HomeMy WebLinkAbout16727 (25) CITY OF DIAMOND BAR EX P I R E D
------��`--- DEPARTMENT OF COIvIIvIUNITY&DEVELOPIv1ENT SERVICES
�� E I� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 JUN 191.�02 pRESS
�' �"-���� BUILDING PERMIT APPLICATION FIRMLY
: �7
� JOBSITE �J/],r��/ `'i,�/E�Q,���N� �G¢/
y APPLICATIOD✓� �/ PERMIT I _ � P/C
o ADDRE�Pi�ri %cy! �—a�v� DATE l�_� NUMBER �P #
°r APN LOT—�-��T��RACT ISSUE TYPE OCC
p OWNER V �. /✓JFfY// DATE CONST. GROUP
o ADDRES /iJE� ZONING SETBACKS
Z CITY TEL. FRONT RW ❑
� APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
z
m CONT CTOR � G��i /N�" SIDE ❑
Q ADD
°C ROPOSED USE
O C� ��..
o ARCH/E G/ I
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f89B/CBfPOh
W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNTYWHICHRE�UIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,OqREPAIRANYSTRUC� W P8f10/DBCk
w 7URE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- �
� CENSE UW(CHAPTER D(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� POOVSpO
� FESSIONSCODE)OHTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IEC7S 7HE APPLICANT T0 Z Re-ROOi
A CIVIL PENAL7V OF NOT MORE THAN FIVE HUNDRED DOLlAFiS(S5o0).):
Z ❑I,ASONMEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COff1lflBfC13I �
WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7odl,BU51- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NO7 APPLV TO AN OWNEP OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
w OFFEFEDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITFIINONEYEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
�_ ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCON7RAC71NGWI7HLICENSEDCANTRACTORS
TO CANSTRUCT THE PRQIECT(SEC.70l1,BUSINESS AND PROFESSIONS CADE:THE CANTFACTOflS LI- V2IU2�1Of1 ADJ.AREA
W CENSEUWOOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y 70H5 LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
� U
� �
DATE OWNER U
Z w
� LICENSED CONTRACTORS DECLARATION w
� I HEREBYAFFIRM UNDER PENALTV OF PERJUHV THA7IAM LICENSED UN�ER PROVISIONS OF CHAPTER � I . `6I?2A'I �jh��i /) �I�
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CO�E,AND Z ! 'f/�/<� /`/�c�G+�� �,.!
�X MY LICENSE IS IN FULL F CE AyD EFFEC7. m -
� LICENSE CLASS � LIC.N0. / j
� � J
U DAT CONTRACTOR d
W �
� WORKERS'COMPENSATION D C ATION Q
� I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECUR IONS:� Z
Z _I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSENT TO SELF-INSURE FO ERS' _
¢ CAMPENSATION,AS PROVIDED BV SECTION 37o00F 7HE LABOR CODE,FOR THE PERFORMANCE �U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
0
w _I HAVE AND WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE,AS PEOUIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WOiiNERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER AHE: CONSTRUCTION
J
j CARRIER PLAN REVIEW
Z POLICV NUMBER ELECTRIC �
Q �� (fHISSECfK7NNE�NOTBENMPLEfEDOFiHEPEM4�ISFORONEHUPDREDDOILNLS 100)OpLESS). PLUMBING
Z �CER7IFY 7HA71N THE PERFORMANCE OF THE WORK F ICH 7H RMIT I SUED,I MECHANICAL
(.'} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER S 5 T BE SU O THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNI NDA EET ULDBECAME INSPECTIONFEE
= SU&IECTTOTHEWORKERS'COMPENSATIONP VI510 OF 37000FTHElABOR . _, � ,I I__,��
O/t D�}�FSA�LFQqT�ITHCOMPLVWITHTH P I510 . � ISSUANCE I
� /_d/C/ A 1 �
J O LJC (1 SMIP
p DATta�K_ APPLICANT:
J WARNINCa:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UN F L,AND SHALL BE ENERGY P/C I
� SU&IECTANEMPLOYERTOCRIMINALPENAL71E5ANDCIVILFINESUPTOONE UN EDTHOUSAND ENERGYPERMIT
DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,�AMAGE AS P VIDED FOR IN
� SECTION 770B OF THE UBOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBV AFFIqM UNDEfl PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.7097,CIV.G�. .
Z
W
� LENOER'S NAME
� LENDER'SADDRE55
� TOTALFEES �g �
� I CEFiTIFY iHAT 1 HAVE READ THIS APPLICATION AND STATE THAT TFiE ABOVE INFORMATION IS CARRECT.
w 1 AGREE TO COMPLY WITH ALL qTV AND COUNTV ORDINANCES AND STATE lAWS RELATING TO BUILDING
� CONSTRUCT ON,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS UNTV TO ENTER UPON THE
Z ABOVE-M TI D PERTV Fqr�INSPECTION PURP . �
� �� COMMENTS
0
�
m PEPMIT7EE NAM RI �
� O
Uj SIGNATUR F E DATE
= RECPT.NO. PAID BY VALIDATION
~ HITE— e artment Co YELLOW—Finance Co PINK—Assessor Co GOLOENROD—File Co GREEN—A licant's Co
P PY. PY, PY, PY, PP PY
\
-. � .. . ;
(���(1� OI� �Old�ii��9� �3�1fi�
G6�1S�f�"l�C�u 0��1 G�3CC���Cb� ,�.
�� f. c��� oa��� ,.a.
��C� � `1tC � ' ��� �1��.�C.�C�U 1�� _ a � ° � �
SET BACK FLO�R J�IST � �
-----T--- - -- ---
FTGS/FORMS/STEEL ; � FHA REQMTS —�--�
ELECTRIC GROUND UNDER FLOOR DUCT �
- --�- ----
GROUND PLUMBING i UNDER FLOOR CU�!DUIT �
� I
— ------ --...---...._.
SLAB GRADE ___ __ FIREPLAGE FOUNDATlON
_.__ _.____...��� _.___..--
TEMP POWER , FIR�PLACE B(�ND��A�/f ___ � __
W,4TER SERVICE MID HT. BOND BEAM ____
ROOF SHEATHIh1G 8 Ff. BdND BEAM I
FRAMINGNENTILIATION FINAL BOND BEAM ' ___
ROOF COVER PRE-GRADING _
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING �
-- -- _.__. ---._...--
ROUGH PLUN161NG FINiSH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATHISIDING POOL FENCING
WALL I�lSULATIOPI POOL FIIVAL �
---- -- ---._...- �-+— ---_.
CEILIiVG IN�ULATION � OFF SITE IMPS. i
DRYWALL NAILING DEDICATIUNS
SEWER FINAL ENG.
SEPTIC TANK LAiVDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZOi�ING '
FINAL CONST. F!RE DEPT. FINA�
FINAL HEATING � HEALTH DEPT. FINA� !
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUNiBING ENERGY �
---r
I
���o' 'n_ i �___
COfi�ME�TS
SEPTIC TA�lK SIZE
SEEP PIT/U SIZE
�
� �
� -- — �
