HomeMy WebLinkAbout17832 (25) _ -,•`
CITY OF DIAMOND BAR `-�
--�---��` --- DEPARTNfENT OF COrRvIUNTI'Y&DEVELOPMENT SERVICES
I
21825 E.Copley Drive �
'°"� (909)860-3195 Fax(909)861-3117 �--''J� RESS
��`-����' BUILDING PERMIT APPLICATION FIRMLY
QJOBSITE • a � �.� n�"�� DATECATION � � PEMB R��� #/C
¢ ADDRESS I
� ISSUE TYPE OCC
APN OT TF3A T DATE CONST. GROUP
°C OWNER �� G�
O
o ADDRESS ZONING SETBACKS
Z CITY ZIP TEL. FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW O
z
a coN7R,4CTOR ApPL1ANCEINSTALLERSINC. SIDE ❑
� Ao�REss �@g3 Indast^,a�o
p PROPOSED USE
o CITY i<,bn,.,.,��I�ATO�n71�,� TEL.
o ARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBY AFFIRM UNDEfi PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CANTRACTORS LI- G8f89BIC8fpOfl
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCITVOR (n
U COUN7VWHICHREOUIRESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w TURE,PRIOR TO ITS ISSUANCE.ALSO REQUIFIES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w PafiO/DBCk
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CON7RAC70R5 LI- �
� CENSE UW(CHAPTER 9(COMMENCMG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSp2
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR 7HE ALLEGED EXEMP- C7
� TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5ao).):
❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, Q
Z Commercial -
WILI DO THE WORK,AND THE STRUCTURE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7044,BU51- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK NIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
w OFFEREDFORSALE.IF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAIiOFCOMPLE-
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROfTHEPROPERTY,AMEXCLUSIVELVCANTRACTINGWITHLICENSEDCANTRAC70R5
W
� TO CANSTRUCT THE PR0.IECT(SECJO��,BUSINESS AND PqOFESSIONS CODE:7HE CONTRACTORS LI� VelUetlOfl ADJ.AREA I
W CENSE LAW DOES NOTAPPLV TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
� TORSLICENSEUW.).
� ❑I AM ExEMPT UNDEFi SEC. B.8 P.C.FOR THIS REASON Q
� U
LL ¢
DATE OWNER �
Z W
� UCENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PENALTV OF PEFL1UilY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � T
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F 7HE BUSINESSAND PROFESSIONS CODE,AND
�X MY LICENSE IS IN FULL F RCE AND EFFECL �^ � m I I
� UCEN LIC.NO. G � �
� J
U DATE CONTRACTO a
W ��� WORKERS'COMPENSATION DECLAFiATI —� �
Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECIAFATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
CAMPENSA710N,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE IU
OF TH WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w AVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 37000F7HE OR CADE,FORTHE PERF RMANCE OF THE WORK FOR WHICH 7HIS PERMITIS
ISSUED.MY R' MP ATION I SURANCE CARRIER AND POUCV NUMBER ARE: CONSTFlUCTION
J
� CARRIER PIAN REVIEW
ZPOLICYNUMBER ELECTRIC
Q `
� (fHLSSECiIONNE�NOTBEOJMPLEfEDOF71-IEPERMfTISFORIXJEFNt�DREDD0I.Ll�AS(5100)ORLESS). PLUMBING '�J
Z I CERTIFVTHA7IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL
U' SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBlECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGfiEETHATIFISHOULDBECOME INSPECTIONFEE
= SU&IECTTO THE WORKERS'COM7ENSATION Pf70VISIONS OF SECTION 37000F THE LABOR �"1�(1�
E I H COMPLV WI T SE P VISIO7 S ///��� ISSUANCE �X v
p DATE: APPLICANT: �I_ I��I ��� SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJEC7ANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DO�URS(f��.o00�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OFTHE LABOR COOE,MTEREST,ANDATTORNEV'S FEES. RETENTION FEE: �
Q
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �
Z
W
� � LENDER'S NAME
F_ LEN�ER'SADDRESS /�
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES ��� ! A /
� I AGREE TO COMPLV WITH ALL CITV AND COUNTV OFDINANCES AND STATE L4WS RELATING TO BUILDING \� t��
� CANS7RUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUN7V TO ENTER UPON THE
Z ABOVEL�MENjIONED PROPERiY FOR I SPECTON PU POSES. COMMENTS
� �1�
m � EIPFiI�'�l� �V��C. ��fOV�
Q
N �
� SIGNATUREOF RM EE � � •
= RECPT.�'O. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
�. � .. , ' ^ � i.�4..i . . .5:.::>.': . . . ai ... . , n. .`������. ..:h..- ..v ... _ .. _ . �
���1� �r� ��Q��I�� ���
�������Q�� ����I�'a� �
�� � U � ��U�� � LIU�1�1,' ���Jln� u�,�-K`.�i.r'tS�J�, ,,, r. << d ,,`,� ��, a�lJG�� , ,p o
,�__ _ _ .
a� �
SET BACK ! O� R JOIST �
-- __ __ � ___ ___----_ _ __. ��:_L.�__ ___ __. _____._ + --�----_ _-.
FTGS/FORMS/STEEL ' FHA REQMTS �
_. _ _.._.__ __---- __._ _ ._.__.._...._._
EI.ECTRIC GROUND j j UNDER FLOt�R DUCI' � ;
. -;--- _.. _..--------
GROUND PLUMBING + ; UNDER FLOOR CUf�!DU1T _ __ __
S�AB GRADE ' _ _,_ �lREPLAGE F�UNDATION '
TEMP POWER I ,_i. _FIREPLACE BONQ BEAM
- -- - -- ----- — __._..__.
WATER SERVICE -- ' _-- ---� MID HT. BOND BEAM ' ."' .� .
- -----;�.--�-----:-.-- ---__--
..,
ROOF SHEATHING �_8 FT. BOND BEAM : . � �
,.:,..: ,
_ -�..��:�_—; --__.......---
FRAMINGNENTILIATIdN t FiNAL BOND BEAM _ � __ __
ROOF COVER ' Pt�E-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
------,---- ----- -• -__.._.._ _.__.__--------__ _....-------
R�UGH PLUfVIBItVG j I FINISH GRADING
h� ... '_�_�__._ .._..___........___....._..
SHOWER/TUB TEST � ; POOL ELECTRIC
EXT. LATH/SIDlfVG ' i POQL FENCING ;
WALL INSULATION ; POOL FINAL '
-- ----- � -
CEILING IN�ULATIOiV � � �FF SITE IMPS. �
- - - ---- ---__--- --.-- ---_ _____..--__..}.
DRYVVALL NAILihlG DEDICATIONS
-- --- ---�-------.._.___--� --
S�WER �INAL ENG. �_---
SEPTIC TANK LANDSCAPE11ARiG.
SEEP PIT/LL. _ ON SITE IMPS.
GASAIR TEST FINAL ZOfVING __ __ _
FINAL COiVST. � _ _ �� F!RE QEPT. FINAL ___,
FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC i ; DEV. FEES PAID
FIiVAL PLUMBING ���—~-V,���`' ! ENERGY. --- -
'� i
---- C�G,1�OO C�OC�4 I
c��n����r5 . ._ . - - .._
�;
SEPTIC TAPVK SIZE
SEEP PITlU SIZE -- ---
� --- _.._.._...�.
l�i � --------
� —