HomeMy WebLinkAbout17878 ----�� _ CTTY OF DIAMOND BAR ;
DEPARTMENT OF COrRviUNITY&DEVELOPMENT SERVICES �YY�� UY�. I
21825 E.Copley Drive '
�- (909)860-3195 Fax(909)861-3117 �� / RESS
��'%�M�� BUILDING PERMIT APPLICATION � FIRMLY
} JOBSITE ��O�^� �,� J_�, n �Jc���S��R, APPLICATION �.��U� RMIT �`�� P/C
o ADDRESS_ cJ T /�- ( ' DATE UMBER � #
� ISSUE TYPE pCC
APN LOT TRACT DATE CONST. GROUP
p OWNER -�— �
p ADDR�� 3���,LTfJR�L�9-/U�I: l�� ZONING SETBACKS '
z CITY .fnt�2J4tiL.�� ZIP !9 !' TEL��O s S/o 3990 FRONT qyy p
� APPLICANT TEL. REAR p
�� SIDE/SIDE STAEET RW ❑
CONTRACTOR lzf_!7-�� � SIDE p
ADORESS A -�
� CITY G� : /+�D ZIP s/7, TEL.S��7(�Z'7Co ej PROPOSED USE
o ARCH/ENG/
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBV AFFIFiM UNDER PENPLTY OF PERIURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gef89B/CBfPOR
W CENSELAWFORTHEFOLLOWINaREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
C� COUNTVWHICHREQUIflESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W Patio/Deck
< NRE.Pi710R TO ITS ISSUANCE,AL50 RE-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATFMEM THAT HE OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF THE CONTRACTORS LI- ,
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPB
FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEOED EXEMP- (�
TION.ANY VqLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SUBJECTS TNE APPUCANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f600).):
� ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1fT16fC18I
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BUSI� J �
� NESS M1D PROFESSIONS CODE:THE CONTRACTOFS UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV N?10 BURDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUQH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSPLEIF,FqWEVER71'1EBUILDINGORIMPROVEMENTISSOLDWRHINONEVEAROfCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT 6UILD OR
� IMPROVE FOR THE PURPOSE OF SALE),
w ❑I,AS OWNER OF THE PROPEHTV,AM EXCLUSNELY COMRACTING WITH LICENSED CONiMCTORS
� TO CONSTRUCT THE PRQIECT(SEC.70I4,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI� V01U8f1Of1 ADJ.AREA
W CENSE LAW DOES NOTAPPIV TOMI OWNEH OFA PROPERTY WHO BUILDS OR IMPROVES hIEREON,AND
� YM1iOCONTRACTSFOqSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTIN DESCRIPTION FEE
Y TORS LICENSE UW.). •
0 ❑I AM E%EMPT UNDER SEC. 8.8 7.C.FOR THIS REASON Q , �"J�.t �~� � .D
� DATE OWNER H / �
O V
� � •
� UCENSED CONTRACTORS DECLARATION W �2 .7 v
� I HEREBY AFFIRAI UNDER PENALTV OF PEFLIURV hIAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � S `D
� D(COMMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE.AND Z '
XL' MV LICENSE IS IN FULI F�E AND EFFECT, m
�� 5 �f-S
� LICENSE CLASS LIC.NO. �� � � /,�
V DATE CONTRACTOR � J � �T `�
a
w
� WORKERS'COMPENSATION DECLARATION a � �,I• S D
U /
� I HEREBV AFFIRM UNDER PENALTV OF PEFJURY ONE OF THE FOLLOWINO DECLARATKKJS: Z uy kJ/� ,� �
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-INSUREFORWORKERS' a �-/ C
� COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U � �����L'L �/�IL� • /D
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � � �`��`�/�' � D
,�.
Qw _�HAVEAND WILL MAINTAIN WOH)(ERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
37oa OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 'A0
ISSUED.MV WOR)(ER 'CO�MpPENSATION INSURANCE CAR�RIE/F/�D POLICV NUMBER ARE: CONSTRUCTION �J
jCARRIER �t/I�r - //J/llU PLAN REVIEW
Z POLICVNUMBER �Z. L/7 7 "aj� ELECTFiIC
¢
� (IFASSECTqNNE�NO7BEOLMPLEfmOFTHEPERMfTISFORONEHINOREDDOLLPRS(f10D)OqLESS). PLUMBING
W
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUED,I MECHANICAL
GJ SFULL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
(/� WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO TME WOFKERS'COMPENSATION PROVISIONS OF SECTION 3]00 OF THE UBOR
OCOOE,I SHALL FORTHWITH COMPLY WITH /O/�SE/PJRO/V/I510N5./G/' �y ISSUANCE �
1p DATE: APPLICANT��7��/L�/yI�•V� SMIP
J WAPNINO:FA1LUflE TO SECURE WORNERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SNALL BE ENERGY P/C
J
� SU&IECTAN EMPLOVER TO CFIMINAL PENALTIES AND CML FMES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f100.oa0�,IN ADDITION TO THE COST OF fAMPENSATION,DAMAGES AS PROVIDED FOR IN ��
J SECiION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
� FOR THE PERFORMANCE OF THE WOR)(FOR WHICH THIS PERMIT IS ISSUED(SEC.70D7,CIV.C.�.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � _ ��0�
� I AGREE TO COMPLV WRH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE flEPRESENTATNES OF h115 CAUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
� �/�/` � �/�r�/ `�
m P ITTEE (PRINn
Q � ��
� SIONATUREOFPERM E DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessoi Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
�d1�'�f �f� ��zQ�(��� [��i� ' ,
96�J�(�[c(��'U�f�l9 f�i[�C��CF$�
f�C� � , ` °� Q n O�pLC�OG�J _ DD CQ t� . DG�pC� � �
5ET BAGK FLOOR JOIST' .
F-fGS/FORMS/S7EEL FHA RE�MTS
ELECTRIC GROUND , UNDER FLOOR DUCT �
GROUND PLUMBWG .�i �,�r ' ��"-°4 UNQER FLOOR,CU�IDUIT
���� , ��...... . ..1. _
SLABGRADE '`�,��2k1'��..*-��'==`•=---- -•_.,,,,, FIREPLACEFOUNDATION '
TEMP POWER FIREPLACE BUND BEAM
. WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHIh1G 8 FT. BOND BEAM '
FRAMINGNENTIUATiON�.= ; ;L�- t�- FINAL BGND BEAM
ROOF COVER PRE-GRADiNG
ROUGH HEATIIVG p � �i� BENCHING
ROUGH ELECTRIC ,�\ ROUGH GRADING
ROUGH PLUNIBING �� FINISH GRADING
SHOWEFL'1'UB TEST POOL ELECTRIC
EXT. LATH/SIDING ; POOL FENCING
WALL INSULATION �-j•-c�L- POOL FINAL
CEILIfVG INSULATION ��-�j�-O' � OFF SITE IMPS. �
DRYWALL NAIUNG ❑EDICATfONS
SEWER FINAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SlTE IMPS.
GAS AIR TE�T F1NAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID �
FINAL PLUMBIMG ENERGY
- - i a p�`�"'��r:s;.'�at�t -
COMiViEfVTS
SEPTIC TAiVK SIZE
SEEP PITIU SIZE
� -
� :�
� �