HomeMy WebLinkAbout105701 CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21610 E Copley Drive Suite 190
(909) 860.3195 Pax (909) 861-3117
BUILDING PERMIT APPLICATION
JOSSITE
ADDRESS
APN OT TRACT
OWNER �—
ADDRESS G
C TY I3La TEL.
PPLICANT ,4— TEL.
CONTRACTOR • ,PG' T �_f P ► rw fes_
ADDRESS G
CITY �-ti 4 CIA'+'1 ZIP EL 7Z'L7
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PEPLUM THAT 1 AM EXEMPT FROM THE CONTRACTORS LI.
CENSE LAW FOR THE fOLLOWNG RCASON ISEC.7031 S BUS.NE SS ANO PnCFEK7
SSNS CODE ANY CITY OR
COUNTY WIIICII REOU1RESA PERMIT TO CONSTRUCT, ALTER. IMPROVE. DE MOUSH. CA AEPAm AW STRUC.
TURE. PRIOR TO ITS ISSUANCE. ALSO MOUIRES THF APPLICANT FCR 5:101 PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROOS.0145 OF THE CONTRACTORS LI-
CENSE UW (CHAPTER a (COMMENCNO W.TH SECTIO! 70001 OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSONS COCE)OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BAS'S FOR THE ALLEGED EXEMP.
TION ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERM r SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS DSM) 1,
IO LAS OWNER OF THE PnOPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATJON,
WALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFER -D FOR SALE (SEC. 7044. BUSI.
NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND VAIO DOCS SUCH WORK HIMSELF OR HERSELF OR
THROUGH NIS OR HER CMI EMPLOYEES, PROVICED THAT SUCH IMPROVE MENTS ARE NOT NTE60ED OR
OFFERED FOR SALE.IF. HD•WCVER THE BLAMING OR IMPROVEMENT W SOLD WTION ONE YEAR OF OOMPLE•
TION. THE OWNER BUILDER WILL HAVE THE BURDEN OF PnOVe4G THAT HE On SHE 00 NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
C 1. AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING MTN LICENSED CONTRACTORS
TO CONSTRUCT THE PROUCCT (SEC. 7044. BUS'NESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAIN DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THE RFON. AND
VMO CONTRACTS FOR SUCH PTMO.IECTS WITH A CONTRACTOR,S)LICENSED PURSUANT TO THE CONTRAG
TORS LICENSE LAW).
O IAM EXEMPT UNDER SEC. 8 L PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED LNDI:R PROVISIONS OF CHAPTER
e (COMMENCING WITH SECTION 7000) Or DIVISON 3 OF THE BUSINESS AND PnOFESSINS COOE, AND
MY LICENSE MIN FULL FORCE AND EFFECT. r
LICENSE CUSS ___� LIC. NO 70 toy'- ✓
DATE CONTRACTOR
WOnKERS' COMPENSATION DECLARATION
I HCnEBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWNG DECLARATIONS
I HAVE AND WILL MA:NTA:N A CERTIFICATE OF CONSENT TO SEL F-DISURE FOn WORKEILT
COMPENSATION. AS PROVOED BY SECTION 3700 CF THE LABOR CODE. FOR THE PEnFOHMANCE
OF THE Wong FOR WHICH THIS PEnM:T 6 ISSUED
�IHAVE AND W:LL UANTAN WORKERS' COMPENSATION INSURANCE. AS RECU'RED BY SECTION
3700 OF THE LABOR CODE, FOR THE PEnronMANCE OF THE WOnA FOR WHICH TH'S PERMIT IS
MS::ED. MY WORKS� /EER►1S�'' C,�OM�PENSAT ION INSURANCE CARRIER AND POLICY NUMBER ARE.
CARRIER -_��c
POLICY NUMBER Q ��Zf`� �--
(Ras sEC(ON NEED NOT BE oDmPLETED CF THE PE•'IF: r FORCNE MfOR EDDOJMLS 3.00) ORLFSSL
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SAWL NOT EMPLOY ANY PERSON N ANY MAN%Ln SO AS TO BECOME CCT TO THC
WORKERS'COMPENSATKONLAWSOF CALIFOnN:A WIFET/U 1 NOLO BECAME
SUBJECT TO THC WORKERS'COMPENSATION P F LABOR
COODEE,ISHALL OIITHWTH COMPLY WITHT
DATE, • r—"F PRICANT.e.
