HomeMy WebLinkAbout16708 � I
�� CITY OF DIAMOND BAR � >��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 V�RESS
'��' BUYLDING PERMIT APPLICATIUN FIRMLY
o DDR�ESS�.��+i' I�� � � APPLICATION . 1 PERMIT i)�,u� #/C ,� i�
���I DATE NUMBER /�? I
� ^ ISSUE 91 TYPE OCC
APN LOT TRACT DATE « CONST.� GROUP
p OWNER W/LL�A'M�YA
�p ADDRESS Z.S���- (dl.A�iC� T�J`i7� L ZONING SEfBACKS
�w CITY ZIP TEL. REART RW ❑
APPLICANT G.�� �(n J�r� TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR IDIS1v� SIDE ❑
ADDRESS PROPOSED USE !�"'z s G� nI
� CITY - ZIP TEL. ,.---�_
w ARCH/ENG/ J � ,� L
� DESIGNER � . NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL. C
� �� � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
¢ OWNER-BUILD DEC TION SFR/ADD/REM
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0 I HEREBV AFFIRM UNDER PENPLTY OF PERIURV THAT I AM EXEMPT FROM THE CONTMCTORS LI- � Garage/Carport
W CENSE UW iORTHE FOILOWINO REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANY CITV OR
U COUHfVWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOUSH,ORREPAIRANYSTRUC- W Patio/Deck
� TURE.VRpR TO ITS ISSUANCE,AL50 REWIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF 7HE CON7RAC70R5 LI-
� CENSE UW(CHAVTER 8(COMMENCINO WITH SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
FESSpNS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
V TqN.ANY VIOUTION OF SECTION 7031.5 BV AHV APPUCANT fOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Root
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
❑I,ASONMEROF7HEPROPERTY,ORMYEMPLOVEESWI7HWAGESASTHEIRSOIECOMPENSA710N, � COrtIrtIBfCl81
MALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI- J
, � NESS AND PROFESSIONS COOE:THE COHTRACTORS UCENSE UW DOES NOT APPLY 70 AN OWNER OF � ��„yT �,r,� 1
PROPEHTY NM1iO BUILDS OR IMPROVES THEREON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR L �
' CC THiqUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m �y -7-�t+ �
Q ,OFFEREDFORSALEIF,HOWEVERTMEBUILDINOORIIAPROVEMEMISSOLDWITHINONEVEAfiOFCAMPIE- �7 C.U�
Z �TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NO7 BUILD OR -
� IMPROVE FOR iHE PURPOSE OF SALE).
w ❑I,/SOWNEROFiHEPROPEHfV,AMEXCLUSNELYCOMMCTINOWfTHLICENSEDCOHTRAC70R5
� TO CONSTRUCT TNE PR0.1EC7(SEC.704t,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- IU0I1011 ADJ.AREA
W CENSEUWDOESNOTMPLYTO/WOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
F NTIOCONTRACTSFORSUq1PRq1ECTSWI7HACONfRACTOR(S)UCENSEDPURSUANTTOTHECONTRAG DUANTITY DESCRIPTION FEE .
Y 70RS LJCENSE UW.).
� � ❑I AM EXEMpT UNDER SEC. B.8 P.Q FOR 7HIS REASON � LD,M' ' S'UN �
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Z DATE OWNER /,�i. y V y_{ ���, .� .
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� LICENSED CONTRACTORS DECLARATIO W �y 6pr�,��
� 1 HEREBY AFFIRAI UNDER PENALTY OF PERIURY 7HAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER Z Q V-f r-a �`1�,.,/' �
d Y(COMMENCINO WITH SECTION 7000)Of�IVISION 7 OF THE BUSINESS AND PROFESSIONS CODE,AND L/V K r i
X AIY LICENSE IS IN FUIL FORCE AND EFFEC7.
LLI � �� �.
