HomeMy WebLinkAbout12750 (9) ��_ CTTY OF DIAMOND BAR n
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERYICES
c 21660 E.Copley Drive Suite 190
(909)SSO-3195 Fax(909)861-3119 PRESS
����°�� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE � �'7 v UI+9�I� U I S�l� � /Y S APPLICATION�-Z /�,��UMB R�� A�
o ADDRE55 DATE � J
� APN LOT TRACT DATE �2`� ��' /h ONST. GRO�UP
SOWNER
ApDRESS ZONING SETBACKS
� CITY ZIP TEL. R�RT AW ❑�
APPLICANT TEL. SIOE/SIDE STREET RW ❑
� CONTRACTOR �' 0 ✓� �G t SIOE ❑
� ADDRE � PROPOSED USE
0 CITY ZIP�,_ TEL.
� ARCHlENG/ �
DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FAGTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/qEM
O
I XEREBY AFFl10.1 UNDEfl PEN/LL.TY OF PEIWRY i}IAT 1 AM EXEMPT FNOM THE CONTRACNFS LI• G9�8gfl�CHIpOR
8 CENSELAWFORTNEFOLLON�Wc1REASUN�SEG703f.6B113WESSANDPNOFESSION5000E:ANYCITYOR (n
ppUHTYWHICfIREGUIHE5A0EpMRTOCONS7RUCT.AL7E0.�PPOHE.OEMDUBM.Of7REPAIRANV$TRUG UJ P�110�DBCk
il1FlE.PRqll TO RS RSUANCE,ALSO f1EW f1ES TME MPLICANi FOR SUCH PERMIT TO flLE A SICINED w
CTAiEA1EM 1HIR HE OR SHE IS LICEN3E0 PURSUANT TO THE PRDYIEIONS OF THE OONTMCTORS U•
CENSE LAW�CHAPTER�(COMMENCINO WITH BECT�ON TOW)OF�NISION J OF TNE BU9�NESS AND PRO- � POOUS�8
FE9510N5 CODE)OR 7MAT HE OR 6HE IS EXEMPT THFAEFHOM AN0111E 9ASI5 FOR iHE ALLEOED E]CEMP�
TION.ANVVIOLATIONOFSECTION70]7.6BVANYMPIN:ANiFORAYERMITSUBJEMSTHEMPLICANTTO Z Re-Root
� 11GVILPENALiYOFlpTIJORETMANFNENUNOREDDOLtAp513boo).�: � J
� OI.A60VJNEROFTXEPNDPERTV,ORMYE4%AYEESNA7NN'AGESASTiEIR90LECOMPENSATION, �pmme�Cjal
MALL 00 THE YYORI(AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR S�LE(SEC.7PII,B1151-
NE55 NO VROFESSIONS WOE:iHE OONTRACTORS LICENSE Uw DOES NOT APPLY TO AN pWNEfi OF
y prppERTVMAiOBULDSORiMMPROVE3TIEREON.ANDMM1W00E56UCHWORKHIM3ELFORHERSELPOR =
Q TlSqUGI1q5 OR XEHOWN EAIPLOYEFS.PROVIDED 1NAT8UCH IMPROVEMENTBARE NOT MTENDEDOR m
� OLfEREUFbR9PLEli1WWEYERTNEBUL.DINOORNAPROVEMENTISSOLDWRMINONEYFAROFCOYPI,E
TqN,TFE OWNERBUIIDEH WILL MAVE 7HE YURDEN OF PROYINo TN�T NE OR SHE DIO NDT BUILD OR
MPFqYE FOR 7ME PUAPD9E OF SALE�.
W ❑I.ASOWNEROFiHEPROPEHTY,AIAE%CLUSIVELYOOMILICfINOWRNLICBJSEDCONTRAGTORS
� TO OON"TRl1CT iHE Pf10JECT(SEG 70N.9USINE55 AND DNOFESSIONS COOE:THE OOHTMCiORS U� Ve1Y9110n AQI.AREA
CEHSE UW OOEB NOTAPPIV TO MI OWNER OF APROPERIY W17�BUILDS OR IMPROVE9 TIEREON,AN�
yy1qCON7pACTSFORSUCHPRQ1ECiSVA7HA00NTRACTORf9�LICENSEDPURSUANTTO7HECONTfUG QUANTITY DESCRIPTION FEE
� idi9 UCENSE LAW.). /.
�IAM IXEMFT IMDEH SEC. B.f V.C.FOfi THIS REASON � G 'e I V f f O
� �N u It f�c.� ZO
�= OATE OriNER �
W ti e 2C�
� LJCENSED CANTRACTORS DECLARATION � S D
� IXEREBYAFFIiWIINDEFVENALTYOFPER1URYhU71M1UCEN5EDUN�ERPROV1510NSOFCHAVTEH Ur w(�r ,� ` � 7 't� y O
� �(CO/MAENCINO WITN 6ECTION 70W)OF DMSION a OF TNE BUSINF.$S AND PROFESSKKJS COOE.AND Z
X MV LK;EIVSE IS N FULL FOHCE M10 EFFEGT. /J �
0 LICENSE CLASS �/GM LIC.NO. /v • �• �
�j DATE I�'�I"7 � J
CONTMCTOfi 0.
tL
� WORKERS'COMPENSATION DECLARATION �
� I HEREBY�FFlRM UNOEH PENALTY OF PERIURY ONE OF THE FOLIAWING DECLAAATIONS: U
� z
a
� �IWNEANDWILLNAMTNNACERTFICATEO�WNSEMT06ELF•INSUREFORVYONKERS' _
G�D►IPENSATqN,ASVfiOVIDEDBY3ECTONe70oOFTHEWORCODE,FORTFfEPEHFORAI�NCE W
OF THE WORK FORVNIN7Nh11S VERMIT IS ISSUEU. �
� �1 MAVE AND WILL MAIMAIN WONKENS'COMPENSATION INSURANCE,AS REOIARED B'/SECTION
QQ 97UOOFTqELABORCOOE,FOHTMEPEHFORMMlCEOFTHEWORKFOHWHIWTHISPERMITIS
ISSUED.MV WO.N�K1EAS' VENSATION INSURANCE CAPRIER ANO POLICY NIlu18ER�RP CONSTRUCTION
j ciwRIER CVT�1 �-W�1'1��" �/���'^'a�� PLAN - EW
� POLICY NUueER �-�7 : _ ____ —
ELE -t-��
0 (Ri68ECIqNN�NOTBE001.�LETmOF7FEPER1AfI6Fi�RONE11lMOREDDOLI/ASI5�00)ORLE^.�} PLUMBING
z 1 CERTIFV TNT INTHE PERFORMANCE OF THE WORK FON WNipl TFNS PERNIT IS ISSUED,1 MECHANICAL
(J SIMLL NOT EMPIAY ANY iERSON IN ANY MANNER 50 AS i0 BECOME SIIBJECTTO THE
� WORKERS'O]MVENSATIONUWSDFCALIFORNIA.IWDAGREETM�TIFISFIOUL�BECOME INSPE fEE
6l1BJECT TO THE WOFIKERS'COMPENS117qN vqONSIONS OF SECTION 7�0o OF 7HE LABOR /�/�'\
OCWE.ISH�ILfOR'�M"AIHCOIAPLYWITHTH0.5EPHOVISIONS. ISSUANCE �y��'1 �_yL
' p pA7E: APPI.IcaNT. SMIP r
� ENERGY P/C
WMNING:fNWRETOSECURE WORKER5 COti1FENSATION COVERAOE IS UMAWFIII,ANO SHALL BE
�y SUBJECTANEMPIOYER70CRIMINALPENALTIESANOCMLFINESUPTOONENUNDRE07MOU5AND ENERGYPERMIT ����
DOLLMS(itOD.000�.W ADD�TWII TO THE CO6T OFCOMPENSATKN.DM1ACiE514S PROVIDED FOR IN
J SECTqN770BOFTHEUIBONCWE,NTEREST,MI�ATTOMEYSFEES. RETENTIONFEE:
OCONSTRUCTION LENDINGAGENCY PRE•ALTFEE: �'+i�t nc T/A11d��..,�
� 111EREBVAFFlpMUNOERVENALTYOFPElWRYiMATTMEREbAGONSTRUCTIONLENDINpAGENCY i�iTTT TT7�T/'1 AATn C��
Z FORTHE PERFOFMANCE OF THE WORK FOR WHIQ1 Tl115 PERMIT IS ISSUED(SEC.30Y7.G�V.CJ.
