HomeMy WebLinkAbout16051 (1110) _�� 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
� JOBSITE 9 v �, 7/1 APPLICATION i /� /-� PERMIT ��(� P/C
o ADDRESS �� DATE L v,�_ NUMBER � \ #
$ ISSUE �S TYPE OCC
APN LOT TRACT DATE U CONST. GROUP
p OWNER -SA�� ��
ADDRESS ZONING SEfBACKS
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� ADDRESS C L� � �� PROPOSED USE � f N /.� �
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� DESIGNER NO.DWEL. . NO.
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u� DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLAAATION SFR/ADD/REM
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p I HER�V AFFlRM UNUER PENALTV OF PERJURY THA7 I AM EXEMPT FROM 7HE CONTAACTORS LI- QgfBge/C9fpOff
LlJ CENSELAWFORTHEFOLLOWRI0REA90N(SEC.703t.68USINESSANDPROFESSIONSCODEMIYCITVOR (n
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�?� TURE,PiWR TO R8 ISSUANCE,ALSO REW IRES T1iE APPLICANT FOR SUCH PERMIT TO FILE A 51(3NED w PefiO/DBCk
STA7DAEM 7HAT HE OR SHE IS 110EN5E0 PURSUANT TO THE PROVISIONS OF THE CONTMC70R3 LI-
� CENSE UW(G/APTER Y(COMMENCUiO WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO- LL' POOUSPB
FE&SIONSCOO�OHTHATHEORSHEISIXEMP7THEREFROMANOTHEBASISf-0RTHEALLEOEDEXEMP- (� �) "
� TION.ANY VqLAT10N OF SECTION 7031.6 BV AHV APVLICANT FOR A PEPMIT SUBJECTS THE APPLIGN7 T0 Z Re-Roof L/
� A CIVIL VENALTV OF NO7 MORE THAN FNE HUNDRm DOLURS({6001.):
� ❑I,ASOWNEROFhIEPROPERTY,ORMVEM7LOVEESWIhIWAOE5A5THEIRSOLECOMPENSATION, 0 CORImBfClel -
WILL 00 THE WORI(M1D THE S7RUCNRE IS NO7 IN7ENDED OR OFFERED F-0R SALE(SEC.70N,BU51- J
N NESS AND GROFESSIOiJS CODE THE COHTRACTORS LICENSE UW DOES NOT MPLV TO M!OWNER OF �
PROPEATY YHiO BU0.DS OR IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� h1ROUGH HIS OR HER OWN EMPLOVEE3,PROVIDED h1AT SUCIi WPROVEMENTS ME NOT INTENDED OR m '
OFFHim FOR SALE IF HOWtI�ER 71�E BUdDINO OR IMPROVEMEM IS SOLD N7TlAN ONE YEAR OF COMPLE-
Z �'TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT FIE OR SFIE DIO NOT BUILD OR
� WPROVE FOR THE PURP0.5E OF SAL�. �
❑1,AS OWNER OF THE PHOPEHTV,AM IXCLUSIVELY CONTRAC7INO WfTH LICENSED CONTMCTORS
� TO CONS7(1UCT THE PRO.IECT(SEC.7oH,BUSINESS AND PROFESSIONS COOE THE CONTRAC70R5 U- Veluefl0ll ADJ.AREA
� � CENSEUWDOESNO7MPLY70ANOWNEHOFAPROPER7YYh10BUILO50R1A1VROVESTHEREON,AND
M7fOCOMMCTSFORSUp1PROJECTSWITiACONTMCTOR(S)LICENSEDWRSUMlTTOTMECONiHAG pUANTITY DESCRIPTION �E .
� TORS UCENSE LAWJ. '
O I AM IXEIAPT UlIDER SEC. B.i P.C.FOR TMIS REASON �
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DA7E OWNER �
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F LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTY OF PERtt1RY 7TUT I AM LICENSED UNDER PpOVISIONS OF CHAPTER �
� G(001AMENCWO NATH SECTION 7000)OF DIVISION 3 OF iHE BUSINE55 AND PROFESSIONS CODE,ANO Z
YC, MY LICENSE IS IN FULL FORCE AND EFFECT.
