HomeMy WebLinkAbout18122 _ . �
1F� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
���'� BUII,DING PERMIT APPLICATION FIRMLY
o� JOBSITE /��G, '�]-'�/��'��� � DATEiCATION� � Z NU B R 1�#��
ADDRESS / /r �"�
$ ISSUE (r' TYPE OCC
APN LOT TRA T DATE J � � CONST. GROUP
°C OWNER
O
" ADDRE ZONING SETBACKS
Z CITY • ZIP TEL d � FRONT RW ❑
g APPUCANT � �� LL � TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRACT O L SIDE O
Q ADDRESS PROPOSED USE
� CITY �= ZIP EL7 �1
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OOWNER-BUILDER DECLARATION SFR/ADD/REM
� I HEREBY AFFlRM UNDER PENALTV OF PERNRY THAT I AM EXEMPT FROM 7HE CANTRACTORS LI- � Garage/Carport
W CENSEUWFORTHEFOLLAWINGREASON(SEC.7031.58USINESSAN�PROFESSIONSCODE:ANYCITYOR
U COUNT`/MMICHREWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIPANYSTRUC- W Patio/Deck
� NRE,PRIOH TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE UW�piMTER Y(COMMENCINO WIiH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- u' PooUSpa
fESSqNS CODE)OR THAT HE OR SHE IS EXEMPT TiEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TIDN.AHYVIOLATIONOFSECTION7o31.68YAHVAPPLICANTFOPAPERMI75UBJECTSTHEAPPLICANTTO Z Re-Roof
� ACIVIL PENALTV OF NOT MORE 7HAN FNE HUNDRE�DOIURS(i5oo).):
� OI,ASOWNEROFTHEPROPER7V,ORMVEMPLOVEESWITHWAGESAS7HEIRSO�ECOMPENSA710N, � COR1rtIBfCl81 � �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOF SALE(SEC.7041,BUSI- J
NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF
� PROPEHTYINIOBURDSORIMPROVESTHEREON,ANDNMODOESSUCHWORNHIMSELFORHERSELFOR �
Q THROU(3H HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUpi IMPpOVEMENTS ARE NOT INTENDED OR m
QOFFEREDWRSALEIF,HOWEVER7MEBUILDINGOHIMPROVEMEMISSOLDWfTHINONEVEAROFCOMPLE-
Z �'TION,TME OWNEH-BUIIDER NALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEJ.
❑I,AS OWNER OF THE VROPEHfY,AM EJ(ClU51VELV CONTMCTING WITH LICENSED CONTRACTORS
� 70 CONSTRUCT THE PRQIECT(SEC.7ou,BUSINESS AHD PROFESSIONS CODE:THE CON7RACTORS LI- V21UellOfl ADJ.AREA
W CENSE U1W DOES NOTAPPLV TOAN ONRJER OF A PROPERTYNM1IO BUILDS OR IMPROVES 7HEREON,AND .
� WFIOCONTRACTSFORSUCHPRQIECTSWIhIACONiRACTOR(S)IICENSEDPURSUAHTTOTHECONTMG pUANTITY DESCRIPTION FEE �
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
I 3 Q
DATE ONMER V
W
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIfiM UNDFH PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPT[R Z �` ,_
� Y(COMMEHCtNO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CA�E.AND
YY UCENSE IS IN FULL FORCE AND EFFECT. m
0 LICENSE CLASS ✓ � LIC.NO. /D���7� j '
F�—
V DATE � �'�� CONTRACTOR�II�� a
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEPEBY AFFIRM UNDER 7ENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: U
N Q
� I HAVE AND WILL MAINiAIN A CERfIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' 2
' � COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOH CODE,FOR THE PEHFORMANCE �U
OF THE WOPN FOR WHICH THIS PERMIT IS ISSUED. �
�
w �t HAVE AND WILL MAINTAIN WOHKERS'COMPENSA710N INSUMNCE,AS REQUIRED BV SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
� ISSUED.MY WORKERS'C/OM'PENSATIO�N IN/�URANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CARRIER L�C`T- D/V PLANREVIEW
