HomeMy WebLinkAbout17672 - 21700 LAURELRIM DRJ
CTTY OF DIAMOND BAR
DEPARTIv NT OF COMMUNTIY & DEVELOPMENT SERVICES
21825 E. Copley Drivo
909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
JOBSITE n + / APPLICATION PERMIT P/C
ADDRESS_I'10 `_G I YCIJ 1%%l r' D! [-Ci". DATE O NUMBER k
ISSUE
v/1 TYPE OCC
APN LOT TRACT DATE CONST. GFiOUP
OWNER
ADDRESS ZONING SET9ACKS
CITY ZI TEL. - FRONT RW
APPLICANT '„ REAR
SIDFJSIDE STREET RW
CONTRACT SIDE
ADDRESS
CITY ZI TEL. .I PROPOSED USE
ARCH/ENG/
DESIGNER NO. DWEL NO. N0.
ADDRESS UNITS STORIES BEDROOMS
CITY ZIP TEL.
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
OWNER-BU LDER DECLARATION
SFRlADD/REM
I HEREBV FFlRM UNDER CFNALTY Of PEiWRY THAT 1 AM E%EMPT FROIA TNE COMTMMORS ll- GefepB/CelpOrt
CENSEUWFORTHEFOLLOVlINpHEA50N(SEC.70.71.68u51NESSANOPROFE5510NS00DE:ANYqTYON (n
COIMTYVMIGIHEOU RESAVERMRTOCONSTRUCT,ALiEi IMPROVE.DEMOUSH.ORREVIIRANVSTRUC• W P81I0/DBCkNRE, iRqR TO R9 ISSUANCE, ALSO REOUIRES'ME APPUCAN7 FOR SUqI PERMIT TO FILE A SK,NED WSTA7ENENT7WlTNEIXiSHEl5UCENSEOPURSU+IM TO TME PROVISIONS OF iNE CONTMCTORS LI•
CENSE LAW (CHFPTEfl Y(COMMENCWO W1TM SECTION )000) OF DMSION J OF THE BUSINE53 ANO PHO
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FESSqNS COO OR THA7 HE OH SME IS E7(EMPT TMEREFROM ANO THE BASIS FOR TME ALLEGE EXEMP•
TION.ANVVIOLATIONOfSECilON7071.68YANVMPLIGWTFORAPERAIITSUBJECT57HEAPPUCANTTO Z Ra-Roof O
A GML fEWLLTI OF NO7 MORE 7HAN iiVE MUNDREO DOLLARS (i5ao).k
04 w^WNEROFTHEPPOPfRTV,ORMVFM7LOVEESWITHWACESASMEIqSO ECOMDENSATION, O C,pmm9fClel -
WILL 00 TME WOPo4 AND TME SiRUCTURE IS NOi NTENDED OR OFFERED FOq SAIE (SEC. 70/, BUSI• J
NESS AND VROFESSIONS CODE: THE OONTRACTORS LICENSE LIiW DOES NOT ADGLV TO Ml OWNER OF
PROPEPTY NT1O BUILDS OR IMPpOVES TMEREON, AND VA10 DOES SUCH WORK MIMSEIFOR HERSELF OR
THROUGH/USORHEROWNEIAFLOYEES,PROVIDEOTHATSUp11MPROVEMENiSMENOTINTENDE00i1 CD
OFFEREDFORSALEF,IpWEVEfliHEBUIDINOORIMPROVEMENTIS IWITMINONEYEAROFCOMPLE
T10N. THE OWNERBUIDEN WILL IU1VE iME BUROEN OF PPOYINa iHAT ME OR SHE DiD NOT BNLO Ofi
pAPROVE FOR TIE PUROOSE OF Si4E
O L O ER OFTNE iROPERTY, AM E7fCLU5NELY COMMCTINO YATM IICENSED CONTMC70R5
TO CONS7RUCT THE VR0.IECT (SEC. )Ou. BUSINESS AND PROFESSIONS CO E: THE CONTMCTORS ll• VO etiql ADJ.AREA
CENSE UW DOES NOTAPPLY TO AN OVmEH OFAPROFERiY Wlp BUIlDS Oq IMPROVES 1HEHEON, AND
WHOCOMMCTSFORSUCHOROJECTSWI7HACONTMCTO{i S)LICENSEDFUHSl1ANTTOTHECONTM6 pUANTITY DESCR PTION FEE
TORS UCENSE LAw .
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O I M1 EXEIAPT UNDER SEC. B, a P.C. FOR TMIS REA..ON aU
OATE OWIJER
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LICENSED CONTRACTORS DECLARATION –iw
IHEHEBYAFFIHMUNDERPENALTYOFPEiUUMTNATIAML CENSEDUNDEHPROV15KKiSOFGHAPTER
Y(COA/uENCMOWfTHSECT10N7000lOFONISiON]OFTHEBUSINESSANDPROFESSiONSCOOE,MA Z
IY IICENSE IS N fL4 FORCEAND EFFEGT. m
LICENSE CLAS 1y., LIQ NO. , j
DATE 4 fi, CONTMCTOR a
WORKERS' COMPENSATION DECLARATION a
IHEREBYAFFIRMUNOERPENALTYOFPERIURYONEOFTMEFOLLOWiNODECLARA71pN5: V
Z6
I HAVEAND WILL AI INiAIN A CERTIFICATE OF CONSENTTOSEIF•INSUFlE FOH WOfiKERS' 2
CMIPENSIRqN,A57ROYDEDBVSECTION770oOFTHELA80RCO0E.FORTHEVERFORMANCE WOFiHEWONNFOFWHICHTMISPERIAITISISSUED.
