HomeMy WebLinkAbout17869 �� C1TY OF DIAMOND BAR U�C /
DEPARTMENT OF�OIvIIvIUMTY 8c DEVELOPMENT SERVICES �`-�
,��� 21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRESS
�'�.::�'� BUILDINGPERMITAPPLICATION FIRMLY
o DDRESS1�� _f+���� ' DATECATIOI � �-� NUMB R /! �G� ���
c� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
" ADDRESS��� , ZONING SETBACKS
z CITY ZIP TEL. FRONT RW �
�,/� REAR D
g APPUCANT �Z Tr{�` SIDEJSIDE STREET RW O
� CONTRACTOR SIDE O
ADDRESS
� CITY ZIP�_�TE � PROPOSED USE- •
� ARCH/ENG/ �
o_, ADDR SS NO.DWEL. NO. N . �
� CITY ZIP TEL UNITS STORIES BEDROOMS
� DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION
OOWNER•BUILDER DECLARATION SFR/AD�lREM
W CEHSEUWFORTFIEFOLLONIN6REASON(SEC.70.7R68 NE34ANOVROFE�SSiON5CO0E:ANYdTYOR Garage/Carport
U COUNTtNMICHRE0U1RE5APERMRTOGONSTRUCT.ALTEN,ldVRO�E,DEMOlJSH,OFREVNHANY57RUG W Patio/Deek
� TURE FRpR M RS ISSUANCE,/LL50 REOUIqES TME APPLICMIT FOR EUCH iERMIT TO FlLE A SICNEO W
� 6TA7EMENT T1UT ME OR SNE IS LICENSEO iURSUANi TO THE VROVISIONS OF TNE CONfMGTORS LI�
.� CENSEUW(CWIPTEHO(COMMENCWOWIiHSECilON700010FDIN510N]OFTHEWSINESSAN�PRO- � POOVSpO
FESSIONS COOE�OR THATHE Ofl SNE IS EJfEMPT iHEREFFiOM AND TNE BASIS FOR TME ALLEGEO E%EMP•
� TqN.ANYVIDLATqNOFSECilON7o71.68YANYMPLIGWTFORAPERMITb�BdECT57MEMPUCANTTO Z Re•Roo� • G��
� ACMLVENALTYOFN0T410RE7HANFNEHUNDREOUOLLARS(fsao).):
� OI.ASOMMEROFTHEPRDPERTY,ORMYEMPLOYEESWI7HWAGESASTIIEIRSOLECOMPENSATION, � CpmrtlBfCla1 -
Z WILL DO THE WORI(AND TNE STRUCTUPE IS NOT IMENOED OR OFFEREO FOR SALE(SEG 7M�.BUSb J
y NE55 M10 DqOFES510NS CODE:TME CONTMLTONS LICENSE lAW DOES NOTAVPLY TO AN OWNER OF =
PROPEN7VW/pBURDSORNAPROVESTHEFEON,ANDWHODOE55UCHWONKHIMSELFORHERSELiOR m
Q THf10U6MMISORNEflOMMEMVLDYEES,PROVIOEDTMAT5Up11MPROVEMENTSMENOTINIENDE00H
� OFFEAEGPoRS/LLE�F.HOWEVE0.TMEBULWNCORIUPqOVEMEM1550lDYnTMWONEYEAROFCOM%,E
Z T10N,THE OwNER�BInIDER NnLL FNVE TME BURDEN OF PROYINa TMAT ME OR SME DIO NOT BURD OR
= MPpOVEFORTN[PUA�OSEOFSALE�.
O 4��H'NER OF TME PROPERTY.AM E%CLUSfVELY CONTMGTIN6 WI1M LICENSED CDNiMCTOfl3
WW TO CONSTRUCT THE PFIOJECT(SE0.70H.BUSINE55 AND PROFESSIONS CODE:TNE CONiRACTORS LL
CENSEUWDOESNOTAPPLYTOANOWNEHOFAiROPEHTYNRID8UILDSORMPROVESTHEREON.AND V8IU8G011 ADJ.AREA
� YAfOCONTMCTSFORSUQiPRQ�ECTSYnTHACONTMCTOR{5)L�CENSEDVUfiSUANiiOTMECONTMF QUANTITY DESCRIPTION FEE
� TORSLICENSEUW.).
� O IAM EXEIAPT UNDfP SEC. B.��G FOR 7HIS PEASON U
u" DAiE OWNER �
Z W
F LICENSED CONTRACTORS DECLARATION W
� IHEREBYAFFIRMUNDERPENALTYOFPERIURVTIUTINALICENSEDUNOERPRONSIONSOFCHAPTER �
d Y(L�OMMENqNQYl1iH5ECTI0N7000)OFDIVISIONJOFTMEBUSINESSANDPROFESSIONSGOOE,MID Z
X YY LIGENSE IS N Ft1LL fOfiCEAND EFFECT. m
LLJ 7
� 110ENSE CUSS C�� UC.NO.��L„��� 7 � - J
V DATE CONTRACTOp a
LL
� WORKEHS'COMPENSAT70N DECLARATION �
= U
� IHEREBYAFFIHMUNDERPENALttOFPE�URYONEOFTHEFOLl01MNa0ECLAMTiONS:
� Z
Q
� _IHAVEANDMALLWUNTAR1110ERTIFICATEDFCONSENTTOSELF-INSUHEFOfiWOqKERS' _
� CDMPENSATION.ASPROVIOEOBYSECTION�7oaOFTHEU80qCO0E,FORTHEPERWRMANCE �U
OFiHE WOAK FOR W111CH THIS PERMIT IS ISSUfQ �
�
�I HAYE AND YALI MAINTA�N WORIfER4'COMDENSATION INSU�UNCE,AS HEOU�RED BV SECTIOM
QO J7000FTHELABORCOOE,FORTHEVERFORAIANCEOFTHEWORKFORWHiCHh1ISPENARIS ��� �Z+
ISSUED.YYWORKERS'CouPENSATIONIN5URIWCECARRIEHANDPOL�CYNUMBEHARE: CONSTF7UCTION
j CARH�ER PLAN FEVIEV✓
� ro�kv r+u�neen ELECTRIC
0 (THSSEC110qNEIDNOTBE00i.pLE�EDOFhEGEIVX�ISPoRONEHt�ORED00tUiLS6�WIORLES51 PLUMB�NG
w ICERTiFYTHAi1NTHEVERFORMANCEOFTMEWORKiORMMIp/THiSPERM�T154S5UED,l MECHANICAL 1 � `�"""��
(,z�} SHALLNOTEMPLOYANV7ERSONNANVMANNEFSOASTOBECOMESV&IECTTOTME - � �� �` � � �.����
� SMORKER4'COMVENSA71ONUWSOFGLL60RNI^ANOA6flEETHATIFISMOUIDBECOME INSPECTIONFEE
SUBJECTT0T11E WOPo(E�'COMDENSATION PROVISIONS OF SECTqN 77000F 7ME UBOH �SSUANCE
COOE.1 SH�LL FORTHN7TM COMPLY WITM iHOSE PROVISIONS.
S �
0 SMIP I �S
p DATE:�Cl���APPLICANI�s�'� �
� �NERGY P/C �
WARNINO:FAILURETOSEWREWORKERS'C01APfN5ATIpJtOVERACEISUNUWFULA SIULLBE I
� SU61ECfANEMPLDYENTOCRIMINALPENALTIESANOCMLFWESUPTOONEMUNDREDT/KIUSAND ENERGYPERMIT
OOlUi4i�Sf00.000).NMDITIONiOTHECOSTOFCOMP6!lSATqN,DAAIACESASPROVIDEDiORIN � � -
JSECTION�70EOFTNELAHOR[Y7DE,INTEHEST,ANOATTORNEYSFEES. � �
¢ RETENT�ON FEE:
ow., CONSTRUCTION LEND�NG AGENCY ppE-ALT FEE:
O •
� INEREBVAFFlRMUNOERPENALiYOFPERNNYTHATTHEREISACONSTpUCT10NLENOWO�fiENCY
� FOR THE PEHFORAUWCE OF TME WORN FOI1 WHldl THIS VERIAIT IS ISSUED�SEC.�av7,CIV.G�. -
Z
w
� LENDER'S NAME
� IENDER'S�DDRE55 //�
� IAGRE1ETOCOMPL WITHALLLITYMIDCOUNTYORDTNANCESANOSTA�EUW REAUTNaTOBU�LDNO TOTAL FEES /y(i �D
� CONSTRUCiION.ANONEREeYAUT110RIZEpEGRESENTATIVE50FTNI5COUNTY70EN7ERUPON7HE
Z ABOVE•MENIIDNEO PROPERTY fOR INSPECTqN PURVOSE9. COMMENTS
� :-
�� � ��_�� /I �"
m P�EpMITjTE.E�N�AAIE�(VRIN.n �� w'' �(_ O E � J ' ��� �
' , �
(n SIGNANREOFVERMIT7EE � �+^,C�
� RECPT.N0. 1 PAID BY e� �+ VALIDATION
WHITE—DepaAment CooY.YELLOW—Finance Copy.PINK—AssassorCopy,GOLDENROD—File Copy,GREEN—Applicant's Capy
. . ; . �� � ;:.. ...l•',�..�;_,n_.... .:..'^-",.r•::�,',�n, ./,^.^�. . �.. ., "•S:n).�. .0 r.-. ...1..,' � . . .. .. .r.. . .�. �� , . . . . , .. r .., .r. .. ., . _
.� �CIT'�' OF DIRMafv�D Bl�R
� It�l�FEC�iOf�! RECOt;D
;:. ..��� i���7��1►� -- �'�1�� �►r�-,����1�� . I�l��..`�s!��f������ - l�;J���.� .. I���-�.'�r.���
- �___...�_� _��,...._._.. . ... _.....�._._..� .�_. -- - - ._ a�
SET BACK� • `� FLOOR J015T, - '
FTGS/FORMS/STEEL FHA REQPATS
ELECTRIC GROUND ' UNDER FLOOR DUCT ,
GROUND PLUMBING I UNDER FLOOR CUf�IDUIT � � '�
SLAB GRADE � � I FIREPLACE FOUNDATION . I
TEMP POWER I I FIREPLAC�BOND BEAM � �
WATER SERVICE � - I I MID HT.BOND BEAP�1 ' • '
ROOF'SHEATHING ' . �T�G���. � i 8 Ff.�BOND BEAM .
, •F R A M I N G N E N T I L I A T I O N+ �• I F I N A L B O N D B E A M I
ROOF COVER �`��� I PRE-GRADING I I
R�UGH HEATING BENCHING �
ROUGH EIECTRIC � ROUGH GRADING
ROUGH PLUMBING � � � FINISH GRADING
SHOWERJTUB TEST ; POOL ELECTRIC
EXT.LATHISIDING i I POOL FENCING
WALL INSULATION I � POOL FINAL I
CEILING INSULATION � OFF SITE IMPS. �
DRYWALL NAILING � DEDICATIONS �
SEWER i FINAI ENG.
SEPTIC TANK . � � LANDSGAPE/IRR1G.
SEEP PlT/LL. � . ON SITE Ih1PS.
GAS AIR TEST I ; FINAL ZONING �
FINAL CONST. ( ' ' FIRE DEPT. FINA!
FINAL HEATING i ; HEALTH DEPT. FINAL � �
FINAL ELECTRIC j ; DEV. FEES PAID �
�. FINAL PLUMBING I � ENERGY �
� ( .
� rc�..-p�:� ,.���jc��.
.
� • �_ �_._
� COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�.�� _ �
,,y��� ,��
-�,
,, .
� _����.� _...; � . ,