HomeMy WebLinkAbout17901 �` CITY OF DIAMOND BAR C'/—/
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
Z�� 21825 E.Copley Drive
(909)860.3195 Fax(909)86l•3117 �R�SS
�"%��=� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION �y PERMIT �7 P/C
o ADDRESS DATE d �/Z NUMBER � /� #
c� ISSUE TYPE OCC
� APN OT TRACT DATE CONST. GROUP
� OWNER
O
" ADDRESS ZONING SETBACKS
gCITY • ' ZIP TEL. � 3'I REART RW o
APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTO _�.(� SIDE ❑
� ADDRESS _> PROPO�USE
o CITY • ZIP TE ' r Q
o ARCH/ENG! � T�
� DESIGNER NO.DWEL NO.
a ADDRESS UN17S STORIES BEDROOMS
� CITY ZIP TEL
rNi� OESCRIPTION SO.Fi. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDEFl DECLARATION SFR/AODlREM
O
p 1 HEAEBY AFFIRM UNOER PENALiY OF VERIURV THAi I MI EXEMPT fROM THE CONTMCTORS U- Gef8g0/(;e1pOR
W CENSEUWFORTHEFIXLOWINOREASON(SEC.707/.68USMESSANDPROFESS�ONSCOOE:ANYpT'OR (n
U Cq111}yyYHIpiREOUIRESAPERMRTOCONSTRUC7,KTER�P������U51iOHREPNRANVSTRUC- W patlolDeck
� 7UR�PRqfl TD RS ISSUMICE.ALSO ftEWIRES TME I1PPL�CANT FOR SUQ/PERMIT TO F0.E�SIGNED �
STATEMENT THAT HE OR SHE�5 110EN5ED PURSUhNT TO iHE PROVISIONS OF T11E CONTMCTORS LI-
� CENSEIAW(CHA7TERY(COMMENCWQYVIiMSECTI0N70D0�OFDIVI5IDNJOFTME8U5�NESSM7DPR0• � PooVSPa
iESSqN5CO0E10RTHATHEORSNEISEXEMVTTMEREFROMANDTHEBAS15FOH7HEALlEQEDEXEMP-
� TION.ANYVIOUITIONOFSECTION7071.68YANYAPPLICMfiFORAVEflMITSUBJECTSTHEAPPLICANTTO Z qe•Root
A CML VENALTV OF NOT MORE THAN FtVE HUNOPED DOLtMS(SSOO�.Y
� OI,ASOWNEROFTHEPRDPENTY.OfiMYEMVLOYEESWIiHWACESASiHEIR50LECOMPENS�TqN, � �mmercial •
Z WiLI DO TME WORK,I�NO TME STRUCTURE IS NOT IMENOED OR OFFERED fOR SAIE(SEC.70u,BUSI- J
NE55AND VROFESSIONS COOE:7HE CaMRACTORS LICENSE UW OOES N�TAPPLY i0 AN OWNER OF
N PROPERTYWFiOBUILD50RMPROVESTMEREON,MIDWNO00E55UCHWORKHiMSELFORHERSELFOR =
� THHOUGHH�SORHEROY�NE�PLOVEE5,7ROVIDEOTHATS�CHW7ROVEMENTSARENOTWTENOEOOR CD
�� OFFEREOFORSALE�F.i/OWEYE0.7F�E8NLdNOORIMPROVEMENT15501DN'ITHINONEYFAROFCOMPLE•
Z T10H,THE OWNER�BUILDEN VYILL H�VE TME BUROFN OF GpOVN16 THAT HE OR SHE DID NOT BURD OH
= IMPROVEFORTHEPURPOSEOFSALE� .
�y,� OI.ASOWNEROFTHEiROPERTV,I�ME%CLUSNEIYCONTMCTINOWRHIICENSEOCONTRACTORS
(,L TO CONSTRUCf T11E PRQIECT(SEG TON,BUSINE55 AND PROiE55lON5 CODE:7HE CONTMCTORS U• V31u8IlOn _ ADJ.AREA
111 CENSEUN�DOESNOTAPPLYTOANONMEROFAPROPERTYVmOBUILO50R0.1PROVESTNEREON.ANO
3- NR1pCONTMCTSFORSUpIVR0.1EGTSW�7HACONTMCTOR(5)LICENSEDPUR^>UANiTOtHECONTiUG QUANTI7Y DESGflIPT1ON FEE
f' TORSUCENSEUW.).
� ❑I I1A1 EXEMPT UNDER SEC. 8.�O.0 FOR TNIS REASON 4
� U
tL. �OA1E OWNER
� LICENSED CONTRACTORS OECLARATION W
� INEREBYAFiIRMUNOERPENALT/OFVENURYTHAT1.4.lUCENSEOUNDERPROVI5qN50FCH�PTER �
d, •ICOMMENpN(3WIIMSECTION7000)OFDMSION�OFTMEBVSINESSANDPROFESSqNSCOOE.ANO Z
`L IAY LICENSE IS N ML FORCE�NO EFiECT. m
0 UCENSE CLA55 LIC.NO. � �
V DATE LONTRACTOR � �
W
� WORKERS'COMPENSATION DECLARATION a , .
� IHEREBVAFFIFA/UNDERPENALTYOF�E0.IURYONEOFT11EiOLLOWIN60ECLAIUTIONS: V
[/] a
� �IHAVEANDIN�LLM/UNTAINACER7�FICATEO�CONSEMTOSELF-INSUREFOqWORKERS' $
� �pYPENSA710N.AS PROVI�EO B�SECTION f7000FTNE LABOR COOE,FOR THE PERFORMANCE W
OF THE YYORK FOR WNlpl iM15 iERMIT IS 655UED. �
�
�I HAVE AND WILl4AINTAM VYOPoCERS'CONPENSATION INSURM'CE.AS PEWIRE�BY SECTION
� J7oo0FTHELABORCODE,FORTFIEPEHFORMANCEOFTNEWONCFORVAIICMTHISPERMRIS ��d Sa
ISSUEO.YYN/ORKERS'COMPENSATIDNINSURIWCEGRRIERANDVttICYNUTABEHARE: CONSTRUCTION
j �qq�Eq � � PLAN REVIEW
� POLICY NUAA9EH � (��,'�r� ELEC7RIC
0 (M1CsSECiqNNEIDrqtgEopAslEfEopFilEOEqM715roa0NEHUraREnDottMsB�a)ORL£SSl PLUMBING _�.
Z I GERTIFY iNAT W TME PERFORMANCE OF THE WOitK FOR WHIp1 iM15 VERMIT I5155UED,l MECHANICAL �"\�'• � '-�
(,rJ SNALLNOTE�PLOYANYVERSONNANVMANNERSOASTOBECOMESU6IECTTOTHE � �
(n WOqKERS'COMPENSAT10NU1MSOfCAIIFORfJt0.µDA0flEETMATIFISHWIDBECOME INSPECTIONFEE �-
SUBJECTTOTHE WORKERS'COMPENSA110N PRONSIONS OF SECTIDN 17000FTME UBOR �
OGOOE.IS/WlfOf{TNMTHCAMPLYWITHTT105EP 10`N5. ISSUANCE E ��� �
� �ATE���PPLICANT:��I 1 __ __ SAAIP j U
W ENERGY P/C �
WARNINO:FAILURE TO SECURE WORNERS'CqNPENSATqN COVERAOE IS UNU1WFUL ANO SWLLL BE
LL SU&IECTANEMPLOYEflTOCR�MINALPENALTIE5MIDCMLFWE5UPi00NEMUNDREOil�OUSMID ENERGYPERM17 1• ••�--�=-��'�f'-"�— ---_�•��1
OOLURS(f 100,000).IN ADDITION TO THE COST OF COMPENSATICN,DAIAA6E5 AS VROViDED FOR IN V
J SECTION77080FTHEU180RCOOE.INTEREST,IWO�T70RNEY5FEE5. RETENTIONFEE:
K
pW., CONSTFiUCTION LENDING AGENCY pRE-ALT FEE:
� IHEREBVAFFlRMtMOERGENILLTYOFVERIURYTHATTHER615ACON5TpUCTWNIFNDwOA6ENCV �
d- FORTME VERFOHMANCE OFTHE WOR1{fOR WHIp1TM15 PERIAIT IS ISSUED�SEC.i0D7,GV.W.
�
� IENDEfl3 NAME
F_- LENDER'SADDHESS
W ICERTIFYTIATIH�VEREPDTNISAGPUCATIONANDSTATETHAiTHEABOVENFOiVAATIONISCOqRELT. TOTAL FEES � /`]�?• 3D
p., IACREETOCOAI7�YWITHALLCITYANDCOUN7YOROIfUNCESANOSTATEUWSREUITW(7TOBUGOING �
CONSTqUCT10N./Na�NEREBV AUTiqRRE REPRESENiAT1VE5 OF THIS COVNN TO ENTER UPON THE
ZJIBOVE�MEMIONEDGRDPERTYFORINSpECTiONVURPOSES. COMMENTS
0
J
�
m PER1AiTTEENAV vtU �
Q /�
Cn � `��r � �
� S�GNANRE PE EE ' �ATE
� RECPT.NO. PAID BY I S VALIDATION
WHITE—Oepartment Copy.YELLOW—Finance Copy.PINK—AssessaCopy,GOLDENROD—File Copy,GREEN—ApD�icanPs Copy
_ _ . . . .._... ,. . ,. _ __ . _,
� . . ,,... . .� .� .. . ...- . .. . . ,-.....�. �_:�.,, �,,.:.� -�.� . y.. . �,•.. . �r�, , � . - - . � � -
•,� : ,,... . . � ,�.- . .� _.. _, _... ... ,..
��- . . .. . . . . .. , . - , . . . . ,. .. . .. ..,.. .� , .. ., .. . �. ., , - .. �
CITY OF DIAMOND BAR
ItVSf�EC i ION RECORD '
:I�����C�>;l : ������, _�����:..cr�'��.� �Ii�.���,��1!�_ ' :�.�'��i�. :..E����:���1�
- - --- __._..._-__ __ ....
SET BACK � FLOOR JOIST � �- -
FTGS/FORMS/STEEL FHA REQMTS '
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBItJG UNDER FLOOR CUI�IDUIT -
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM � - �
ROOF SHEATHING `7�� o - ` � 8 FT. BOND$EAM ,
FRAMINGNENTILIATION FINAL BOND BEAM I
ROOF COVER �a z PRE-GRADING
ROUGH HEATING BENCHING
ROUGH EIECTRIC ROUGH GRADING
ROUGH PLUMBING I FINISH GRADING �
SHOWER/TUB TEST POOL ELECTRIC
EXT.IATHlSIDING POOL FENCING
WALL INSULATION • POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK , � LANDSCAPE/IRRIG.
SEEP PIT/LL. ' ° i ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
iC 'RF•ia �1;E9 C C�' ;
COMMENTS
SEPTICTANK SIZE
SEEP PIT/U SIZE .
���� .. _
����_ � _ �����
�
,
� �� �� � � � : �.� ,