HomeMy WebLinkAbout17913 (224) CITY OF DIAMOND BAR -----��`` --- DEPARTMENT OF COMMLJNTI'Y&DEVELOPMENT SERVICES Qy�1�"`" ' 21825 E.Copley Drive ��9'��°"i'i��� � (909)860-3195 Fax(909)861-3117 --- PRE$$ ""�.���'� BUILDING PERMIT APPLICATION .. .. �' �«�� FIRMLY � JOBSITE � � ,� - Q APPLICATION � . •'� � .(��J-�BER�� #/C o ADDRESS DATE d-�� ry � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP pOWNER� • • ,.. , - _ `L ADDRESS�.�-'Lcs S 'v1r�i'�' ���-rt,t� . ZONING SETBACKS o � Z CITY �'Ita,��S� ZIPCi�'�TEL.<=�1 FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW O z Q CONTRACTOR `' SIDE ❑ o ADDRESS"' - � ' � PROPOSED USE �/J I�61-�/�,�5�r�'C� o CITY��yj(,6��Y�11,/ ,ZIP C'_` TEL.�J,�t(�Vl7' o ARCH/ENG/ iz DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION p� ' OWNEA-BUILDER DECLARATION I 0 SFR/ADD/REM p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FiiOM 7HE CONTRACTOFiS LI- G3f8(JB/CBfPOh W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANYCITYOR (n U COUNTVWHICHREQUIRESAPERMITTOCANSTRUCT,ALTEH.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� Z TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCM PEHMIT TO FILE A SIGNED w Patio/Deck W STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI� w � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPB 0 FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (� V TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roaf A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500J.): Z ❑I,ASOWNEAOFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � CORIfflOfClal - WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J � NE55 AND PROFESSIONS CODE:7HE CANTRAC70RS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF � PROPER7Y NhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR ' Q THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGOHIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-BUILDEFi WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE). I _ ❑I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH UCENSED CANTRACTORS W � 70 CANSTfiUC7 THE PR0.IECT(SEC.70a�,BUSINESS AND PROFESSIONS CODE:THE CON7RAC70Fi5 LI� V21Ue�lOf1 ADJ.AREA � � W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCON7RAC7SFOHSUCHPR0.JEC7SWITHACON7RAC70R(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE I Y TORS LICENSE LAW.�. � ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q __ � DATE OWNER � I - Z w � UCENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � " \ Q �t' 1 d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND � Z J v u `X MY LICENSE IS M FULL FOflCE AND EFFECT. m . � IICENSECLASS ' i s f �WC.NO. � •�/� '��,, � j U DATE ' .LN C,`�/ CONTRACTOR rC�'/L'L d W � WORKERS'COMPENSATION DECLAFATION ¢ � 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z � I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSENT 70 SELF�INSURE FOR WORNERS' a � - 2 CAMPENSATION,AS PROVIDED BY SECTION 37000F THE UBOR CODE,FORTHE PERFORMANCE w Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w �_I HAVEAND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIRED BV SECTION Q 37000F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORK S'C MPENSATIOKINSURANCE RflIER AND POLICV NUMBER ARE: CONSTRUCTION J � CARRIER - G � PLAN REVIEW ZPOLICYNUMBER 'C�� 'Gi.� •��3� ELECTRIC Q � 0 (fHISSECfIJNNE�NOTBEOCf.1PLETEDOFTHEPERMfrISFORONEHUI,DREDDOLLNiS(t700�ORLESS). PLUMBING ``l� Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ���^_-+-��. (.'} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE _?� / -"�^'-�-- �/j WOFKERS'COMPENSATION lAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � �� � .%�� I� � i � � = SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 700 0F THE LABOR � � � ,, � ' 1� CADE,I SHALL F THWITH COMPLY WITH TH E PROVISIONS. ISSUANCE v p DATE: � '1 APPLICANT. .L� SMIP i APR 9 9 ?nn� J WARNING:FAILURE TO ECURE WORKERS'COMPENSATION COVERAGE IS U WFUL,AND SHALL BE ENERGY P/C � � SUBJEC7ANEMPLOVE TOCRIMINALPENAL7IESANDCIVILFINESUPT00 HUNDREDTHOUSAND ENERGYPERMIT I�R�7'. } DOLURS(S1o0.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �_���__ , � ' � SEC710N 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. FETENTION FEE: � -� -= --- I � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRESS w TOTAL FEES ` o���� � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. � I AGREE TO COMPLY WITN ALL CITY AND COUNTV OFDINANCES AND STATE LAWS RELATING TO BUILDING �� � CONSTRUC710N,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS COUN7Y TO ENTER UPON 7HE Z ABOVE-MENTIONED PROPERTV FOR IN EC710N PURPOSES. COMMENTS 0 ��� m PER� NAME �RINT) Q � � Z• ��. �„ � _ �SI ERMITTEE ATE I = RECPT.N0. PAID B VALIDATION ~ WHITE—De artment Co YELLOW—Finance�Co PINK—Assessor Co GOLDENRO�File Co GREEN—A licant's Co P PY, PY, PY, PY. PP PY �. - ..- - — � --- - ���� �� �alxl(���J���I�f� � � Of���'�C�`�U�(�l f��C��[�� �OG��C��rDO� D� ���� � O�G� .� DQ� , b Q D � , •, O o �� 0 O � . � 1� �':" O ...d �� � SET BACK FLOOR JOIST ' : --.- .—_-- _:____ _.....___._ ..------ ._..___ — ___.._..--- __.___ FTGS/F�RMS/STEEL ; ; FHA REQMT5 ; � ELECTRIC GROUND ' UNDER FLOOR DUCT � �__...__ -- --- ---------- ---- -__..._----�_� �_ GROUND PLUMBING ! � iJNDER FLOOR CU�IDUiT i ' -----_._._._..--- SLAB GRADE ' FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM � --_.-a---..__T. ___ _.__ WATER SERVICE � MID HT. BOND BEAM ___ � � � ROOF 5HEATHING 8 Ff. BOND EiEAM ' __ ___i . -- _._.__.._.._.__. FRAMIIVGNENTIUATION I FINAL BOND BcAM _ ___ ! ______ ROOF COVER PRE-GRADING � _ ROUGH HEATIN� BENCHSNG � ROUGH ELECTRIC ROUGH GRAdIN'G v� - -- ROUGH PLUMBING , FINISH GRADWG __ — - ------ �. __..__ -----__- — --._......___.__. SHOWER/TUB TEST POOL�LECTRiC EXT. LATH/SIDING POOL FENCING VJALL IiVSULATION POOL FINAL ' CEILING If��ULATIOfV OFF SITE IMPS. DRYWALL NAILING DEDICATIONS �— --�----___.__._._ __ u� �. SEWER �INAL ENG. SEPTIC TAI�K LANDSCAPE/IRRIG. S�EP PfT/LL. � � ��� ON SITE 1MPS. ; GAS�,IR TEST FINAI.ZONING ' FINAL CONST. �lRE QEPT. FINAL FINAL HEATING HEALTH DEPT. F(NAL � FIN�L ELECTRIC DEV. FEES PAiD ---- --_....-- FINAL,PLUMB�IG J • _ -�- '- ^ENERGY _ • ;. , ' ,_' - _ •i. � - - - _ - � ' • � i ! ,:• .. , �� _, i . : -, ;: . —-•, --- ..�.,. , . --- ..._ � . , � � ' , `���'�:�t -CO�o ��� ----- � ---- ---- , . �� COiViNi�i�TS . ' . , , SEPTIC TAiVK SIZE SEEf' PITlU SIZE —--- ---� -- - � � � � �� � I � �.---- ----_