HomeMy WebLinkAbout7841CITY OF DIAMOND BAR
CONINI UNITY DEVELOPMENT DEPARTMENT
21660 E. Copley Drive Suite 190
909) 800-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE '
IADDRESS fi,&jq
APN - LOT TRACT
OWNER
ADDRESS
CITY ZIP TEL.
APPLICANT TEL.
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCFLT-:NG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OW%'[R.BL;ILDcn DECLARATION
I HERESY AFF;RM UN:)ER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Lt.
Cr ISE LAW FOnTl4EFOLLOW.N;rPCASON(SEr-7-31.SBUS'NESSA.%'DPR--rcsscNscocc A..4yciTvoR
OWN7.YV61IICl REQUIIIE S A PERMIT TO OCNSTPUCT. ALTER. IMPROVE. CEMOUSHLon nrPAIANYSTR . If Lie
TUAC. PR,CnTO ITS ISSUANCE, ALSO REOUITES Tp.r APPUCA117 FCR SUCH TERM T TO CASIC%ED
STA71,MINT T)MT HE Oil Stir IS UCENSID PUnSUANT TO 7yr PIIOV'S.ONS OF THE CONTRACTORS Ll-
Cr%SE LAW ICIMPTER 9 1OOMMrNCING W:TH SEC710N 7W.1 Or DIVISION 2 OF THE BUSINESS AND PRO.
FESS.O.%S COOL) OR THAT HE On 94C IS EXEMPT THEREFROM AND THE BASS Fort u-rALCEGFDrXEM--
TION ANYVIOLAT ICNOF SECTION 7031 58YANYAPPLICANTFORAPERV TSU13JECTS THE APPLICA"IT TO
ACIV.LPENALTYCFN0TMORE THAN F.'.'E HUNDRED DOLLARS(35DO)),
CILASOWNEROFIRIC PnO,'EIrY.OnMYEkir-LOYEESW:THWAGrSAST)Ifin SOLE OOMPENSATVIN.
MULD0 1HE WORK. AND THE STRUICTUR-E IS NCT IN7ENjE5 OR OFFERED FOR SALE [SEC. 7044. Ifni.
NESS AND PRO;ESSONS CODE. TFE CC gu.-Tom UCLN:E LAW DOES NOT APPLY TO A.N ONNrR OF
PROPERTY V6140 EIJILDS Oft IMPROVES THIERECN. AND A110 DOES SUOi WORKPIMSELF on HErisn-Fon
THROUGH HIS OR HEROV611 EMPLOYEES. PnO'ADEO THATSLICH I1JPnOV`EMEN7S A-1: NOT INTEK7ED On
o;,;EnrDFOA%A_E. F.FICW-VErtrmCBLPLDI.%GOnXAPF40v-rv.rNTISSOLCW!T)4NiO EYEAROFOOMPLE. TION. THE On, Ell 0!J:LOER W:LL HAVE THE EURDEN 01 PTIOVING THAT HE on SI N 1) D Nor 0U'LD On
impnoy; Fon vicPLIRPOSE 0, SALE).
TO:?
OI In OF THE PROPERTY.AM EXCLUSNELY CONTRACTING Vf:TH LICENSED OONTRACTOrtskY'SL0)CT`THE P CCT (S -C. 7044. BUS'NrSS AND PriorEssioNs CODE THE CONTRACTORS Lt.
r
Roj - - '
iSOPERTY W!IO GUILDS OR IMPROVES THEREON. ANDCSELAWDOESNOT - TO OVNEROFAAPPLYAN
WHOCONTRA."S FonSUCFl PnQjE_"S V61TH A CONTP.ACTOr,,S)LICE.%'SCDpunsuOLNT TO THE CONTRAS-
70FIS LICENSE LAW)
rj I ALA EXEMPT UNDER SEC. _11 & PC. FOR THIS REASON
DATE OV.NER
LICENSED CONTRACTORS DECLARAII ION
I mrnrDYAFFIAM L1N3En PENALTYOF PErUUnY TWATIAM LICENSED UNDER PnOVISiONS OF CHAPTER
COMME 1"G WTH SECTION 7DW.) or ommm 3 or THE EIUS;NESS &No PnCFESSONS COCE. ANDNC
My LICENSE IS IN FULL FORCE AND EFFECT.
LICENSECLASS LIC. NO.
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I FEqEDYAFF:PMU"DER PcNA:.TyoFpc,,LL;nYONC or THE FCLLOI.%ING DECLARAT.."S:
IHAVEANOWL' MA.NT"! C1117IFICAIE 01 CONSENT TO SEUF,M1:1Rr FOR WoFllm
COMPENSATION. ASPnOV-EDDYSEC-X)N3,'OOCF7HELA3OnCC)DE.FOnTii[PEP.FOAM&',CE
orTHCwonKFOIIWHIC4fTw:S PETIMITIS ISSUED.