`� UCENSE CV.SS G LIC.NO. �� ( 7� � C/ �
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� WORKERS'COMPENSATION DECLARATION -
� I HER�YAFFlRM UNDEH VENALTV OF PERIUfiY ONE OF THE FOLLOW WO DECLARATIONS: Z
� _I HAVE AND WILL AWNTAW A CERTIFlCATE Of CONSENTTO SELF�INSURE FOR WORKEFS' a
2
CO/�PFNSATION,AS PROVIDED BV SECTION 37aa OF THE LABOfi CODE,FOR THE PERFORMANCE U
O OF 7TIE WOPoC FOR WHIp17HI5 PERMIT IS ISSUED. � �-' .
_1 HAVE MID WILL MAINTNN WOPo(ERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 370o OF THE UBOR COOE,FOR TNE VERFORMANCE OF THE WORK FOR YhIICH 7HI5 PERA/1T IS I A{U �' .
ISSUED.AIY W�DRI(EAS'COMPENSATION INSURANCf CARRIER AND POLICV NUMBER ARE: CONSTRUCTION V������ 2 �: 2001 �
jCARRIER � • (Yt - PLAN REVIEW ����T-�� nq � .
0 �CII'_
Z ��Y��ER ELECTRIC TlT rr rn� •n�r�n♦ ��r•ar �
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� (ncssEcna+r+�rareeoo�r�aFn�aew�rrsFoaa��naeo � ao�a �ss} PLUMBING
Z 1 CER7IFV TUT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFiM1T IS ISSUEO.I MECHANICAL
C3 SHALL NOT EMPLOY ANY PERSON M ANY MMlNER SO AS TO BECAME SU&IECT TO THE
(n WOPo(ERS COMPENSATqN UWS OF C�LIFOPNIA,AND AGREE TMAT IF I S/IOULD BECOME INSPECTION FEE
S &VBJECTTOTHEWORKERS'COMVENSATIONPROVISIONSOFSECTION37000FTHEUBOR
cooe sw�u Fo n�coMp�v Nnni nase pqohsarrs. ISSUANCE
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p DATE: � D 1 APPLICANT. ��7 �L �SMIP
w ENERGY P/C
� WARNINO:FAILURE TO SEWHE VARKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
� SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CM�FMES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(5100.000),BI�DD1710N TO THE COST Of COMPENSATION,DAMA(3ES/�S PPOVIDED FOR IN
� SECTqN 370E OF T1E LABOR CODE,INTEREST.AND ATfOqNEv'S FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBYAFFIRM UNDER PEN/�LTY OF PERIURV THAT THERE IS A CON57AUCTION LENDIN(3 AOENCV �
Z FOR THE PERFORAIANCE OF THE WOFlK FOR WHICH TMIS PERMIT IS ISSUED(SEC.7061,CIV.C.�.
W .
� LENDERS NAME , , � .
H LENDER'SADORESS
� I CERTIFV THAT 1 HAVE RF1D hIIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORAECT. TOTAL FE ES � � 'I � ���
w I A6REE TO COMGLV WITH�LL.l CRV AND CAUNTY ORDW/�NCES AND S7A7E IAWS RELATINO 70 BU0.DIN0 . �'
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� CONSTRUCTION,AND MEREBV AUTHO(iIZE REPPESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' '
Z ABOVE-MEMIONED PROPEHTV FOA INSPECTION PURP0.5E5. COMMENTS � ' '
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m 7ERMIITEE NAME(P � '
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� RECPT.NO. . PAID BY � VALIDATION
WHITE-0epertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Applicant's Copy
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INS�EC�'It�� RE�t3R¢� � - __
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SET BACK � FLOOR JOIST
FTGS/FORMS/STEEL - ' � FHA REC�MTS
ELECTRIC GROUND . , UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FlREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHiNG I��-d� 8 FT. BOND BEAM
FRAMINGNENTILiATION FINAL BOND BEAM
ROOF COVER Z-02-a( PRE-GRADING
RdUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUM1/IBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/51DING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAIUNG DEDICATIONS ~'
SEWER FINAL ENG. �� ��
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP P1T/LL. ' ON SITE lMPS.
GAS AIR TEST F1NAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEAL7H DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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