HomeMy WebLinkAbout15219 �x0o �red
1� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
w 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 PRES$
� ���� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE ' APPLICATION ��J PERMIT ��j P/C
o ADDRESS�� G� �iL�/ � �/'J /��J L X� _ OATE � NUMBER �/� p
� c� ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �7 /�Lv�9 �-. , � �-�/9 l.i/K-/1
ADDRESS C /3 ZONING SETBACKS
Z CITY ZI �� TEL. U FRONT RW ❑
g APPLICANT TEL. REAR O
� SIDFJSIDE STREET RW ❑
CONTRACTOR SIDE p
Q ADDRES PROPOSED USE
� CITY ZIP T .
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL. " . .
� DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION
OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTMCTORS LI- G8f0(JB/CBfPOfI
W CENSEUWFORTHEFOLLOWINGREASON�SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITVOR (�
C..7 COUHfYWHICHREOUIRESAVERMITTOCONSTAUCT,ALTER,IMPROVE,DEMOLISH,ORREFAIRANVS7RUC- W P8i10/DBCk
Z TURE,PRIOR TO ITS ISSUANCE,AlSO REOUIRES THE APPLICAN7 FOF SUCH PERMIT TO FILE A SIGNED
- � STATEMEHT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI- w ,
C CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 9 OF THE BUSINESS AND PRO- � PooVSpa
`� FESSIONS CODE)OR THAT HE OH SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
�) TqN.ANY VIOL.ATION OF SECTION 7031.5 BV ANYAPPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
� ACIVIL VENALTV OF NOT MORE THMI FNE HUNDRED DOLURS(S5o0).):
� ❑I,ASOWNEROFTHEPROPERTY.ORMYEMPLOYEESWITHWAGESASTHEIPSOLECOMPENSATION, � COrtIRIBfCl81 �
NALL DO THE WOqK,AND THE STRUCTURE IS NOT INTENDED OR OFFEHED FOR SALE(SEC.70u.BUSI- J
NESS AND PiqFESSIONS CODE:THE COHTMCTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF
� PROPEHTVWY108URDSORIMPROVESTHEREON,ANDWHODOESSUCi1WORKHIMSELFORHERSELFOR �
Q iHROU(iH HIS OR HER OWN EMPLOVEES,VROVIDED THAT SUCH IMPROVEMENTS AHE NOT INTENDED OR m
O ,OFFEREDFORSALEIF,IiOWEVER7MEBUILDINOORIMPROVEMEHTISSOLDWITMINONEVEAROFCOMPLE-
Z •TION,THE OVINER�BU�LDER WILL HAVE THE BURDEN OF PROVINO THAT HE Ofi SHE DID NOT BUILD OR
� IMPROVE FOR TME PURPOSE OF SALE).
❑1.AS ONMEROFTHE PROPERfY,AM EXCLUSIVELV CONTMCTING WfTH LICENSED COMRACTORS
� TO CONSTRUCT 7HE 7RQIECT(SEC.)a4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U9110f1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOMIOWNEROFAPROPER7YNMOBUILDSORIMPROVESTHEREON,AND
� WIIOCOMMCTSWRSUCMVRQIECTSWIhIACONTMCTOR(S)LICENSEDPURSUAHfTOTHECONTRAG pUANTITY DESCRIPTION . FEE �
TORS LICENSE IAW.).
�/ 1
❑I AM EJ(EMPT UNDER SEC. f , B.d P.C.FOR THIS REASON � 0� ' �'1 S , �/� �/
3� cc P �+v
DATE � ^ � � Q L OWNER V �
W L
F LICENSED CONTRACTORS DECLARATION w rJ ,
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNOER PROVISIONS OF CHAPTER � I
� Y(COMMENCIHO WITH SECTION 7000)OF DIVISION 3 OP THE BUSINESS AND PROFESSIONS CODE,AND Z I
�� AIY LICENSE IS IN FULL FORCE M1D EFFECL m �
� IICENSE CUSS LIC.N0. j
V DATE CONTMCTOR d
W -"
� WORKERS'COMPENSATION DECLARATION � •
Q
� 1 HEREBYAFFIRAI UNDER PEN�LTY OF PERIURY ONE OF THE FOLLOWING DECURATKKJS: �
`=' a
� _I HAVE AHD YVILL AWNTAIN A CERTIFICATE OF CONSEN7 TO SEIF-INSURE FOR WORKERS' 2
COMPENSATION,AS PROVIDED BV SECTION 37o00F 7HE 1A80R CODE,FOR THE PERFORMANCE U
Q OF THE WOHN FOR WHICH THIS PERMIT IS ISSUEO. �
0
I HAVE AND WILL WIHTNN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 770o OF 7HE UBOR CODF,FOR 7HE PERFORMANCE OF THE WORN FOR WHICH 7HI5 PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER PLAN REVIEW
ZPOLICYNUMBER ELECTRIC � �
Q
� (fF15SH.'f10NNE�NOT8E001.�LETmOFhEPER1.fT6FORONEMMX7EDD011ARS(t100)ORLESS} PWMBING T ( (�y
W !� ;1 IGA
Z I CERTIFV THAT IN hiE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I
� SHALLNOTEMPLOVANYPERSONIN/WYMANNERSOASTOBECOMESUBJECTTOTHE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SU&IECi TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION a7oo OF THE LABOR
CADE,I SH/J.L FORTT/WI7H COMPLV WI7H THOSE PROVISIONS. ISSUANCE �
� SMIP J
p DATE: APPLICANL . y� ,
W ENERGY P/ .�.r.�A A/I(1T1TT�D
—� WMNING:FAILURE TO SECURE MIORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE �Tryryryyyy+�q,,,�jjjJ�J�Jy T'fA'T7TA �+/^..�,¢My
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRE�THOUSAND ENERGY PE��v+... A AT�C A 1'�G A n
DOLURS(f100,000�,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
¢ SECTpN 370E OF THE LABOR CODE,INTEREST,AND AT70RNEY'S FEES. RETENTION F s
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENPLN OF PERJURV THAT THERE IS ACONSTRUC710N LEN�ING AGENCY
FOR THE PEf1FORMANCE OF 7HE WORK FOR WHICH THIS PERAl1T IS ISSUED(SEC.30D7,CIV.C.).
