Loading...
HomeMy WebLinkAbout16844 (25) �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ,�Y; 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FI LY o� JOBSITE � / ��O �„ ' /I. � APPLICATION t� � � PERMIT ,n P/C ADDRESS ! �f'r� DATE � �O NUMBER �Y� 8 � ISSUE +� � TYPE OCC APN LOT /T ACT DATE L� CONST. GROUP p OWNER � i2 I Lre� '+�l'�-(o, "' ADDRESS �j S ���� /�c+�i.. .�rr^� ZONING SETBACKS z CITY ��--( �2 ZIP__y}„�J�L.�i/_2�� FRONT RW O � APPLICANT TEL. REAR p � SIDEISI�E STflEET RW D � CONTRACTOR .v �'u-c_ �t�✓ SIDE ❑ � ADDRESS ,y,�/ o CIN ✓�-- ZIP Q��7 TEL. ✓r ' PROPOSED USE C _ o ARCH/ENG/ '""'� r �^ �y � DESIGNER NO.DWEL. ���i` N0. NO. '�n.' ADDRESS UNITS STORIES _P BEDROOMS = CITY ZIP TEL. c�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER OECLARATION SFR/ADDlREM O p I HEREBYAFFIRM UNDEF iENALTY OF 7ERJURV 7HA71 AM EXEM77 FR01A TME CONiMC70RS LI� G2f2g6/CBrpOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7037.6BUSMESSANDPROFESSiONSCODE:IINYCITYOR (n U CIXINTYVIHICNREOUIRESAVERMITTOCONSTRl1CT,AL7ER�PROVE,DEMOLISH.ORREPAIRANYSTRUG W PdliO/D9Ck � 7URE,PR10R TO RS ISSUANCE,/�150 RE�UIRES iH[APGLICANT FOR SUCN 7ERu�T TO FILE A SIGNED w S1A7EA1EM THAT HE OH SHE IS IJCENSED PURSUM1f TO TNE PROVISiONS OF 1ME CONTMCTORS LI- � CENSE UW(CHAVTER C(COMMENCW6 YATN SECTION 7000�OF 01VIS�ON]OF TME BUSiNESS AND VR0- u- PooVSpa FE55IONSCAOEjORTMATHEOR5HEISEXEMPThIEREFROMANOTHEBA515FOR7HEALLE6EDEXEMP• (� TION.ANYYKKATIONOFSECTION7W1.6BYANYAPPLiGANTFORAPERM175U&IEGTSTHEAPPLIGANTiO Z Re-Roo1 A CML VENALN OF NOT MORE TW W FNE HUNOPED DOLURS(i500)�: ZOI.ASOWtJEROFTHEiROPERTY,OFMVEM�LOYEESWITHWAGESASTMEIRSOLECOMPEN5AT10N, � COmmBrCi21 VALL DO TXE WOR1C AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR ShlE(SEG 70N.BUSI� J � NE55 AND VROFESSIONS COOE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO IlN OWNER OF ? DR�PERTYYApBVIIDS OR MvqpyES THEREON,ANO WNO DOES SVpI WORN MIIASf�FOR MERSELF OR Q THqOUGHMI50RHERONTIEMPLOVEES.PROVIOEDTHATSUp/IMPROVEMFNTSARENOTWTENDEDOR m � OFFEREDFORS/LEIF,HOWEVERTMEBULLDINGORMPROVEMENiS50lDN9TMiNONEYEAROFCOMPLE� � iqN,TME OWNER�BUILDER WILL HAVE THE BUR�EN OF iROVIN6 THAT ME Ofi SME DID NOT BUILD OR � IMPROYEFORTHEPURPOSEOFSALE�. w ❑IASONTlEROF7HEPHOPERTY,AME%CLUSIVELYCONTMCTPlGVlITMLICE�SEDCONTMLTORS �[ TO CDNSTRUCT THE PRQIECT(SEG 7ot�.BUSINE55 AND PROFESSIONS CODC:THE CONTMCTORS LI� ValU3ti0� � J.AREA W CENSEUWDOESN07AP7LYTDMIOWNERdFAPROPERTYWlIOBUILDSORWPROVESTHEREON.AND � NMOCOMRACTSFORSUCHDRQIECTSWITHACANTRACTOR(S�l10EN5EDPURSUANTTOTNECONTRAG