HomeMy WebLinkAbout12921/
�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES EXPI RED
21660 E.Capley Drive Suite 190 '
w (909)860-3195 Fax(909)861-3117 J U N 13 1002 PR ESS
"TM'� � � BUILDING PERMIT APPLICATION �IRMLY
� JOBSITE APPLICATION PERMIT � Z P/CGt�I.-��
o ADORESS 5� TDPS r,o� PL DATE ��/4�9q NUMBER # �
c� ' ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
� OWNER Ss��l MN/� A-[aH.4Mb0
O
p ADDRESS r co Te�°CI�6 f'L ZONING SETBACKS
Z CITY �, 8 . ZIP�G _ TEL. FRONT RW ❑
g APPLICANT _F,4N T.4-N� TEL.6/���-9�8 REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR �.(.t.(����d��J SIDE ❑
Q ADDRESS PROPOSED USE
� CITY ZIP TEL.
oARCH/ENG/ f'1/
� DESIGNER ��7//�-f F'f' � iC�^� /-1'rro .
a ADDRESS 4zI S, ,E;.�e..,-a. �l .4,.t NO.DWEL. NO. NO.
� CITY
�- �-�'n�� ZIP 9� TEL.L/�3 i-�f"� UNITS STORIES BEDROOMS
y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PENAL7Y OF PERNRY THAT I AM EXEMPT FROM THE CONTiUCTORS LI- rt
W CENSEUWFORTHEFIXLOWINGREASON(SEC.7031.58USINESSMIDPROFESSIONSCODE:ANYCITYOR (^
U COUNfYWHICHREWIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIqANVSTRUC- PflflO/DBCk �J � 2"
w NRE,VRIOR TO ITS ISSUANCE,ALSO REOUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMEM THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSIDNS OODE)OR THAT HE OR SHE IS E7(EMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANVVIOLATIOHOFSECTION70.71.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAN7T0 Z Re•Root
� A CML PENALTY OF NOT MORE 71UN FNE HUNOREO DOLURS(S5oo).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrt1BfCIHI �
YALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.70/4,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
N PROPEHTYWNOBUIIDSORIMFROVESTNEREON,ANDMMODOESSUCHWORNHIMSELFORHERSELFOR �
Q THROUOM MIS OR NER OWN E�IPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
O ,OFFEREDFORSALEISFIOWEVEi�TiEBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,ASOWNEROFTHEPROPEHfV,M1E%ClU51VELVCONTRACTINGWITHLICENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7oH,BUSINESS AND PROFESSIONS COOE:THE CONTRACTORS LI- V81U2110f1 ADJ.AREA
W CENSELAWDOESNOTMPIYTOANONMEROFAPROPERTYNR10BU1LDSORIMPROVESTHEREON,AND
� WHOCONTMCTSFORSUCHPR0.IECTSWIh!ACONTMCTOR�S)IICENSEDVURSUANTTOTHECONTRAG pUANTITY DESCRIPTION FEE
Y iO1iS LICENSE LAW.).
� ❑I AM El(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
3
� �
DATE OWNER U
Z w
� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHA7TER � .
d Y(COMMENCWO WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS/J1D PROFESSIONS COOE,AND Z
X MY UCENSE IS IN FULL FORCE AND EFFECT. m
LLI �
0 LICENSE CLASS LIC.NO. �
VDATE CONTRACTOR d
�,, OND BAR
� WORKERS'COMPENSATION DECLARATION Q p� SAFE'I'
= U
� I HEHEBY AFFIRM UNDER PENALTY OF PERIURY ONE OFTHE FOLLOWING DECLARATIONS:
C� Q
� I HAVE AND WILL MAINTAIN A CEi{fIFICATE OF CONSENT TO SEIF-INSUHE FOR WOHKERS' 2
� COMPENSATqN,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR 7HE PERFOHMANCE W
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W I HAVE AND WILL MAIMAIN WORKERS'COM7ENSATION INSUFUNCE,AS REQUIRED BY SECTION `7 p�
O 370D OF THE LABOR CODE,FOR hIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � �t<J � �
ISSUEO.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: UCTION
J
� CARRIER N REVIEW �
� POLICV NUMBER �
Z
Q
� (fF45s[CfqNNE�ra7eECOAf'LEfIDOFnEPEaMisFnRONEHtNIfimDout�Fis(ttoo)oRLEss� PIUMBING
W
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(, SHALL NOT EMPLOV ANY PERSON IN M!Y MANNER SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATION IAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME FEE
S SUBJECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR . k�l�
CADE.1 SHNl FOHTHWITH COMPLY Wlhl THOSE PROVISIONS. UAN O \1
� SMIP � S O �
p DATE: APPLICANL .
w ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNLAWFUL,AND SHALL BE
LL SU&IECTANEMPLOVEH70CRIMIN/�1.PENAL7IESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(S10o,000).IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTpN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� � I HEHEBV AFFIRM UNDER PENAL7Y OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH 7HIS PERMIT IS ISSUE�(SEC.3087,CIV.C.).
W
� LENDER'S NAME
F— LENDER'SADDRESS
¢ ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATE7HATTHEABOVEINFORMATIONISCAHRECL TOTAL FEES •
W I AGREE TO CAMPLY N7TH ALL CfTV AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDINCa �`
� �
� CONSTRUCTION,AND HEREBY AUTFIORIZE REPHESENTATIVES OF THIS COUNTV TO ENTEH UPON 7HE �J , V
Z ABOVE•MEIfT10NED PROVERTV FOR INSPECTION PURPOSES. COMMENTS �
� 2
_ �^^.�'i -T'L�l � -
m P,ERMITTEE NAME(PRINn �
Q
�
N SIONATURE OF PERMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE�epaRment Copy,YELLOW�inence Copy,PINK—Asse Copy.G LDENROD—File Copy,GREEN—Applicant's Copy
�M��- G�ra lrlr�C���-�-� ;
CITV OF DIAMOfVD �AR
�NSPECTION RECOB�D,
.. ..,. .
:: . .,:-D , .� ' � � `. . ,p � � D � � � � i � 0
?
SET BACK � F�OOR JOIST � �, �s� �
FTGS/FORMS/STEEL � �FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT , , ,
GROUND PLUMBING UNDER FLOOR CUMDUIT
SLAB GRADE FIREPLACE FOUNDATION � • � � � -
TEMP POWER FIREPLACE�BONb BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING - - 8 FT. BOND BEAM
FF{AMINGNENTILIAT'ION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING " '
ROUGH ELECTRIC - ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST - � POOL ELECTRlC
EXT. LATH/SIDING POOL FENCING
WA�L INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NNILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING •
FIiVAL CONST. FIRE QEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC �;�; c.<.�: DEV. FEES PAID
FINAL PLUMBING ENERGY
:�;;�,r
. , , .�r�{ y .'p �' r� ' .d.
3�t >�<eh��
' • ' . .. .. . ' ,. , j � , ` .
COiViMENTS . ..
�
SEPTIC TANK SIZE
SEEP PIT/U SIZE --
��� � / ��:Y�� F*� �� .
. �+
,` E �'. � � 'A � �
�� R�x ti�` � �� �� � }� :" � '
f�i ry i;i�. T`�A�. 1+ � �
'. �� `: f '"� 5�.
� k �
'���^�g �k� '����F"��'�,.k�� �.. .
;.x � � .,t �"+4'� , � �.��p 1.c , ._� ..
'St tl 1 ��� { .
y �''�
` ��^� t�,�, ��'z ������x�y ' - . �
`v�s� f,�`,� 1� � ,� 5� g ,.;
'�. Y"°; ,{'�.Y L
dib � \/��`�j Y< � si A�j y{I� - _ .
�ya! �,i✓ 5�����1��� " '
r �
� t