HomeMy WebLinkAbout11793 (5) :--.
l�I�ri 3
-�-- -•'•�� - CITY OF DIAMOND BAR r-
COMMUNITY DEVELOPMENT DEPARTMENT
. -,.-,?
2Lfi60 E.Copley Dnve Suite 190 � PRESS
, ,, (909)860-3195 Fax(909)861-3117
"�w" BUILDING PERMIT APPLICATION �' ``` "-.�: �f`:. �;.�,° ., � �.:. ,,.F�RM LY
.....� r; , ` •�
� JOBSITE ,�"Q Q' ��� ' �U� APPLICATION �• PERMIT j / P/C Q�4
o ADDRESS �� �� � DATE NUMBER ! I� #�J
� APN LOT TR CT Z� ISSUE���/�T�—TYPE OCC
_— DATE '�� CONST GROUP
� OWNER �� 1 . .
o ADDRESS s w. ZONING, S.ETB.ACKS � �� . ?�'
w FRONT ' � RW ❑
gCITY ZIP�_ TEL. y �
APPLICANT TEL. � REAR f�
� S10FJSIDESTFIEET . , RW �1
:
� CONTRACTOR �� � _ SIDE l
� ADDRESS PROPOSED USE �� PL� �-
� CI7Y ZIP TEL.
o ARCH/ENG/
� DESIGNER NO.DWEL. , NO. NO.
ADDRESS UNITS_�_ STORIES Z" BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
u�
� OWNER-BI:ILDER OECLARATION SFR/ADD/REM D
O
p I HEREBY AFFIRM UNDEA PENALTY OF PERJURY THAT I PM EXEMPT FROM iHE CON7RAC"OFS LI� GyfOJBIC9f(Mfl b � '
W CENSEUWFORTHEFOLLO`MNGREASON(SEC.7031.6BUSMESSANOPROFESSIONSCA�E:ANYCITY�q (n
U CDUNTVWHICHREWIRESAVERM!TTOCANSTRUCi,ALTER,IMPROVE.�EM�USH,ORHEPAIRANVSTRUC- W Patio/�eck
Z TURE.PFIOR i0 IT&ISSl1ANCE,pL50 REOUIRES hiE APPLICANT Fpfl SUGH PERMIT TO FIGE A SIGNE'J W
W STATEIAENT THAY NE OR SHE IS UCENSED PURSUANT Ta TNE PPOVISIONS OF TME CONTRACTOqS LI� � '
� CENSE LAW(CHAVTER B(COMMENCINO WITM SECTION 7000)OF DIYISION 3 OI"THE B1151NE55 MID PP.O- � PooUSpa � � . � .
FESSIONS COOE)OR THAT HE OR SHE IS E%EMPT TM EREFRON AN:7 7HE B0.515 FON TME AILEGEO EXEMP�
VTION.ANVVIOLAT�ONOFSECTION7031.SBYANVAPPLICANTFORA�ERMITSUBJF.CTSTHEAVPLICANT'TO Z qe-Raof �
F, AGIVILPENILLTYOFNOTMOFETHANFIVEHUNURFDOOLLAHS(fSDo�J:
� ❑I,ASOWNEROFTHEPPOPERTY.ORMYEMPLOVEESW�i7HWAGE5A5TMEIRSaLECOMPEti5A7ioN, 0 CommefCial •
Z WIIL 00 THE WOflK.AND iHE 57PVCTURE IS NOT INTENDED OR OFFEREO FOR SAI.E(SEC.70a4,BUSI- J
NE55 AND PROFESSIONS CODE:TNE CONTFAGTORS LICENSE LAW DOES NOT APPLY TO AN OW NER OF �
� PROPERTVWHOBU0.DSORIMPROVESTHEREON.ANDWHODOESSVCHWORKHIMS[LFORHERSELFOR =
� THNOUOFiHI50RHEqOWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEM[NTSAR'eNOTINTENDEDOF m
OOFFEREOFORSALE.IF,MOWEVER,THEBUILDINOORiMPROYEMENT1550LDWiT1iINONEYEAROFCOMPLE-
Z TION,TFiE OWNER-BUIL�EH WILL HAVE THE BURDEN OF PROVING THAT ME OR SHE�ID NOT BUILD OR , y
� IMPROYE FOR TME PURPDSE OF SALE�.
