HomeMy WebLinkAbout13333 (14)CITY OF DIAMOND BAR (�
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 1
21660 E. Copley Drive Suite 190
(909)860-3195 Pax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS,2r� (/ n ,.,�
,�L}EAO I� �t� 9,9
APN LOT TRACT
OWNER MCI GI�t,C(Lr12
ADDRESSZ�_� 3 _
CITY ZIP TE .
APPLICANT _�[� t� TEL
CONTRACTOR M v (—Lf�LT
CITY L2IrZ. ZIP TEL. (_ 7
ARCHIENG1
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER•SUILDER DECLARATION
1 HCREDY ArRRM UNDER PENALTY OF PERJI:RY THA' 1 AM EXEMPT FROM THE CONTMCTOnS LF
CENSE LAW FOR RIE FOLLOW NO REASON ISEC 7071 S B'JSLNESS AND PROFES SIGNS CW F ANY CITY OR
COLMYY1HIOH REOI RES A Pr' TO CONS T R'JCT.ALTER WIPTIO7'i. DEMOLISH. OR REPA:nANY STn'JC-
TUBE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A S'GNEO
STATEMENT THAT HE OR SHE tS LICENSED PURSUANT TO THE PROVIVOKS OF THE CONTRACTORS LI.
CENSE LAW (CHAPTER a (COMMENCING WITH SECTION TOM) Or D: V.SION 7 OF THE D::S'NE SS AND PnO
FESSIONS COOCI OR THAT HE OR SHE IS EXEMPT THICRE FROM AND THE BATAS FOn THP ALEGED E%EMP•
TOY:. ANY VIOLIL7ION OF SECTION 7071.6 BY ANY APPLICANT FOR APE RMI T SUBJECTS THE APPLICANT TO
A CM.L PENALTY OF NOT MORE THAN F.NE HUNDRED DOLLARS ISSX) I-
173 LAS OWNER OF THE PnOPE Rrx OR MY EMPLOYEES W'TH W AGESAS THE n SOLE COMPC VSAT ION,
MALL DO THE WORK ANO THE STR;,'CTUnE 6 NOT IN TENCCD on o, FCREO FOR SALE (SEC 7344. BUSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOCS NOT APPLY TO AN OWNER OF
PRDPEIrrY WHO DUACS On IMPROVES TIERED. AND IW O DOES SUCH WOIM HIMSC.F Cn HERSELF OR
THR(X (il/ HIS ON HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPnOVEMLNTS ARE NOT MEWED Oil
OFFERED FOR SALE. IF,FOWEVEFL THC 13MONG OR IMPROVEMENT IS SOLD WITH NONE YEAncr COMPLE-
TION, THE OWNER BLALDER WILL HAVE THC BL'RDLN OF PROVING THAT HE OR SIE CID NOT BUAD OR
W PAOvE FOR THE PURPOSE OF SALE)
C L AS OWNER OF THE PFLCPER7Y. AM EXCLUSrVELY CONTRACT. NO W TH LICENSED CONTRACTORS
TO CONETRUCT THE PROJECT ISEC 7014. BUSINESS AND PROFESSIONS (bDC THE CONTRACTGriS LN
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PIOPERTY WIIO BUILCS 011 NPROVES TKilrON. ALN)
WHOCON:RACTS rOn SUCFIPnCUL CTS WTIAF•OSTRAC70RIS)LICENSCD PCNSUANTTOT'ECONTRA.^.
Tons LICENSE LAW).
D 1AM EXEMPTUNDERSCC. D 3 PC.FCR THIS WASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFRW UNCCR PENALTY OF PENURY THAT IAM LICENSED UNDER PR0%1SIONS OF CHAPTER
e ICOMMENCNQ W:TH SECTION 7000) Or C:VISION S OF THE B'JS.:NESS AND PROFESSIONS CWC. AND
MY LCEMSE M N FLAT FORCC AND [rF ECT. A
LICENSE CUSS LIC. NO. 0
DATE ` CONTRACTORFtA,{�GLlT`�
WORKERS' COMPENSATION DECLARATION l
1 HEREBY AFFIRM UNDER PENALTY Or PERJURY O.E. Or THE FOLLOWING DCCLAMTIONS,
-1 HAVE AND WILL MA'NTAN A CET:FiCATE OF CONSENT TO SELF -RI SURr FOR WORKER
COMPEN SATION. AS PRO1rDCD BY SECTION 3700C_
THE
LABOR CODE. FOR THE P[PrOPAIANC E
OF THE WORK FOR W11'CHI TH:S PCnMIT IS ISSUED
I HAVE AND W'_L MA.,NTA:N WORKER:' COMPENSATION INSURANCE. AS nCQU PC7 DY SECTION
77M OF THE LABOR CODE. FOR THC PERFORMANCE Or THE WCIIK FOR WH'CII THIS FIERY T IS
ISSUED. MY
IN COMPENSATION INSRANCE CAnr,ICn AND Pd ICY NJMCn MC
CARRIER rU��:/�,� )
POLICY NUMBCA _(_S A b Q
(nes SCCnDN NEEDNDT DC CCULET.0OrT E FERMI! IS F'OROP )UdXtl DDD1AW,,;:.'r!OALESS:
I CERT IrY THAT N TIE PEnrORMA\CE OF THE YORK FOR WH:CHI THIS PERMIT M. ISSUED, I
SHALL NOT EM-LOY ANY PERSON N ANY MANNER SO AS TO BCCCME SUBJECT TO THE
WONIERS' COMPENSATION LAWS OF GIL'FOnNIA. AND AGREE THAT IF I SIOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION Pno%nsK)NS OF SECTION 3700 OF THE Lmon
COCE /)SHALL RTFMIT/COMPLY PATH THOSE PROANS•ONS.