W
� lB�DEfl'S NAME
F- LP�DEH'S ADDRE33
W ICERTIFYTMA7IHAVEREMTNISMPLICATIONANDSTATE7}UITTNEABOVEWFONMATIONISODqRECL TOTAL FEES
ONM � � � �
� IAGREETOCdAPLVN7TNALLCT'ANDCOl1NNORDINMICESANDSTATEUWSflELATIN(i70BlILDINO
CpNSTiiUCTIOM,AND HEREBV Mf�IqRIZE REPRESENTATIVES OF 7HIS ODUNTY TO ENTER UPON THE
S� ABOVE•MEMIONED PHOPEN7Y FOR INSPECTqN VURPOSES. COMMENTS I
� J� d`1 I�i( ��v�.
� nE rtr e,y�(`NTl _- .. r'
� �
� SIClNA E OF PERM�T7EE �TE
� RECPT.NO. PAID BY ' VALIOATION
WHITE—Depehment Copy,YELLOW—Finence Copy,PINK—Assessa Copy,GOLDENROD—FileCopy,6REEN—ApplicaMY Copy
� ' ' � . , , , . .. , . . , ,. , . , . , � 'r , . , , . : , . . ..
_.... - - -.__.. ....._ . .. .
CITY OF D1�t,h�60ND BAR
INSPECTiON RECOl�D
s � � s - � e � � -
S�T BACK ' • , - `' ' FLOOR,J�IST
�I'GS/FORMSISTEEL ` ,_ , �HA REQMTS
EIECTRIC GROUND �' ' UNDER FLOOR DUC7
GROUND PLUMBING UNDER FLOOR CG�IDUIT
SLAB GRADE FIREPLACE FaUNDATI�M11
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MIQ HT. BOND BEAM
RODF SHENTHIfJG - '' - � : 8 FT. BOND BEAM
FRAMING/VENl`ILIATION ' I � FINAL B�ND BEAM
ROOF COVER ' PRE-GRADING
ROUGH HEATING BENCHING �
� ROUGH ELECTRIC ' 7 ,.. - ' — RQUGH GRADING
ROUGH PLUMBII�iG " � FINISH GRADtNG
SHOWER/TUB TEST POOI.E�ECTRfC
EXT. LATH/51DING I pOOL FENCING ,
WALL INSULATION i i POOL FINAL
CEILING lNSULATION i E DFF SITE IMPS.
DRYWALL NAILING : pEDICATIONS
SEWEF�� FINAL ENG.
SEPTIC TANK , LANDSCAPE/IRRIG. ;
SEEP PIT/L..L. � i � �N SITE IMPS. � ,
GASA�R TEST ! � FINAL ZONfNG i
F1NAL.CONST. j __ —; � FIRE'DEPT. FINAL
FINAL NEATING i _ I HEALTH DEPT. FINAL j
FINAt�LECTRlC Z c x. �' ! ; DEV. FEES PAID �
F91�Ai.PLtlMBING � � G ; ! ENERGY
._.
�
j a� +� m -_ � _—__.�
COMMENTS �
. ,
t.1IA'; � '
SEPTIC TANK SIZE' •'�' �` �` �'"�-• �
SEEP PIT/U SIZ��a..::� •�.�a,:;1���•�.a�:� :ji> 't'!'1:a
� �'��I • �•YA1'r" 7'•T11
i ,i�i 1�rJs�:T-7'T' — _ —_—_.__
�
, � y�.