HomeMy WebLinkAbout12446 (14) �
�
,��-
� � CITY OF DIAMOND BAR j /'
DEPARTMENT OP COMMUNI'FY&DEVELOPMENT SERVICES j'"
� 21660 E.Copley Drivt Suite 190 /
(904)860-3195 Fax(909)861-3117 PRESS
B[JQ.DING PERMIT APPLICA��'ION FIRMLY
y JOBSITE `��7 --�� APPLICATION ,� PERMR �n P!C �
� a ADpRESS ✓ G-.�� ��-�T /GL�C�... � �I-
p DATE NUMBER G p�_
� APN LOT TRAC DATEE ��J '��'��fJ"CO ST. GROUP
g OWNER
p ADORES ZONlNG SETBACKS
' w CITY � ZIP TEL. FRONT RW ❑
I � APPLICANT � TEL. REAR ❑
� � SIDEISIDE STREET RW ❑
CONTRACTOR SIDE ❑
ADDRESS
� CITY ZIP TEL. PR�POSED USE
oARC G/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNlTS STORIES BEDPOOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIaN
Q ONMER-BUILDER DECLAHATION SFR/ADD/FiEM
� 1 NEREBY AFFlfiMI UNDEP PENALTY OF PERURY THAT 1 AM IXEMPT FROM TiE CONTRACTOqS U- Gp2gp/C81p011
CENSEUWFORTNEiOLLOWN(3REASON(SEC.7037.6BUSINESSANOPP.OFESSIONSOOOEANYCITVOF (n
COl1MTYWNCHPEW1f1ESAPERYITTOWNSTiIUCT,ALTE0.M1IPROVE.DEMOLISH,OflREPNPANYSTRUG 4j,J p�i07D9Lk
NNE.PpqR TO ITS 56WNCE,ALSO RFOUWFS THE APPLICRHT FOR SUCH PFRMIT TO FILE A S1CJ.IED
�� STATBAENT TMAT HE OR 9HE IS 110ENSEU PURSUiv/T TO THE PROVISIONS OF THE CONTRAC70R5 LF w
CEN$E lAW(CHA7TER B(C041JENCCXI WITH SECTION 7000)OL pIVI510N 3 Of THE BUSINESS ANO PRO- LL PooUSpa
5�1 fE44GN.SGODE)OfllH.ATMEOR5HE13EXEMPTiMEREiROA1ANDTHE8A515f-0RiHEALLEGEDE%EMR (�
� TION.ANVVIOUITIOHOFSECTION7091.6BYANV�PPLICANiFONAPERMITSUBJECTShIEMPLICAN7T0 Z Re-Rool
� ACML PEIULiY Of MOT MORE 7H�N flVE HUNDRED DO�IARS(i5001.F
� �4ASOWNEROFTHEPROPERTY.OHMVEMP�OVEESVATHWAGESASTHEIRSOLECOMPENSATION, � COtI1111BfCIfli -
YblLDO TME WORK AND iHE STfiUC1i1RE IS NOT IMEN�ED OR OFiEREO FOR SALE(SEC.70�4,BUSF J
N NECS AlY7 PROFES4 W�}S CODE:NE CONTRACTORS LICENSE UW DOES NO7 APPLY Ta AN OWNER OF ?
PNOPEfffY N710 BULDS OR MPROYES 1HEilEON,ANU MMO DOES SUCl1 WORKHIMSELF OR HERSELF OP
CL Tl�ROUGH HIS OR HEfl ONM EYPLOYEES,PpOViDFD i}iAT SUCFi INPPOVEMENTS ARE NOT INTENOFD Ofl CO
� OFFFAEDFORSALEIF,HOWEVER��O�NOORYPROVEIAEMfIS50LDWITHINONEYEAROFGUA/�LE-
TIOl1.TME OWHEF�BU1�,pER WILL HAVE THE BUR�9i OF PROVMO 1FV.i HE OR 3HE DID NOT BUILp OR
IYPNDYE FOR THE Pl7Rvo5E OF SAIE).