DATE: ��y 4 APrLICANT P
I WARNINQ.F LURE C'nE M/OHKERi'COMPENSATIDN C012F GC IS UhLAWT1A. AN7 SHAll PE
SLLUECT AN EMPLOYER 70 CR7A:NAL PENALTIES AND CI V L FINES UP TO CNF HJNDnEO TIOI;SAND
DOLLARS 131 M.OW), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
I SECTION 7709 OF THE LABOR CODE. NTCnCST• AND ATTORIEYS F E ES.
CONSTRUCTION LENDING AGENCY
i
1 HCnCSY ArF:RM UNDER PENALTY Or PERJURY THAT THTnr IS A CONSTnUCTION LE NON. ASCNCY
FOIL THE PCRFOnMAYCC OF THE W'OnK FOR W IICH THIS P[nM:T IS ISSUE D (SEC. 7017, CIV. C.)
I
LENDERS VAMC
LENDEFFS ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THC ADO'YE INFORMATION IS COnRECT.
1 AGREE 70 COMPLY W.TH ALL CITY AND COUNTY ORD NANZES AND STATE LA WS RrLATPIG TO DULDING
CONSTRUCTION. MDHEREBY AJTHOR:ZE R. PnCSENTATIVES OF THIS CWNTY TO ENTER UPON TI -C
AUCIVC 4f h.CNED FRRO/rPjERTTYY FOn INSPECTION PPUU•RPOSSSESS-••�—J PERMITT (P .FLT)
IEE
__
SIGN I1. FP „ DCII' '—
PRESS
FIRMLY
APPLICATION/' PERmrr P/C
DATE `f 2 NUMBE it
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE C
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PROPOSEDUSEZ/�1J�flf�?�tL
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NO. DWEL. NO.
UNITS STORIES i BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
SFFL'ADD..nEM
M
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WPa:i:,T)ock
Poc"Spa
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Commorcial
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VaIJa!:On ADJ.ARF_A
OUANTITY DESCRIPTION FEC
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W
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CJ
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2
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CONSTRUCTION •
PLAN REVIEW
ELECTRIC�-{; A n
PLU'!3:tiG AI ` 2 %Jn
MECHANICAL CITl�` (lj: i)1 t, riOtil) 134 c
INSPECTIONF&UA7�r.:�nlV(' r`NTI) SAFETY
ISSUANCE
SOP r�
ENERGY PIC
ENERGY PERVIT
RLTENTION FEE:
PRE -ALT FEE:
TOTAL FEES '
COMMENTS
iT
1_11CPT,10- � y�
PAID D VALIDATION
Y4FIITL—DeCar1jnenl Copy. YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—FIN( Ccpy, GREEN—AFpllcant's Copy
CITY OF DIAMOND BAR
114SPECTION RECORD
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FLOOR JOIST
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UNDER FLOOR GO,',!r),JIT
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7.1 POVIIEF). FIRELP-LACE BONO E:EA"".-
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-.11) I -IT. BOND 13-EAM,
8 FT EO` D BEAM.
Pr);)F COVER 1 PR E -GRAD ING
rl'j,,M!i fir7AMN'3 I B E N C H 11 -J G.
R OU G[ i G R 1 0: NG
P.011.32,i EM
GRADIN3—
.'E r m'i U -FE POOL ELECTRIC
1'. L-,'%TH. !,SIDI NG PCIOLFENCING
L I PIS, JL AT 1 ON POOL F'I Nt, L.
C, I'L. 1 4'3 1.1. SS I J L,J 10 t'J I OFF SITE 1IMPS.
b V10 L ME [) I I- AJ 10 114 s
F I N' t% 1. E NKS.
SFT I C -1 /�N'K LA N' DS .-A. PPIR 1 G. i
A. 113 TE I I i r zm"
ING
rjf-.V. 1:;:ES PAJD
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SEPTIC TANK SIZE
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