W (]tA50WNEROFTHEVROPEHT�:AMEXCLU5IVELYCANTMCTINGWITHLICENSEDCONTMCTORS
Q TO CANSTRUCT THE PRQIECT(SEC.7a4a,&151NES5 AN�VROFE5SIONS CA�E:rHE CDNTRACTORS L6 V81112I1Of7 ADJ.AREA�
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERttWH09UILD50RIMPROVES�NEREON,AND
� WHOCONTRACTSFORSUCHVRQIECTSWITNACONTRRCTOF�S)LICENSEDPURSUAMTOTH[ODNTRAC- QUANTITY DESCRIPTION FEE
� TORS LICENSE UW).
J
0 I'.I AM E%EIutPT UNOER SEC. ._8.6 P.C.FOH THIS REASON U
�S ¢
�'L' DATE OWNER V � '
Z W
� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBV AFFIPM 11N0ER PENALTV OF PERJURV THAT I AM LICENSCD UN�ER PfiOVI510N5 OF CHAPTER � '
d 9(COMMENCINO WITH 5'eC710N 7000�OF DIVISION 3 OF THE 6USINE55 ANO OROFESSIONS CODE,AND z
�C MV LICENSE IS IN FULL FORCE ANO EFFECT. ����_ J m
LLI
� LICENSEC LIC.NO.. �y-/� �����w �
V �ATE Q � CONTMCTOFl �J 1(� /K a
W
� � WORKERS'CAMPENSATION DECLARATION a
= U
N 1 HEREBY AFFIRM UNDER VENALTV OF PERJURV ONE OF THE FOLLOW�NG OECLARA�IONS�
� Z
Q
� IHAVEANDW�LLMAINTAINACER7IKICATEOFCONSENTTOSELF�INSUREFORWORKERS' _
� CAMPENSATION,AS 7POVIDED BY SECTION 3�0o OF THE LABOR CODE.FOR iHE PERFOPMANGE �U
OFTHE WORK FOR WHICH TMIS PELiMIT IS ISSUED. `
W
.�1 HAVEAND WILLMAIN7AIN WORKERS'CAMPENSATION INSIJHANCE.RS RE�U�RE�BY SECTiON ' ���/`O
Q 37000F TME LABOFl LO�E,FOH THE PERFORMANCE OF THE WORK FOR WFIICH THIS PEAMIT IS ' V
� ISSUEO.MY WOHNERS'COMPENS ION INSURANCE CARR!ER AND POLICV Nl1M�ER ARE' CONSTRUCTION
4 /��
� CAHRIER �'+l PLAN REVIEW _ Z�i�3
Z POLICYNUM9ER � ELECTRIC
Q
� (IWSSECfpNNE�NOTBEWI+1PLEf�OF7HEPEFlMTISPDR�NEHIMOREDDOUJdiS(StoO�ORLESSi. PLUM6ING
W ICER7IFYTHATINTHEPERFORMANCEOFTHEWORKFORWNICHTHISPEHMiTI5155UE0.1 MECHANICAL
2
(,'J SHALLNOTEMPLOYANYPERSONINPNVMANNERSOAST08ECAMESVBJECTTOTHE
� WORKERS'COMPENSATION LAWS OF CAIIFOPoVIA�N�AGREE THAT IF I SHOUID BECOME INSPECTION FEE
SUBJECT TO THE WORNERS'COMPENSATION P ROVIS�ONS OF SECTION 3]Oo OF THE LAB�A e�
� CAOE,ISHALLFORTHW�TNCOMFLYWI7HTMOSEPROVISIONS. ISSUANCE •
p DATE: APPLICANT: SN1�P � �
� ENERGY P!C
WARNINO:FAILURE TO SECURE WONKERS'COMPENSATION CAVERA6E IS UNIAWNI.ANO SMALL BE Q 1(��
�y SLBJECTANEM7LOVERTOCRIMINALPENALTIESAN�CIVILFINESUPTOIXJEHUNORE�THOUSANO ENERGYPERMIT � [ { J
DOLLARS(5100.000).IN ADDITION TO THE C0.ST OF COMPENSRTION.DAMilGES AS PAOVIDED FOA IN -- 1
J SECTION 3709OFTHE LA60R COOE,INTEREST,pN0 ATTORNEYS FEES. RETENTION FEE: � '�' '.� �SI OO
�
O CONSTFUCTION LENDING AGENCY � pREALT FEE� � �'�':��
I� 1 HEflEBV AFFIRM UNDEfl PENALTY OF PERJUflY THAT THERE�S A GONSTRUCTION LENDING AGENGY ____ _
FOR TNE PERFORMANCE OF THE WORK FOF WHICN 7HI5 PERMIT I5155UE��SEC.3097.CIY.CJ.
