HomeMy WebLinkAbout18815 (21) �` C1TY OF DIAMOND BAR
� DEPARTMEIdT OF COMMUNTIY&�DEVELOPMENT 5ERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
X���� BUILDING PERMIT APPLICATION FIRMLY
} JOBSITE APPLICATION /��PERMIT�Gf� p1Cn �
o A�DRESS a311�� C"�-NTI,i, Sr'�Q.ZNG �./tNE DATE I O I'� �`�NUMBER �" x VZ � ZD
� APN LOT TRACT ISSUE I TYPE OCC
p OWNER _ �"�R . P.N�d DATE_ l� �J� CZ CONST. GFiOUP
o ADDRESS ZO � ZONING SETBACKS
z CITY C'1La=1�i�nc�4 ZIP�ll�l TE Z.6 �-34 FRONT _ �J' � RW ❑
p APPLICANT 'M2• P•N � P�-�c-'1- TEL. � REAR N p
7d.. SIDFISIDE STREET � RW ❑
� CONTRACTOR SIDE S� Q
A�DFESS G���
� CITY ZIP TEL PFiOPOSED USE Tw'����
o AFCWENG/
OESIGNER
t�ii NO.DWEL NO. �` NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES �' BEDROaMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAFiATION SFR/ADDlHEM
O
p 1 HERfBY AFFIRM UNDER VENAL7Y OF PERIURY TNAi I MI E%EA1PT FROM iHE CONTMCTORS LI• G2f8961CafpOR
W CENSEUWFOR7HEFOlLONANOREASON�5EG70]1.68USINESSMIOPFOFESSIONSCODE:ANVCITYOR (n
U COVNTYWHICMAEOUIPESAPERMITiOCANSTRUCLKTER��aFlOYF.DEA�Ol15H2ORREPAIRANVSTRUP W P21i0/DBGk
W TURE,VRqq TO RS ISSUANCE.AL50 REWIRES THE�7FLIGWT FOR SUCH PERMIT TO iILE A SIGNED W
� STATEMENT hIAT NE OR SHE IS LICENSEO OURSUAIR TO ME PROVISIONS OF TME CANTMCTORS LI• �
� GENSE LAW(��PTER i(COMMENCM6 YATN SECTION 7oa0�OF DMSqN]OF THE BUSiNE55 ANO PR0. POOVSPB
� FESSqN5CO0E�ORTMATNEOF5ME15E%EMPTTNEPEFPOMANDTHEBASISFORTXEQLEGEDE%EMP• C7
TqN.�M/V10LATIONDFSECTION70]1.6BYANVAPVLICANCFORAVERMITSU9JELTSiHEAvp�ICANTtp Z qe-ppp� •
A CML VEN�ITV OF NOT AWRE TMAN FIVE HUNDHED OOLURS(f So011:
� ❑L�dNNEROFTMEPROPEHiV,OR�IYEAIPLOYEESWITIWA0ESA57HEIR50lECOMCENSATAN, 0 CORIff10fCIflI
Z YV4L 00 TME WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFfD FOH SAIE(SEC.7UN.BU51- J
� NE55 ANO GROFESSIONS CODE:iNE CONTMCTORS UCENSE LAW DOES NO:APPLY TO AN OWNER OF j
PROPERTY NM1q BU0.D5 Oil IMPROVES TH[AEON,AN�NMO OOES SUCM WOAN HiMSEIF OR HERSELF OR
WTM(iOUCHH150RHEflOWHEMVLOYEES,FROYlOEDTHAT5UG11MPROVEMENiSARENOTWTENDEDOR m
0 OiFEREDFOR5ALEIF,MOWEVER7ME8ULD:NdORIMPROYEMEMRSqDWiTHiNONEYEAqOFCOMPLE-
Z iION.THE OWNER�BVILDER MnLL HAVE T17E BUR�EN OF PROViN6'MA7 ME OR SME Di0 NOT BUID OR
� pAPROVE FON iHE PURP0.5E OF SALE} ,
w OLASOWNEROFTHEPROFEHTY.AMEXCLUSNELYGONTRAC1iNGWITHLICENSEDCONTMCTORS
� TO CONSTRUCT THE P110.1ECT(SEC.70u,BUSINE53 AND PROFESSIONS CODE:THE CONTRACTOHS LI- V01U3i1Ot1 � ADJ.AREA
W CENSEUWDOESNOTAPPLYTOIWOWNEROFAPROPERTVN'MDdU1LDSOHIMPROVESMEFEON.ANO
� WNOCOMRACTSFORSUCHVROJECTSVA7NACOHTMCTOq(5)L10EN;fDPUPSUANTiOMECONTMC QUANTITY OESCRIPTION FEE
� TORSLICENSEUW).
� O I AM E%EMPT UNOER SEG. B.i i.C,iOR THIS REASON Q
� J U
LL DATE �� �S Cy nNR1Fi1 K FS 1 q 1J �J♦ �T L R 1 U
0
� LICENSED CONTRACTORS DECLARATION W
� I XEHFBV AFFIRM UNDER PfNAITV OF VERJURv TNAT I M1 UCENSED UNDER PROViSIONS OF CHAPTER � .
� Y(CYMIMENCIN6WITNSECTION7000�OiDNI5qN30FTHEBU51NE55ANOGP.O�E5S10f�5G0'JE,AND Z '
�� MY UCENSE IS IN FULL FORCE ANO EFFECT. m
� `
0 LICENSE CUSS LIC.NO. � (
V DATE COMRACTOR d
W .
� WORKERS'COMPENSATION OECLARATION �
� IHEREBV�iFIRMUNOERPENALTYOFVE0.1Ui1vONEOFTI/EFOLLONnNOOECLARATIONS: Z
� _IMAVEANDNnLLMAiMA1NACERTIFICATEOFCONSEHTTOSElFaNSUHEFOR�WpKERS' _
GOMPENSATqN,ASPROVIOEOBYSECT10N�7o00FTMELABOi1CODE,FORTHEPERFOFUANCE w
Q OF THE WORK iOR WHlpl THIS VERMiT I$ISSUED. �
� _IHAVEANDMALLMA�NTAINWORKERS'COMPENSATIONtNSURANCE.ASREWIREDBVSECTqN
O87000F THE IABOR CODE.FOR ME PERFORMANGE DF THE WORN FOR NM1CM THIS PERM1T15
� ISSUED.MVWORNERS'COMGENSATIONINSURANCECARRIERANDPOLICYNU/ABERARE: CONSTRUCT�ON �
� CARRIER PLAN REVIEW
� VOLICYNUMBER ELECTRIC
0 (iYEssEC11p+NEEDNOTBE00RRF�mOFTEFERMRSFOHONEHI�OP£�DOIUiRS6��lORtFsst PLUMBING
Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKfORWHId1iMISPERMIT15155UED,1 MECHANICAL
C} SHALLNOTEMPLOYANYPERSONNNJVMANNERSOASTOBELOMESUBJECTTOTHE
� V/ORKERS'COMPENSATqNlAw50FCAL1iORNiAJW0A6REETMATIF151KKriDBECOME INS?ECTIONFEE
S SU&IECTTO TME WORNERS'COMPENSA7qN iROVI510N50F SECTION 77000F 7ME UBOR
COOE,I SHALL iORTMMTH GOMPLY WITH TMOSE PROVISIONS. ISSUANCE �
� SMIP
p DATE: APPLICANT:
� ENERGY P/C
WAqNIN6:FAILURE TO SE WRE WORKERS'ODIAPENSATKKI COVERAGE IS UNUWFUL,AND SHAL�BE
� SU&7ELTANEMP�OYERTOCHIMIWLLiENALTIESANDCMIFINE5UP700NENUNDREDTMOUSAND ENERGVPERMIT
OOlURS(5100,000�,IN ADDITION TO TME COSTOF COMPENS�TqN,DAMACES AS PROVIDED FOF IN
� SECTqN]7oe OF THE U80R COOE,NTEREST,AND ATTORNEYS FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: '
� IMEREBYAFFIRMUNDEtiPENµTYOfPERJURYiNATTHEREI3ACON5TRUCTqNLENOWGAGENCY
FOR TME PERFONMNICE OF TME WORK fOR NMICH iN15 PERMIT IS ISSUED(SEG.�oi7,CIY.CJ.
