HomeMy WebLinkAbout12811 (3)� � - -�
`.;.[���0���.
� ,.�-� 1�'�t.-_,
. _, �F� CITY OF DIAMOND BAR c;S�P� 1 a 1�2
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 �
(909)86Q3195 Fax(909)861-3117 PRESS
�-`�^' BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPIICATION PERMIT P/C
o ADDRESS �v '�'� DATE /1 �/J��/�� NUMBER 1�� I #
c� ISSUE T�-TYPE OCC
APN L T TRACT DATE �- CONST. GROUP
p OWNE�'1�� T��'L CJr
p ADDRESS�� G+'/� ZONING SETBACKS
Z CITY ���GGG.�.��o+✓ Z�P TEL. FRONT RW ❑
S APPUCANT iJ''f�.�� �r Gt�.d�1 TEL.71�f p j,�'i��l.Z9 REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR /Y►-�'�- ��T.�t� T�G.� SIDE ❑
� ADDRESS ��f$' ti: � r� PROPOSED USE � f.��E�
� cirr �'r_'_�F_.e�a�, ziP� TEL. SRoC- 9oLlr7 _ ---
o ARCH/ENG/ 'rl� -�l
� DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PENALTY OF PEiL1URV THAT I AM EXEMP7 FROM THE CONTMCTORS LI- G8f89B/CBfpOfl
W CEHSEUWFORTHEFOLLOWINOREASON(SEC.7037.5BUSINESSANDPROFESSIONSCODE:ANYCI7VOH (f)
U COUHfVWHICHREOUIRESAVERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLJSH,ORREPAIRANVSTRUC- W Patio/Deck
Z TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS 110ENSEU WRSUANT TO hIE PROVISIONS OF THE CONTRACTORS LI- W
� CENSE UW(piMTER Y(COMMENCINO Wlhi SECTION 7000)OF DIVISION J OF THE BUSINESS AND PRO• - � POOUSpB
FESSIONS OODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANYVIOLATIONOFSECTION7o31.58VANVAPPLICANTFORAPERMI75UBJEC757HEAPPUCANT70 Z Re-Roof
� ACML PENALiV OF NOT MORE T1AN FNE HUNDRED DOLLARS(5500).):
� DI,ASOWNEROFTHEPROPERT/,ORMYEM7LOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, 0 Commercial -
NALL DO THE WORI(AND THE STRUCfURE IS NOT INiENDEO OR OFFEREO FOR SALE(SEC.7wa,BUSI- J
NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
N PROPEHfYWIqBU1LDSORIMPROVESTHEREON,ANDWHODOE55UCHWORNHIMSELFORHERSELFOR �
Q TNROUGH HIS OR HER OWN EMPLOYEES,PHOVIDED THAT SUCH IMPROVEMENTS ARE NOT IIJTENDED OR m �
0 ,OFFEREDFORSALEIF,FIOWEVER7MEBUILDINOORIMPROVEMENTISSOLDWRHINONEVEAROFCOMPLE-
Z 'TqH,TME ONMERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF S/�LE).
w ❑I,ASONMEROFTHEPROPEHTV,AMEXCLUSIVELYCOHTRACTINOWITHLICENSEDCONTRACTORS
Q TO CONSTRUCT THE VRQIECT(SEC.7aa�,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70R5 LI- V81U8f10� ADJ.AREA
W CENSEUWOOESNOTAPPLVTOANOWNEROFAPROPEHTYWHOBUILDSORIMPROVESTHEREON,AND
� WlIOCOMMCTSFORSUCHFR0.IECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHEOON7RAG QUANTITY DESCRIPTION FEE ,
70RS LICENSE LAW.).
p ❑1 AM EXEYpT UNDER SEC. B.6 P.C.FOR THIS REASON Q �� �
3 c>
� �
� DATE OWNER � �
z W
F LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRLI UNUER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WRH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PHOFESSIONS CODE,AND Z
�� MY LICEHSE IS IN FULL FOHCE AND EFFECT. m
� LICENSE CLASS �Yd l LIC.NO. G ^ O j
J
V DATE coHrancroR a
W
� WORKERS'COMPENSATION DECLARATION a
= U
� I HEREBY AFFIRM UNDEH PENAL7V OF PE0.1UM ONE OFTHE FOLLAWING DECURATIONS:
� Z
a
� _IHAVEANDWILIMAINTAINACERTIFICATEOFCONSENT705ELF-INSUREFORWORKERS' S
COMPENSATION,AS PROVIDED BV SECTION 37ao OF THE LABOR CODE,FOR TNE PERFORMANCE U
� Q OF 7HE WORK FOR WHICH THIS PERMIT�S ISSUED. �
�
W �1 HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSUFUNCE,AS REQUIRED BY SECTION
Q 37000F THE U180R CODE.FOR hiE PERFDRMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY MfORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jCIIRRIER C�C-�-�/�� q - - PL.AN W
� POLICYNUMBER������/aZ�C LECTRI ('OO
� (nassEcnor+r�IDra7sEoa.RErIDOFn�PEwarisfoaontetalra�000unasR�ro�oa�Ess� PLUMBING
Z I CERiIFV iHAT IN THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
('} SHALL NOT EMPLOY ANY PERSON IN PNY MANNER SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATIONUWSOFCALIFORNIA,ANDAGREETHA7IFISHOULDBECOME INSPECTIONFEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR /y¢�
CADE,1 SI/ALL FORTHWIhI COMP�V WI7H THOS PROVI510 . �SSUANC �vv
� SMIP
p DATE: APPLICANT: � . .
