HomeMy WebLinkAbout1 <:<=_;';t�_ C1TY OP'DIAMOND BAR
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j I I I i ' !� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
, ��Ill��i :�4+,l� 21810 Copley Drive,Diamond 13ar,CA 91765 � PR�SS
"� (909)839-7020 Fax: (909)861-3ll7 Building Inspection Hotline(909)839-7037 F�RMLY ''
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�''�"'�' BUILDING PERMIT APPLICATION
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� JOB SITE ADDRESS 7-�1j� R v^��'''^'�t Y RAwCN R� APPLICATION DATE: ��/? /�3 P/C# '�QTG
w ISSUE DATE: �C� � 1(� PERMIT# �
z APN LOT TRACT
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o OWNER SNv CZ� LI IYPE CONST. OCC GROUP:
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� ADDRESS -�..�-`.fy ILuNNi.�L� Sr+-n.�,cN R'7
—' CIlY D� A�oUo �P.ti- ZIP r{I��s TEL.�Paz-6�, -7�S - (3b�i ZONING SETBACKS
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� APPLICANT t-ID.M-L.AN swc,ov,;1 TEL._4,Si '�d v1b� REAR ❑
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a CONTR,4CTOR s��-P�►✓�Ax SIDE/SIDE STREET RW ❑
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o ADDRESS
°r /� PROPOSED USE �'-�� M�•�^'1" S. � ��"� b�- -rO�'�`z
o CITY l��V E2i�O ti ZIP ZS�7 TEL. �$ I .7U1� �7�b �l Zp � ��.v�LS� J rr�v i:+LTv'K/
o ARCH/ENGIDESIGNER
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o ADDRESS
o ri DWEL.UNITS #STORIES k BEDROOMS
z CITY ZIP TEL.
m DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
a OWNER-BUILDER DECLAHATION
°C I hereby aflirm under penatty.of perjury Nat I am exemDt Irom ihe Coniractor's State License Law for the reason(s) SFR/ADD/REM
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o intlicated below by the checkmark(s),I have placed next to the aDDlicable item(s)[Section 7031.5,Busfness and Garage/Carport .
o Professions Code:Any city or counry that requires a permit ta construct,alter,improve,demolish,or repair,any
iz structure,Drior to its issuance,also requires the applicant for the permit to file a signed stalement that he or she � Patio/Deck �
a is licensed pursuant to the provisions af ihe Co�rtractor's SWte License Law(Chapter 9)Commencing with Section W
� 7000 0l Division 3 of Ihe Business and Prolessions Code]or ihat he or she is exempt from licensure and the basis for � Pool/Spa
� the alleged exemption.Any violation of Section 7031.5 by any apDlicant for a permit subjects the apD�icant to a civil penalty C7 �
� ot not more than five huntlretl dollars(3500). Q Re-Roof �I
o (J I,as owner of Ne property,or my employees with wages as their sole compensation,will do(J all 01 or(�portions � Commercial �
� ot the work,and the struclure is not intended or offered for sale(Section 7044,Business and Professions Code:The m �
� Contractors'State License Law dces not appty to an owner of property who,through employees'or personal etfort,builds
� or improves the pmperty,provided that lhe improvements are not intended or offered for sale.If however,the building or
� improvement is sold within one year o1 compfelion,the Owner-Builder will have the burden of proving that it was not built
p or improved for the purpose of sale.).
� (�I,as owner ol ihe property,am exclusively conVacGng with licensed ConVactors to consiruct the project(Section
z7044,Business and Professions Code:The Contractors'State License Law does not apDly to an owner ot property who Valuation: s �� Adj.Area:
N builds or improves mereon,and who conVacts for lhe projecls wilh a licensetl Contractor pursuant to Ihe Contracmrs'State QUANTIIY DESCRIPTION FEE
License Law.).
Q � ( Ac D15c.o...wLC,1
o U I am exempt hom licensure under the ConVactor's State License law lor the foilowing reason(s): �
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"—' By my signature below I acknowledge that,except tor my personal residence in which I must have resided tor at least one W
o year prior to complebon of the improvemen�covered by ihis permi[,I cannot legally sel�a structure that I have built as an W
a owner-buiider if it has not been consimcted in its entirety by licensed contractors.I understand mat a copy of the applicable
� law,Section 7044 of the B�siness and Professions Code is available upon reduest when this application is submitted or at
X the following Web Site:http/�mav.leginto.ca.gov/calaw.html. �'
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o UATE: SIGN: �
� LICENSED CONTRACTOR'S DECLARATION � �
w I hereby aftirm under penalty of perjury that I am licensed under provisians of Chapter 9(commencing with Section 7000)
m ol Division 3 of t�e Business and Professians Code,and my license is in full force and effect. J
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y UCENSE CLASS: LIC.NO.: za
aZ DATE: CONTHACTOR: �
a WORKER'S COMPENSATION DECLA(iATION �
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECWiATIONS:
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oI have and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION:
� Section 3700 0l the Labor Code,for the pertormance ol the work for which ihis permit is issued.
Q r PLAN REVIEW: Q�o-. '�}"
� �I have and will mainfain Worker's Compensation�nsurance,as repuired by Section 3700 of the Labor Code,tor ELECTRIC: TJ�, C��d
� the peAormance ot lhe work for which this permit is issued.My WorkePs Compensation Insurance Carrier and
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a PolicyNumherare: PLUMBWG:
� CARFIER F���h.A L ��{ �^,�� MECHANICAL:
� POLICYNUMBER �71� 'L6 d^c4 INSPECTION FEE:
N (THIS SEC�ON NFED NOT BE CAMPLEffD IF THE PEAMR IS FOR ONE HUNDRED DOLWIS($100)OR LFSS�.
� ISSUANCE: �O .�j-r}.
0 t certify ihat in the peAormance of the work br which ihis permit is issued,I sl�all nol employ any person in any manner so as to
o hecome subject to the waker�s Compensation Laws ot Calitomia.Md agree that if I shoultl become subjecl Lo ihe worker's SMIP:_ �. �
� Compensalion proasions ot Sec6on 37IX1 of lhe Labor Code,I shall IorUnvith compl wi _ prouis' ENERGY P/C:
LL DATE: �b � APPLICAN7: ENEFIGY PERMIT:
� WARNING:Failure to secure Worker's Compensation overage is urA wlul,and shall subject an employer to criminal RETENTION FEE: 01'3 . �
w pena�ies and civil tines up to one hundred thousand dollars($100,000),in addition to the cost ol the compensation,
�- damages as prmided for in section 3708 ot the labor code,interest,and attomey's fees. PRE-ALT FEE:
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a CONSTRUCTION LENDIN6 AGENCY BSAF:__ � . O�
w I hereDy atfirm under penalty of perlury that there is a Construction Lending Agen�y for t�e peAormance ol the work for
� which this permit is issued(Sec.3097,Civ.C.).
� LENDER'S NAME
� LENDER'SAD�RESS:
TOTAL FEES
a I ceAify that 1 have read this application and s[ate mat the above information is cortect.l agree to compty with all city and SQ�,
Z counry ordinances and state laws relating to 6uilding consVuction,and hereby authorize represenk�tives of this county to COMMENTS:
o enter upon the above-mentianed proDerry for inspection purposes.
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¢ PERMITTEE NAME(PRI � —`�/ ,0 3 �
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= SIGNATURE OF PER� DATE T— RECEIPT H `���� PAID BY: 10 l,a VALIDATION: " �\
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WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant'S Copy
CITY OF DIAMOfVD �AR
INSPECTION RECORD
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SET�BACfC/,LETfER ,,,t= �� TRACTANDLEDGER
FOOTINGS FORMS ' SiNITCH GEAR
S�p,g - - _ COMMERCIAL HOOD
UG.PLUMBING' - T-BAR
�UG.ELECTRICAI'� `��� , �� INTERCEPTER
� �;�:r ��� ,
�UFER�GROUND_�', '` � HOT MOP/SHONIERPAN
_ _ .._ �.
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECENED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONOUIT
SHEAR�WAL"LS;EXTERIOR - °' � ` POOL/SPA' _
SHEAR,WALLS-INTERIOR�:�. .- - ; ' _ ` - - `_ . ` ROUGH PLUMBIN6 �� �_" "' -
�`
FRAMWGNENTING . ` ' - ! � � ROUGHELECTRICAL'j� • -`''� _
ROUGH MECHANICAL ;' ,..,, >':'=� �. ,;_� : . -:�--'°" RqUGH MECHANICAL-:: , _ �
ROUGHELECTRICAL W(-,j,C( ;) � GASTEST' - - -
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ROUGH,PLUMBING. : . � .� `� ;� �` , :� � •' .� PREGUNITE '� ��'i . .
_ _ , ,
INSUlATION WALL POOL PRE,DECK.BONDING ��'�� ' ' � '�`�� -�' �� � '� `
,. :�'. ,�i
INSULATION CEILING �P TRAP �� �� _
DRYWALL FENCE;/GATE/ALARM�
LATH(PRE) FINALPO.OL ,����; _ _
LATH EXTERIOR WALLS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�T( )2ND( )LIFf
SCRATCH COAT WALL BOND BEAM '
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION R0:FRAMING PLANNINGAPPROUAL _ „.=;' _
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"` ` '� ' `ROUGH fIRE APPROVAL- ' . . `
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FINAL BUIL�ING <�; . ._ - " ` , �
FINAL MECHANICAL , � FINAL FIRE DEPARTMENT, '�; - `:����
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�FINAL ELECTRICAL :.; .' ' - . l0' . ' - ` FINAL PLANNING'..,` ;
FINAL PLUMBING •` . , � �. , :,' . � FINAL ENGINEER{N6/PW: ; • .:` ` ` -
. :
T.C:of OCCUPANCY '' : i - -• > � FINAL COMMUNtTY SERVICES � _
CERT.�of OCCUPANCY,�_�� ,. ,- - � � ;�; .�..:.�,. � �� � �. ,.." EINAL HEALTH DEPT.� �,�,., .
FINAL IMDUSTRIAL INASTE ••. . •.'= <., '� = -
COMMENTS: --- -- -- -- -- —
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