HomeMy WebLinkAbout14434CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEV LOPMEIr"f SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax (909) B61-3117
BUILDING PERMIT APPLICATION' ,
ADDRESSi1 /�
APN LOT TRACT
OA
v,NER RV ^ S QL
ADDRESS e- L
TEL7 - ' -(v
APPLICANT ��,��'TEICI07::.
CONTRACTOR
ADDR SS � —e it
CITY iip'11273 TEL.S
ARCFL'ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-CUILDER DECLARATION
I HEREBY AfFIRIW UNDER PENALTY OF PENURY THAT I AM EXEMPT FROM THE CONTRACTOnS LL
CCNSE LAW FOi THE.FOLLOWNG REASON (SEC. 7331 S B:JS.NESS AND PROFESSIONS CODE ANY
C1 YOR
COUNTY W1 nCH RECIUIRCS A PERiU.'T TO CONS •RUCT. ALTE1L:Men=% M LIO_S+ l CR RC PA:n ANY S •RJC-
TUBE. PRIOR TO ITS ISSUANCE. ALSO RE OLI:nES THE APPLICANT FCR SUCH PE RM:T TO FILE A S'G4ED
STA'CMENT TUT HE OR SHE IS LICENSED PURSUANT TO THE PR+OVSIONS CF THE CONTRACTORS L6
CCNSE LAW (CHAPTER I (COMMCNCNG WI TH SrCT)CN TOM OF D-VISION 3 CF THE PUSNESS A%0 Pn0-
FESSChS COCE] OR THAT HF OR SHE IS EXEMPT THE REFRROM AND THE BASIS FOR 1HC ALLEGFD ExrMP.
T1CN. ANY VIOLATION OF SECTION 7031 S BY ANY APPLICANT FOR A PERMIT SUNIC'S THE APPLICA4T TO
A CIVL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3•:I01)
O I. AS OWNER OF THE PTDPERTY. OR MY EMPLOYCE5 WI: H WAGES AS THE'n SOLE COMPENSATI N.
MALL DO THE WORK ANO THE STRUCTURE R NO' NTCNCCD OR OFFERED FOR SALE I;EL. 701-. BUSI.
NIESS AND PnOFESSIONS CODE THE COh'TRA.^.7CnS LICENSE LAW DOES NOT APPLY 10 AN oWNCn Or
PnOPERTY WHO BUILDS OR IMPROVES THEREON. AW.T 1W LO DOES SUCH WORN H!MSCLF On HF RSI LF OR
THROJC I NS OR HER OWN EM,'LOVEES. PIM DE D THAT SUCH IMPROVE MEATS ARE NOT INTENDED On
OFTERED FOR SALE IF. HOWEVER THE BUILDINGOn AHPRIONEMCNT IsSOLD WITHIN ONE YEAR OF'COMPILE
THE OWNER BJILDCR WLL HAVE THE BURDEN Or NHCV.NG THAT HE Cn SHE CID NOT BUILD CII
NPFIOVE 1001 THE PUP;'OSE OFSALEL
C L AS OWNEROr THE PROPERTY. AM ExOLLSNELY CON:RACTINO W'TH LICENSED CONTRACTORS
TO CONSTRUCT HE
C Pg0.T^.T (SF.C. 7'11M. BUSINL'11 AND PROMS IONS DOLE T..1 RACICRS LI-
CENS[ LAW pOC7 NOT APPLY TO A4 OWNER OF A PROPERTY YJID CULDS On W MOVES THEREON. AND
W11DOONTRACTS FOR S'JOH PRLL'CCTS W TH A OTNTRIAC101:51 LICENSE.^. PU95JA NT TO THE. CONTR.AC.
TOl9 LICENSE LAN I
O IAM EXCMPT WDER SEC. B S PC. FCR TH S Ri ASO4
DATE _ OW`.PR-
LICENSED CONTRACTORS DECLARATION
IHCRCBYAFFY1M lIVDER PENALTY D<PERLVRY THAT IAM LIC=N�(.IHEREBYAFFIR(COLAkIENCINWITHSECTION IO(C; Or DJ'ASIONURYT AT IA.LCMY LICENSE S N FLSL FORCE AM EFFECT10
LICENSE CUSS 61r LIE. NO.�DATE CONTMCTCr�_ Ui• QD
Y:ORKERS' COMPENSATION DECLATATION
1 HE REBY AFrRM UNDER PENALTY Or PERJURY ONE OF THE FOLLOW NG DECLARATIONS
I HAVE AND MILL LIAN7A 14 A CERTIFICATE O1 CONSE4• TO M-1,1I.SJRE FOR Y.r. , I"
COUPE NSATION. A5 PRCVOLD BY SEC7" 3.100 OF THE LADOR COCE. FOR THE PERI"
OF THE WORM FOR WHICH THIS PE14MIT IS ISS:EO
_IHR.'EAND WILL MA:NTA"WOILXERS' COMPENSATION INSURANCE. AS REOJ.RC O SECTOR
37000F THE LABOR COCE, FOR THE PEnrCFIMA4CE Dr THE WORK FCn W:�DIH .S PEnMIT IS
65UF.D MY W:.`nKEP LYIMPENKATION INNS•. RiAtiCE/GRRIER AN` PD,ICY FIL CH A:
L'ARRICR Gl N�TC/L�' _L�lr. /
POLICY NUMBCRu�C3�L.M'.��yi..G.LJ�'�
(R-K%SEC[ION![[x!L%T IICCO.fIETE'J'Y TC F'CRi f' F,I rIJf:OF_ FLNXS• 'JCUAAS S:x: CR L;(
1 CERTIFY THAT NTHE PFRrOT1MANCf. Cr iH[ WOnX FCn W"n:C1N THIS ' ERMIT G ISS:.ED.I
I S7WL L NOT EMPL OY ANY PERSON IN ANY MANNER$OAS TOBECOAC['BJCCTTE, IIR.
