HomeMy WebLinkAbout11516 ~ � '�..:- . � ��:-� -- - ------: ---- --- � -,. - -- -
---��-- CITY OF DIAMOND BAR , � - •-
COMMUNITY DEVELOPMENT DEPARTMENT ' '"' �
'�-:,.� 21b60 E.Copley Drive Suite 190 , PRESS
(909)860-3195 Faz(909)861-3117 •
�'"" BUILDING PERMIT APPLICATION FI R M LY
� 'JOBSITE':' /J//L2 ( � �.. ��y'����/ DATEICATION � Z. ' •'�!� NUMB R I f✓ '.� M�' � n'I�'
. y
: o ADDRESS � �1✓ V��T-G/V �
� APN T TRp�T ' ' ISSUE TYPE OCC �
�•�� DATE y CONST. GROUP
p OWNER �
p ADDRESS � G �� ZONING SETBACKS
Z CIT1O 2IP EL •d�(OD' FRONT - RW ❑
g APPLICANT ' TE . REAR ❑
� , •.SIDE/SIDESTREET` �• ' RW O
� CONTRACTaR � - —,�-f -SIDE � p
� AODRESS •�� !
� CITY ZIP TEL 4 � PROPOSED USE
w ARCH/ENG/ • � ^ �, _
z DESIGNER' �b�N� . NO.DWEL .
.d ADDRESS UNITS " � '�STORIES�`� �� � �` 8 DROOMS
� CITY ZIP TEL. ' , �+ 1
�
cn DESCRIPTION ' S0.FT. FACTOR PSF ADJ.AREM/ALUATION
p� __ OWNER-BCILDER DECLARATION_ . . SFR/ADDlREM'
� O a
p. _ I MEREBY AFFIRM UNDEH PENALN OF PERIVRY THAT I N.1 EXEMPT FROA1 THE CON7MCTOFlS Lb G3t8g@/C8fp0A'S ��� � � , �� � �
W CENSEUWFORTFIEFq.LOWWOPEA50N�3EC.7WI.SBU41NE34ANDPROFESSiONgCOOE:ANYGTYOR '
U COUNi7WHIp1fiEW�HESAPERMITTOCONSTRUCi,AITERMPROVE.DEMOLISH,OHREPAIHANYSTRUC• . .. ,
�� Z TURE,PRIOR TO RS ISSUIWCE,/0.50 REOUIRES THE�PFLICANT FOR SUCH GERMIT TO FllE A SIGNE� W PatldOeck':�� �' ' �'���. � � ;
W STATEMEM THAY HE OR SHE IS LICENSED PURSUANT N iME PROVISIONS OF TME CONiMCTORS LI• w
� � CENSE LAW(CHAPTER i f��ENCW6 WITH SECTION 7000)OFpIVI510N]Of iHE BUSINE35 AND PRO- u' POOVSpB
FESSqNSCODE)ORTFIATHEORSHEISE7fEMPTh1EREFHOMIWO7HE8A515FORTHEALlE6EDE%EA1P� (�
VTION.ANVVIOLATIONOFSECTION7oJ1.SBYANYAPPUCANTFOqAPERMITSUBJECf37HEMPUCANTTO Z Re-Roat .
AGVIL PENILLTY OF NOT MORETHAN FNE HUNOREO OOLURS(f5D0).r " '
Z ❑I,ASOWNEROFTHEPROPERT`/,ORMYEMROYEESWI7HWAOESASTHEIRSOLECOMPENSAT�ON,' � �mmercial , � .