W ��N
`T LEN�ER'S NAME !�__ _ _
�
!— LENOER5ADORE55 _ y
w 1 CEHTIFY THAT I HAVE NEAD THIS APPLICATI�N pND STATE THATTHE ABOYE INFORMATION IS COFRECT. TOTA L FE ES a zzs-,�3 � � !�r7� �`+
0. I ACREE TO COAIGLY WITN�LL CITY AND COUNTY ORDINMICES ANO STATE LAWS RELATNJG TO BUiLOING
� CONSTflUCTION.AN�HEREBYAUTHORIZEREPRESENTAi1VE3OFTNISCOUNTVTOENTEflUGONTHE
ABOVE�MENTIONEO PROPEHTY FOF INSPECTION PURPOSES.
Z ^ COMMENTS,__ �
OIWL/'�'NV �T��/�/- — — —
m PERM��77 EEjNAME�PRINn (/►r y�jJ
¢ `rJ�G1 � � ✓ V 1
� 310NATUREOFPEPI�.�EL� ��� �ATE �p
z RECPT.NO. _ `___PAID BY _ VALIDATI .
~ WHI7E-0epartment Copy.VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—Applicant's Copy
, ' ,1
�ITY OF D1/4NiOfi�D BAR
INSPECTION RECURD
�r' ,t3
� :
_ , ,. . .
_ �:,,�.,
. . : ..,
� � , . � . . s ei � t ;
,�
.�: .�..._..rw... ...
SET BACK � � , '� FLOOR JQIST., , , . -
�-----__��...—�- -- _. .�-. :� --�_.._.....__.._....._..._..--------
FTGS/FORiUISlSTEEL 7-/S�d� FHA REQMTS,�::- ...� , :"
,• .:, • ..
--�-----_-.---- -- ---- - - `� -
•. �.�_----- ----
ELECTRIC GROUND 'f-JS- S� � �� UNDER FLOOR DUCT :=� ! y� � '
,, , . . ,
. , , .
.,. . . . .. . ... .
- - ---- -.._....----._____..._._....
GROUN�PLUMBING � -� .� _�� UNDEi�F�0(�fi�°cGn��iui7 '� ' : :. '__ �___�. • ------
SLAB GRADE �J,����Y�_B I FlREPLACE FOUNDATION ___ ___ ^_
TEMP P01r'VER i FIREPLACE BOND BEAM ' �' ' '
WATER SERVICE ,7 •. `-,�I_ � . MID HT. B�ND BEAM —`— - —� �_
ROOF SHEATHlNG �� O z , 8 FT. BOND BEAM
FRAMlNGNENTlLIATION �� ! ' FINAL BOND BEAM _ _ , _
RODF COVER � i PRE-GRADING (
ROUGH HEATING t 9 BENCHING �—_W-------
ROUGH ELECTRlC � � ` `� ., �.. ! ROUGH GRADING � `_ _
ROUGH PLUMBING ; � ' � � F� INISH GFiAbiNG
SHOWER/TU8 TEST ��_ POOL ELECTRIC ��_ ^ __
EXT. IATH/SIOING POOL FENCING �
WALL lNSULATION � � ' ~ ; POOL FINAL
CEILiNG INSULRTION ��� ^ ; OFF SITE IMPS. ----------
-- � ---------._...__.....--
pRYWALL NAILING � � DEDICATIONS
SEWER ��__�� � FINAL ENG. "_ ��
SEPTIC TANK ; ` ��-�``� ! � LANdSCAPE/lRRIG. � �
5EEP PI7JLL ` � ON SITE IMPS. I j
_�_...._ ,
GAS AIR TEST z L ; � , -_--..-----..._._._
. FINAL Z�NING I
FINAL CONST. 3 ?� '� FIRE DEPT FINAL ' !
FINAL HEATING i HEALTH DEPT. FINAL j _��
FINAL ELECTRIC i :� DEV. FEES PAID i �
�-;—
FINAL PLUMSING `i. i ' ENERGY i �
f -_-.__ + • I , ( • __...._'-�_"___
� r 1
� � � .. 1 , � �;yy�.__._._..�_�.--.�
- __� �,��� • �� , — ---- �
COMMENTS
� , , , t, . , ; ,
— - , � . . . , -------------....._.._
,r� ...
: a � .. . ^
, `. k -----
SEPtI TRNK SIZE ----��.-'-------
SEEP PIT/U SIZE _:. �.=� --- - -------�-----
� �.. -----
: `� ' `� ' �
ti- --------�
-----�-------�
, . �� �� ,� �� .,,
�J;i (•� �� � '* � .-,_�
,
+ ,, r.'���, - - , ---