUSINESSAND PROFESSIONS CODE, AND
MY LICENSE 13 N FULL FORCC AND EFFCCT.
LICENSE CUSS LIC. NO
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DCCLARA'ONS
I PAVE AND WILL LAXNTAN A CCRTIFICA7E OF CONSENT TO SELF -N SURC FOR WORKERS'
COMPENSA7ION.AS PROVIDED BY SECTION 37000F THE LABOR ODGE. FOR THE PERrORMANCE
OF THE WORK FOR WHICH THIS PERMIT 13 ISSUED
_I HAVE AND W'IL MANTA:N WORKERS' OOIAPENSATON INSURANCE. AS RCOLARED BY SECTION
37000E THE LABOR CODE. FOR THE PERFOiWANCE Or THE WORK FOR WMCH Tits PERMIT 13
ISSUED. MY WORKCRS' COM?ENSA' ION NSURA/.CE CARRIER AND POLICY NL1JBCn ARE:
CARRIER
POLICY NUMBER
(THIS SECTIW NECD NOT BE CDI P ETED OF TIC PCMB C FOE! ONE IUZMD DOLLA-IS (S10C)OR LESSL
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WICCIT THIS PERMIT IS ISSUED. I
SMALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BCOOJC SUBJECT TO THE.
WORKER:' COMPENSATION LAWS OF CALBORN A ANT) AGREE THA r IF 1 SHC)ULD BECOME
SUEWEC7 TO THE WOnKERS CUMPEASATION PROVISIONS OF SECTION 3700 Cr THE LABOR
CODE.
I SMALL FORTHWITH COMPLY WITH THOSE PROVISX)NS.
DATE: APPLICANT.
WARNING FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS L'FLAWTUL. AND SKALL BE
Su1UCCT AN EM,^LDYE R TO CnIMNAL PENALTIES AND CIVIL FMCS UP TO OAC HUNDRED THOUSAND
DOLLARS (111 900.0x). N AODITION TO THE COST OF COMPENSA'10k DAMAGES AS PROV'DED FOR N
3ECTON 3701 OF THE LABOR CODE, INTERESXANDAT70RKEY'3 FEES
CONSTRUCTION LENDING AGENCY
1 HERCBY AFFIRM UNDER PENALTY Or PERIUnY TW. INE RE IS A CONSTRUCTION LCND3+0 AGCNCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM:T IS ISSUED (SEC. 3097, CIV C.),
LENDERS NAME
LENDCFFSADORESS
I CERTIFY THAT I KA'.O
'C READ THIS APPLOATNAND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LA:NS ROLA'. NG TO BUILDING
CONSTRUCTION. AND HEREBY AUTHONZE REPRESENTATIVES OF THIS CO(AITY TO ENTER UPON THE
AROVC MENTIONED PROPERTYFOR INSPECTION PURPOSES
' /�,�� J � ccure•!s
SIGNATURE OF PERIATTEE CATE
PRESS
FIRMLY
APPLICATION L �� � IERMFF r
V
DATE- / NUMBER M
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE Y&MO L CV,20d S411-014 '
c�elccF. G[acs SSI n� c
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFFVADD,TIEM
cn
Garapa'CaDDrt
LL1J
Patio,'Deck
LL-
Pool'Spa
IrRE.41-'rc
Commercial
m
VaIUeII Q0A ADJ.AREA
QUANTITY DESCRIPTION FEE
J
Q
U
9�
v
W
w
0
_2
m
CL
CL
4
U_
2
Q
x
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING z!,
MECHANICAL
INSPECTION FEE
ISSUAN'
SM.IPCE
SHIP tJ rl�
ENERGY RIC
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES +
COMMENTS
RECPT. NO. PAID BY VALIDAT
WHITE—Department Copy. YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENHOD—File Ccpy. GREEN—App1(canrs Copy
CITY. OF DIALMND BAR.'
INSPECTION' RECORD
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SETBACK
FTGS/FOR :"S;STEEL I i
ELECTRIC GROUNDI : UNDER FLOOR DU
:;T - ,I, �,_ ._i:�r-, ,•__� �; `�^'__
-----
GROUND P1.0IM, 81IN, G _ 1 _ ': UNDER FI-Od i C( NDUIT !
SLAB GRADE FIFIFF'Lf,CE rOUt1DATl0"1— -- ---- ( -
-TEMP PMVER FIREPLACE Ei7tJD BEAI;" - - - -- - - i - - - --- .- - - - -
WATER SERVICE HT. E3O"J7 E3EAI1
ROOF SHEATHING.ii i'i. Ii �;J7 f3EAI.1-
FRAMING!VENTILIATION I - ! FI�J�,!. rn"J7 f3^J1t' f -
- -- - - -
ROOFCOVER PRE (aI;"SDIPJG
- —
ROUGH HEATIN
ROUGH EL.ECTRI,^,•IOJ
I - - - � U ' !
I •I i L:. i GRJ':Ul;JG _
ROUG14 PLU'.MING I-
-- ' - - -- -- FIN:S1 I GR ;DIPJG
S}10v"JER,TUB TESTF'OOl_-ELE:C;TF?I:;-
- - --
EXT. ILATIL'SIDING — .I - --- I_ I I PrOot_ rENCII:G I !--------- --
►"Ji,LL INSULATION POOL FlINIA .
CEILING INSULATION I i I ()--I: SITE IM!' -)S. !
DRYWALL NAILING DEDICATIONS -
SEWER --- I --- — - -- •L-'A-N4-Dt ENS.
_1- CA-E••'I-R-'IG--.SEPTIC TANK ---..._...-----iI -•-----..-..--*i!
— _...--------...--------..-._--
--
SEEP PIT/L.L. I -�__— ON' SITE 1'"P,S. I I
GAS f,IFi TEST IIy� I I I. „ ZOIJ,I•:C;
----..-_.....--�- ----•- - ----•--------. --
FINAL CONST.-�`-� L !. FIR!---DEPT.'FINt.L
FINAL HEATING7-- ;�I I E_!E AL 111 DEPT. FINAL -- -- ------
FINAL ELECTRI:, I I Dr -Al. f FIS PAID - I - - -- - --- -- ---
FINAL PLUM.DING I 1 -NE Y
CONVA ENTS --- -- --- — - -- -- -- '
SEPTIC TAtJIC SIZE
SEEP PIT/U SIZE