WILL DO TNE WORK,ANO iHE STRUCTURE IS NOT INTENDED OR OFFEREO FOq SALE(SEG 7?tr,BU51• J �
� NESS AND VROFESSIONS CODE:THE CONTRACTOHS 110ENSE UW DOES N0T APPLY TO i1N OWNER OF ? _ _
PROPERTY WHO BUILDS OR IMvqOVES TMEREON,AND WHO DOES SUd1 WORN HINSELF OR NERSEIF OR �
� TMROUGHNISORHEROWNEMVLOVEES,GROVIDEOTHAt5Up/1MPti0YEMEMSARENOTMENDEDOiI m
QOFFEREDFORSALEIF,IIOWEYER7MEBULqNGOflIMPROVEMENTIS" 1WITMINON[YEAROFCOMPLE• � `
Z TION,THE OWNER�UILDER MALL 17AVE THE BURDEN OF PROViN6 TF1�T HE Oq SME DIU NOT BUIID O(i „ _ ,
� IMPROVEFOHTHEWRVOSEOFSALE�. ,
O I.AS OWNEH OF THE PimPERTY,AM E%CLUSNELY COMRACTW6 WITH UCENSED CONTMCTOqS
� TO CANSTRUCT THE PRQIECT(SE0.70q.BUSINESS AND PROFESSIONS COOE:TME CONfMCTORS LI• V01Ueti0ll d ADJ.AREA � � � "
W CENSELAWOOESNOTAPPLYTOMIOWNEROFAVfiOPERTYM'FIOBUILDSORIMPROVESTHEREON.AND
� NAqCONTMCfSiORSUCNDRQIECTSWITHACONTMCTOR(5)LICENSEOPURSUJWTTOTHECONTMG ' QUANTITY DESCRIPTION �� - �E
� TORS UCENSE LAW.). . . . . ) .. .
� O I AM EXEMPT UNDER SEC. B.8 P.G FOR THIS REASON � � I'IJ ,�
LL' DATE OWNER � ' •� � JWIr�'�'1 ^ ... . �
Z � W �/��J I '. . . . .'! , I
'._ F LICENSED CONTRACTORS DECLARATION ' � W
� IMEREBVAFFlRMUNDERPENAITYOFPERtt1RYTMAT1AMlICENSEDUNDER7ROVI510N50FCHAPTEfl
" � Y(COMMENCINO WffH SECTION 7000)OF DNISION 70F TME 9USINESSAND PROFESSIONS CODE,AND � Z ' e. 1 � '
�X' IdY LICENSE IS W FULL FOFCEAND EFFECT. � m
LLI � �
� LICENSE lA S LIC.NO. � � r .
V DATE� CONTRACTOR ����LL�� � d .
W . :' � . � .i� J _'
� WORKERS'COMPENSATION DECLARATION Q � � �� ��
� 1 HER[BV AFFIRM UNOER PENALTV OF PERNRY ONEOF THE FOLLOWING DECLARATIONS: ; Z
� _INAVEANDWILLMAINTAINACERDFICATEOFCONSENTTOSELFdNSUiIEfORWORKEHS' 2 - "
CqAPENSATION.ASDROVi0EU8VSEC710N770oOFTHELAPORCOOE.fORTHEPERFORAIANCE w
_ Q OF7HEWORKFORWHICHTHISiERMITISISSUED. ; �
OW IHAVEAN�WILLIAA�NTAINWORKERS'CAMPENS�ITIONINSURANCE,ASPEWIREDBYSECTION
70o OF THE LA90R CODE.FOR THE PERFORMANCE Of THE WOfiN iOR NMICM iH15 DEMIIT IS �j c
J ISSUED.MVWOHK 5'COMPENSATIONINSURlWCECMRIERANDPOLICYMIMBERARE: CONSTRUCTION �/ D. /O
j GRRIER_`=��� ��n - PLAN REVIEW Z 3 D.'Z'7 A�
Z roucvHurnoEa �.��.Z` ELECTRIC 7- � N 0
¢
. � (nassEci�oMNEEnNOTOEoobaEtEDOF7tEVEw�ftlSFbaONEHIf�Di7EODJtluiSgtmlMtESS1 PLUMBING S .��j
Z �CERTIFV THAT IN 7HE PERFOPMIWCE OF iHE WONC FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL �_"�O
