HomeMy WebLinkAbout12910� \/
1� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860.3195 Fax(909)861-3117 PRESS
����A�� � BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION PERMIT I /C
o ADDRESS U , /b�• DATE ��// P� NUMBERI�q #
� ISSUE TYPE OCC
APN `L'OT TRACT DATE CONST. GROUP
p OWNER GC/�'�(/� �
�` ADDRESS S�GIiv►-�r ZONING SETBACKS
Z CITY ZIP TEL FRONT RW ❑
g APPLICAN� ✓w� TEL b J REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTO '� (� Ob�� SIDE ❑
Q ADDRESS - PROPOSED USE 1��Mo U� S71AJ�1 K0�T��Tr'�y���
� CITY Z�PLI�7((^ TEL. 7 � �'
o ARCH/ENG/ �� �"� � � ,
aDESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES � • BEDROOMS
� CITY ZIP TEL.
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
0 I HEREBY AFFlRM UNDER PENAL7V OF PERIURY THAT I MI EXEMPT FROM THE CONTRACTORS LI- G8ffl9B/CBfpOA
W CEHSEUWFORTHEFOILOWINOREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANYCITVOR (n .
U COUHfYMMICHREOUiRESAPERMiTTOCONSTAUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck �
Z TURE,VHIOR TO ITS ISSUANCE,ALSO RC-0UIRES THE APPLICAHT FOR SUCH PERMIT TO FILE A SIGNED
W STATEAIENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CONT{UCTORS LI- w
� CENSE UW(CHAPTER Y(COMMENCIN4 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS/VJD PRO- � POOVSPO � '-'.��,•' /1 ('
�� FESSIONSCODE)ORTFUTHEORSHEISEI(EMPT7HEREFROMANDTHEBASISFORTiEALLEGEDE%EMP- C7
� TION.ANYVIOLATIONOFSECTION7071.5BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLIC/JlTTO Z Re-Roof
� A CML PENALTY OF NOT MORE THAN FNE HUNORED DOLLARS(t5ao).):
� OI,tiSONMEROFTHEPROPER7V,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCl21 . �
WILL DO THE MIORK AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70H,BUSI• J
NE55 AND VROFESSIONS CODE:THE CON7RACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
� PROPERTVVM1iOBUILDSORIMPHOVESTIEREON,ANDNMODOESSUCHWORKHIMSELFOqHERSELFOR m
Q T}1RODUH HIS OR HER OWN EMPLOYEES,PHOVIDED 7HAT SUq1 IMPROVEMENTS ARE NOT INTENDED OR
QOFFEflEDPoRSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE•
Z �TION,THE OWNER�UILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OH SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTY,AMEX0.USIVELVCONTMCTINOWITHLICENSEDCONTMCTORS ,Y_ �
� TO CONSTRUCT THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VelUBllOf1 �/�A l7 ADJ.AREA
W CENSE UW DOES NOTMPLV TOAN OINNER OF A PROPERTY N710 BUILDS OR IMPROVES THEREON,AND
� NT1000MMCTSFORSUq1PRQ1ECTSWIT!ACOH�RAC70R(S)LICENSEOPURSUANTTOTHECONTfUP QUANTITY DESCRIPTION FEE
Y rau uc�se uw.�.
� ❑1 AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON U
3 �
� DATE ONMER F
Z V
W
F LICENSED CONTRACTORS DECLARATION W
� 1 HEREBY AFFIRM UNDER PEN/�LTY OF PERJURV THAT I AM LICENSED UNDER PNOVISIONS OF CHAPTER �
� Y(COMMENCINO WffH SECTION 7000)OF DIVISION 3 Of THE BUSINESS AND PROFESSIONS CODE,AND Z
YV LICENSE IS IN FULL FORCE AND EFFECT.
