HomeMy WebLinkAbout7841 (19)CITY OF DIAMOND BAR
CONINI UNITY DEVELOPMENT DEPARTMENT
21660 E. Copley Drive Suite 190
909) 860.3195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS•1 d L^ASQ 1r Mr,/iti
APN LOT TRACT
OWNERS
ADDRESS
CITY trt ZIP TEL.
APPLICANT TEL.
CONTRACTORADDRESS
CITY ZIP TEL.
ARCFL'ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OW%'[R•BL:ILDCR DECLARATION
I HERESY AF FIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF
CENSE EA'A FOn Tl4E FOLLOW NG PCASON (SCC. 7091.5 BUS'NC SS AND PROr E55 ONS COCC AYY CITYOR
COI.'NTY rilaOI RCOUIRE S A PERMIT TO WNSTRLCT,ALTER. IMPROVE. CCMCL:31i On RFPA?i ANY 3TRl1C•
TURF. PRIOn TO ITS ISSUANC , ALSO REOUIRES TMr APPUCAV' FCR SUCH PERM T TO FLEA SIGNED
STA: LMENT THAT HE OR SIZE IS UCENSED PUnSUA.•fT TO THC PIIOV'S.ONS OF THE CONTRACTORS LF
Cr%SE LAW (CI MPTCR 9 (OOMMr NCING W':TH SEC'ION 7W.1 Or DIVISION ] OF THE BUSINESS AND PRO.
FESS'O..%S COOL) OR THAT HE OR 94C IS EXEMPT THEREFROM AND THE BASS FOR TME ALLEGFD rXEMP.
TION AYY VIOLATCN OF SECTION 7071 S DY AYY APPLICANT FORA PER V T SU13JECTS THE APPLICANT TO
A CIY.L PENALTY CF NOT MORE THAN F.':E /HUNDRED DOLLARS 1357011'
CI L AS OWNER OF TIIC PnO,'ERrY.On MY EMPLOYEE S W-•TH WAGES AS THC In SOLE COMPEN SATK;N.
M LDO 1HE WORK. AND THE STRICTUR-E IS NCT INTENDED OR OFFERED FOR SALE [SEC. 7044. Ifni.
NESS AND PROFESS'ONS CODE.. TME CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY W140 BJILDS Oft IMPROVES THEREON. AND W110 DOCS SUO1 WORKHIMSELF On HERsn-FOR
THROUGH HIS OR HCR OVM EMPLOYEES. PTIO'ADCD THAT SLICII I1JPnOVEMEN7S A-1: INTEh. ED On
OFF EnrD FOA SAE. IF. FIOWTVER. THE BLPLDI.\G OR XAPFgVEM.rNT ISSOLC W!TInY ONE YEAR OF OOMPLE•
TION, THE On, Ell D'J:LOER W:LL HAVE THE D'JRDEN OF PROVING THAT HE On S1E O D Nor DU:D On
W Pnoy; Fon 711E PURPOSE Or SALE).
IA OW'NIn OF THE PROPERTY.AMEX.CLUSNELY CONTRACTING Vf:TH LICENSED CONTRACTORSTOON,,; SL CT THC PFKIICCT (SEC. 7044. BUT: NESS AND PnorEssioN S CODE THE. CONTRACTORS LI.
CCNSC UiY DOCS NOT APPLY TO AY ONhER Or A PROPERTY W!IO GUILDS OR IMPROVES THEREON, AND
WTfp CONTRACTS Fon SUCFI PnO1ECTS V61TH A CONTRACTCR,S) LICENSCD PURsuOLNT TO THE CONTRAO-
70FIS LICENSE LAW)
D IAM EXEMPT UNDER SEC. B i PC. FOR THIS REASON
DATE OV.•NCR
LICENSED CONTRACTORS DECLARATION
I HEnCDYAFFIAM UN•^.CR PENALTY OF PErUUnY THAT IAM LICENSED UNDER PnOVIS10NS OF CHAPTER
9 ICOLMLTFCI\G WETH SECTION 7DW.) or O:V15.'ON 7 Cr THE DUS:NESS AYD PRCFESSIONS CO,^.E. AND
MY LICENSE LS IN FILL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
IHEREDYAFF:PMLNDER PCNALTYOFp[n.'UnYONC Cr THE FCLLOriTTG DECLARATIONS: -
I HAVE AND W LL MA.NT" A CCR'IFICAIE OF CONSENT TO SELF,INS:IRC FOR WOFllmR
COMPENSATION. AS PIOY.GED DY SECTION 3700 OF THE UBOn CODE. FOn T¢ PERFOAMA',CE
Cr THC WonK FOIL WHICSf TH:S PERIMIT IS ISSUED.
I HKdr. A,%D WILL MA:NTA N W'OPJKEns' COMFIEN3ATON INSURANCE. A3 RCOUTIED BY SECTION
7700 OF TFC LAROn COCE. FOR THE PERFORMANCE Or THE WORK FOR WH.CFI THIS PERMIT IS
LSSJCD MYWOPNEATCOMPENSATCN INSURANCE CARREn AND POLICY NUMBER ARE.