Z
w
cZ LENDEiiSNAME
i
� LENDER'SADDRESS
� TOTAL FEES '^
¢ I CERTIiY THAT I HAVE READ THIS APPLICATION AND ST�TE TIUT THE ABOVE INFORMATqN IS CORRECT. 1// �
pw., IAGREETOCOM7LYWITMALLCITYANDLWNTYORDINANCESANDSTATEUWSpEUTIN6TOBU0.DING «
CONSTRVCTION,�NO MEREBY AUTMORIZE REVRESENTATNES OF TMIS C WNTY i0 ENTEN UPON TNE
Z ABOVE�MENTIONEDVROVERTYFORINSPECTIONPURPOSES.
COMMENTS
� Pi��S11LTT M N +4t-�i J L�
VERMI ENAME PRIHT� � �!`
¢ ��t,�.���N-ct� o.� _ � L�' t��'�
�
N SIONATUREOiPERMITTEE DATE
� RECPL NO. PPJD BY � VALIDATION
WHITE—DeOartment Copy.YEU.OW—Finance Copy,PINK—Asaessor Copy,GOIDENR06—File Copy,GfiEEN—Hpplicant's Copy
1��-��
c�:�� or- ��nr,r�rsc� 6AR
� er�sf��i s�ra ��ca�o
��C��-�.����t����.-�iw�����"�.�� �►��=�,��������►_ o �_��..��►� '�. �
�SET BACK I . ; __. .��•T"'....i��•FLOOR JOIST ___ ...._� __.._.:i�,___. -
i
Fl"GSIFORMS/STEEL ' � , ; � FHA REQPv1TS �
EIECTRIC GROUND ; ' � � ' . UNDE� FC.00R DUCT I
GROUND PLUMBING ___�__ ____� i UhJDE_R FLOOR CUf,IDUIT . � � _
SLAB GRADE _,�_ __ ______I_�_FIRF_PLACE FOUNDATION I I
TEPJIP POWER I ' ; FIREPLAL'E E30PJD BEAM _
WATER SERVICE � � MID FtT. �OND E3EA���1
ROOF SHEATHING � ___ �. FT8 BOfJD BEAti1 4
-- rt------ —
FRAMINGNENTILIATION I _ _ � __ F��dAL EiOtdD 6EAM
- �---- -- --
ROOF COVER I � � PRE-GRADIh�G
ROUGH NEATING , BENCHIfJG
ROUGH ELECTRIC I R�UGH GRADING
ROUGH PLUMBING I I FINISH uRADiPdG �
SHOWER.rfU6 TEST —�
� i POOL ELECTRIC
—-�---
EXT. LATH/51DIPJG � ! POOL FENCIPlG
WALL INSULATION i POOL FINAL i I
- �---- -
CEILIPJG INSULATION ��OFF SITE IMPS.
DRYWALL NAIUNG _ _ � DE�ICATIONS
SEWER ___� _ � FINAL EPJG.
SEPTIC TANK I LANDSCAPElIRRIG.
SEEP PIULL. I ON 51TE IMPS.
GAS AIR TEST i � FINAL ZOPJING
FtNAL COt�ST. � _ �� FIRE-�E?T. FINAL
FINAL HEATING i_l HEALTH UEPT.'FIPdAL •
Fi�JAL ELECTFiIC � I DEV. FFES PAID`_
FINAL PLUh1BING e�/�-(�� �, i_� I ENERGY _
_ _,-�,�.
--- ��,, cl�io'e�,_.._._
_ ���. ,
CUMMENTS ____
SEPTIC TANK SI7_E
�SEEP PIT/U SIZE '
�.F��� -- --- — --
,. �� ; -- —
f . �- �i
�I�V� � ,I�`:� � --- --
—i
•!� j _ ' — r `; .
. ����I , . _ -