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HomeMy WebLinkAbout17828 �X'P��y�� CITY OF DIAMOND BAR -----�� -- DEPARTMENT OF COMMUNTTY&DEVELOPIv1ENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS '-���� BUILDING PERMIT APPLICATION FIRMLY o ADDRESS �I��� �( t � DATE CATION �.� {`�� NU BER /� #/C v � issuE TYPE occ APN TRACT DATE CONST. GROUP p OWNER o ADDRES ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW O z a CONTRACTOR nne���N6��NSTAL�EiiSINC. SIDE ❑ � ADDRESS PROPOSED USE o� CITY Z���. ��2 ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEHEBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM E%EMP7 FROM THE CANTRACTORS LI� Gefe90/CefpOft W CENSELAWFORTHEFOLLOWINGHEASON(SEC.703t.5BUSINESSANDPROFE5510N5CADE:ANVCITYOR (n U COUN7YWHICHREOUIRESAPERMITTOCANSTRUCT,AITER,IMPROVE,DEMOLISH,ORREPAIRANY57RUC� w TURE.PRIOR TO I75 ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO 7HE PROVISIONS OF THE CANTRACTORS LI- � CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' Pool/Spa Q FESSIONSCODE)ORTHA7HEORSHEISEXEMP7THEREFROMANDTHEBASISFOH7HEALLEGEDEXEMP- (� V TION.ANV VIOUTION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z qe-Roof A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(5500).�: � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COrtIf118fC121 � Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7046,BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF � PROPER7V WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OR HERSELF OR � THFiOUGH HIS OR HEFi OWN EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT IN7ENDED OR� m Q OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- Z 710N,7HE OWNER�BUILDER WILL HAVE 7HE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUIID OR � IMVFOVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWI7HLICENSEDCONTRACTORS � TO CANSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VaIUOIlOf1 ADJ.AREA W CENSEUWDOESNOTAPPI.YTOANONTJEROFAPROPERTYWHOBUILD50RIMPROVES7HEREON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWITHACAN7RAC70R(S)LICENSEDPURSUANTTOTFIECAN7RAC� DUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON Q � U � � DATE OWNEFi � Z w �Q LICENSED CONTRACTORS DECLARATION w CC I HEREBY AFFIRM UNDER PENALN OF PERIURY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER � ' d 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z `X MY LICENSE IS IN F F E AND EfFECT. � �^ � m � LICENS S LIC.NO. L � � J V DATE � CONTRACTOR a W �� WORKERS'COMPENSATION DECLARATIO a NI HEfiEBY AFFIPM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCANSENT705ELF�INSUREFORWORNERS' 2 � ¢ �CAMPENSATION,AS PROVIOED BY SECTION 770o OF THE LABOR CODE,FOR THE PERFORMANCE w Q OFTHE WORK FOR WHICH THIS PEHMIT IS ISSUED. � w VEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION Q 370o OF TH BOR CADE,FAAAR THE PER RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV 1([i� O�A N URANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION J � � CARRIER r PLAN REVIEW ZPOLICY NUMBER ' ELECTRIC Q Y � (iHISSECfYJNNEmNOTBENMPLEfEDOF7HEPEWMISFORONEFN1�FiED001.LPA5(f100)ORLE55). PLUMBING �1 Z I CERTIFV 7HA71NTHE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL (�7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE N WORKERS'COMPENSATION UWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHEL480R C1.�C`(-1j� � I FOR WITH COMPLV WI�}��E PRC/ISION / /� ISSUANCE �A vtJ � '/'/I���( , Y Ylilil�'W l." I SMIP p DATEx� APPLICANT. . J WARNING:FAILURE O SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(5�00,000),IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN (��\ J SECTION 3708 OF THE UBOR CODE.INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: , \ V�+ Q a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDEq PENALTY OF PERJUHV THAT THERE IS A CONSTRUCTION IENDING AGENCY a- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CN.C.). Z W � LENDER'S NAME F- LEN�ER'SADORESS w TOTAL FEES I _�, � � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE TNAT THE ABOVE INFORMATION IS CORRECT. � I AGREE TO COMPLV WITH ALl CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 1�� � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � Z AB E�MENTION PROPE TV FOR I SPE ION P�RPOSES. COMMENTS � � m PE I E E PRINT) � Q � � � SIGNAT O R DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A IicanYs Co P PY, PY, PY, PY. PP PY � � ���"�� ��� �}Ol�[�]i((�I�IQD [��a�' ���i���`���f�l G�[�C�C�6�S� O��V U�1VUv � DQ� oU`� l�f�� oUVCJU L�`J U U✓UV OQ fL� �Yllit�u p o __ -.,._._.._� , SET BACK � , FLOOR JOIST � _..__ �-- --__ .-- — --- --.._.._ �--- -_.. FTGS/FORMSlSTEEL � ; FHA REQMTS - --- -----�--------- --;_.._._....... _.--- --_ .... . _ --_. _._.___._._.__ ELECTRIC GROUND � _ j i_UNDER FLC?C?R Dl7�T i ..------f—__....--- ---..._� _._._ .._..__� ------ - -__ ..._ GROUND PLUMBINCti I�� __ __, i UNDER FI_OOR CiJ��C�UIT ;: — '"'__ _ _.._._. y.__. �___— ._......._. SLAB GRADE � � FIREPLACE FUUr�fU�TiON � _ TEMP POWER FIREPLACE BOND BE1�M __ ___ __ WATER SERVICE MID HT. BOND BEAM ` _ _ ROOF SHEATHIPVG 8 Ff. BOND BEAM i FRAMIf�GNEIVTILIATION I ! FINAL BOND BEAM ; ____ ROOF COVER PRE-GRADING ROUGH HEATING ___ BENCHING —� _�_ _..._ ROUGH ELECTRIC ROUGH GRADING - --- ----- �....---- . _ __ __......._..-- _..,..._.._____-- ROUGH PLUMBING ; ' FINISH uRADING —. -----.y_._._. ____--- —-------- ---..._._.....__. SHOWER/TUB TEST ; POOL ELECT(�IC -- -._.__� ...---(---------- EXT. LATH/SIDI(VG ' , POOL FENGING � WALL IfVSULATIOiV ' POOL FINAL '; CEILING INBULATION � OFF SITE IMPS. DRYWALL fVAILI(VG � DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. - --+- - — GAS AIR TEST _��_ FINAL ZONING � __ __ FIIVAL CONST.. � . �!RE DEPT. FINA'L FINAL HEATING j HEALTH DEPT. FiNR� � FIMAL ELECTRIC � DEV. FEES PAID FINAL PLUfihBING j ENERGY ; -- I C�C�Gi�OO� o � o. . i CUfi�fi�Ef�TS SEPTIC TAiJK SIZE ` SEEP PIT/U SIZE - ------ --�--- � - ,� � -- --------- c� ° —_ -------------