HomeMy WebLinkAbout15167 (27)CITY OF DIAMOND BAR( r Z
DEPARTMENT OF COMMUNITY & DEVELOPM S
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS �
APN LOT TRACT
OWNER
CITY ZIP I TEL. _55
APPLICANT —�� r1U- 7E14-
CONTRACTO Gs►G14 _ �LCc�— l;!
.ADDRESS rJ
C1TY 1 '- ZIP T
ARCR'ENG/ '
DESIGNER
ADDRESS
CITY ZIP TEL.
OYNER•BU!LDER DECLARATION
I MEREBY ArrYW TINDER PENALTY Or PEFLIL•nY TMA' 1 AM EKrMPT FROM THE CONTRAC'.ORS LI-
CENSELAW%F1 THE FOLLOWING REASON (SEC. ?WI.5 BUSINESS AND PnCF ESSIONS CODE ANYC:TYOR
COLNTVVAO HRFOIARESAPCRMRTOCLDNSTRICT.ALTERPROVC.DEUOUSH. 011 RSTM
IC.
STC.
TIRE. PRIOR TO ITS ISSUANCE, ALSO REGUNCS lilt APPLIWICANT FOR SUCI PEEWIT TO FILE A SIGNED
STATEIAENT TUT. HE OR SHE 15 LICENSED PURSUANT TO THE PROV:SIOS CF THE CONTRACTORS LI.
CENSE LAW IMM
(CHAPTER 9 (COCNICING W-TH SECTION 700C) OF DIVISION 7 CF THE BUS-Nf SS AND PE10.
FESSIONS CDOC) OR THAT HC OR SHE IS EKCMPT THEREFROM AND THE BAS'S FOR THE ALLEGFO E AE V P.
TION ANY VIOLATION OF SECTION 70aI.S BY ANY APPLICANT FOR A PCRM;T SAIJEC:TS THE A'PLICANT TO
A CML PENALTY OF NOT MORE TUN FNE HUNDRED DOLLARS (95)(1) 1'
OLA.SOWNCROF THE PROPERTY. On MY EMPLOYEESWITH WAGES A: DHF•RSOLE 001,11NSATI0N•
WALL DO THE WCRUC AND
THE STRICTURE 6 NOT INT CNCED OF OF FC RED FOR SAL E (SEC. 7045. RJSI.
ME 55 AND PROFESSIONS CODE THE CONTMCTOnS LICENSE LAN DOCS NOT APPLY TO AN OWNCn Or
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND TWO DOES SUCH WORK H:MSCLF CR HERSELF OR
THROUGH HIS Oil HER OWN EMPLOYE ES.
PROVIDED TMA' SUCH MPnOVEMENTS ARE NOT NTENOCD OR
OFFERED FOR SALE. IF. IOW'EVER THC BOLDING OR MPRIOVELIENT ISSOLD W'TH NONE YEAROF COMPL E -
TION. THE OWNER BUILDER WILL HAVE THE BUR..^.CN OF PnovNO TUI IHC OR SHE DID NOT BUILD OR
IMPROVE FOR TIE PUnPOSE OF SALE).
C LAS OWNEROF THE PROPERTY. AM EKCLUSWCLY CONTRA --TNG WITH LrCENSrO Dow. RACTCnS
TO CMISTRUCT THE PROJECT (Sr C. 70u. BUSINESS AND PPOrESSIONS CCOC: THC CONTMCTCRS LI-
CENSE LAW DOES NOT APPLY TO AH OANLR Or A PnOPERTY WHO BJLCS On MPRCVES TH111110M. AND
YW ID CON i MOTS FOR SUCH PRCI;F.CTS WITH A COATRACTCRI S. LICENSED PURSUANT TO THL CONTRAC-
TOR(CENSE LNN).
EI(CMPT UNOCR SEC. B 9 PC FORJIN'S PERSON
DATE
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFF:Ru UNDER PENALTY OF PCFLJUAY THAT 1 AM LICE NSEO UN.^._R PRDVIS IONS OF CHUPTE R
9 (OOWENCINC. W NTH SECTCN 7'001 or CNISION S OF THE SUS:NC SS AN5 PROFES';'ON i COCE. AND
MYLCCNSE IS N FULL FORCEAND EFFECT.
LICENSE CLASS -rC 30LIC NO. —10fRAI�,!
� DATE _! TA"a0 CCNTHACCR WORK S' COMPENSATION ECL
ITA Arj.�I±E(yJr.oF cr „Lt s
II WTI MAINIA IFI A'E SENT 70 SELF+N'.;:nEFOI WORKERS
COUPENSATON.AS PTOVIDEG BY smC ..ON 7T000r TIE LABOR COCE. FOR 1 '' PCProRM W CC
CF THE YORK FOR WHCIH THIS PERMIT IS ISSUED.
�I HAVEAND WLL MANTAN WORKEATCOMPENSATCN INSURANCE. AS RCO:::IIED B/StCi
9.000; TME LA70n COCE.FORTME PERronMANCE OF THL' W"JFK FCR WIIIDHI TCS PEPM:TIS
ISSUED. MY woFV(CRS CDM''+CNSA: ION INSURANCE CARR:Cn AND POLICY M; V: E n ARE.
CARILCR
POLICY NUMBER
(DI:5EC-1CNNSET NET BE 0!MLETED OF TEC PE; VT Ci FCY;OL HU14LrLD DOUAIG(S'CC;CR LES;::
1 CERTIFY TAT N THE PERFORMANCE OF THE W'OPK FOR WIIICII IH'S PERM T 15 ISTiUED.I
SH ULL NOT EMPLOY ANY PE RAN IN ANY MANNER SO AS TO BECOME SIB: LC7 70 TIE.
WORKERS
COMPENSATION LAWS OF CALIrORN;k AND AGREF T1IAT IF 1 SMAILD BECOME:
SUBJECT TO THE WORM ERS'COMPENSATION PEOY.riION�CF SECTION OCC THI•U •L
E.1 SHALL FORT/M'ITI C WT TIOSC PROV A
DATE:ZGNT.
WAR:'NG FAILURE TO SECURE wonKERG•COMIIENSATION COVERAGE IS UNLA'ATLL. AND SMALL BE
SAM
ECTAN EMPLOYER TO CRMAAL PENALTIES AD CML FINCS UP 10 ONE H;A_ RCD 1) KDUSAND
DOLLARS I9+00.00DL IN ADDITON TO THE COST OF COMPENSATION. DAMACCS AS PRovCED TOR IN
SECTION 57.5 OF THE LACIDR COLE. N TEnEST. AND ATTOA%EY'S FEES
CONSTRUCTION LENDING AGENCY
1 HCREDY AFFIRM UNDER PENALTY OF PENURY THAT TIIr,Pr. IG A CONSTRUCTION LENDING AGENCY
Fort THE PERFORMANCE OF THE WORK FOR WHICH TRS PERMIT IS I5SL ED (SEG 33N7• CIV C 1
LENDERS NAME
LENDCR'S ADOnESS
ICCnTIFY THAT I MA'!E READ TITS APPLICATION AND STATE THAC TINE AD•7VE INFORMATION IS CORRECT
AGRE E lO COMPLY KTM ALL CITY AND COUNTY OHDINMCI S AND STA -C LAWS nrLATNG TO BUILDINGCONSTFAICTCN. AND RIE nEDY AUTOR:LL' PCPRESr NTATIVE S OF 111.5 COUNTY TO ENTER UPON THE
ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PL.WI, 7.AFAE II I:IJT)
I NA. JIIC INIfIEE GAIL
PRESS
FIRMLY
APPLICATION PERMIT PIC
DATE NUMBER •
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING S ACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
N0. DWEL. NO.
UNITS STORIES _�/�J„
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
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LL
POoVS,^.a 1 !�
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Commercial
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Va!ua:ic. r' ADJ.AnEA
OUANTIT DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW ..jj
ELECTRIC (1�1�
PLUS'D:\G
MECHANICAL
r
INSPECTION FEE --y
J1'�D
ISSUANCE
pl
sAgr _O n�� • S�
ENERGY P/C
ENERGY PERMIT
RETENTION FEE.
PRE -ALT FEE:
TOTAL FEES
COMMENTS
C
RECPT. N0. V _ PAID BY VALIDATION
WHITE—DepRRmont Copry. YELLOW—rnance Copy. PINK—Assessor Copy. GOLDENROD—Tile Copy. GREEN—Applicant's Copy
73
CITY OF DIAMOND BAR
114SPECTION RECORD
A., r
SETBACK
I I FLOOR JOIST.
FTGS.'F0RM.S!STEEL
j Ff IA RE-MITS
UNDER FLOOR DUCT
-UNDER FLOOR 0,O.,fDUIT
ELECTRIC GROUND
GROUND PLUf.-',81,',JG
SLAB GRADE
FIREPLACE FOUNDATION'
FIREPLAC E BO . ND BEAlk-1
TEMP POWER
WATER SERVICE PAID HT. BOND BEAM...
ROOF SI-IEPATHli,.'-G,_ 8 Fr. BOND BEAIM
FRAMINGVENTILIAT ION 1
1 FHNALBb`JD MEM.1
ROOF COVER
PRE -GRADING
ROUGH HEATING l
I
I BENCHING
ROUGH ELECTRIC
ROUGH GRADINGI
ROUGH PLUR.11BING I
I j FINIISI-I GRADING
SHOWER!TUB TEST
PCO! ELECTR!C
.S
EXT. LATH'SIDING
POOL FENCINIG
WALL INSULATION
CEILING INSULATION
POOL FINAL
OFF SITE C.1FS.
I)RYV-.IALL NAILINIG2
DEDICATIONS
MVER
FINAL ENG.
SEPTIC TANK
I
j LANDSCAP01MG.
SEEP PIT/L.L.
ON SITE S.
GAS AIR TEST
FINAL CONST.
FINAL ZONING
FIFRE DEPT. FINAL
FINAL HEATl!--.G
I HEALTH,DEPTFINAL
FiNAL ELECTRIC
DEV. FE PAID
T-PlAl. PLUMBING
ENERGY
COMMENTS
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SEPTIC TANK SIZE'
SEEP PIT/U SIZE