(;} SMALL NOT EMPLOYANY GERSON W ANY MANNER 50�5 TO BECAME SU&IECT 70TME
� WORKERS'COMPENSATION UWS OF CALIFORN10.µD AGREE THAT IF 1 SMOULD BECOME INSPECTION FEE '
S SUBJECTiOTME1MDRKERS'COMPENSATIONPfiOVI510NSOF6ELT10N97000FTHEU�EOR
E,I S ALL FORTHWI7H COIAPLV MATH sE PAohsioras. / ISSUANCE O�O�
� �( `�- ��� SMIP. . . _ .. . _
p DAT . �y � APPIICANT. Q
� ENERGY P/C �•��I
WI.RNINO:FA4UFE TO SEIXIRE WORKERS GqAP O SHALL BE '
LL Sl1BJECTANEMPLOVERTOCRIMINALPENALTIES CMLFWESUP700NEINNOREDiHOUSAND ]7 ��
DOLURS�f100.D00�MADDITIONTOTHECOSTOFCOAIVENSATqN,DAMACESA50ROVIDEOFORIN ENERGYPERMIT �
¢ SECTpN 770e OFTME UBOR CODE,NTEREST,AND ATfORNEY'S FEES. RETENTION FEE: � � ' y•�`7
oCONSTRUCTION LENDING AGENCY PRE•ALT FEE: 2c�_�� �� �
� 1 HEREBYA�FIRM UNDEP PENALiY OF PEiWRY iHAT THERE IS A CONSiRUCTION LENDiNG AGENCY J
FOR iME PERFOFMANCE OF TME WORK iOR WHlpl THIS VERMIT IS ISSUED�SEC.ioY7,CIV.C.�. �
-� Z
w
� LENDER'SNAME '✓� `, �
-H� �LENDERSADDRE55 " �
W ICERTIFYTHATIHAVEREAUTHISAPVLIC�710NANDST�TETUTTHEABOVEINFORMATIONISCORRECf. TOTALFEES '� ',�! " ��9..Z� '
�. ,IAGREETOCOMPLYWITHALLCITVANOCOUNiVORDINANCESANOSTATEUWSREUTINGTOBU4DINC � ' - �
� CONSTRt1CTION,ANOHERE8VAt1THORREHEPPESENTATIVE50FiMI5COUMYTOEMERUPONTHE � ' ' � '
Z A MENTIDNEDOROPERiYFORIN57ECTIONPURGOSES. � , , ,
COMMENTS i
� ��� �����+�� � 2�`L/ ' .
¢ P RMI E(V 7 - , . � t•_'.• �/' /_ 7� - . . . L 1 ; � ' . �
� � T ���i ��_-�•�
� 5 NATUREOFPERMITIEE � „ .�ATE .. , ,
� RECPT.N0. PAID BY ��''VAIIDATION
`1 � WHITE—Department Copy,•YELLOW—Finance Copy,PINK—Assessor Cop'r,GOLDENROD--Ftle Copy,GREEN—Appllwnt's Capy� � , � _ ,
,` . . . . _ . ... . �.. _. .. �.. � _. .. ..,.., . . _. .t�. ._ . ,. . . ,.. .., . .
, � �—
; _ �, CITY.OF,DIAMOND BAR ; ;;. ' ' ;� � �,.
. , :_� � , . , . . � ' ' � -
�� � � � INSPECTION RECORD ' � . . . . '
., , . . . �,. � ,, . . .
. � � . • � - � � , . � .
SET BACK ' - '� , _,�, _� FLOOR JOIST - � --- - - ' ' �
FTGS/FORMS/STEEL= S-�'-�Y' _ `�' �.�l3� � FHA REGIMTS '-,-";-��;�,,;_� : ;',:' - ' ..:
ELECTRIC GROUND � �'� UNDER FLOOR DUCT: � ,-__.. ,�.�� . ~, � i.�.,� ,• � ,
GROUND PLUMBING UN�ER FCOOR COf�IDUIT� •', ' , -� • .-:+ ` :�' :r".�f� ' i �'
SLAB GRADE - ` S-�'Y �iiv,'.%?�� FIREPLACE FOUNDATION "� ' ' ' � ' " � .