CAnn'En
POLICY NUMLIER. .—.. - .
RAS SCCRL7N rSCDrgT Cr. C01.41LETEDOF THE PERMIT G POR ONE FUDACD DOLIAIS,11-MOR LESS}
I CERTIFY THAT IN THE PEF.ronmA.NCE Or TILE WORK FOR "fell TH-3 PERMIT Is ISSUED. I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER BOAS TO BECOME-- SUI JECT TO THE
WORKEns,COMPENSARON LAWS Or CALIrORNIA.ANDAGREE THAI IF I SHOULD BCW VE
SUFUECT TO THE WOnKEAS'MCOPENSATION PnOV6KNsof SECTION 7700 Cr TME LABOn
CODE.1 SHALL FCR:IFMTH COMPLY WITH THOSE PROVISK7NS
DATE. APT'LICANT.
WARN YG rA:LUFIC TO SECUnc womERa COMPENSATION COVERAGE Is U•.LA'NrLr. AND SHA.L BC
SUEUECT AN EMPLOYE A TO CR-U:NAL PENALT:rs AND CIVIL FMCS UP TOONE ML")RCD THOUSAND
W LDOIS (S too DOC). N AOCIT:ON TO THE COST OF COM-ENSATCN. DAMAGES AS PROV.^ED rOfl IN
SECTION 770! OF THE LAC Oft CWC. NT EREST. AND ATTORNEYS FEES
CONSTRUCTION LENDING AGENCY
I FlEnrnY AFFIRM UNDCn PENALTY OF PENURY THAT TI IERE IS A CONSTRUCTION LEN.7.NIL AGENCY
FOR THE PERFORMANCE OF THE W'On-( FOR WHICH THIS PLRM:T 15 ISSUED (SCC. 3097, CN C).
LENDER'S NAME
LE NDEI SADDRESS
1 CERTIFY THAT I HANE READ TH:S APPLICATION AND STATE THAT THC AROV'C NrCnMATCN IS CORRECT.
I AGREE TO COMPLY W:TM ALLCITY AND C1OL:NTYOf10:NANCCS AND STATE LAWS nrLA'.NG TO BIJ DING
CONSTnUCT ION.AND HC RCDY AUTHORIZE RCPnCSENTATIVES OF THIS COUNTY TO ENTER UPON THE
ADOVE.MEN:ION ED PROPERTY ron INSPECTION PURPOSES
9RFH L_CSH - _
PERMITTEE NAME (PRINT)
S.GwuIAE Or PERM TfEE V DATe
EXPIRED
OCT 3 0 2000 PRESS
FIRMLY
APPLICATION . PERMIT P/C
DATE_a s ^ 1_ NUMBER 0
ISSUE / /' TYPE OCC
DATE—
r/
l CONST. GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDE/SID E STREET RW
SIDE
PROPOSED USq)
NO. DWEL. NO, NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR(ADDSLEM
GarageXapperl
PwioDock
LLU
LL Poc:'S;a
Z Re -Floc!
Commo-cal
ED
Valuation ADJ.ARr-A
OUA14TITY DESCRIPTICN FEE
Q r t --S
P LI
U
w S'LOn
Jw
z 2e' r
in -
jJQ.
E
U
ZC
Uw
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMONG
MECHANICAL !.-•c:"
INSPECTION FEE _
ISSUANCE ^ '-
SM:P •`
ENERGY P,'C
ENERGY PERMIT
RETENTION FEE: ;2, 11 ,ND L`-!••• •-1 •.
PRC -ALT FEE:
TOTAL FEES
COMMENTS
rRECPTPAIDBy VALIDATION
WHITE—Department Copy, YELLOW—Flnanco Ccpy, PINK—Assessor Copy. GOLDENROD—Filo Copy. GREEN—Applicant's Cepy
CITY OF DIAMOND BAR
INSPECTION RECORD
r I
i ET BACK
FrGSIFORIMS.'sTEEL
ma
FLOORJOIST
FHA REMITS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING I I I UNDER FLbbn-CO.,!DUIT
SLAB GRADE I I I FIREPLACE FOUNDATION
TEUIP POWERFIR-E-PLACE BOND BEAM.
WATER SERVICE I I ?,11D HT. BOND BEAM
ROOF SHEATHING
FRAI-.1ING,rVENTILIATION
ROOF COVER
ROUGH HEATING
08Fr. BOND BEAM
T o)uo ILFIINAL BOND BEAM, tT J i_ -
7
I PRE -GRADING
BENCHING
ROUGH GRADING
GRADING
POOL ELECTRIC
ROUGH ELECTRIC
ROUGH PLUMBING
SHOWER.'TUB TEST
EXT. LATH!SIDING I I POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION I I OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER I FINAL ENG.
SEPTIC TANK I LANDSCAPE/IRRIG.
SEEP PITIL.L.j ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMMING I ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE