HomeMy WebLinkAbout12053 1�_ CITY OF DIAMOND BAR EXPIRED
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�, 3 21660 E.Copley Drive Suite 190 �U N 13 2002
(909)860-3195 Fax(909)861-3117 PR ESS
`����. BUII.DING PERMIT APPLICATION �IRMLY
� JOBSITE � � � APPLICATION � _� PERMIT ���jI C
a ADDRESS DATE NUMBER�_✓fi
c� ISSUE TYPE OCC
APN LOT TRA T DATE CONST. GROUP I
� OWNER
O
ADDRESS a ZONING SETBACKS
Z CITY • � ZI TEL. REART RW p I
g APPUCANT TEL.��� SIDE/SIDE STREET RW ❑
� CONTRACT �• SIDE ❑ '
� CIIY S 0 ZIP��QTEL.�LQ - 2� PROPOSED USE
o ARCH/ENG/ •
� DESIGNER , NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I MEREBY AFFlRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE�CAMRACTORS LI� Gef2Q0/CBfPOff
W CENSEUWFORTHEFOILOWINOREA50N(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUHT`/WHIC:MREOUIRESAPERMRTOCONSTRUCT,�LTER.IMPflOVE,DEMOUSH,ORREPAIRANYSTRUC- W PgliO/D6Ck
Z TURE.PRIOR TO ITS ISSUANCE,�LSO RE9UIqE5 hIE APPLICMIT FOR SUCM PERMIT TO FILE A SIGNED
�l� STATEMEM THAT ME OH SHE IS LICENSEO PURSUAHT TO 7HE PROVISIONS OF THE CONTRACTORS LI� W
� CENSE UW(QIAPTER Y(COMMENCINO WI7H SECTION J00o)OF DIVISION�OF THE BUSINESS AND PRO- � PooUSpa
FESSqNS COD�OR hIAT ME OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEdED EXEMP•
TION.ANVVIOLATqNOFSECTION7IX11.6BYANYAPPLICANTFORAPERMITSUBIECTSTHEAPPLICAHTTO Z Re-Roof
� A CML PENALTY OFlpT MORE THAN FNE HUNDRED DOLURS(t500).):
� OI,ASOMMEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCl81 � . .
WILL DO THE WORI(AND THE STRUCTURE IS NOT IMENOED OR OFFEREO FOR SALE(SEC.70/a,BU51- J
N HESS AND PROFESSIONS CODE:hIE COHTMCTORS LICENSE UW DOES NO7 APPLV 70 AN OWNER OF �
VROPEHfYWIpBUiLDSORIMPROVESTHEREON,/�NDWHODOE55UCHWORKHIMSELFORHERSELFOR m
CC THiqUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
QOFFEREDFORSALEIF,MOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWfiHINONEYEAROFCOMPLE•
Z �'TION,THE OWHER-0URDER WILL MAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� WPROVEFORTHEPURPOSEOFSALE).
W ❑I,AS ON?IEROF THE PROPERTV,AM EX0.U51VELY CONTRACTINO WffM LICENSED CONTMC70RS
� TO CONSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U0fI0t1 ADJ.AREA
W CENSEUWDOESNOTAPPLV70ANOWNEROFAPROPERTVWHOBUIlD50RIMPROVESTHEREON,AND
� NR1000HTMCTSFORSUCHPRQ1ECiSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE �
� 70RS LICENSE UW.).
Q ❑1 AM EXEYFT UNDER SEC. B.d P.Q FOR THIS HEASON �
lL ¢
DATE ONMER V
� LICENSED CONTFACTORS DECLARATION W
� 1 HEREBYAFFIHN UNDER PENAL7V OF PERIURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �
p_ Y(COMMENCiNO WITH SECTION 7000)OF ONISION 3 OF THE BUSINE55 AND PROFESSIONS CADE,AND Z
`u W UCEHSE IS IN FULL FOPCE AND EFFECT. m
� LICENSE C SS LIC.N0. � � ,
V DATE CONTMCT a �.
W
� WORKERS'COMPENSATION DECLARATION Q �
� U
N I HEREBV AFFIRM UNDER PENALTY OF PE0.IURY ONE OFTHE FOLLOWING DECLARATIONS:
� Z
Q
� 1 HAVEAND WILL MAIN7NH ACERfIFlCATE OF CONSENT TO SELF-INSURE FOH WORKERS' _
� COAIPENSATION,AS PROVIDED BV SECTION 370o OF THE IABOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR NMIq1 THIS PERMIT IS ISSUED. �
� ��//�
w /`�I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSUfUNCE,AS REOUIRED BV SECTION
Q � 9700 0F THE LABOR CODE,WR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15
ISSUED.MY WORKERS'COMPENSAT�NI INSURAN�Ce{l�R,�IER,.�yjr_+.��ICV NUMBER ARE: CONSTRUCTION
� CARRIER� (�� `�� PLAN REVIEW
� POLICY NUMBER� � ELECTRIC �
L
Q
� �sEcilonr�r�o7BEoo�.aFiIDOFnfr�w.aisroaaae�ooatnas�siaoloa�Essl PLUMBING � .
W MECHANICAL
Z I CERTIFV 7HAT IN THE PERFORAIANCE OF THE M/0RN FOR WHICH THIS PERMIT IS ISSUED,I
(,'J SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SOAS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECT 70 7HE WORKERS'COMPENSATION 7ROVISIONS OF SECTION 37000F THE I_ABOR L-.�
CODE. SHALL oan+win+canv�r EPROVISIONS. Y ISSUANCE i
/l
p DATE: APPLICAP ' - c �\\ SMIP . I
� ENERGY P/C I
J WARNINO:F LUR[T SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE
� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT ' I
OOLURS(i100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS GROVIDED FOR IN
J SECTION 37oe OF iHE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �
Q
pw.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ���� �;��
O
� I HEfiEBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORN WR WHICH THIS PERMI715ISSUED(SEC.3007,CIV.C.).
Z
W
� LENDER'S NAME
F- LENDER'SADDRESS
� ICER7IFYTHATIHAVEREAD7HISAPVLICA710NANUSTATETHAT7HEABOVEINFORMA710NISCAHFECL TOTAL FEES � ,R � �
W I A�NEE TO COMPLV N7TH ALL CITY AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING
� CONS7RUCTION,AND HEREBV AUhfORIZE REPRESENTATIVES OF THIS CAUNTY TO ENTER UPON T1E �
ZABOVE-MENTqNED PROPERTV FOR INSPECTION PU POSES. COMMENTS ��
0
J
�
m P NAME(PRII(T) � �
a
E(iPPE MITTEE � ATE y
� RECPT.NO. -� PAID BY � VALIDATION��
WHITE-0epeAment Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
, ��-,.� . .. . .. .��.-�:- .. ..��..__., . �{. ...� . . • ' ,. � . � . . .� . ,. . , . .
' . � CI�'Y O� DI/1iVIOND BAR ,
,,, .
Ii�9SPECT90fV F��CO��
��r o o �� � ��,� . ��� . a � , . � .
;��. -
� � v� � � r �
.r � � , : . � _ ,.
SET BACK �� � � � 's , � � FLOOR JOIST �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR COt�IDUIT
SLAB GRADE FIREPLACE FOUNDATION � - - -
TEMP POWER FIREPLACE BOND BEAM ` � - '
WATER SERVICE • MID HT. BOND-6EAM - • -
ROOF SHEATHING 8 Ff. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRlC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON 51TE IMPS.
GAS AIR TEST FINAL ZONING
FINALCONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL�L.ECTRIC ' DEV. FEES PAID
�FINAL PLUMBING ENERGY
� s
� � i�..� 4"'�}P•� � '��r.K ;��. _
COMiViENTS �
SEPTIC TANK SIZE . ..
SEEP PIT/U SIZE .
�
�. �- .
_
�� _�?°� ��. ,�,� ... .. <.. , _
�� �� � � ���. �
� '��� �fir�� � � r
��
� �"�� ����` �
♦tit�Akt 4'P" �,� � '' �+
t. � f F .�S f� ,
ZP
4 ��
� y �� h'�+i yF's�. y�. '
� �` n ti' •`
ry-�
•.t � -ca�+y ' a � : - - - . .
!� C � ��t
� mk'r +�,��� ''�'; � � ' -
����
1 :y �