HomeMy WebLinkAbout14921CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suitc 190
(909)860.3195 Fax(909)861-3117
BUILDING PERMIT APPI.ICATION
JODSITE / -
ADDRESS �� ZN,
APN LOT �/,S_ TRACT
OWNER AC4L_
ADDRESS � e Z
CITY - Z Fl TELZ&J-
APPLICANT TEL.
CONTRACTOR
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CITY C-0911,14- ZIP Q0,t7/ TEL
ARCFL'ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
C16VNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY or PERJURY THAT I AM CXC4RT FROM THC CONTRACTORS L4
CENSE LAW FOR THE FOLLOW NO REASON (SEC. 7a3ts BUsLNFSS AND PROFESSIONS CODE. ANY CITY CR
COUNTY W ICH REOUIRF9 A PCnM'T TO CONSTRICT. ALTS R IMPROVE. DC1A^.L•S,'. 0•l REPATIANY STRUC.
TURF. PRIOR TO ITS ISSUANCE. ALSO RCOU'RCS THE APPLICANT FOA SUCH PEFM:T TO FILE A S'GNED
UT
STATEMENT THE On $
HL- IS LICENSED PURSUANT TO TIC PRoVIO
sNS CF THF CONTRACTORS LL
CENSE LAW (CHAPTER 9 ICCMMENCNG WITH SECTION 7WJI OF D!VISON s Or THE BJSNE SS kv.) PRO.
FESSIONS COLE) OR THAT HE OR SHE IS FJFM;'T THE RCFROM AND THE BASIS FOR THE ALEGFD EIEM-.
T1DN.IL4Y VIOLATION OF SECTION 7031 S BY ANY APPL ICANT FCNI A PE RMIT SURIECTS THE APPLICANT TO
A CML PENALTY OF NOT MCRC THAN FM MFNDFIrD DOLLARS [$S00))
OL AS OWNER OF THE PROPERTY.OR MY EMPLOYEES W TH WAGES AS THr:n SOLE COMRENSA'ION.
WILL DO THE WORD AND THE STRUCTURE IS NOT INTENDED on OFFERED FOR SALE (SEC. 7044. BIJS:.
NESS AND PROFESSIONS CODE THE DONT RACTOM1S LICENSE LAN DOCS NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR MPFIOVEL) W q S THEREON. ANDOES BOC! I WORN HIMSSCLF CR Hr RSFLF OR
THROUGH HIS OR HEROW4 EMPLOYEES. PROVIDED THAT SUCH MP ROVCMCNTS ARE NOT NTENMM OR
OFFERED FOR SALE. V HD WCVEK THE BUILDING OR IMPROVEMENT IS SDLD WITK4 ONE. YEAR DF COM'LC-
TON. THE OWNER-BULDCR WLL HAVE THE BURDEN OF PROVING THAT HF. OR SHE DID NOT BUILD On
IMPROVE FOR THE PURPOSE OF SALE).
O L As OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACT:NG WITH LCENSED CONTRACTORS
TO CONSTRUCT THE PIIOJFCT (SCC. 70,Ik BJSINCSS AND PF FES SIGNS COCL THE CONTRACTORS I.I.
CCNSC LAW DOES NOT APPLY TO A4 ONNCR OF A PROPERTY W1 O P.'JLDS CR MPPOVES OHF RFON. AND
WHO CONT RATS FOR SUC1I PRYUECTS W DI A CONTRACTOR; S) LICENSED PURSUANT TO 7Hr ODNTRAC-
TORS UCENSF. LAW).
O I AM EIF. MPT LNDER SEC B LPC FOR THS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFF)M UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PnOV SKNNS OF CHAPTER
s ICCUMCNCOn WITH SECTION 7000) OF DMSION 70F THE BU SAL SS AN;) PROFESSIONS CODE. AND
W LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
�_
DATE '� ` CCN.: PACTOn
YiORKERS' COMPENSATION CECLARATIO"1
REFI AFFIRM U1d7ER PCI:ALTY OF PFILJ;RY ONE OF THE FaIDW.NC CCCLARATK)Ns.
I` (HAVE A4U WLLMA 4TAN
A CEFTTfICATE OF CONSENT TO SEL FaNSURE FCR WORKERS'
PE N.A. ION.AS Ill. DBY SECTION5770 OF THE LARO•l COCr.. FOR THE PCRrCr,MANCE
OF THF WORK FOR WPO, THIS PFRMIT IS ISSUED.
I HAVE AND WLL MAT.:AN WORKERS COMPE NSATON IN S1:RA.4CE. Al REO'JIREO BY SECTION
7700 OF THE LABOR COOL. FOR THE PERFORMANCE CF THE WCPK FOR WHICH TI!S PERMIT IS
IS K. -CO. W MOFLKFn S' COUPENSATON INSURANCE CARRER AND POLICY IJ VrER MF.
CARA'ER
Paler Fawarn
m c. SF.CTICh W.MNOT BC CSR.tLETEDOF TC PERMIT IS FORCE HANIRrDCLOUAF.S i'T, dl:[SSL
,CERTIFY THAT INTHCPCRronLAANOC OF THC WOR{ Fon Wrcm TILS PERM, 1SISSULD.1
5HALLNOTEMP:OYA4YPERSONNANYMAY!1Cn ^ASTOBCOCNI S: ' TOTI-E
WOI4fEns CDUYCNSATON LAWS Or CALIFORY- JAC CETIIAT IS .AOB000MC
S'.;rLjECT TOTHE WORIFni COMP E45ATIOry P IF ..OF TI IE LABOR
COCE.1 SMALL FORT. fWIT1 COMPLY W TI/ T F IO' ON
DATE: APPLICANT. _
WARNNG FALURETOSLCUREWORKERS' CN SA TION CIOVERA ..ISUNLA'WUL.AtiOSHALLBE
SU3JECTA4EMPLOYERTOCR:MIKALPE'NALTILS :3 IL FINES L TO CHE MUNDREO TIOUSANO
DOLLARSRIOO.OfI!I.INADD:TMTOTHI COST OrcoMPFNsATIDN. DAMAGC.:AS PROWDED FOR IN
SFCTON 7700 Or THE LAp.OR CODE. INTE REST. AND ATTOFINC YS FEES
CONSTRUCTION LENDING AGENCY
111E FIERY AFFIRM UNCEn PENALTY OF PERJURY THAT TI ERE IS A CONSTRIICION LEND'NG AGENCY
FOR TNF PFRFOHMANCE of THE WORK FOR N1 NICU TH S PERM17 IS ISSUFO (SEC. 3(M7.CIV C).
LENDER'S NAME
LENDERS ADDRESS
1 CCRT:FY THAT 1 HA'JE READ THIS APPLICATION AND STATE DO! THE Ae� INFORMATION IS COnnrCT.
I AGFA E TO COLAPLY WITH ALLCITY ANO COUNTY OR^.INANCES AND STATE LANs RELATING TO BJLD!NG
CONSTRUCTION. AND HEREBY AUTHORIZE REPRLSENTATNE S OF INS COUNTY TO ENTER UPON 7HC
MOVE-MCNTIONED PROPERTY FOR INSPECTION PURPOSES.
_ 3
aMA. JIi DAT e
PRESS
FIRMLY
APPLICATION PERMITI y lC
DATE NUMBER p
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETDACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES ;>—_ DEDROObI$_57_
DESCRIPTION SO. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR'ADD.'RE!A
In
Gara,R'Ca'poR
WF'a:;a'Deck
LL
POC.'Spa
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Re -Roof
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Commercial -
ED
Valuaftn ADJ.AREA
QUANTITY DESCR:PTICN FEE
yon 15M_7v
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLU'.'e:NG 70
/�/E
MECHANICAL /�
INSPECTION FEE �
ISSUANCE
A
ENERGY PIC� ' 1
ENERGYRFI T,
PEWIT `//''v'�.LMOF—DIANIIONLYB
RETENTION FEE: 3I;IL-�3..�I't i3 - Ay
PRE -ALT FEE:
TOTAL FEES.1
COMMENTS
-
—
'AID
RCCPT. NO. BY VALIDATION
W)IITC—Mna^mint Cary. YELLOW—F nonce Copy. PINK—Assassor Copy. GOLDCNRO -FIs 301LIEN—APPIcant's Copy
ti
CITY OF DIAMOND BAR
INSPECTION RECORD
SET BACK I
I
I I FLOORJOISTT,-
FTGS/FOR'AS/STEEL
I
FHA REO"ATS
ELECTRIC GROUND
-I UNDER FLOOR DUCT
1
GROUND PLU.IBING
I
UNDER FLOOR COINDUIT
SLAB GRADE
I
FIREPLACE'FOmbATIOPJ
I ;'
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
I PAID HT. BOND BEM --'•'
ROOF SHEATHING
a FT: BO:dO'BE<�fvl
FRAIAING/VENTILIATION
I
FINAL BOND BEAM
ROOF -COVER
I ".
I PRE -GRADING
ROUGH HEATING
I BENCHING
ROUGH ELECTRIC
I~ ROUGH GRADING
1
ROUGH PLUMBING
FINISH GRADING
SHOVJER:'TUB TEST
I
POOL ELECTRIC
EXT. LATH.'SIDING
I
I I POOL FENCING
l
WALL INSULATION
I
I I POOL FI?JAL
CEILING INSULATION
I
I I OFF SITE RAPS.
DRYV-JALL NAILINGI
I
I I DEDIC ATIONS
SEWER
I
I I FINAL ENG.
SEPTIC TANK
I
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
I
I ON SITE Ii:1PS.
GAS AIR TEST I
I
FINAL ZONING
FINAL -CONST. - i
'' I
FIRE DEPT. FINAL
FINAL IDEATING=� :
FINAL ELECTRIC —�.-
FIiJAI_ PLUMBING — �_
HEALTH DEPT. FIPJAL
DEV. FEES PAID
ENERGY
COIXA E NTS
_
SEPTIC TANK SIZE
SEEP PIT/Ll SIZE
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