HomeMy WebLinkAbout17158 (17) �� C1TY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 E.Copley Drive
(909)860-3195 Fae(909)861-3117 PRE$$
`-:� BUILDING PERMIT APPLICATION FIRMLY
JOBSITE ,G1� APPLICATION �) PERMIT � P/C
o ADDRESS ��� /.�-�IC..'P��-- DATE � �� NUMBER p
� ISSUE � r('�� TYPE OCC
APN LOT—, �— TRACT DATE V�_CONST. GROUP
°C OWNE�'F IZr7h//
0
ADDRESS �S�3 /9�-l�i-_�I ZONING SETEiACKS
Z CITY��SIv��____1 f�KZIP TEL. REART RW O
g APPLICANT TEL. SIDElSIDE STREET RW ❑
� CONTRACTOR � Cl "� (� SIDE ❑
Q ADDRESS�.jG'�' ' f}wi P�AJ F��-t�iC _
� CIN Ci/-//��� ZIP 9/�/n TEL.(3 7� 9'5-�-~ PROPOSED USE
w ARCHlENG/
w DESIGNER N0.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
= CITY ZIP TEL.
� DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION
�
Q OWNER-BUILD[R OECUIRATION SFR/ADDlREM
O
p 1 HEREBV AFi1RA1 UNDER VENALTY OF PE0.1L'RY TFUT 1 MI E%E61PT FROA1 THE CON7MCTORS LL Garega/Carport
W CENSEUWFORTHEFOILOWWOREASON(SEC.70]I.SBVS:NESSANDVROFESSiONSCODE:ANVCITYOF (n
U �1TYNMIdIREOUIRESAPEM�RTOCONSTAUCT,ALTER.MPROVE,DE�A0l15N,ORREPAIqANVSTRUG W Patio/Deck
wTUFE.PRpR TO ITS ISSUANCE AL50 REOUIflES THE ACOLIGIM FOR SUCH PEN.aT TO FILE A SIGNED W
� STATEMENi TXAT ME OF SHE IS LICENSED PUFSUANT TO THE fROVi5lON5 OF THE CON7MCTORS LI�
� CENSEU�N(CMAPTER9(LOMMENCPl6YATHSECTION7WO�OFDIVIS�ON70FTMEBUSINESSI1NDVfl0- LL' POOVSPa
iE5510M1S COOEI�THAT HE OR SHE IS EXEM?T TMER[FROMlW D THC BASIS FOR 7ME�ILEGED ExEMr•
V TION.ANVV10lAT10NOFSECTION7o71.6BVMIYAFPLIC+INTFORAPERM�TSU0.1ECT5TME�7PLICAN7T0 Z R8-ROCI
� A pNl PEN�LTY OF NOT A10RE THAN iNE HUNORE�DOLURS�f SDo��:
0 04A+�WNEROFiNEPROPENT'�,ORMYE��LOYEESWITHWAGESASiHEIR50LECOlAPENSATION. � COmmerCi�l
Z W:LLDOTHE WORK�ND THE STRUCTURL IS NOT INTENDEDOR OFFERED FOR SALE(SEC.70��,BVSI- J
NE55 AND VROFESSIpNS COOE:THE CONTRACTORS LICENSE UW DOES N07 APPLY TO AN OWNER OF
N VpOPERTYV/�q9URD50RIMPROVE57MEREON.MI'J1M10DOESSUCIIWORNMIMSEIFORHERSELFOR �
� 7HROUGMHISORHERONT�EIA7LOYEES.V1tOV�DEDiMATSUCHIMPR�VEMENTSIIRENOTM7EN�EDOR m
W OFFEREDiORSALE.IF,l10WEVE0.TMEBUILOINOORMPpOVEMENTISSOLDMnTMIYQYEYEAROFCOMPLE-
0 TION,TNE OWNER�BUItDER WILL NAVE TNE BURDEN OF PROVING T1UT ME OR SME DID NOT BUIID OR
Z MPROVE F00.TNE OURFOSE OF S.LLE�.
_ �4�OWNEROFTHEPROPERTY.AA/E%CLUSIVELYCONTRACTINGW�THUCENSEDCDNTMCTORS
� TO CONSTRVCT T1[VROJECT(SEC 70N.BUSMESS AND P{WFESS:ONS CODE'.TME CONTMCTORS U- V01Ua11Df1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPEftTYWrqBU1LDSORIMPRDVESTMERCON,AND
� YV/qCONTMCTSFOfISUCMPROJELTSWITN�CONfMCTOR(S�UCEYSEDGUFSUANTTOTHECON7MG OUANTITY DESCRIPTION FEE
Y TORS LICENSE UW).
� J
� O I�UA EXEMPT UNDER SEC. B.i P.C.FON TH�S REASON U
�
Q
LL" DATE OWNER V
W
�4 LICENSED CONTRACTORS DECLARATION W
CC INEREDVAFFIRUUNOERPEIULTYOFGE0.IURYTHATIAIALICENSEDUNDERPPOVIS:ONSOFCXAPTER Vr
d Y�COlU�ENCWOWITNSECT10N7000)OFDNISION70FTNEBUSIN[SSANOPROFESSIONSCOOE,AND Z
x 4v LICENSE IS N F111L FOi7CE IWD EFFEC7. �
W (�
� LICENSE CUSS G '�E�J IIC.N0. / /�� �
V DATE�3�! I `ZC�'�I COMRACTOR��� � a.
W n,�
� WORKERS'COMPENSATIONDECLARATION IQ�ry1I� U
� l •1
� IHEREBYIIFFIRMUNDERPENALTYOFiERNRYONEOFTMEFOILOW:NG0Ep11RATpN"
N zQ -tJ/:.
� _IMAVEANDYViLLMAINTA:NACERTIFIGTEOFCANSENTiOSELFiNSUREFORWOfiKERS' _
� CqAPEN5AT10N,A5PROV10ED8YSECTIpJ71000FTMELABORLODE,F011TNEPERFOfUA�IJCE �U
OF TME WOHN fOR WHIG7 TMIS GERMIT Li ISSUED. �
0
W �I HAVE AND 1MLL uA1NTAIN WOfiKENS'COMPENSA710N INSURANCE,AS REOU�RED BY SEC710N
Q 9TOD OF THE UBOfI CODE,FOiI TME PERFORUANCE OF THE WORK FOR WHIdI 7N15 PERMIT IS
ISSUED.MYWORNERSCO�APENSATIONINSURANCECARFiERAN�POIICYNViA9ENME: CONSTRUCTION
j �J/��L/i'/St� / �/� l. PLAN REVIEVV
CARRIER !o z�l.r/'�.lg
� POLICYNUMOER ELECTRIC
¢
� (iF65ECi10NNCmN078[OOAf'LE7EDOF7IEPC�'6inRONEMIl�fiL�OCL1�itiR��IdiLE551 PLUMBING
Z ICERTIFYTMATRiTHEVERFORMANLEOFTHEWORKiORWMICHTHiSVERAIIT['i15SUED,I MECHANICAL
(} SMALLNOTEMPLOYANYPERSONINIINYMANNE�SOASTOBECOMESU&lECTTOTHE
N WORKERS'LOM7ENSALIONU'MSOFCALIFOHNIA,AhDACREET IFISHWIDBCCOME INSPECTIONFEE
S SU&IECTTOTHEYUORKERS'COMPENSATqNPROVISiONSOFSE ��ON�7000FTHEUBOR ISSUANCE ,
CODE,I SHALL FORTMN�TM COun�Y Wl HO VROVISiONS.
O SMIP
p DATE: �r^ APPLIGANT. - —
w �� ENERGY P!C
J WAFNINC:FA0.UR[TOSECUREWORNEFS'COAA7ENSATIONCOVER .^aEISUNUWFUL.AI:OSMALLBE
� SUBJLCTANEMPLOYERTOCRIM!NA:PENALTIESANOCMLiWES �700NEMl1MJRCDTM0U5AND ENERGYPERMIT
OOLURS(f 100.000),N/�DD1710N TO THE COST OF COMPENSATION.D.UAAGES AS VfiOYI'JED FO{t IN
J SECTqN77aeOF7MElIDORCODE,NTEREST,ANDATTOANEY'SFEES. RETENTIONFEE:
Q
W CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE:
a
O
CL IMEREBYAFFIRMUNDERPENILTYOFPCRri1RVTMATTHEREISACONSTRUCTIONLENOINGAGENCV
� FOR THE GERFONaANCE OF TH[WORK FOfl WwCH THIS PCRMIT IS i55UED�SEC.7av�.dV.C.).
Z
w
� LENDEfiSNAM[
S
F_- IENDERSADDRE55
WICEflTIFTTHATINAYEREADTH15AGPLICATIONANDSTATEiHATTHEA80VEWFORMAilONISCORRECT. TOTAL FEES •��
p_ IAGREETOCOMPL�NATM�LICIT/ANDCOUNTI'ORDINlWLESANDSTA7EUwSREUTWG708ULD1YG
CONSTRUCTION,/J7D NEREBYAUTHOF7RL R[PR[SENTATIVES OF THiS CWNTY TO ENTER UPoN 7HE
Z ABOVE�MENTIONEOPROPERTYFORIN57ECT10NGURVOSES. COMMENTS
� ��
m
q PE E NAUE(�RINn
N �. —
N 51 UHEOFPE iT7EE \ DATE
� RECPT.NO. � ._PAID BY VALIDATION
WHITE—Depanment Copy.YELLOW—Finance Copy.PINK—Assessa Copy.GOLDENRO�—File Copy.GREEN—ApplicanYs py
�.. ... ............._ .�_�.,.,..�.�....,...,.�. .........i"'^1..� ..:..:`• . � .n..+.�.-�m�-- . ..._..,f..S�/E'.•�TTw.� --�..• ..t .. .. .. ..��._. .�.�...�. r , ...... .. �..
�i 1�i� ��" �lra�:��E\I� L7f�{i
��`�: '�JF'��L, i i�.l�� �ii=Ci�Ji-ifi
_._..__ .._._.__..___.�_....._._.__.----- .. _ ._._. . � .._ ---- - '---..�_._,_._. __.._ ._.� __�_ ��.,
I►�F-'7C�:si;�r�ca►�i r;._'��= I�`ky.�=�,"��iY,.��.__. _ j►'E=i.�=..c���l�i��i� � e,�'�.:� — 1►'ti'1-���`��'c)��
............ .. ._. .....:- .. ...._.._ � _. . ._... _..._. ... _. . . . . .. _. ........_. .. .. .... -- ------------.. ..... ....-----._.__.-- ---..
SET BACY ' ' ' I � FLOOR„OlST 'I '
�.- ------=--- ----'- --- ------ --------- --
. — ---
FT�GS/FOfi��15'STEEL _ i . � � FhI.A �E:Q�v1?S �
� ----.._.___._��__. . . -�----
—���---
ELECTRIC GROUND ; i ' ! � UND-R f=LOOR DUCT i i
GROUND PLUiJ!31t.G—�--- --�-- ---.- - � � UiJ�:R Fi..COr;CUi���UIT -� -- ' -------- ----
SL{'iB GRP�DE I � I FIREPLAC� FOUidDl�TIO^1 i____ I
— -----�-�--- - -- -- --
TEP�1? P01''JER � ----�_ _ -- ---- I I FIREPLF�C� E30"�D Ei'i�i�i _--� -----I -
�NATER S�RVICE � I i 1 r:^i� Fa1. E_�N- )LA "--
---�----- -- ' ---- D E,:,•.�.: � - � --
ROOF SHEATHING I i I I � FT. ��•"JD GCF�•'•' i
FRAP,�It•JG,NENTILIATIOPd � I I FIf�AL BOiJ7 EEA`,1 I
� I — ----
ROOF COVER ------��s-- � rR�-GRP,DIhdG �---- �
-1- -� --I
ROUGH H�Ai iNG �i✓-!`+�i ��G` ._�L � � B�f•:CH!h;G i
ROUGH ELECTRIC I � � ; R�UGfi GRF,DC�u I I
ROUGH PLU��'�If•1:a � ' � Fli•,ISFI uHF�DI?�G �_ �
SHO�"JER,�i"Ur3 TEST � I _l_I_�'�a�-El_ECTRIC ��_�
EXT. LF,TH!SIDIfJG � � I F'CaL FEN�It:� � I
I;VALL IMSULATION � I �1 POOL F�I�;�,L -�. �
CEILIN3 IfJSULATiON � _�__ � I O!=F SfTG IP.^,FS. ; _ _�
� DRY�"JALL NAILING � DEDIGt�T10'JS � I
SEti^JER -- -�— --__.� rI�JP.LEPJG. � — —
SEPTIC TANK � � LAPdDSCAPEIIRRIG. � —�
-1---- �-�---
SEEP PIT/L.L. � ! L O"•J SlTE I:-1PS. � �
G:,S/',IR TEST � � Fi�JAL Z:J"�ING _ I__ I
FINAL CQNST. � � � � �!r=sE DEPT. Fti•:/�L I I
f�INAL H�ATIPJG�-f1/ I-��— I_I HEALTH DEP7. FIP•lAL I I
FI�J6;L ELECTRIC � I I DEV. FEES P.�ID i I
FIN�L PLUP.9�iIPJG jQ -�-C(�� � � EhJEHGY _ � �
� � � � �' �
-- ---�-- � �.' -..__..:''_ ,`�-�.�__�_.—_ -�-- � —
� , —.
, ,
cor,�nnEr�Ts �
SEPTIC TANF: SIZE
SEEP PIT/U SIZE � �- -�--
---•— --�
'-�� � -------� —
��i� -
`F . � , j , �— . . - ,