HomeMy WebLinkAbout18125CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
y 21825 E. Coplcy Drive
909) 860-3195 Fa c (909) 861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
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DATECATION /
7/ NUMB R/ I p!
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c ISSUE TYPE OCC
APN T TRACT DATE CONST. GROUP
p OWNER i
ADDRESS ZONING SETBACKS
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g APPLICANT TE REAR
SIDFJSIDE STREET RW
CONTRACT P 4NCE INSTALI Fpg , SIDE
ADDRESS
p PROPOSED USE
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o ARCH/ENG/ OESIGNER NO.OWEL. NO. NO.
n. ADDRESS UNITS STORIES BEOROOMS
CITY ZIP TEL.
c» DESCRIPTION S. FT. FACTOR PSF ADJ.AREANALUATION
p OWNER•BU LDER DECLARATION SFRlADDlREM
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p I HEREBV AFFIRM UNDER GEN LiY OF PERAlHY THAT 1 AAA E%EMPT FROM THE CONTMCTORS L4 G2fe9B/C81pOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7071.58USINESSANDPROFESSqNSCODE:ANYpTYOR (n
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STATEMEM TUT HE OR SHE IS LICENSED WRSUM7T TO TNE PROVISIONS OF THE CONTMMORS U
CENSE UW (CNAPTER 9(COMMENCWO WITH SECTION 7000) OF OIVISION J OF iHE BUS NESSAND PRO u' PooUSpa .
FE531ON5 COOE) OR THA7 HE OR SHE IS EXEMPT THEREGROM /NO THE BASIS FOR TME ALLEOEO EXEMP•
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NESS AND VROFESSIONS CO E: TIE CONTFACTORS IICENSE LAW DOES NOT AVPLV TO AN OWNEN OF ?
FROPERTY WHO BUROS OR qAPROVES THEREON. ANO W170 DOES SW7 WORK HIMSELF OH HERSELF OR
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O 4 OY/NER OF iHE PaOPERTT, AM E%ClUSIYELY CONTMCTW W1TH UCENSED CONTMGTORSQTOCONSTRUCTTHEPR0.JECT SEG 7061, BUSINE55 ANO PROFESSIONS CODE'. TME CONiRACTORS Lb VaIU81I0f1 AQI.AREA
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WORKERS' COMPENSATION DECLARATION .j 7L I' a
1 HEREBYAFFIRM UNDER PENAL7Y OF GE0.1UR'I ONE OFTHE iOLLOWINO DECLAMTpNS: Z
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IHIWEMIDWILLMAMAINACEHTIFICATEOFCONSEN7TOSELF INSUREFORV.OR1(ERS' _
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ENEHGY P!CWARNINO: FAIUIRE TO SECURE WORNERS' ODhIPEN5 T10N COVERAGE IS UNLAWFUI.., AND SNALL BE
SUOJECTANEMPLOYERTOCRIMWALPENALTIESMlOCMLFNESUPTOONEHUNOREDTI0USM10 ENERGYPERMIT
DOLURS (S IOD,0o0), W ADDITION TO ME fAST Of COMiENSATqfJ. DMIAGES AS PROVWED fOR IN
ECTION770lOFTHELABORCODE,Pl7ERE5T,11NDAT70RNEY5FEE5. RETENT ONFEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
CC IN[REBVAFflRMUN ERVENALTYOFPEFLIURYTHATTHEREISACONSTRUCTIONIENOWGAGENCY
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Zw LENDER'SNAME
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CONSTRUCTION. AND HEREBY AUiHOR ZE REPRESENT TIVES OF THIS COUNTY TO ENTER UPON THE
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WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLOENROD--Fite CoDY. GREEN—Applicant's Copy
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FTGS/FORP 1S/STEEL _ FHA REQh1TS •
ELECTRIC GROUfJD--- -- ' '; UP•dDER FLOOR DUCT {I I
GR UND PLUMBING i_ __ i Ui lDER FLOOR CU DUIT I I _
SLAB GRADE i j _ FIREF'LAC OUNDATION I 1
TEMP POWER I I I FIREPLACE BOfvD 6EAti1
WATER SERVICE __ h11D HT. EOND BEAhrI ____ •" '"
ROOF SHEATHING I I 8 FT. BOPdD BEAtit
FRAPAING,NENTILIATION I FiNAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATIf G BENCHING
ROUGH ELECTRIC R UGH GRADING
ROUGH PLU A8ING FINISH GRADIPJG
SHOWER/TUB TEST POOL EL.ECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATIQfJ POOL FINAL
CEILING INSUL.f,TION OFF SITE IMPS.
flRYWALL NAILIfJG DEDICATIONS i ---
SE4VER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE I PS.
GAS AIR TEST FINAL ZONING
FINAL COfVST. r!RE DEPT. FIPJAL
FINAL HEATING HEALiH DEPT. FIfJAL
FItJAL ELECTRIC j DEV. FEES PAID
FINAL PLUPABING _rl C E dERrY _—`
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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