QUANTITY DESCRIPTION FEE Y TORS IICENSE UW). � ❑I AM EXEMDTUNDEH SEG B a P.C.FOR TNIS REASON Q � U U.. � DATE OWIrER U Z W �Q UCENSED CONTRACTORS DECLAf7ATI0N � W 2 INEREBYAFFlRMUNDERGENAITYOFPERJURVTNA7IAM�ICENSEDUNDERPROVISbNSOFCHAPTER Vr d i(COMMENCINGWIiMSECTION7000)OFDIVISpN70FTME8U51NE55M1�PROFE5510N5CODE.AND Z MY LILENSE IS IN NlL FOflCEAND EFFEC � LICENSE CUSS ,��!�+ J /� m l ��.No. � //��! � � V DATE COMRACTOA ✓~ �- W � WOFKEFiS'COMPENSATION DECLARATION � —� � a N IHERE9YAFFIRMUNDERPENALTYOFPERJURVdJEOFTHEfOIIOW�NGOCCLARATqNS U C� Q � _IHAVEANDYALLMAINTAINACERTIFICATEOFCONSENTTOSRFaNSUREiOfiWOR1(ERS' _ � CpAPENSIRION,ASPROV10EDBY5ECTON77000F7MEUBORCODE,FORTMEPERFpRMANCE W OF THE WORK FOR WMICH THIS VERI.�IT IS ISSUEO. ,� 0 w �IHAVEANOWILLIdAIMA1NWORKfRS'COMGENSATIONINSUMNCE,ASRE6J�REDBVSECTION /� O �7000FTMElABORCODE,fOflTNEVERFORMA4CEOFiHEWORKFORWHiCHTHISCERM1T15 — �� /� 55VED.MYWORKERS' t P�N T,IO�N�IN,/SUflM1C�ECARRIER r+ova�crrruuoeau�e CONSTRUCTION � L. Q > CARRIER �L�,�'f 0�� �,.t�"'� PLAN REVIEW —�� � � `��� � POLICV NUMBER�,i��� �� 'T� ELECTRIC �E'�/"`:_ '_ . - ¢ o frwsSEcr�r�mrarseea��rwoFnevew.�rswr�a+E�uron[�oai.vsR+�on�Ess} PLUMBING � 1 Z ICERTIFYTHATINTHEPERFORAAANCEOFTHEWORNFORWHICHTHiSPERMRI5ISSUED,1 MECHANICAI 1 (} SHALLNOTEMPLOYA4YDERSONMIMIVMANNERSOASTOBECOMESU&)ECTTOlME N WORNERS'COAIPENSATqNL�W50FCALIFORN:�ANDAGREETNATIF15HOl1LDBECOME INSPECTIONF E SUBJECT TO THE WOiIKERS'C0IAPENSATION PROVISIONS OF SECTKKJ 370o OF THE UBOR f� COO ISHALI O TMCOMPIYYAMTF105EPROV15iON5. ISSUANCE '{,��' ,_ -.-L �j � �+ L - p OATE� ✓ / APPLICANT. �/✓ SMIP �� w � ENERGY P!C � WARNIN :FA4UR TOSECUREWORKERS'COMPENSATIONCAVERPCEISU4UWNL.ANDSHALLBE LL SUBJECTANEMPIOYERTOCflIMINALCENALTIESANOCMLFWESUPTOONLHUNOREDTMOUSANO ENERGYPERMIT DOLLARS(SI00.000),W AODITION TO THE C0.5T Oi CCMPENSATION.DAMAGES AS PROVIDEO FOR IN ¢ SECTqN770EOFiHEUBORCODE,M7ENE5T,/�NDATiORNE15FEE5. RETENTIONFEE: � � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IMEREBV�iFIRMUNDERPENALTYOFGEqJURYTHATTFIEREISACONSTRUCTIONLEN0INCAGENCY dZ FORTHEPEHWfiMANGEOFiMEWONKFORWHICHTHISVERMITI5155UE0(SFC.]J9�,CIV.CJ. W � � LENDER'SNM�E '� � LENDEH'SADDRESS \"' � TOTAL FEES ' �'�j � w I CERTIFY THAT I HAVE NEAD THISAPPIiCATpN MID STATE THAi TME�BOVE hFOFMATKKJ IS CORREC7. � IAGREETOCOMGlYN7THALLCIT`IAt+DCOUN7YOR0'NANCESurOSTATEUwSRELATINGTOBU1tDtNG V. CANSTRUCTION,ANOHEREBYAUTNORIZERE7RESENTATNESOFTHISLOUN7Y70EN7ENUPONTHE � � Z ABOVE�MENTIONEDPROVERTVFORINSVECTiONVURPOSES. , (',OMMENTS � �h-�;� 2 c��-� m ¢ PERIAITTEE E(PWNn � N s� M EE o�rE RECPT.NO._ pND BY VALIDATION � � WHITE—DepaRment Copy.YELLOW—Fu�ance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApO�iw fs Copy . , , . . . . � .. �� .. � . , .. . � .. . 4� . i', . � , . i i � r.- . . ' . � .. . i . . . . . . , . . �.. � . _. . �1� � �_ � _ �a����_'icll:Y'��_ �_;lr.! �" h�'P:_ . .:L.� � it.,'i�� . ��.:'�.^`.r": ... ,__._.__.___ _.___. __._. _. _ _ _ , . .".'_ .. _. .-._ _.. .._'_"_"._.. _.--_.. _... .__'___.._"_" " ' _ _...,.... .._ ._ .__....,_,...._. , t��!'..'-.z 'rl��,�' . . l:��:,��-.r :E 1� ii`a:.'�:.. , 1� I� . f._.. . ., (�l::'�,:.�r:l�: . , . .. .�. . . SET 6F�Cf; � . � I FLOOR J�IS7 --- - -- - - ------ �------ --'-----�- --� -- ----- FTGS!FORf�"S;STEEL ; � ' ' i f"H,'�RFC,�i:TS j I - • ----- ------r-� --- ---- -- ------ --- ELrCTR(C GFi�U�JD I i ' I i U�.DER FLOOr DU�,T ; I -- -- --•---------� •- - -- - GRQU�•!D f'LU�.131iJG � ; i ' � -- � Ui.DcR FLOOR CUi DUfi , ! --- --� •- ----- ------ ------- - SLAE3 GR�',DE I �----- --- i FIi�FPLAC� FC)tJiJ7,t,T10?J � I -- - �-- ---- — --- --- TEP.1? PO\NER i I __ _j � FIFiEPLACE BOND EEAt�" . _ _ ------ ' —. 41JATER S�R'��IC� I ! �,�}� i h.",iD f IT. E3�"!D G��^,^, � —E— ----- — -- ------- ---- — --- - -- RQOF SH�F�THfidG I r D('I ...(./�-----�-�"� F-f. E:�NL` BL=f,.t:------i--- i— 1 ��-- �_� --- ---- - --- ----- FRAP�I?JG.��E�JTILIATIO(J i � -_-------�� FIf,�+L EOi.� B�l,":1 -- ---�------ � ROOr CO�ER �o b f_�• , i � Iqr-�� .�,{� -- --PR�--GR!'�D��d�, _ --- �- -�'-_"_ _ - -�--------------- H'JUGH HEATING I���, 6EhdCHI�J� i � ROUGH ELECTRIC � I I E30U�tI GRP,Dli1� � � --- ----�-- --- --------- - - ROUGH PLUi�"21ida � � � F1��15H GRr^,DIPJC'� � � -- - -- --=- - SNOI^,'ER,'TUb TEST � F'OOL ELECI RIC � � _ ---1-- --- --- --- -- EXT. L/�TH�SIDIiJG � � I POJL FEhJCI,,u � � �:'AL!IPJSULF,TIOfJ �, }- -- � FOO'FI'•:AL - ---- � - ---- CEILINu 1��1�ULATIOPJ � 1 �FF SITE IP,"?S. � DRY1:'l1LL�JAILItiG � } � DEDIC,�,T17i1S i -�' _ — 5E�",'ER i -- - � � FI�JAL ENG. I SEPTICT/�t���< � �_� LFtt�LSCF�Pc/IRRIG_ �—j SEEP PIT/L.L. I ' '; � OPJ SITE i^.tr�. GAS AIR TEST ! i J FINAL'Oi ll'�G i, Flf`Jf�L CO;JST. � I ' �!RE DcFT. FIi lA' I FIfdF�L HEF,TfNG I ; __ � j HE�.LTH UEPI. Fif:��L FIPIt,L ELFCTRIC I - ; I DE'r'. F�ES PAI�) FIN.AL PLUitE31NG I ; ---� i I �t1='r3G'r' ------ � I -- i � � f- ---i _ _._._ __ .__ ____________, -- , . �.. _ �-- -- � _ I �. . 1. � ----- -- I cc�r,r�t�,E��TS SEPTIC TA�JF: SIZE SFEP FIT/U SIZE - � - - — —- i'�i — — - ��v,i � -- ,4 .