WAR/AHG. FAILURE TO SECUnE WORKE RS' COMPEN SATON COVERAGE IS UN NN'FLIL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENAL71rS AND CN -`IL FINES UP TO ONE HUNDnrO THOUSAND
DOLLARS RIM DOC). N ADDITION TO THF: COST OF COMPCN SATION. DAMAGES AS PROVIDED FDR) IN
SECTION 37Ge OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FCA THE PERFORMANCE OF THE WORK FOR WWI" THIS PEAWT 151SSU13 [SEC. 30x7. CN E.J.
LENDERS NAME
LENDEWSADORESS
1 CERTTY THAT 1 HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE NO
FGRMATN IS COME CT.
IAGREE TO COMPLY WITH M L CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CGNSTn'JCTK)N, AND HEREBY AUTHORIZE REPRESENTATIVES OF TICS COUNTY TO ENTER UPON THE
ABOVE "IONF, PROPEnTYFO INSPEC7''IDNPUR�CS.
PE NAME IPRI
r
5 ATURE OF PERIMITTEE DATE
PRESS
FIRMLY
�) �� PicPERMIT�
DATEAPPLICATION"7
DATE /1 C.�
NUMBER 0
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
m
Garaga'Carpon
WPBtometl
LL
POOL'Spa
zF1e•Rocl
Ccmmercial
m
Valuation ADJ.AREA
OUANTITY DESCRIPTION FEE
y
U
Cc
F
U
W
W1
U
2
,
ED
2
J
CL
S-44 000
U
x
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UD U FV
4
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CONSTRUCTION
PIAN REVIEW
ELECTRIC 1
PLUMBING Vo
MECHANICAL F
INSPECTION FEE 04
ISSUANCE
SMTP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES F
COMMENTS
I
RECPT. NO. _ PAID BY VAUDATION 1
WHITE—D"rimenl Copy. YELLOW—Finance Copy. PINK—Assessor COPY, GOLDENROD—File Copy. GREEN—AppOrAnl's Copy
CITY, OF DIAL;, NID EAR'
-ISPECTION RECORD
6
SET BACK
FTGS/F0RMS:ISTEEL
ELECTRIC GROUND I i -LIN6E'R FLOOR DUCT
GROUND PLUMMING
SL.A3 GRADE FI-lFFU,C;E FOUNDATIOIN
TEM, P PC' I ER nrREF'L-AGi:. rKiND BE -411'."
WATER SERVICE f.!IDHT.'-Uo,-,D BEA%' J.
ROOF SHEATHING' il Fr. BOND BEAM
FRAMIN GfVENTILIATIO, 4 FINAL BOND BEAM
— — -f - 1-- ----.
ROOF COVER -
PRE GRAD!NIG
-
ROUGH HEATING I
ROUGH ELECTRIC_:-. - I I D, J G I I G R AD V.1 G
R 0 U G I I P L UM23 INKS i I I F'I,'J!Sl I GRADING .. .
SHOVVEWTUG TEST j PC01- I-L.FGI RIG
Ems. LATH.ISIDING P001-
V,'ALL INSULATION FI -01. FINAI.
CEILING INSUI-ATION I I I o-., SITE 11: F'S I !
DRYWALL
ITEDRYWALL NAILING
SEWER
--..._.__I
..........
1.1 FIN-.'- ENG..
SEPTIC TANK— I . ......
I LANDSCAPE11FIRIG.
ON s I I E I
SEEP PIT/L.L.
—
GAS AIR TEST
FIN!,l. Z01,
F 1 N A L G 0 N'S T. FIRE DEPT FM/,L
FINAL HEATING.HEAL, H DE "II
FINAL ELECTFE—
+ 16 - -- GE\'. I FES R -MD
FINAL PLUMS NG j I j j r- Hl 1: Fj Y.-
COMMENTS'.
SEPTIC Ti%w SIZE
SEEP PITIU SIZE
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