0 LICENSE CLASS LIC.NO. � L �y� .S
V DATE CONTRACTOR a �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDEfi PENALTY OF 7ERIURY ONE OF THE FOILOWING DECURATIONS: U
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0 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIDED 8Y SEC710N 37000F THE LABOR CADE.FOR THE PERFORMANCE �U
OF THE WORN FOR MM111CH 7HI5 PEFtAIT IS ISSUED. �
�
w _I HAVE AND WILL AWNTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF 7HE LABOR CODE.FOR THE PERFORMMICE OF THE WOHK f-0R WHICH THIS PERMI715 �� �
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEfi ARE: CONSTRUCTION _ ��L/ � �
jc�RaieR PLAN REVIEW „ � �
z po��cY NUMBEa ELECTRIC
¢
� (nLLSSEcfnHNE�tA78E00h�LETEDOFnEPERMTSFOROPlE1x11�DtiFnDalARs(Stao)oat.Essl PLUMBING /�
Z I CERTIFV 7HA7 IN THE PERFOiiMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ' \
(} SH�LL HOT EMPIOV ANY PERSON IN M1V MANNER 50 AS TO BECAME SU&IECT TO THE ' �
� WORKERS'COMPENSATiON LAWS OF CN.IFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
SU&IECT TO THE WORKERS'COMVENSATION PROVISIONS OF SECTION 37000F 7HE LABOR !� , Q�
OCODE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE �� J �
p DATE: APPLICANT: ' SMIP �� I ��O ^
J WARNINO�FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C 0 , !�'
� SU&IECTMIEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �� �
DOLLARS(i100,0001.IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN -
J SEC710N 37oe OF THE LABOR CODE.INTE{iEST,AND ATfOHNEV'S FEES. � RETENTION FEE:
2
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONS7RUC710N IENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �
Z
W
� LENDER'S NAME
1— LENDER'SADDRESS r�
� I CEPTIFY 7HAT I HAVE REA�THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES ���r �I //� ' A�
w I AGREE TO CAMPLY WITH ALl CITV PND COUNTY ORDINANCES ANO STATE lAWS HEUTING TO BUILDING �" .i
� CONSTRUCTION,AND HEREBY AU7HORIZE REPRESENTA7IVE5 OF THIS COUN7V TO ENTER UPON THE ,
ZABOVE-MEN710NED PROPER7Y FOR INSPEC710N PURPOSES. COMMENTS - 1 D� •O�
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m PERMI7TEE NAME(PPINT)
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� SIGNATU OF PERMITTEE � DATE •-
= RECPT.NO. PAID BY VALIDATION „�
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GHEEN—ApplicanYs Copy
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FTGS/FORMS/STEEL i ' j FHA REQMTS �
ELECTRIC GROUND I UNDER FLOOR QUCT �� _^
GROUND PLUMBING I _ ____ _1 UNDER �LOOR CUMDUlT �• . �' •
--- ---.. __ .__..__�_� _— _. ..:_._._.__.t
SLAB GRADE � FIREPLACE FOUNDATIQN __ _ _�
TEMP POWER � ; FIREPLACE BOND BEAM
WATER SERVICE _,_MID HT. BOND BEAM _ __ _____�
ROOF SHFATHiNG � I 8 Ff. BONQ BEAl11f ---_�_`
FRAMINGNENTILIATION FINAL BOND BEAM
ROdF COVFR � PRE-GRADING
ROUGH HEATIlVG � BENCNING ___ �_ �
ROUGH ELEC7RIC T� ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWERlTUB T€ST POOL ELECTRIG
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WALL INSULATION POOL FINAL
GEIUtVG IfVSULATION I OFF SITE IMPS.
�RY`JVAL.L NRIL.ING " � DEDIGATiONS ---------
SEWER � FINAL ENG. �--- ------------
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SE�P P►T/LL. � . � .ON SITE IMPS.
GAS�4lH 7EST � FiNAL ZONI�IG _� ._._ � ------
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