HomeMy WebLinkAbout13706 (1082) ;r
-=��• � CITY OF DIAMOND BAR �
COMMUNITY DEVELOPMENT DEPARTMENT �
, .,,.� . 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-31I7
'""' BUILDING PERMIT APPLICATION FIRMLY
y JOBSITE L�•�� V I�S �fA vf'- DATEICATION NUMBE #'C
o ADDRESS r
c� ISSUE TYPE OCC
APN LOT �s TRACT DATE CONST. GROUP
p OWNER �-
ADDR�ESS � 4F ZONING SETBACKS
Z CITY J�'l9'71Yf��– ZIP92&? TEL. FRONT RW ❑
g APP�ICANT TEL. REAR p
� SIDElSIDE STREET RW ❑
� CONTRACTOR Vd' �.s' '/�' __^__ SIDE ❑
o ADDRESS
CITY M�N?T"�'��M� ZIP fI• TEL. � - (r PROPOSED USE
/
o ARCH/ENG/
z DESIGNER NO.DWEL. � NO. NO.
a ADDRESS UNITS STORIES Z BEDROOMS��
� CITY ZIP TEL.
�
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BI:iLDER DECLARATION SFR/ADD/REM
O
p 1 HEREBY AFFIRM UNDER PENqLTY OF PERJURY THAT I AM EXEMPT FROM THE CONTMCTORS ll- G81'egB/C81p011
LI,J CENSEIAWFOflT11EFOLLOWINOFEA50N(SEG.7031.68USINESSANDPROFESSIONSO�DE:ANYCINOR (f�
V CWNTYWMICHREWIRESAPEflMITTOCONSTHUCT,ALTERIMPROYE,DEMO11511.ORREPNRANY5TRUG W
Z NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICAN7 FOR SUCH PERMIT TO FlLE A SIGNED PatldDack
W STATEMENT TIiA7 NE OR SHE IS IICENSED PURSUANT TO TME PpOVI510N5 OF TNE COMTMCTOR5 LI- W
� CENSE UW(CHAPTER 9(COAAAAENCINO NATH SECTqN)D00)�F�IVISION 3 OF THE B1151NES5 AND�RO. LL' POO�SpB
GESSIONSCODE�ORTHATHEORSHEISE%EMPTTHEREFROMMIDTHEBASISFORTHEALLEOEDEXEMP� (�
� TION.ANYVIOLATKINOF6ECTION7IXlI.SBYANYAPPUCANTFOflAPEHMIT6UBJECTSTHEMP4CANTTO Z Re•Root
F A CIVIL PENALN OF NOT MORE THAN FIYE HUNDRED OOLLARS(65oa�,):
� ❑I.ASOWNEROFTMEPROPERTY,ORMYEMPLOYEESWITlIWACiE5R5TNEIR50LECOMPENSATpN, �0 COTRIBfC18I
WILL 00 THE WORK,AND THE 97RUC7URE IS NOT IN7EN�E0 OF OGFEFED PoN BALE(6EG.7DN,BU51� J
� NE55 AND VROFESSIONS CADE:THE CONTRAC70R5 LICENSE UW OOES NO7 APPLY 70 AN OWNER OF j
YROPERTV YhlO BU0.DS OR IMPROVES THEREON,ANU WHO OOES SUCH WORK HINSEIF OR HERSE�F OR
Q TFiROUGHMI50fiHENOWNEMPLAYEES,PROViDE�THAiSUqi1MPROVEMEM5APENOTWTENOEDOR m
QOFFEREDFORSALEIf,FIOWEVER,THEBUILDINGORIMPROVEMEN7165dDW1TwNONEYEAROFC0IARE-
z TION,THE OWNER-BUILDER WILL HAVE TME BVROEN OF PROVINO THAT ME OH SHE�ID NDT BINID OR
� IMPROVE FOF THE PURPOSE OF SALE).
W ❑I,ASONMEf10FTHEPROPERTY,AMEXCLUSNELVCONTRACTINOWITNUCENSEOCANTMCTORS
� TO CONSTflUCT THE PROUECT(SEC.70sq,BU91NE55 AND FROFESSIONS CODE:THE CONTMCTOflS U- V8W8�Ip1 AQI.AREA
W GENSEIAWDOESNOTAPPLYTOANOWNEROFAPflOPERTYNMOBUILDSORIMPROVESTMEREON,MO
F WHOCANTMCTBFORSUCHPRO.lECTSWITHACONrMCTOR(S�LfCENSE�PURSUANfTOTFiECONTMC- QUANTTY DESCRIPTION FEE
Y TORSLICENSELAW.).
� ❑I/JA E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON a
3 U
ODATE OWNER U
� LICENSED CONTFACTORS DECLARATION W
� IHEREBYAFFIRMUNDERiENALTVOFPERtt1AYTNATIAAILICENSEDUNDEHPROVI510NSOFCHA7iER �
d 0(COMMENCING WRH SECTION 7000)OF OIVISION 30F i11E BUSINE55 AND PROFESSIONS CAOE,�ND Z
�C YY LICENSE IS IN FULL FDRCE AND EFFECT. m
�J� q�/ �
`� LICENSE SS �� ^�' UC.NO. r S C
V OATE L Z _ COMrRACTOR �
� WORKERS'COMPENSATIONDECLARATION � Q L� �'— 2�S r
� IHEREBY FIRMUNOERPENALTYOFPERJURYONEOF7HEFOLLOWINGDECUMTqN& Z .� /�,fJ� .I? i_[�� �G
L ✓ /�7 [fY I
� IHAVEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _
COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE.FOR TFIE PERFORMANCE W
Q OFTriEWOflKfORWHICHTHISPERMIT1915SUE�. � p O � �
i
� _IHAYEANDWILLMAN7AINWORKERS'COMPENSATIONINSURANCE,ASREIXIIREDBYSEC710N
Q 87000FTHEI.ABORCODE,FORiHEPERFORMANCEOFTHEWORKFORWHICHTN45PEAMITIS
ISSUEU.MY WOi1K C PENSATION I 'URANC ARRIEA AND POLICY NUM6ER ARE: �CONSTRUCTION
} CARRIER � "� � ,�Nr• PLAN REVIEW
ZVOLICYNUMBER � � ..�:.��� ELECTRIC
d
� (TFI6SECfqNNE�NOTBE00A1REfEDOFhEVERhMTISFORONE/1UnDRE00ttlAJiSISI�MORLES31 � 1
W � lZ I CERTIFYTNAT IN THE PERFOPMANCE OF 7HE NlORK FOR WHICM h115 PERMIT IS ISSUED,1 MECFIANICAL
C� SHIILLNOTEMPLOYANYPERSONPIANYMANNERSOAST08ECOMESU&IECTTOTHE 7 v
Uj NpRKERS'COMPENSATIONLAWSOf IFORNIAANOACREE7/UTIF16HOULDBECOME
SUBJEC7TOTH WORKERS'COMPEN IONPROVISIONSOFSECTION37000FTHEUBOR
� CODE. SHALL RTHWITHCOMPLYWIT SEPROVIS 5. ISSUANCE �
�
p OATE: �APPLICANT: SMIP
� ENERGY P!C
WARNIN6:FA RE TO SECURE WORKENS'COMPENSATION OOVERAGE IS UNLAWFUL.AND SHALL 6E
� SUBJECTANEMVLOYERTOCRIMINALPENNLTIESANDCIVILFINESl1PTOONEHUNOREDTNOUSAND ENERGYPERMIT
}, DOIURS(5700,0OO�,INADOITIONTOTNECOS70FCOM7ENSA710N,DAAIAGESASPROVIDEDWRIN
J BECTqN 3708 OF THE LABOR CODE.MTEREST,ANDATTORNEI^S FEES. RETENTION FEE:
�
� CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
� 1 NEREBV AFFIRM UNDER PENALTV OF VERIURV THAT THERE IS A CONSTRUCTION LEN�INO AfiENCY
FOR THE PERFORNANCE OFTNE WORK PoR WHICH THIS PERMIT IS ISSUED(SEC.9071,CIV.C.).
Z
W
� LENDER'S NAME
F- LENDER'SADDRE55
w ICERTIFYTFi11TIHAVEHEPDTHISAPPLICA7IONANDSiATETM�TiHEABOYEINFORMATIONISCORRECL TOTAL FEES �/
� 1�GREE TO ODA7PLV WITH ALL CITY AND COUNTI'ORDINNlCES AND BTATE UWS RELATINO TO BUILpING
� CONSTRUCTION,ANDHEqEBYAUhqRIZEREPRESENTATIYESOFTHISGOUNTYTOENTERUPONTHE
PBOYE�M IIXJEO PROPERTY FOR INSPECTION PURPOSES.
C C��
COMMENTS
m ��F'�
Q PE E IP 1 l] �/ � �^
cn YL..��--�— FI
Vj SIaN�TU�OF P Tf �ATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessar Capy,GOL�ENROD—File Gopy,GREEN—AppllranYs Copy
- - _._ .. ..�_--- �---"�--"
CITY OF DIAMOiVD BAR
INSPECTItJf�! RECORD
- a o � • s - � o e �. � .
SET SACK � FLOOR JOIST
FTGS/FORMSlSTEEL FHA REQMTS '
ELECTRIC GROUND UNOER FLOOR DUCT
GFtOUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIAEPLACE FOUNDATION �
TEMP P�WER FIREPLACE BOND BEAM- � �
WATER SERVICE -� - MID H7.,B�NQ BEAM � �
ROOF SHEATHING � � 8 FT. BOND BEAM
FRAMINGNENTILIATIOIV FINAI:BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
RC)UGN ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TU8 TEST PODL ELECTRIC
EXT.LATH/SIDING POOI:FENCING
� WALL INSULATION � POOL FINA�
CEILING INSULATION OFF S�TE IMPS.
DRYWALL NAILING DEpICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSGAPFJIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � ) ; FIRE DEPT. FINAL
FINAL HEATING /f o 4 f HEALTH DEPT. FINAL i
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING I ENERGY
,
� . . . . .
---- - a � — _
CDA�lMBI�T�'.� � � � � ' .
„�t ,
��
� .
� . : ... , • � � `,
SEPTIC TANK SIZE
SEEP PIT/U S1ZE
� i
+. .