Z POLICY NUMBER G r�� � ELECTRIC
� (TF95SFCfqNNE�NOTBE00AWlEfmOFi}fPERMTISFORONEFAJti)FF.DDOLLARS(f100)ORLFSS? PLUMBING ' ��O
Z I CERTIFV THA71N 7HE PERFORMANCE OF THE WORK FOH WHICH THIS PERMI7IS ISSUED,I MECHANICAL
() SH/�1L NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
N WURKERS'COMPENSATION UWS OF CALIFORNIq AND AGREE THAT IF I SHOU�D BECAME INSPECTION FEE
S SUBJECT 70 THE MfORKENS'COMPENSA710N PFOVISIONS OF SECTION 3700 OF THE IABOR /r.�.�
CODE.I SHALL FORTHWITH COMPLY WITi THOSE PROVISIONS. {� ISSUANCE �_ • C/V
� OA7E:��� ��/r 1 �L/C..K�� �SMIP �
0 APPLICANT: .
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNLAWFUL,AND SHALL BE .
� SUBJECT AN EMPLOVER TO CRIMINAL PENAlT1E5 AND CIVIL FINES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT
DOLLARS(S10o.oao).IN ADOITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF hiE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. � RETENTION FEE:
Q
d CONSTfiUCTION LENDING AGENCY PRE-ALT FEE:
' � I HEREBYAFFIRM UNDER PENALTV OF PERIURY 7HAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oY7,CIV.C.).
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS /�.�
w I CER7IFY THAT I HAVE READ THIS APPLICA710N AND SUTE THA77HE ABOVE INFORMATION IS CORRECL TOTAL FE ES �6�-� y/V
. � I AGREE TO COMPLY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATIVES OF THIS COUN7V TO ENTER UPON THE /� A J {,�/`��,I��1 j�7L��
ZABOVE-MENTIONED PROPERTY FOR INSPECTION PUHPOSES. COMMENTS G� ✓ �(,/(�S L'/(/V���C.�
� ��� ���{�
m PERMITT E RINT) �
� a��- �=[�-� 6
i � SIGNA RE OF PERMITTEE DATE
� RECPT.NO. PAID BY � VALIDATION
WHITE—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
. . . , . . . .. . . .. . ,
C��'V O��96�6�h14?��9� �AR .
9�B�IPf��I�0�1�1 f�R�rG�V��D
. � ,. , � _
. . , n� (��
�y�� � �
Ul�l�SI�J U��/ULJ � �d � . :c F ' � L�� � D �� Ol RJI�)� d �
SET BACK ; FLOOR JOIST
FTGS/FORMS/STEEL FHA RE�MTS � �
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PI.UMBING UNQER FLOOR CU�!dUIT '
SLAB GRADE - FIREPLACE F�UNDATIDN . L �
TEMP P{JV�IER i FIREPLACE BOND BEAM • '
WATER SERVICE _ _�__ MID HT. BOND BEAM •_ _v� __
ROOF SHEATHING 8 FL BONQ BEAM � __�____ _
FRAMINGNENTILIATION J� FINAL BOND BEAM
ROOF COVER �— PRE-GRADING� �
,ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBING FINISH GRADING
SHOWER/TUB TEST P00�ELECTRIC
EXT:IATH/SIDING � � - POOL FENCING �
WALL INSULATiON POOL FINAL
CEIL(NG INSULATION OFF SITE IMPS.
DRYWAL.L MAILING DEDIC,4TIONS
SEWER � FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PiT/LL. ON SITE IMPS.
GAS t�IR TEST FINAL ZONI�JG
f=1NAL CONST. FIRE QEPT. FiNAL �^
�ifdl�L F9EATiNG � , � HERLTH DEPT. �iNAC 1--�–�' �_..___
._._- --- – � -- --__._f__ _ _._..__.__.
F'i!�t,L ELECT9IC � DEV. FE�S PAID
�_E='��d,�I.�PLUMBlN� � ENERGY _ � – � —
� - � -- ------
�.___� -
� ���� � � �-��-f.�
; ��.
� �O�/IfV�ENI"S
� --
SEP71C TANK SIZE ------- ------------
SEEP PIT/U SIZE ..---- -- —
� , ' . . -- -- -
� . � _
,, . ' ---
I� � �. __ __ ________---��_ -----