HomeMy WebLinkAbout11058 (5)CITY OF DIAMOND BAR '
I I COMMUNITY DEVELOPMENT DEPARTMENT �
21660 E. Copley Drive Suite 190.
(909) 860-3195 Fax (909) E61.3117
13UILDING PERMIT APPLICATION
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ADDRESS r 8 S'Pro S e-G4-D,S t'�i .12. G. if
APN LOT TRACT
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ADDRESS 3oo�3�iy S. F/�s'rPc•fnrl �—
CITY D • Y3 ZIP
APPLICANT . h V��[t� T
CONTRACTOR -1 Ll ' -'T--'-, G ,
ADDRESS 1 1 %z /' r x s3a;yf.
CITY 'r ii -or , 0f4_ ZIP 7� TEIL7R/ Q�1fr
ARCFL'ENG/
DESIGNER ,_ f•{- ✓ 641 i tLQy
ADDRESS 0373 z Fj
CITY ZIPg2t.2 1 TElf
OW.NER-BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY TIA7 I AM EXEMPT FROM THE CDNTRACTCns Lb
CENSE tA'N FOR THE FOLLOW NG REASON (SEC. 7031.5 BUS:NE SS AND PRCFESS:ONS CODE A!NY CITYCI
CouNTYKI,.CH REQUIRESAPE IMITTO CONSTRDCT. A.TER,IA'PnOVE.D'eVO:JSII. OR R:PAIR ANY STRL'C.
THnE. PR OR TO ITS ISSUANCE, A_SO RCOU.ICS THC APPLICANT FOR S::CH PERMIT TO F.'_F A SIGNED
STATEMENT THAT HE OR SNC IS LICENSED PUnSUA\T TO THE Pnov-s.ONS OF THE CON' IACTOnS ll-
CCNSC LAW ICHAPTEA O ICOMMENCING W.TIH SECT104 700:1 OF DMISION 3 OF THE EUS NESS AICD PRO.
F E5510N5 CODE) OR THAT HE Ori S^C IS EXEMPT THEREFROM AND THE DA 31 S FO -1 THE ALLEGED E%EM'.
T.ON ANY VIAA"ION OF SECTION 7031 S BY ANY APPLICANT FOR A PERU T SUBJECTS 711E APPLICANT TO
A C1V'L PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (ssm) )
Ll I,AS D'ATNE R Or THE PFICPE FITY, On MY EMPLOYEES W'TH WAGES AS THE n SOLE CCM:'ENSA-INN.
W'LL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7014 B::S:.
NESS AND PROFCSS'ONS CODE THE CONTRACTORS LICENSE UNDOES NO: APPLY TO ANO'A•\CR CF
PROPERTY WHO BUILDS On IMPROVCS 7H CROON. AND W'IO DOES SUCH I W DAK H:USELF Cn HE RSELF Oli
THROUGH HIS CII HER— EMPLOYEES. PROVIDED THA' SJOI IMPROVEMENTS ARE NOT INTENDED OR
GrFEFIED FOR SALE IF, IK)WTivE0. T•E CU'LCBHGOR MPnC'dCML'NT IS SDLO V:.TMNGNE YEAR OF LOMPLC-
TION. TPE
OWNER
BUL DER W :L HAVE THE BURDEN OF PROV-NG THAT HE CR SHE Do NOT Eno CR
IMPROVE FOR THE PUPF'CSE OF SALE)
CI LAS OWNER OF THE PnOPCnTY. AM EXCLUSIVELY OCNTRACTNG WITH LICENSED CONTRACTORS
i0 CONSTRUCT THC -..--CCT (SEC. 7341 F.US:NESS AND P.DDFESS:ONS CODE. THE CONTRACTORS LI-
CENSE LALV DOES NOT APPLY TO AN CW'.ER OFA PROPERTY VOID DU'LDS Cn IM OnOVES THEREON, AND
R'I K) CONTnACTS FOR SUC1i PMCC'S WITH A oCNTnACTOn;SI LICENSED PL'nsiANT TO THE CCNTRA^-
TcnsuccNSELAW)
01AMEXEMPTUNDERSEC. B NPC FORDISP.EASON
DATEDWTirR
LICENSED CONTRACTOFIS DECLARATION
1 HEREDY AFFIRM UK—'En PENALTY OF PEFUIJRY THAT 1 A.0 LICENSED UNCEn Pnovis!ONS OF CHAPTER
i (COMMENCING WITH SECTION 7o(X1 OF DIVISION 3Or THE BUSINESS AND PROFESS ONS CODE.AND
MY LICENSE IS N FULL FORCEAND EFFECT.
LICENSE CUSS C —SO LIC. 1:0 77 I't) -7 / E'
DATE M-17--'17 CONTRACT011 �v— t��•y M
WORKERS' COVPENSATION DECLARATION
I NEREDY AFFIRM UNDER PENALTY Cr PENURY ONE. OF THE FOLLOWING DECLARATIONS
1 HAVC AND W'LL MA•KITAW A CCRTIrICATE Or CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATI)N. AS PROVCED BY SECTION 77 DO OF TIIE LADOn COLE, ron THC PCRronUANCE
OFTHE WORK FOA WHICHTH15 PERMIT ISISSUED.
_ I HA':C AND W ILL MA:NTA'N WCRKE4S' COMPENSATION INSIInANCE• AS ROCU: ,To BY SCC TIC',
5700 CF THC LAROn CODE, FCR THC PEnronMANCE Or THC WCnK FOR W'I i:CI I THIS PCnu:T IS
ISSUED. MY WCRKE qT CCOM''EN�SA'gN IN^•'��gµCE CAAJRMCR Ah:)POLICY KJU3ER ARE
CARR;ER �5 '1 Tj_.. w�'•�
POLICY NUMBER
(i1ISSCC-01NEEDI XDEocart':E0or TIcPEFVAT IS FOR ONE HATCrYD DL1AF6 R'm)OR LEsG)
I CERTIFY TI IAT N TMC PCnFDMAANCE OF TMC WORK FOR WHICH THIS PERMIT F ISSUED.I
SHALL NOT EMPLOY ANY PERSON N ANY MANNCn SO AS 70 BECCME SEL' -ECT TO TI•E
V.'OnKEnS'COMPENSA:IX4 LAWS OF CAJrCF.N'A, AND ASR:E THAT IF 1 SHOULD P.E A&C
SUBJECT TO THE WCn<RS'COMPENSATION PnovisioHs Cr SECTA4 3TOOCF THELALK)R
CODC. I SHALL FOIITIIW:TH COMPLY WITH THOSE PROVISIONS
DATE: APPLICANT.
WARNING FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUWECT A4 EM'LOYEn TO Cn M:NAL PE\ALTIES AND CM•L FINES UP TO 014E HL•NCI7LD TH*USAND
DOLLARS (31M.090). IN ADDITION TO THE COST OF COMPENSATION. DAUACE S AS PROVIDE? FOR N
SECTICN 3.'35 OF TI IE ULIOn COCE.IN : ERES:, AND A'TCn4EY'S FEES
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PE4ALTY CF Pf n-A1nY TI'AT THE.nr IS A CON STPI CT•ON LENDING AGENCY
FOR THE PERFORMANCE Or THE WCAK FOR WIDDi TIES PERMIT IS IS5L'ED (SEC 30'. CIV C)
LENDER'S NAME
LENDCRSADDncss
1 CERTIFY THAT I HAA: PFAD THIS ADPLICATION AND STAT T14Ar T•E ABOVE INFORMATION IS OOnnECT
1
Ar CC TO CCUPLY WIT,i ALL CITY AND COUNTY ORDINANCCS AND STATE LAWS Rr LATING 10 BU'LD:NG
CONSTRUCTION. AND HEREBY AUTHOR. 7E nEPnCSrNTAT:VES OF Tits COUNTY TO ENT ER UPON THE
ABOVEMENTIOhED PROPERTY FOR INSPECTION PURPOSES
C. e,:-- o„_ Qgdp F.`
PCRV'• [:LMA _ RIOT)
(2 - t2 - �7
;%A.uriO rE M. - CA:E
PRESS
FIRMLY
APPLICATION PERMIT
DATE -q— NUMBER #
ISSUE TYPE OCC
DATE CONST GROUP
ZONING SETBACKS
FRONT RW 0
REAR ❑
SIDUSIDE STREET RW ❑
SIDE
PROPOSED USE
NO. D1•VEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION
SFn.'ADWRE1d
Garago.'CaTcn
WPa:,o'Deck
LL
PCoL'Spa
ZRD
-Roc! t 0 0
OJ
Commercial
Ib
Wuat on U ADJ.AREA
QUANTITY DESCRIPTION FEE
J
v
U
F—
U
w
w
(7
L')
a
R
U
z
LU
L
CONSrnucnoN
PLAN REVIEW Lrr `v I
ELECTRIC
PLUs!o:xG
LIECHAN'CAL
INSPECTION FEE
ISSUANCE
SLIP
ENERGY PIC
ENERGY PERS!;T
nETENTIO"J FEE: nl)
PRE. -ALT FEE: (f
TOTAL FEES
COMMENTS
RECPT. NO. :_ PAID l3Y _:7�>-
-,t--7 VALIDATION
1 / WHITE—Depart:nentCopy. YELLOW—FlnanceCopy.PINK—Assessor Copy. GOLDEWIOD—Fi;eCCpy.GREEN—ACPI.CanrSCCpy
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION
SET BACK
DATE INSPECTOR
I
INSPECTION DATE INSPECTOR
I I FLOOR JOIST
FTGS!FORMS,ISTEEL
I
I ; FHA REO`ATS
ELECTRIC GROUND
I
1 UNDER FLOOR.DUCT .-
GROUND PLUMBING
I
I UNDER 'FLOOR -CONDUIT I
SLAB GRADE
I FIREPLACE FOUNDATION I
TEIAP POV,'ER
I I
I FIREPLACE BOND BEAT -A '
MATER SERVICE
I
PAID HT: BOND BEAM
ROOF SHEATHING
I
I a FT. BOND BEAh1
FRAMING!VENTILIATION
�`
FINAL BOND BEAM
ROOFCOVER .-
'ROUGH HEATING
% jam.
I PRE-GRIIDINa-.
=
I BENCHING
ROUGH ELECTRIC
I
I ROUGH GRADING
ROUGH PLUMBING
I I
FINISH GRADING
SHOWER/TUB TEST
I
POOL ELECTRIC
EXT. LATH!SIDING
POOL FENCING I
I
WALL INSULATION
I
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
I
FINAL ENG.
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
_
ON SITE I"APS.
GAS AIR TEST
I I
FINAL ZONING
FINAL CONST.
FINAL HEATING
13 ��
I "�
I I FIRE DEPT. FINAL
HEALTH DEPT. FINAL
FINAL ELECTRIC
I
I I DEV. FEES PAID
FINAL PLUMBING
I I
I ENERGY I
I
COMMENTS
_
SEPTIC TANK SIZE
SEEP PIT/U SIZE