TEMP POWER , - FIREPLACE BOND.BEAM `; ' ' ''- '' ' � _ • '
WATER SERVICE� • '' '�. -��r • .; ` �•'`!'.. ., � MID HTi BOND$EAM -, � '^ ," , ,
ROOF SHEATHING �Sr /Irh� ' 8 FT.BOND BEAM
FRAMINGNENTILIATION - �tr�t,� FINAL'BOND BEAM ` '`"' `
ROOF COVER - - PRE-GRADING - - � ��
ROUGH HEATING ' - ���f1 . BENCHING "
ROUGH ELECTRIC �,/ fl ROUGH GRADING , �
ROUGH PLUMBING -/- �'' FINISH GRADING � ' ' ,
SHOWER/TUB TEST POOL ELECTRIC -
EXT.LATH/SIDING POOL FENCING • ' �
WALL INSULATION POOL FINAL ,
CEILING INSULATION ' OFF SITE IMPS..
DRYWALL NAILING. . , , DEDICATIONS -
SEWER- -- -- -- --- - - '- - - -�-. . _ - � - FINAL ENG. ,
SEPTICTANK - -- "-- -. __._. '�,' _' LANDSCAPE/IRRIG. ' -� �
SEEP PIT/L.L - - ON SITE IlvIPS.
GASAIR� EST -- -- - - '"' � '" - „ FINALZONING '
FINAL CONST. - - - - - -- -�� -- FIRE DEPT.FINAL -
�FINAL HEATING HEALTH DEPT.FINAL .�, ;--_ - -
FINAL LECTRIC � , _�� � DEV. FEES PAID .
FINAL PLUMBING ` ENERGY ��
lr �=� �: �c;-` 1 • < ; , .
.: .._
� , c � • _ v -� . �
. .
�, � . ... _ , .. _._
.2 � �_�y..�:�� .,�.a.L� i1 --;. .. . .... _ .,r•
- - . ...__.....__....�. , .,
C(OMMENTS �'`� `
_ .� , , .
-
.
- --._._....._ - - - . ,,,.
. ,,
- , - . , , ,
-- � ---�-. _.. .._..- -- - - - ... .. - - --._ _ . _ _ , , .. . _ ,. , ,. , , _ , ,
, t� t... t�: r' .
- - • - - , , �.i.�� . /�
"�� �, � .�
- - - - 1� �::�. :�ti ., �_, . . _ ���i, .�`� �.�; t�_;�.-
.
` 'l ,
��,. t�
_ - ', -, ,.�, _i,._,,
. �z . �� _ � , . , . ,
J r�'�` _. ._ . . - - ' ' , , � ' ; . . . .
..r• .. � _ _ . . �` . . , .)l��-� '�Z.'f'��j �� �,�' ��,+ .
,_� �,`1,,� _ .\ a i. � 1i� ``�
�' �\ \, . . , . - . �_ . . � , . �
SEPTIGJANK SI � � '_�' , ;7 , . .
SEEP PIT/U SIZE � i .Y �.�.,� ,..:. , . .
, � - ,i�.. '.�,_-.; -. _�.__ ' ' _ . ' ,
`+ �����:1
- -- �_- �- _ _ _ _ ��__. .i
. n- � £ _
.�< <- �._�_,r ,4/c:L. ��,__; ,-.1.=.9
� '�, `.' � J. ,_,,� �.�: ' _ n�� �i. �
';; :,- _ ,;� ,'ti� . �) ,
,... ,.c..._�.L . _ ✓ ... . _.
' _'"' _'_ __'.� _.. " _ "_ _"' ...."'' ".... T+•
� __ \ /
- -._ . .____ \1
._ � '�� � � � � � 216 60 •EAST COPLEY DRIVE.SIIITE 19 0
.,��' � � ( � 1 DIAMOND BAR, CA 91765-4177
� 909-860-3195.FAX 909-861-3117 '
. + � � -
�r�uxruK�t� � .
. • rs89_. . Job Address• � 7.2f Gr�4'aN T'�ef!!N Lti/
Dear Property Owner: . , � � �
An application 'for a building permit has been submitted in your name
stating yourself .as the builder of the property improvements specified. ••
For your protection, you should be aware that as "owner-builder" you are �. •
the. responsible party of record .on �such a pernit. . Building permits are not
required to be signed by property owners unless they are personally •
performing their �own work. If your.work. is being performed by someone other
than yourself, you may protect yourself fron possible liability if that �
person• applies for the proper� permit in his or her name. �
. '-Contractors are .required by law to. be licensed and bonded by the State
of California and to have a business license from the City or County. Thejr
are also required by law to put their license number on all permits for which
they apply.