1 HAVE ANO VIILL AIAINTAM WORI(ERS' COMPENSATION INSUMNCE, AS REOUIHEO 8V SECTION /
770DOF THE LABOR CODE. FOR TME PERFORMqNCE OF 1ME WORK FOH WMlpf 7H15 PEPMIT IS /
ISSUED. MY WORKEB AIPE SATION IN RANCE C RRIER M1D POLICY NUMBER ARE: CONSTRUCTION (
CAfiRIER ( PLAN REVIEW
PoLICY HUMBER .,. "' ELECTRIC
IH6SEci oNNEmroisEml i;ErEooFnEPEw fiswRa+EMl.raiEooaWl5R wlaaLEss1 PLUMBING
ICERTIFYTHA7MITNE ERFORIAANCEOFTHEN ORKFDHWHICHTHISVEM/ITISISSUED,1 MECHANICAL
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSA7qNLAW50FCALIFORNI0.ANDACREE7MnTFISHOIhDBECOME INSPECTION FEE
SU&IECT TO THE YIORKERS' COMPENSAiION DROVISIONS OF SECTqN 970o OF TNE UBOR
CADE. SHALLF RTF(WITHCOMPL'WITHT EPROV.SqN{._ ^^
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ISSUANCE
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DATE: APPLICANI SMIP
WAqNINO:FAIWRETOSECUREWOFKERSCOMPENSATIONCOVEMGEISUNLAWFIA,ANDSHALLBE
ENEFGYPlC
SUBJECTANEMPLOYERTOCRIMW IPEWLLTIESANDCMLFWESUPTOONEMUNDRE TF10U5AND ENERGYPERMITDOLLAHS (ft00.D00 IN ADDITION i0 THE CAST DF COMVENSATpN, D A[1E5115 PROViDED FOR IN
SECTqN loe OF TfE U1BOR CODE, NITERESL AND ATTORNEY'S FEES. RETENTION FEE: _
CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
I HEREBY AFFIRM UNOER VENALTY OF PERM1IRY THAT THERE IS A CONSTHUCTqN 1EN01N0 A6ENCY
FOR TME VERFORMMICE OFTHE WORK FOR NMICH THIS PERMIT IS ISSUED (SEC.70Y7.CIV. CJ.
lEN0ER5 NAME
IENDERS AD NE55
I
ICEHTIFYTHATIHAVEREA TIISMPL1CAtIONMlDSTATETHATTNfi BWEwFORMATIONISCORqECL TOTAL FEES J[( IAGPEETOCOMPLYWfTHAILCT'MIDCWNTYONDINMICESANDSTATEUNSPELAIWOTOBVIWM6 [,
CONSTRUCTION. AND HENEBYAU7HORIIE REPRESEMATNES OF THIS COUNTY TO ENTER UVON iME
ABOVE IAENTa+ EOPPOPERTYFORINSPECTiONPUHPO5E5.
n r COMMENTS
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PER1AITfEE (PRt
o.a. o- 10—
S GNRTURE OF PERMITTEE D TE
RECPt MO. PAID BY VALIDATION
WHITE-0epartmant Copy, YELLOW—Finance Copy, PINK—Aesessor Copy, GOLDENROD—File Copy, GREEN—ApplicanCa Copy
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CITY OF DIANlOt!!D BAR
livSPEC i iON RECORD
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A,
SET BACK • • ~ FLO R JOIST. '
FTGS/FORMSISTEEL ; FHA REQMTS
ELECTRIC GROUND UNDER FLdOR DUCT _
GRDUND PLUMBING UNDER FLOOR CUf IDUIT , •
SLAB GRADE I I FIREPLACE FOUNDRTION I
TEMP POWER I I FIREPLACE BOND BEAh1 '
WATER SERVICE I ' MID HT. BOND BEAM
ROOF SHEATH NG <2 ' 8 F'. BOND B AM. ' j
FRAMINGNENTILIATION FINAL BOND BE/1M
ROOF COVER f'/ PRE-GRADING
ROUGH HEATING I I BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING I, ; FINISH GRADING
SNOWERlTUB TEST i , POOL ELECTRIC
EXT. LATHlSIDING ; i POOL FENCING
WALL INSULATION POOL FINAL
CEIUNG INSULATION ! j OFF SITE IMPS.
DRYWALL NAILING j bEDiCATIONS
SEWER FINAL ENG.
SEPTICTANK j LANDSCAPE/IRRIG. .
SEEP PIT/L.L ! ON SITE INIPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. I ! FIRE DEPT. FINAL
FINAL HEATING ! HEALTH DEPT. FINAL
FINAL ELECTRIC ;' DEV. FEES PAID
FINAL PLUMBING j ! ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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