LLI m
� L�CENSE CLASS�_ LIC.NO. ����� `_ �
V DATE CONTRACTOR_pA�l�a��Q_.��ji f(d��I a
W
� WORKERS'COMPENSATION DECLARATION Q
= U
N I HEREBY AFFIRM UNDER PENALT/OF PERIURY ONE OF THE FOLLOWING DECLARATIONS:
� Z
Q
0 I HAVE AND WILL MAINTAIN A CERfIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' S
� COMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH 1HIS PERMIT IS ISSUED. �
�
W _1 HAVE AND WILL MAIMAIN WORNERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION /�
Q 37000F THE LABOR CODE.FOR T1E PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS / )
ISSUED.MY WORKERS'COMPENSATION INSURMIIC/€CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � l.�
jCARRIER /V PLAN REVIEW
� POLICV NUMBER ELECTRIC
� (IFLLSSECfqNNE�NOTBEOd.�LEfIDOF7FEPERAifISFOROMEF0.NDREDDp1ARS(5100)ORLE55) PLUMBING
W y�
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMI71515511ED,I MECHANICAL �� ��9 M
C'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECTTO THE
� WORKERS'CAMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECTTO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 370o OF THE LABOR d
CODE,1 SHALL FORTHWITi COMPLV WITH THOSE PROVISIONS. ISSUANCE
� �// �� �,�� SMIP
tp DATE:�[I� " APRICANT. �� ^ .
� ENERGY P/C
J WARNIN�:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERACaE IS UNUWFUL,AND SHALL BE �I F I?IAMOIdD BAR
LL SU&IECTAN EMPLOVER 70 CRIMINAL PENAL7IES AND CIVIL FINES UP 70 ONE MUNDRED THOUSAND ENERGY PER �+�/
DOLURS(S1ao.000).IN PDDIi10N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN U �G�yT�SAS'G l 1
J SECTION 37oe OF hiE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FE
2
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEPEBV AFFIRM UNDER PENAL7V OF PERJURV THAT THERE IS A CANS7RUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7oW,qV.C.�.
Z
W
� LENDER'S NAME
F— LENDEf75ADDRE55
� 1 CERTIFY hiAT 1 HAVE READ THIS APVLICATION AND STATE THAT hIE ABOVE INFORMATpN IS CORREC7. TOTAL FE ES �
w I AGREE TO COMPLY N77H AL�CT'AND COUNTV ORDINANCES AND STATE LAWS RELA7INO 70 BUIIDING
� CONSTRUCTION,AND HEREBY AU7}IORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON 7HE //�' F [/ •
ZABOVE-MEMIONED GROPERTY F R INSPECTION PURPOSES. COMMENTS �^ v' 1�� � b O Q •
O
J
�
m VE E E(PR ) �
Q
N
N S�ONAN F PERM DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE-0epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy
CBTY O� DIAMOND BAR
6f�SPECT'IOtV F�ECOF��
, _ �� � . . ,. -
' ° ...�, � ��' �' ° ��m . � � , o � -
. �
,� .
� > , �
�� � ,. �, w . ��. .6 .� �� �
SET BACK � �.�� `�� � � � FLOOR JOIST . • -
j
FTGS/FORPv1S/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE • FIREPLAGE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM ' '
WATER SERVICE - MID HT. BOND BEAM • •
R�OF SHEATHING 8 FT. BOND BEAM � � � �
FRAMING/VENTILIATION � � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUN161NGF . ..� . ,�•-, � FINISH GRADING
SH4WER/TUB TEST�' � ' POOL ELECTRIC '
EXT. LATH/SIDING ; PO�L FENCING
WALL INSULATION ''� POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING " ENERGY
. �� ,
,
�� �
' � �:� ,�; ��� �
COMfViENTS
. .
, �
,F<
;r ..... ��.
� :?f;� �
SEPTIC TANK SIZE� - � '�'.'
SEEP PIT/U SIZE
; s � y� � _;� �
:� � �
��t � �
,����� � � 7 � �� �"`� ' �
P� x� �Z a�., 4 3k�����
u a 4`�, �
�"� t �' ,�,
�,�, r� �C. a��, � r� -
�����i9�t�4�F'� �` ��33' .5¢�k�', �: -. � i
y'�- �" �, ��'���r f�� `�,4� )
�}, ;:._ ` ,y o-�
2`
�c,, 1s� � � S
;r-hli t����'v 'n^F�,� i�, �r"�+. % �. .
� � f �� . "� �
,�'4d j" -. • � � � . . . _ _
dw+,"F � � ��
' t