HomeMy WebLinkAbout11390y�
EXPIRED
CITY OF DIAMOND BAR ' ,1 U L 0 5 2002
COMMUNITY DEVELOPMENT DEPARTMENT
:.0 21660 E. Copley Drive Suite 190. ' . • I PRESS
(909) 860-3195 Fax (909) $61-3117
13MLDING PERMIT APPLICATION FIRMLY
TE
ADDRESS SS Q / e J W if alul /,jel"( 11
APN T TRACT
OWNER -
ADDRESS
CRY IeLIP TEL.
APP C TEL.
CONTRACTOR `
ADDRESS
CITY ZIP TEL
ARCHlENGJ
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERANY THAT I AM EXEMPT FROM THE CONTRACTORS LF
CENSE LAW FORTHE FOLLOWING REASON (SEC. 70.11.6 BUSNESSNJD PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REOUIIRESAPERMITTO CONSTRUCT. ALTER IMPROVE. DEMOUSN.OR REFAIRANYSTRUC...
TORE, PRIOR TO RS ISSUANCE, ALSO REOUBIES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS I.J.
IO
CENSE LAW (CHAPTER 1(COMMENCING WITH SECTION 7000) OF DIVISION 1 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED FXEMP.
TXJN. ANY VIOLATION OF SECTION 7011.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CL PENALTY OF NOT MORE THAN FIVE MUNO RED DOLLARS (1SWO:
O LAS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEM SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE (SEC. 7044, BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OMER OF
PROPERTY VMO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH MIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR4ALE.IF. HOWEVER THE BUILDING ORIMPROVEMENT IS SOLD WITHIN ONE YEAROFCOMPLE-
TION• THE OMER-BUI DER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF HAVE
- M
O L AS OWNER OF THE PROPERTY, AM EXCLUS VELYCONTCTNO WITH LICENSED CONTRACTORS
TO CONSTRICT THE PROJECT (SEC, 7044, BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LJ -
CENSE LAW DOES NOT APPLY To
AN OWNER OF A PROPERTY WHO BUMS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITH CONTRACTORS) LICENSED PURSUANT TO THE LXNTRAC•
TORS LICENSE
01 AME MPT ER SfC. B. S P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HERESY AFFIAM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
a(COMMENCING WTM SECTION TOM) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE AND
MY LICENSE IS N ML FORCE MID EFFECT,
LICENSE CUSS LIC. NO.
DATE CONTRACTOR .. _ .
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
�I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSLME FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 4700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PCRMITIS ISSUED.
I HAVE AND WALL MAINTAIN WORKERS' COMPENSATION INSURANCE AS REWIRED BY SECTION
5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER
POLICY NUMBER -
ow SECTION NFIDNOTBCCOMFLETEDOFTIE PEAK IS FORONE H NDRFDD41M6 (910D)CRLM
1 CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1
SHALL NOT EMPLOY ANY FEASON N ANY MANNER SO AS TO SEOOLUE SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION ]TOO OF THE LABOR
CODE. I SHALL FORTHVATH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT.
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE
SUfUECrAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (1100,0001. INADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION$7os OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. • -
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PENURY THAT THERE IS ACONSTRUCTKON LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3M.CIV. Ill.
LENDERSNAME
LENDERS ADORES$
1CERTIFY THAT I HAVE READ THISIO
APPLICATION AND STATE TWAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BULGING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE4AE ED PROPERTY FOR INSPECTION PURPOSES.
INRMItTd NAME (P - .
SIGNATURE OF PERMITTEE DATE
APPLICATION ." "' PERMIT' : P/C , Q
r 7
DATE NUMBER'''
ISSUE TYPE OCC
DATE CONST.' ,GROUP
ZONING , SETBACKS
FRONT RW ❑
REAR:. ❑
SIDUSIDE STREET RW ❑11 '
SIDE 13 -
PROPOSED
PROPOSED USE !'
NO. DWEL NO. NO.,
UNITS STORIES! BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADDIREM - -
Cf)
Garage/Carport
W
PatWDea
LL
POOVSpa.. .
ZRe
-Root
OJ
Commercial
m
Valuation ADJ.AREA
OUANTITY DESCRIPTION FEE, -
_U
J
w
Z
DO
U
aZ
2
i
CONSTRUCTION -
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE _
SMTP
ENERGY PJC
�+ I^ 8
ENERGY PERMITMAR 199
RETENTION FEE: T J
PRE•ALT FEE:
TOTAL FEES
COMMENTS
I.
RECPT. NO. PAID BY VALIDATION
WHITE—Oepsnment Copy. YELLOW—Finance COW PINK—Assessor Copy. GOLDENROD—File Copy, GREEN—Applicant's Copy
I
- - 1, A
CITY OF
INSPECTION RECORp,:
SET BACK -7I--
-FLOOR JOIST
FIGS/FORMS/STEEL----'FHA
REQMfS"--"--
ELECTRIC GROUND
FLOOR DUCT
1).UNDER_r 2" n
-GROUND PLUMBING V
-'r t -:PF UNDERA06171 'C-bNDUIT
SLAB GRADE Fiqgptlm oUi�b&ibN
-TEMP POWER
—:171REPLACE BOND E�A
BEAM'-
WATEkSERVIG'E Txl�:17.
I D BEAM
"MID HT. BON
_J\
RO0t'S_t4E)%TkNG) iV'-
8 Fr. BOND BEAM
s7/-,Z_§p
FRAMINGNENTILIATION
'FINAL BOND -BEAM
-ROOF COVER M) "is -AN
ROUGH HEATING
BENCHING' ,,.,.I, 7
-ROUGH ELECTRIC`—
-ROUGH GRADING.
-ROUGH PLUMBING -FINISH'GRAIDING"L"'i�'I"
-SHOWER/TUBTEST
-POOL ELECTRIC
-EXT-LATH/SIDING—'—
_7', POOL FENCING'
WALL INSULATION
POOL FINAL;%
CEILING INSULATION
OFF SITE IMPS.`,"
DRYWALL NAILING
DEDICATIONS
SEWER---------.-.
-1-FINAL ENG.,,.,
-TANK::�=:. _LA
S E P -T I C NDSCAPE/IRRIG..-,;';
-SEEP_PIT/LL_t____
4 -ONSITE IMPS.
-GASAIRTEST.1
FINALZONING:`
-FINAL-CONST.-;
-FIRE DEPT._FIf,1AL
-FINAL- HEATING------
HEALTH DEPT: FINAL
,.,-,-.-,-
-FINAL:ELECTRIC
-t-DEV. FEES PAID_,_
FINAL PLUMBING---
--ENERGY
-COMMENTS-
Y' 1
Jo FC
Zr
1;. T11 u41
22
- ------
-1 f 101" 4R T, C
"P,
11 "J!" :1 Y{1. f
SEPTIC TANK SIZE---- - ----------
SEEP PIT/U SIZE-------
i I T 1;
1 1 �3- ]7YT_-,
VIS C., P 7"
__E 7:1 0 I T031" 3 N Y-1