HomeMy WebLinkAbout10570 (5)1 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 _11IzhaTEL.
PPLICANT ,4— TEL.
CONTRACTOR• ,PG' T y/►-rwf�_
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CITY �-ti 4 CIA'+'1 ZIP EL 7Z'L7
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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 VF1101 REOUIRESA PERMIT TO CONSTRUCT, ALTER. IMPROVE. DE MOUSH.OR AEPAm AW STRUC.
TURE. PRIOR TO ITS ISSUANCE. ALSO MOUIRES THF APPLICANT FCR SDCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROOS.ONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER a (COMMENCNO W.TH SECTIO! 70001 OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSDNS 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 OWN EMPLOYEES, PnOVCED THAT SUCH IMPROVE MENTS ARE NOT NTE60ED OR
OFFERED FOR SALE. IF. HOWCVFR THE BLAMING OR IMPROVEMENT W SOLD WTION ONE YEAR OF OOMPLE•
TION. THE OWNER BUILDER WILL HAVE THE BURDEN OF PnOVeOG THAT HE On SHE OD 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 LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THE RFON. AND
VMO CONTRACTS FOR SUCII PROJECTS 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 DIVISION 3 OF THE BUSINESS AND PnOFESSIN S COOS, 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 FOLLOW W G DECLARATIONS
I HAVE AND WILL MA:NTA:N A CERTIFICATE OF CONSENT TO SEL F-DISURE FOn WORKERS'
COMPENSATION. AS PROVDED BY SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE
OF THE Wong FOR WHICH THIS PEnM:T 6 ISSUED
�IHAVE AND W:LL UANTAN WORKERS' COMPENSATION INSURANCE. AS REOU'RED BY SECTION
3700 OF THE LABOR CODE, FOR THE PEnronmAK:E OF THE WOnA FOR WHICH TH'S PERMIT IS
MS::ED. MY WORKS� /EER►1S�'' C,�OU�RENSAT ION INSURANCE CARRIER AND POLICY NUMBER ARE.
CARRIER -���c
POLICY NUMBER Q �Zf�� �--
(Ras sEC(ON NEED NOT BE oDmPLETED CF THE P 111. r FORON E MfOREDDttVfLS 3.00) ORLFSSL
I CERTIFY THAT N THE PERFORMANCE OF THE WORK Fon WHICH THIS PERMIT IS ISSUED. I
SAWL NOT EMPLOY ANY PERSON N ANY MANNLn SO AS TO BECOME CCT TO THC
WORK E RJ COMPENSATION LAWSOF CALIF OnN:A WIFE,T/U 1 NOLO BECAME
SUBJECT TO THC WORKERS'COMPENSATION P F LABOR
COODEE,ISHALL OIITHWTH COMPLY WITHT
CATS' • r—M APPLICANT.e.
WARNING. rALURC TO SECUnE WORKE RS' COAIPEN SATON COVERAGE IS UNIA'WFLIL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENAL7IrS AND CN -`IL FINES UP TO ONE MINDRCO THOUSAND
DOLLARS RIM DOC). N ADDITION TO7Hr: COST OF COMPCN SATION. DAMAGES AS PROvOED 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 NFGFIMD
ATN IS COME CT.
IAGREE TO COMPLY WITH AL L CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CCNSTn'UCTK)N, AND HEREBY AUTHORIZE REPRESENTATIVES OF TW S COUNTY TO ENTER UPON THE
ABOVE " II / ION, PROPEnTYFO;NSPECTIONPUR�CS.
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PE NAME IPRI
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S 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
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POOL'Spa
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Ccmmercial
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Valuation ADJ.AREA
OUANTITY DESCRIPTION FEE
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CONSTRUCTION
PIAN REVIEW
ELECTRIC 1
PLUMBING
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 DIALMRID EAR'
-ISPECTION RECORD
6
SET BACK
FTGS/F0RMS:lsTEEL
1-41A REQ. -.-TS
ELECTRIC GROUND -UNDER FLOORDUCT
UNDER F103RA CONDUIT
GROUND PLUM.BlINC-i
SLJ%B GRADE FI-IFr-'LJ,C;'-7FOUr.'DrTIO.'-J 1.
TEM, P PC' ER - rmEN-ACi:. R ND BEN'A!
WATER SERVICE F. 11 D i T.'- UON D B E A"l.
ROOF SHEATHING' E Fr. BOND BEAM
FRAMINGNENTILIATION1 FINAL 13014D BEAM
— — -f - 1-- ---�.
PRE-GRAUNIG
ROUGH I HEATING
- f.. .,! I a �, c;
ROOF COVER -
ROUGH ELECTRIC-.- HOUGH GRADING
ROUGI I PLU.M.UING F 1,'J!Sl I GPADI.'q'G
SHOVVEWTUB TEST j 1 FIC01- I- L.F(; I RIG
EXTI. UJWSIDING P001-
VVALL INSULATION
FICOL FINAI.
: .-".
0-i'SITE: IMPS
CEILING INSULATION
DRYWALL NAILING
SEWER FlN-.1- ENG..
SEPTIC T�,N'K I I LANDSCAPE:lrlr,IG.
SEEP PIT/L.L. O`j S I I E. 1'.!:'5.----•-----•—•--'
GAS AIR TEST 7 -1 ZOr—
WIG
F 1 N A L CONST. FIRE DEPT FMAL
FINAL HEATING HEAL, H DEPI. 11NAL
Fl -NAL ELECTRIC D-. I F:ES R.'AID
r V
FINAL PLUMSHNG
COMMENTS'.
7 -
SEPTIC Tiw SIZE
SEEP PIT/U SIZE
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