IHKdr.A,%D"',LIMA:"TANWIQII.KEns,coml,F%s,,,,,oN,NsurIA.4CF..A3 REOUTIEDDYSECTION
700 OF TI -E LAJOn COCE. FOR THE PERFORMANCE or TFIG WORK FOR Al-I.CFI THIS PERMIT is
GSjCD MY WOPNEATCOMPENSAT)CIN INSURANCE CA-Lncn AND POLICY Numum ARE.
CAnn-En
POLICY NUVI-En
C01,91LETEDOPTHE PERMIT 6 PORONEWIDA170DEXIAnS,11-MOFILESS.
I CERTIFY THAT IN TH1!PcsronmA.%cr or T14E WORK FOR "fell TH-3 PErwIT IS ISSUED. I
SHALLNOT EMPLOY ANY PERSON IN ANY MAhNER BOAS TO SECOM-- SUILJECT To THE
IVORKEns,COMPENSARON LAWS or CA'OrORNIA.ANDAGRET THAI IF I SHOULD BECOVE
SUFUECT TO THE WOqKEAS'COKIPENSA?K)Npn,,),isoNsoF SECTION 3700 Cr TME LABon
CODE. I SRALL FC"IWITH COMPLY W;TH THOSE P-IOVIS-ONS
DATE. — APMICANT
WATLNNIG rA:LUFIC TO SECUncwomERS'COMPENSATION COVERAGE isu-.LAwrLr. APO SHA.LBE
SUEUECTANEMPLOYE n TO CR-U:NAL PE4ALT:rsAND CIVIL FINES UP TOONE ML")RCD THOLISAND
DOULARS(SIM00C),IN Aorl T;ON TO T H E COST OF COM-ENSATION. DAMAGES AS PROV-VED rOfl IN
SECTION37011 OF THE LAC Oft CODE. IFITI EREST. AND ATIONNIEVS FEES
CONSTRUCTION LEN0114G AGENCY
I mEnrnY A, FIRM; LjNDrn PrNALTV OF PrFUIURY THAT 71 IERE IS A CONSTRUCTION LE%.):%G AGENCY
FOR THE PE RFOSMANCE OF THL %On-( FOR WiflCH THIS PLRM:T 15 ISSUED (SEC. 3097. CIV C).
LENDERS NAME:
LE NDEITS ADDRESS
CERjIFY THAT I FNIE READ TH:S ArPLICATION AND STATE THAT Ti,C AROVE lNrCnMA-CN IS CORRECT. I
AGREE TO COMPLY W!T,1 ALLCM A.NS C1OL-NTYOI40!NANCCS AND STATE I.Aw, nrLA'.NG TO BU D!%G,
coNsTnUCTION. AND HCrEDY AUrHORIZE RrPnCSEN7ATJVES OF THIS COUNiTY TO ENTER UPON THE
A8OVE.MEh,TIDN ED P ROPENTY ron INSPECTION PURPOSES
9RFHL_C--`-H , A_
PERMIrrEE NAME (PR'NT)
S-GwuIAE Or Pulm rrE ()ATj
EXPIRED
OCT 3 0 2909 PRESS
FIRMLY
APPLICATION PERMIT PIC
DATE NUMBER III
ISSUE TYPE OCC
DATE- CONST. GROUP
ZONING SETBACKS
FRONT Rw 0
PEAR -0
SIDE/SID E STREET RW _ 0
SIDE -0
PROPOSED Usq)Lvv,,&_
NO. DWEL. NO, NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFWADD,'RrM
GarageXapperl
LU Pwio,Dock
LL Poc'.,S,-a
Re-nocl
Commo-col
m
Valuat:on ADJ.ARr-A
OUA14TITY DESCn[F'rICN FEE
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P LI
LO
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMONG
MECHANICAL
INSPECTION FEE
ISSUANCE
SM:P
ENrRGYP,`C,
ENERGY PERMIT
RETENTION FEE: ;2, 1! p, ND
PRE -ALT FEE:
TOTAL FEES
COMMENTS
PA VALIDATION . IIIECIT. 10 10 By
WHITE—Department Copy, YELLOW—Finance, Ccpy, PINK—Assessar Copy. GOLDENROD—Filo CM. GREEN—Applicant's Ccpy
CITY OF DIAmOND BAR
114SPECTION RECORD
r I
i ET BACK
FrGSIFORIMS.'sTEEL
ma
FLOORJOIST
FHA REMITS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING I UNDER FLbbn-CO.,!DUIT
SLAB GRADE FIREPLACE FOUNDATION
TEUIP POWER FIR -E -PLACE BOND BEAM.
WATER SERVICE 11D HT. 13OND BEAM
ROOF SHEATHING
FRAI-MING,rVENTILIATION
ROOFCOVER
ROUGH HEATING
08Fr. BOND BEAM
T o)uo ILFIINAL BOND BEAM, tT J l - 7
PRE -GRADING
BENCHING
ROUGH GRADING
GRADING
POOL ELECTRIC
ROUGH ELECTRIC
ROUGH PLUMBING
SHOWER.'TUB TEST
EXT. LATH!SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION orF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITIL.L. ON SITE IMPS.
GAS AIR TEST j FINALZONING
FINAL CONST. FIFtE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMMING ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE