HomeMy WebLinkAbout17293 (25) �XPIRED
CTI'Y OF DIAMOND BAR
�-----��` --- DEPARTIvIENT OF COARvIUNiT'Y&DEVELOPMENT SERVICES JUN 19 2002
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
''%.���'� BUILDING PERMIT APPLICATION FVRMLY
QJOBSITE /�n� �� �/ �/�� DATECATION 1�_�1I`�I NUMB R� #/C
Q ADDRESS I f l li�i ��„�p--
� ISSUE TYPE OCC
APN�`�O�Un Q T��K DATE CONST. GROUP
°C OWNER Vl/ I�
o ADDRESS—� � ZONING SETBACKS
0
Z CITY ZIP TE FRONT RW ❑
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
¢ coNra,ac�LIANCE INSTA L . SIDE ❑
ADDRESS � US V@.
� CITY Lakewootl,CA. 90�dA TEL. 0 7 PROPOSED USE
oARCH/ENG/ '7Q('o
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
ca DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEFIEBV AFFIRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE CONTRACTORS U� G8f8(J8/CBfPOfI
W CENSELAWFORTHEFOLLOWINGREASON�SEC.7o31.58USINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG
W TURE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CANTRACTORS ll�
� CENSE LAW(CHAP7ER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPe
FESSIONSCADE)ORTHATHEORSHEISExEMPTTHEREFROMANDTHEBA515FORTHEALLEGEDE7(EMP- (�
� 710N.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSUBJEC757HEAPPLICANTTO Z Re•Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
Z ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSATION, � COrt1rtlBfClel -�
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.706d,BUSI� J
� NE55 AND PHOFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERN NM1iO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSEI.F OR
CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDFORSALEIF,HOWEVE0.7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
� 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,ASOWNEROF7HEPROPERTV,AME%CLUSIVELVCON7RACTINGWITHLICENSEDCONTRACTORS
W
� TO CANS7RUCT THE PROJECT(SEC.70/a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V21U2liOn ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND .
� NTiOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.). '
�� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR 7HI5 REASON Q
U
� �
DATE OWNER �
Z w
¢ LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PENALN OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � /. I
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PROFESSIONS CODE,AND Z ��1/
`X MV LICENSE IS M FULL FORCE AND EFFECL ^ m �
� LICENSE CLASS C LIC.NO. �J /��!J� j
� J
V DATE I CONTRACTOR �� i I' /' d
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBVAFFIRM UNDER PENALTV OF PERJURY ONE OF7HE FOLLOWING DECLARA710N5: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN770SELF-INSUREFOPWORKERS' 2
¢ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. �
�
w _I HAVEAND WILI MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS RE�UIRED BY SEC710N �
Q 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
ISSUED.MY WOR ERS'COMPENS ON INSU ANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
a �A�y��
� CARRIER n /� PLAN REVIEW
Z POLICV NUMBER .0 V G I/ � ELECTRIC
Q
� (fHISSECTIONNE�NOTBE07MREfEDOFiHEPERMfTISFORONEHUI�DREDDOILARS(f100)ORLESS). PLUMBING ,—� �
W
Z I CERTIFY THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ,�-.�-� /�� �� � I s �
(,�} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE �-=�/r-�� '-
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SNOULD BECOME INSPECTION FEE
� SU&IECT TO THE WORKEFS'COMPENSATION PROV SI S OF SECTION 37000F THE LABOR ISSUANCE /1/'1 T � �n n1 � . Y`�
CODE,IS ALLFO THWITHCOMPLVWITHTHOS SIONS.
� ���." I
p DATE: /D��APPLICANT: SMIP 1
J WARNINGFAIWRETOSECUREWORKERS'CAMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C I
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT ��,TT: _�---����
DOlLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABORCOOE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: �
� CONSTRUCTION LENDING AGENCY ' PRE-ALT FEE:
O
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THATTHERE IS ACONSTRUCTION LENDWG AGENCY
a- FOR THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
Z
W
� LENDER'S NAME
H LENDER'SADDRESS
w TOTAL FEES 6�,_j/�
� 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
� I AGREE TO CAMPLV WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUIL�ING i
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE
Z ABOVE-M TIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
� �-1�ar� S'2!l
J
�
¢ PERMIT7EE NAME(P T � ��/�� /��/
�
/
N SIGNA7URE OF PEF I E ATE �
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy .
C4��'� �f� ��Q6�llli��I� [�I�[�
o����c��o�� ������
OG�° ��C�� DD/1u�C�� � Of� o` � 0(r��° �t��o - ���f7GJ`t�'���. ,[�(� ���r��a[�'�a�`..
: - ---
SET BACK � FLOOR JOIST i �
- ----- -- -_...___ _..- ----
_..._------
FTGS/FORMS/STEEL ; FHA REQMTS I
-- -- ---' -------- --_, � ----- ---._..___ __ ._ — .._---
ELECTRIC GROUND � j UNDER FLOOR DUCT �
GROUND PLUMBING ___ __.____ UNDER FLOOR CUf�IDUIT� ; �
- --- ---- ----
SLAB GRADE ._. FIREPL.ACE FOU�JDATf{3N ;
--.....
TEMP POWER FIREPLACE BOND BEAM __ _
WATER SERVICE ____ ; __ ______ �__MID HT. B�ND BEAM
-___ _.. _----�--- ---�
ROOF SHEATHI(VG ! 8 FT. BdPJD BEAM _ � _____
FRA�INGNEfVTILIATIOf� ; FINAL BOND BEAM �
RC?OF COVER ,_ ' PRE-GRADING _' � __
ROUGH HEATING BENCHiNG I
ROUGH ELECTRIC , ROUGH GRADlNG ____ _ __ ___
- ---- . _ __,_.
ROUGH P�UNIBING --r , i FINISH GRADING
----- --- ---...-------
, . —.______.__.
SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SIDING ; POOL FENCING
WALL IIVSULATIOhI �----� � POOL FINAL �----�� _�����
CEILIMG IN�ULATION ; OFF SITE IMPS. �
DRYWALL NAILIIVG � DEDICATIONS
_ _ — -_ --...____ _ --------------.__�_.
SEWER FINAL ENG. i
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING�
FlN,4L CONST. GIRE DEPT. FINAL
_-_ ;-�----- ---- ---------._.__
FINAL HEATING ; �HEALTH DEPT. FINAL
FINAL ELECTRIC I DEV. FEES PAID
FINAL PLUMBING ' � ENERGY I
- ------ —__. _-------...-------�— ---._......_.
�
I
C�C Gi�Oi� o � o
CUi�iNiENTS
SEPTIC TA�1K SIZE �
SEEP PIT/U SIZE -- ----- v�--------
� -- —
� � -- ---
� , --