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HomeMy WebLinkAbout11954 (5) CITY OF DIAMOND BAR COMMUNTfY DEVELOPMENT DEPA1tTMENT �- � � 21660 E.Copley Drive Suite 140 PR�S•S• (909)860-3195 Fax(909)861-3117 '^"" BUILDING PERMTTAPPLICATION FIRMLY � JOBSRE APPUCAtIQN PERMIT /C o ADDRESS ��.2� ���b �'�/`��'e-- DATE �� � �� NUMBEFi # � APN LOT TRACT S�� ISSUE TYPE OCC —�-- DATE CONST. GROUP p OWNER ���bM C !!«V %�. � � ADDRESS � C�� �'7' �C�. ZONING SETBACKS g CITY �� ZIP��TEL.� FRONT RW ❑ r APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE C o ADDRESS PROPOSED USE `� � ' o CITY ZIP TEL. cn�p�,_- c C���lc�.,, wo ARCH/ENG! � � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.Fi: FACTOR PSF ADJ.AREANALUATION � � OWNEA•BI:ILDER DECL4FATION SFR/A�D/REM O � I NEREBY AFFIRM UNDER PENALTY OF PEHJUPY THAT I AM IXEMPT FROM THE CANTRACTORS LI- G8�A9B/C0lpOR � W CENSELIWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSMIDPROFESS�ONSCODE:ANVCITVOR (n U COUNiYN7iICHREOUIRESA�ERM17'rOCONSTRUCLALTERIMPROVE,DEMOUSH,OFREPAIRANYSTRUC� W PdtiO/DBCk WTL1RE.PR�OR TO RS ISSUANCE,ALSO REWIRES THEAPPLICANT FOR SUCH PERMITTO Fllf A SIGNED W � STATENENT THA7 HE OF 5HE IS UCENSEO PURSUANT TO 1T1E PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CFIAPTER 9(COMMENCING WITH SECTION 7000)Of DIVISION 9 OP THE BU51NE5S ANO Ph0• LL' POOVSPB O FESSIONSCOOE�OR7MA7HEORSHEISE%EMPTTHEREFROMANDTMEBASISFORTHEALLEOEDEXEMP- (� V 710N.ANVVIOU710NOFSECTION709t.6BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANYTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS�S5o0).): � OtASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASIHEIRSOLECOMGENSATION. C� CommBfCi81 Z WIL�00 THE WORK.AND THE STRUCTURE IS NOT INTENOEO OP OFFFAED FOR SALE(SEC.7aa4,BU51- ,_! NESS AND PqOFES5ION5 CADE:THE CONTHAC70RS UCENSE LAW�OES NOT APPLV 70 AN OWNER'OF � PPOPERTYWFIOBUILDSORIMPROVEShIEREON.MAWHODOE55UCF7YVORKHIMSELFORHERSEIFOR � � THROUGHHISOPHERONMEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMEN7SARENO7INTEN�EDOR CD W OFGEREDFORSALE.IF,HOWEVER7NEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMpLE- � TION,THE OWNER-BUILDER WILL HAVE TNE BURDEN OF PROVINO 7HAT HE OR SHE 010 NOT BUILD�OR Z IMPROVE FON THE VURPOSE OF SALE1. _ ❑I,ASOWNEROF7HEPROPENTY.AMEXCLUSIVELYCONiRACTINGWITHLICENSEDCONTRAC70R5 Q TO CONSTRUCT TME PROJECT(SEG.7064,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U� Velue(ian ADJ.AREA W CENSEUWDOE3NOTAPPLY70ANONMEROPAPROFERTYWFIOBUIL�SORIMPHOVESTHEREON,AND � WXOCONTMCTSFORSUGNPRq1ELT5WITHACONTPACTOR(5)UCENSEDPUqSUANTTOTHECONiRAG Q�J/��ITY DESCRIPTION FEE � TORSLICENSELAW.). 0 O I AM E%EMPT UNDER SEC. B.a P.C.FOR THIS REASON U � rs � DATE �� � OWNER � � Z �y � LICENSED CONTRACTORS D �LAR ION W � �HEREBY AFFIRM UNDEH PENALTV OF PERJURV THAT I AM LICENSEO UNDER PRONSIONS OF CHAPTER � � 9(CQNMENCING WITH SECTION 70001 OF DINS�ON 3 OF THE BUSINE55 ANO 7ROFESSKKJS CODE,AND Z X`� MY UCENSE IS IN FULI fORCE AND EFFECT. � LLI ,� 0 UCENSE CU1SS LIC.NO. J V DATE CONTRACTOR 0. W � WORKERS'COMPENSA710N DECLARA710N d � V � tHEREBYAFFIRMUNOERPENALTYOFPEiiJURVONEOFTHEf-0LLOWINGDECGRA710NS � Q 0 iHAVEANOWIU,MAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFOPWORKERS' S COIAPENSATION,ASPROVIDEDBYSEC710N370DOFTMELABORCODE.fORTHEPERWRMANCE U ¢ OFTMEWORKFORWHICHTHISPERMI7131SSUED. � � � W _IHAVEAN�WILLMAINTAINWORKERS'OOMPENSATIONINSURANGE,PSREOUIREDBYSEGTION � .,/(/'p�„� M Q 9�ooOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHIdiTHISPERM1T15 1//LI.���'1 ►/ � f55UED.MYWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUM6ERARE CONSTRUCTION V�-4 L (,�� � CARRIER PLAN REVIEW Z pOLICY NUMBER . ELECTRIC Q � QHISSECTICNNE�NDTBE�MPLETEDOFiHEPERMfTIS�OFONEHJIAREDDOUAAS(t10D)ORLESS�. PLUMBING Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAI (�J SNALLNDTEMPLOYANYPERSIXJINANVMANNEflSOA5TO8ECAMESUBJECTTOhiE WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE �^ r'1 7 � SU&IECTTOTHEWOFKERS'COMPENSATIONPROVISIONSOFSECTION97000FTNELpBOR ,� '� � COOE,I SHA4.FOR'fHWITH COMPL�WITH THOSE PROVISIONS. �SS�JANCE � � �ATE: APPLICANT. SMIP �_�(__ W ENERGY P!C —� WARNING:FAIWRETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AN�SHALLBE J SUBJEC7ANEMPLOVERTOCRIMPW,PENAI,TIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO � DDLURS�5700,000).W��ITION 70 THE COSTOF COMPENSATION.DAMAGES AS PROVIDED FOF IN ENERGY PERMIT � SECTION37080FTHELABORCODE,INTEREST.ANOAT70RNE1^SFEES. RETENTIQNFEE: d CONSTRUCTION LENDING AGENCY PREALT FEE: f°�" O � 1 HEREBYAFFIpM UNOEH PENALTV OF PERJUHY THAiTHERE IS A CONSTflUCTION LENDING AGENCY FOR THE PERWRMMICE OF 7HE WORK FORYMICH THIS PERMIT IS ISSUEOISEC.�OB7,CIV.G), Z W � LENDER'S NPME W LENDER'SAD�RESS ���`� ¢ ICERTIFYTHATIHAVEPEADTHISAPPLICATIONIWDSTATETHATTHEABOYEINFORAIATIONiSCORRECT. TOTAL FEES � IAGREE7000MPLYWITNALLCITYANDCOUNTYORDINPNCESANDSTATEIAWSREU7�NGTOBUILDING CONSTRUCTION.AND HEREBYAUThWRIZE REPRESEMATIVES Of THIS COUNN 70 ENTER 11PON THE ZABOVEMENTIONEP PROPER7Y FOR INSPECTION PURPOSES. COMMENTS � �,¢� C(,3c k � m PERMITTEENAME(PRINT� . .. . `.' � r� 4 �-� �"�3-! _ SI�N�TUPE OF PEPM DATE = RECPT.NO. PAID BY �`�/�L1DA"�TO�___`� �"" WHITE—Department Copy,VELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—App�icant's Copy '"' .. -�` .�,,.;,.:Y: �.�..,,.e.�... �.:,.,.:...M..�,. ..�z�,,. .�.-.�.. ....:.,,:.:. .�.. ..:... :... .'?:- �'�,�'.` p�f�P . ,'�.,,^, -3�w4'uWk ., +n4.v^�N8" ?>y ^'�fi*��a't�M.�" .� . � w�:,.w..:,� ,'�� .��i"A .,"�"�` .,.i.: CITY OF DIAMOI�D, BAR . .':e..: ��`�., , . ��.— INSPEC710tV i�ECQl�D � ' ,. � `' �� ~,��:�:.` , ,__s�,:- � n�.,.:�_;�� -�;;� ■ � � � . . . . . � , . e . SET BACK _ � _ ,,..i' „ _. _ ,F�OQR JOIST __ . _: �. _: .. _ _ _ FTGS/FORMS/STEEL ' ''.''': i _ ' FHA RE�MTS ; _ v ELECTRIC GROUND `: �' ' � UNQ�R FLOOR DUCT --� � -- _ ___ . _ GROUND PLUMBING � ,, _ _ _ URtDER FLOOR CUMDUIT _ - , ` � � SLAB GRADE._ .: : i- F1REF`'LACE FOUNDATI�CSN : _. __._ __._._ ; i. TEMP POWER � -�� - FiREPLAGE BQND SEAM "' ' WATER SERVICE ___ ._.. �: ` , M!D HT. BOND BEAM __ . _ ; ,. ;,.� � __ _ . , _. ROOF SHEATHING � � � S�. BOND BEAM ' ` ' � �'' FRAMINGNENTILfATION � ' �'`'' FINAL BOND BEAM � - _ - - I ' 1.4: R(OdF COVER _ PRE-GRAbING ,�k� ,�:, ... _.. __ ,_ ROUGH H�ATING _ _ � ;- ''" ', BENCHING _ . ._. . _. , ;, _, „ . , . ... ,. ._,. --�. ROUGH ELECTRIC . _.; .. ROUGH GRApINf . �.: ,,. ,, tYN f,,;,; :-. ROUGH P�UMBlNG _... FtNlSH i F�ADING' . ,;.,._ : .,,., ;� N, � : ,m _' . , . . . � ,. ,,.. , - SHOWEF�lT'UB TEST _ __, , PaOt!ELECTRIC � ; ^ � __ ----- _ .. EXT.LATH/SIDING _ _ POQL FENCiNG. , ,_, , _ � <� ,: 4 n .,> ,-: ,� f. .�: WALL INSULATION _ � PDOL FINAL: " , �F . ; �,,: ; _ _._..�_._ _ _ _ � �., CEIIiNG INSULATION � �_ _ � OFF SITE lMPS. - .;,'� , , , ,. . .�, ��<. DRYWALL NAILING DEDIGATIONS .; ` ,� � � n,� t , »�., _ . _._ r � a,��C, ., .. SEWER _. ' ..____- FINAC ENG. _ ----- � , ...�, :,; ` s i3 t � . .. ..__ . . . : .:. r.: n :, ' ,_.,, _.. v SEPTIC TANK , .::,'"',, -- - _ .___,�.:' I..ANQSGAPEJlRRtG. �:;. , � , « �,, I , Ik. SEEP.P17iL.L. ' ; ::;. __ ''`:' ON SITE IMPS. .��_ v �.: , ... GASAIR TEST __ �_ _ ._ _ _ _.. FINAL ZONING _ =:;: � : ��.,=�x,�.,, ::. FINAL CONST. _. _ _.._._._.. _...._ .. _ - _ - FIRE C�EPT:-FfNAL _ _ .. , _ . ,. . ... ,,,,.. _,. __..._ ..._ . _ _ . ,,,._ FINAL HEATtNG _._._..._ . _ _ ____---._ _._. ..__,.�.._.- HEALTH DEPT. F1NAl. _ . _.. _,.. . e ,. FINAL ELECTRIC _.. .___,. � _-__ dEV. FEES PLkID _ � . , � �,,;,;��� �.�, _ . -... FINAL PLOMBtNG _ , . . _ _� _.._ — - _ __..... ._. i E�IERGY ,... ,�:;,,,.: :.,�� _._ _ - _ _____ _ _ ___ _ �;..� .I ";r�,,1J .,_ ..._ ..,.......Z,Cr�7�"i.�iJJ�: � i .• i i __.__...._.___..�..._.____..._.._ ... . ... ,.- . _ _... �, _ -__,._____'._-' "_" � ___.. . . _ ..... . .... .. . .. .. .. .... . - ���. . ��i � � � . .,. .. 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