: If you employ or otherwise engage any�persons other than your immediate
family, and the work (including material�s and other costs) is $200.00 or more
for the entire project , and such persons are not licensed as contractors or
subcontractors, then you may be an employer. -
� � If you are .an employer, you nust register with the state and federal
. go�ernment as an employer and you are subject to several obligations `
including.state and federal income �ax �withholding, federal social security
taxes, . workers compensation' insurance, disability insurance costs, and �
. unemployment compensation contributions. •
There nay be financial risks for you if you do not carry out these
obligations, and tliese risks are especially serious .with respect�to workers
compensation insurance. � . ' _ . •
For nore specific information about your obligations under the federal
law, contact the Internal Review •Service• (and if you wish, the U.S. Small �
Business Adninistration) . For nore specific information about your
obligations under State law, contact the Departnent of Benefit-Payments and
the Division of Indus�rial Accidents. •
' � If the structure is intended for �sale, property owners who are no�
licensed contractors are allowed to perform their work personally or through
their own enployees ' , without a ,licensed cvn�ractor or subcontractor," only
under limited conditions. . �
A frequent practice of unlicensed persons professing to be contractors
' is to secure an "o�aner-builder" building per;ait, erroneously implying that
the property .owner is providing his or her own labor and material personally. •
Building p�rmits are not required to be signed by property owners unless they
� .are. perforning their own work personally. . �
Infornation about. licensed contractors may be obtained by contacting the
. Contractor's State License Board in your co�nunity or at 1020 N. Street
Sacramento, California 95814 .
Please complete and return �the enclosed "Owner=builder" verification
form so that we can confirm that you are aware of these natters. � The
building permit will not be issued until the verification is returried.
CITY OF DIP.i•IOND BAR
� � s ����� . -
• ennis A. Tarango, C.�O. .
� Building Official � . . '
� ; r � , .
• ., . .._
. - . ' ' . .
�`"
-� CITY OF DIAMOND BAR -
OY�NER-BUILDER APPLICANT �
� � 4E A�.A.B.FSS:
. � ���_� ��;8,� 'T���,
. . � - ` T��� �i� �/�� c,� 9�?dS
Attention Property Otivner: ,
An 'otivner-bu i 1 der' �bu i !d i ng perm i t has been app 1 i ed � fior i n your � �
name and bearing your signature.
Please complete and return this infiornation at your earliest
opportunity to avoid unnecessary delay in processing and issuing
. � your building permit. No building pernit will be issued until this
� verification is received. • �
1 . I personally plan to provide the ma,jor- labor and materlals Tor
• construction of the proposed property improvement (yes or no) �
- ���_• ' . ' .
� 2. 1 (have/have nn�1 �v� signed an application fior a �
• buitding N�rm�t t�or the proposed work. .
. 3. 1 have contracted w i th the fio 1 1 olvi ng person tf i rm) �to prov i de �
' the proposed construction:
. Name ' Address ' City
. Phone ' Contractors License No.
4. I p 1 an to prov i de port i ons ofi the �vor.k. but. I have h i red the
. � following person to coordinate, supervise� a .provi�e the major
v�ork : _ . .
PJameM�'. X�USf�/a.L �,ddress City
Phone �'D9� .fs'�d--�d4t� ' Contractors L i cense No.
5. 1 tiv i I 1 prov i de some .ofi� t�e work bu� 1 h�ave contracted (h i red)
the fol lo���ing persons to provide the v�ork Jndicated:
i�Jame . Address
Phone Type ofi �'�ork
' 1fi�v sr�-L q�q�a �
. S i g n e d: rec� � �zi-�1 �
^t=.t,perty Otvner
Soci a l Secur ity �lumber_ .. ��7-� `�3 �' �'��
natP � ���3 � ' .