WJnxr ISCOMPCNSATIDN LAWS OF CAUrOF'A'A. AND AGREE THAT IF SHOULD BECOME
SuEL'CCT TO THE =KER S' ODFAPENSAI ION PROVISIONS CF SECT DI: 7000F THE LABOn
CCCE.ISHALLFOII: HNr:TH COMPLY WIT I TF CSCPROVISDNS. A
1
, DATE. APPLICANT. •�4�.k'�`r+�"'�
1
1 WARN 4G' N EMPLOYE
TO YER TO RE NA LPEN L71ES NSATIOI VINES
IS
HtWNL. MO YHSANU
5;:00.EC7 AN [NROYErt 70 Crt M:NAL PENALTIES ANO CN'L FINE$ UP TO OhC Ml1F!•RCD THOUSA\U
DOLLARS (3100.OW). N TO
TO THE COSTOr COMPENSATION. DAMAGES AS PROVDED ran IN
i SECTION 37_3 OF THE LABOR CDC[. INTEREST. MAA:-TORNCY'S FEES.
J CONSTRUCTION LENDING AGENCY
i_
IOCRCSY AFFIRMMANCE PENALTYOFK Fan RYTHAT TI' PE 15ACO:SUE (SEC. LE'.ONO AGENCY
FOR
TMC PERFORMANCE Of THC WORK FCR WIIIJ 1 THIS PERMIT IS ISSUED (SEC. 7:YT. CIV C ).
1
- LENDER'S NAME
LENDERSACORCSS
: CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THA- THE MOVE ITTORMATION IS CORRECT.
1 AGIIEL TO COMPLY W:TH ALL C::Y AND COUNTY Cn:NAI%CES AND STATE LAN i PF DING 10 BUILDING
3 CONSTRUCTION. AND HEREBY AJTH(NIZE REPRESENTATIVI S OF TIIS CoUhlY TO ENIEn UPON TIIE
AIIOVE-MFNrDNCO PnOPEnrY FOR INSPCCIDN PUIIPDSF S.
D P 'TTEC NAML(PRNQ
r1 MI PEI JAI TIES DA-L
C
PRESS
FIRMLY
APPLICATION/ PERMIT f �(%� P/C
DATE ( NUMBER! / •
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RYJ 0
REAR ❑
SIDE/SIDE STREET RYJ ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION
SO. FT
FACTOR PSF
ADJ. AREANALUATION
SFF VADO n[ M
En
Gara^olCarpOR
W
PatlolDe&
LL
POD'Ispe
ZRa-Roct
Commorcial
5
ED
Vaium.on ADJ.AREA
QUANTITY
DESCRIPTION
FEE
J
Q
U
U
w
J
W
GJ
/
J
a
_! 1
C
U
. Q
=
r
Z,t
.l�UU. FP/
LECTA1
G •../
VCI,�
CALULU
INSPCTIONFCC `� Fes+ 99
V
ISSUANCE-�'_7V.r_��� L]'`•.L-�
SM:P
•�
ENERGY PI'C 'H 0 1
A
ENCRGY PERMIT
RETENTION FEE:
FR&ALT FEE:
TOTAL FEES �� 90
COM V ENTS
l
RCCPT, NO. PAID BY { / ` VALIDATION
VYH:TE—Derartment Copy. YELLOW—Fnaneo Copy, PINK—ASSBSsor uo-y ouwLNIIULr Iltl L,OPY. UPILLN—n, PI-1 s �M47
to ,
,0D BR''
i�115 "MIt sNA
d*
INIPECTION
RECORD
7 7 — -------
G :I=c !rvwr
I c.- r
io s,j v c :1. - rv, i r
SE I C KMi
F-1.00i", 10.1ST
r'7GSIMP.S.'�'M EL
T-1 Vt REMITS
r:l ECTRIC G:;O:!,'ID
I
I UNDER FLO-1r, DUCT.
UNDER FLO---.
i FIREPLACE:: FOUNDATION
:'T[_NT P0%';F.R
PONI. SEAM
V..,,._,.,TE_R CS.E.RviCEM:
M.: D H V. BOND BE: A!,!
FINAL COND DEA.'.A,
P0,M: Ce")VER
PH' -G' AMIG
,,K); K^l I H"PTENG i
G E,.11If__ I i III IS,
ROUGH P; ":G,Frllc
11 -1 U G7.,^ 1! I G, D I N G
E! I 1 15 ,G! I rl I j%1L
— — -------------
Fl,',ljC-14 GRADINIG
S' l,)%'Y'F PVTUD, T E Sl
Pocl_
POOL
-ATION
POOL Fl -NAL
•CrElUrlsj I'd
0 F 17 E' I I E 1 3.
D R Y% L NA L 1 '!!G
s 1E.V1,
SLPTIC i_Ar4,i<
— — -- ------ -
I
':Er:r PYTiL.L.
CY: SITL
.�_i ttS Al I 3 I ES T
FINVIL71M11:1.10
i':nt CONST.
F;,r: FINAL
N.!•, L E.•"ji !:IS
j I—. P, ji: I F
COS .-I.MiEnv TS
SEPTiC TANIK SIZE
SEEP PIT/U 1 SIZE