w ENERGY P/C T@ A Y�'T�
J WARHINO:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNUWFUL,AND SHALL BE
LL SU&IECTANEMPLOYERTOCRIMINALPENAL7IESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT -
DOLLARS(i100,000).IN ADDITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEHEST,AND ATTORNEYS FEES. RETENTION FEE:
Q
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �C I� 1 "7 iQQS�
Q I HEREBY AFFIRM UNDER PENAL7Y OF PERIURV iHAT THERE IS A CONS7RUCTION LENDING AGENCY �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.),
w ('�.�'v nF DI�Tv�ONDA BAr�R�
� LENDER'S NAME �U���,7 A�St1I'L 1 A
F— LENDER'SADDRESS
W ICERTIFYTHATIHAVEREADTHISAPPLICA710NANDSTATETHAT7HEABOVEINFORMATqNISCARREC7. TOTAL FEES � ^ l O�
� I AGREE TO COMPLV N7TH ALL CITV M1D COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING �
CONSTRUCTION,AND HEREBV AUTViOR12E REPRESENTA71VE5 OF THIS COUN7Y 70 EMER UPON THE
ZABOVE-MEHTIONED PROPERTV FOR INSPECTION GUR70SES. COMMENTS
� i//`7!�\ �' �.�/�/�
m PERMITT E�E(� ^ �
� � /� �'- �'��
� SIONATURE OF PERMITTEE DA7E
� RECPT.NO. PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanCs Copy
CI�'V OF DIA�NdO�1D B�►R ,
6�t9��fE�T10&�l �tECO�'iD �
F , . , s
,�°":+� �� u ' } � ..�. ,� .�`� $� o � e �.. s �. � � a ..� m .
.� »,u�
SET BACK , ,'. ' + • .. . , •... . FLOOR aQIST,,� ...., .' _ - .
.,•� �_:,, �'���
FTGS/FORMS/STEEL � � FHA REQMTS
ELECTRIC GROUND ' �`�� ` � ' UNDER F,k�p R pUCT .;.,., .,:. ' �
.,:
GROUND PLUMBING UNDER FLOOR CU�IDUIT •...�.�r.; . •...
SLAB GRADE FIREPLACE FOUNDQTION .. ""'`''-"'�'"''` ' "' `
TEMP P�WER FIREPLACE B fJD B�AM ��.'� � � � �
WATER SERVICE MID HT. BOND B�RM �- '�""'�'``W���."'� "� �'
ROO�SHEATkIN�G:. ; `�� �.. � . 8 FT. BONR..BEAM .. . _ . .
,.. .;.
FRAMING/VENTILIATION FINAL BOND BEAM ' " •
� i
ROOF COVER PRE-GRADING {
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBING FINISH GRADING «� �
SHOWER/TUB TEST POOL ELECTRlC f
EXT. LATH/SIDING POOL FENCING �
WALL INSULATION POOL FINAL .;��;:,
CEILING INSULATION OFF SITE IMPS. � '
DRYN/ALL NAI�ING DEDICATIONS � �
SEWER FWAL ENG. '
SEPTIC TAfVK LANDSCAPE/IRRIG. �
SEEP PIT/l..L. ON SITE IMPS.
GAS AIR TEST � - FINAL ZONiNG
FINAL CO`NST. � � '�. . ' ` M � _ FIRE DEPT. FINAL ,.:..:
FINAL HEATING HEALTH DEPT. FINAL
FI�A�ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY •
d O "�.�:'� ..w�1."+i�:5aV4.[. . ..�1 •�
COiVliViEfVTS
h
i . _ ,� ,:1_.,;',t: .. �� :'�..._
' � +`'~ 1.,.��
- ;{_t��.�f.1''':{i - . � .
SEPTIC TANK SIZE ,
SEEP PIT/U SIZE '.�,�"c�<' ? ; 1:;
" � J�'� �� �� �--; � . � � � �
d y �. '3�y^�3., *� 1.�;.
i4� '�F`k 1�� �`S�, � 'T �� ,"Y, . .. ..... . ' .
R�� 2 F �'y � �
w i :�. - . .
z� �'F � ~ � � '
"� L�' �
ky�i ik
}5 . �� t
'!s
��b � �� 'i'� �'� }, w
# .�.y �f•... ��. _ . � ' . ..., '
��3 �� c�^r� � ,� �' kr �. � �
��� �4 ���y ¢.� .� � ' . f.. ' • � ... ._�.... . . -' ... •• � ` �
�� �1
1
i