Z
W
� LENDER'S NAME
F= LENDER'SADDRESS /�
w ICERTIfVTHATIHAVEREADTHISAPPLICA710NAND5TATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES �/ w / X �
� I AGREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STA7E LAWS REUTING TO BUILDING «� t�
CONS7RUCTION,AND HEREBV AUTHORIZE REPRESEN7A71VE5 OF THIS COUN7V 70 ENTEFi UPON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPEC710N PURPOSES. COMMENTS ��
�
� ��l 2
m PERM E N E(PRINn ^
� ' — 7 - 0� �
� SIG P �T7EE � OATE
� RECPT.NO. PAID BY VALIDATION
� WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,G LDENROD—File Copy,GREEN—ApplicanYs Copy
�B�'�f �(r �����D�� ����
. BB��I�[���1�0�(�I I�f���(��
r-- �.
' UG�°�,�-� OGJ`tt� ���„.� �G? O�C��J�1 p 1 � .;. �G� ° �. �,
�------ . , .
SET BACK �' --- I ';; _ FLOOR JOIST. +- -- . ----
FTGS/FORMS/STEEL � � FHA REC]MTS "
--____ _____ ._ _.._.� ------ _._.__-- ----------._..._,... _�u -----------....
ELECTRIC GROUNQ UNDER Fl_C3�JR QUCT . �_ _,_ __�I �
GROUND PLUMBING UNDER FLOOR CUI�IpUIT .,i �'
SLAI3 GRADE FIREPLAGE FOU.IVDAT�ON _ � ___
� TEIUP POWER _ FIREPLACE BOND BEAM
WAT�R SERVICE MIQ HT BOND BEAM
RQOF SHEATHING 8 FT. BOND BEAM �
F'RA1�IfVG/VEP�TILIATION I FINAL SOND BEAM
r�OUF COVF_R PRE-GRADING i� �
ROl1GH HEATING BENGHING -� _��__—
ROUGN ELECTRIC � ROUGH GRADING ��
R011GH PLUMBII�G FINISH uRADING ^
�� Sl-IOWER/TUB TEST POOL ELECTRIC
E}CT. LATHJSIDING POOL FENCING _
1 VJALL Ii�SULATIOiV POOL FINAL
CEILING INSULATION OFF SITE IMPS. _____
:_DRYWAL.L fVAILIh1G DEDICATIONS �
;EViIER FINAL EN�. `�—"'---- ---_.__---
.� _` �____�� � ____�____ _._.._�— ---
� SEPTIC TAI�PC LANDSCAPElIRRIG_ �^ ___._.__�,_
� SE�P PIT/L.L. ON�SITE l�v1PS. �
�GAS AIR TEST FINA�Z�NING
� r!n'���.COi�IST. ' FIRE DEPT. FfNAL '
'� {_t=;R�;1L HE�iTfNG � �HEALTN DEPT. FII�AL ,; _ ___ _`
� �_F,{�F{L ELECTRIC DE�/. FEES PAID _ _
� ' '•-"�!'r',L�'LUMBIi�lG ENFRGY I
Y�.:�_ �.�� -- --�---�'r__...-'-'-'--- -
i � ' '
�_...�.... .�._ _ ��- -^ ���-.-. ,-.r_. . ,_....._� �.� ._...,_._ . ..__
� L`%;l�U''��F� ��'_j�*-'.:�._�..�........_..��.� �
�__.____- � �_.� ____ �_.._____._____. --
, (-`f� !. HII�ltl 1 S � .
p :✓4.�i��i -
�--- --- �
;
�---- - -
i
(_._ _"� ..-____ _- __."_.._-.
{ .
f ._.. ._�w ._._ . �_-._ ___ .____,_,._„"'�.�____ ..�_�._.,_._ �.�._._._�___.�__.___.'_
1
.. .�.,r... . .. . '�_'__'___'".._._.__._...
;+__ --�-�,,,-.� '_____ _—'___�—_
j , .. '"S
f -----
' ' �y�E15� �
c_ .. _ _ ':�:.
; ,:-L�,,.'`.�r��,qr.�i�.',1' _
7 � � . ��'; ._.,- ----`---
� ��b'TIC TAiVK SIZE ` ;.•.��rt`"t�'�.--.; ,•.i';,'_ .
5EF_-'6' PI�/U SIZE _ - — ---- -- --------
� .�-�- - `_"'.�I
, � � , _ _.___ ____.___ _.._.-- --- -___.___ —� ____
, , : ,
` I — -- --____.___ _
� �
i � —
� i,���� .� ---
� I
, ,
! j ---
{ _ �� ___
i
� i__-�----�_��._� . � � - ---�-----�-�----__ ._.__._�-___
A....._ -.- ._.... .�.