W OI,A40WMEROFI}1EPROPEFRY.KIE%C1I151VELYLOMRACfINOWRHUCENSEDCONTMCTOiLS
� TOCONSTRUCThiE VRO.IECT(SEC.7041,BUSINE55 AND PRDFESSIONS CODE:THE COMRAC70q511- V81U8110/1 ADJ.AREA
W CE7�65EUWDOESNDT�PPI,YTOMIONiNEflOFAPROPERTYW170BUILD50flIMPROVE5IHEREON,�ND
� WqCOFlTiUCTSFORSUCHPROlECTSWIINACONiMCTOR�S�IICENSEDPUR5UM7fTOT1ECONTMG QUANTITY DESCRIPTION FEE
� tORS LICENSE UW.�.
❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON d S S
� U
� � /
DATE DWNER U
n� w .�c•i.t t
� UCENSED COM'RACTORS DECLAHATION W
OE IHE�V7�FFIP4UNOERPENALTYOFOE0.&JqYTHATIA4LICENSEDUNDERPROVISIONSOFCHAPTER � [�
� Y(CQWENCWOWITMSECTION70bA)OFOMS�ON30FTHEBUSIYESSANDPROFESSIONSCODE.AND z (J
X MY UCENSE IS M FiRI FORCE MID EFFEM. ' � . w'�w� _� P �
lL ') (�6.- i�!
0 LICEALSECIA^a4 4C.NO.� ✓ �"j
F J
V OATE cONTRACTOP 0.
W
1NQRKE,6iS'CQMPENSATION DECLARATION H
� � IHEREBY�FFlPMUNDERPENPIT'OFPEqJURYOMEOFTHEFOU.OWWGDECLAMTIONS: Z
) � _IHAVEANDWILLM�M7TAMIIICER'fIFICATEOFCONSENTTOSELF•INSUREFOFWOHKERS' _
� COMPEN9ATION,A9PROVIDEDBVSECTiON37o00FTHEUBORCODEFORTHEPERFORMANCE U
� OF THE WORK FOR WHICM TN�B PE.R�AIT IS i55UED. w
� 0 �
W _IHAVEANDM/ILL1MrtiTAiNM�ORKERS'COMP�TIS�TIONINSURANCE,ASREOUIqEDBYSECTION
Q 31a00F THE U1POR WDE.FOATHE PERFORA�ANCE OF THE WORK FOR WHICHTHIS PERMIT IS
ISSl1EO.MY WORKERS' EMSATION INSUFUNCE CARRIERA/ND POLICY NUM6ERARE: CONSTRUCTION �� I i �
��•�/MJi �
j j CARRlEA /^�� J�'�N/� PLAN REVIEW �
' 02 POLICYNUMBER �`t�C2' ELECTRIC �
Q
0 (ReSSECtqN1.�IDNpTBECqREfEDOF1VEPEw4T5PoaaJEt+tNY7FD0o�1.�iS{Etao)a7LE55} PLUMBING
j � 1 CERTIFV TMAT IN THE PERFORMANCE OF h1E WOAK FOq WHICN THIS PERMIT IS lSSUEO,I MECHANICAL
� (f SHALLNOTEMPLOYANVPERSONMIANVMANNEIIR��SUBJECTTO7HE
I � WORKENS'COMPENS�TIONU`NSOfCALIFOfiN10.A REE7H FLSHOVLOBECOME INSPECT70NFEE
� SU&! TO E WOR�(ERb'�ENSATION PROVISIONS bFSECTIi��oo oF r 90q
� i sn wm�mm coMe�v wi se dnov� ISSUANCE �
n
� � ' SMIP ���iQ
p UATE: � APPLICAM:_
WWAHlIINO:fA1LUHETOSECURE N'OFlKEAS'COMPENSATION COVERAGE IS UN WFUL,AND ENERGY P/C
LL SU&IECTANEMPLOYERTOCRWIIULPENALTIESANOCMLFINESUPTO�IEMUNDREOTNOUSA9ID EMEqGVPERMIT
pOLURS(5100,000).IN M�ITION TOTHE COST OF CONPENSATqN,DAMAGES AS PROVIOED FOR IN /e�
J £ECiqN 3708 OF THE UBOR CODE,tNTEREST,ANp ATTOANEYS FEES. F{Ej NTION FEE: /V v
�
OCONSTRUCTION LENDING AGENCY pR -ALT�F�/,�2
, � IHEREBVAFFIRMUNDERPENAL7YOFPERIURYTHATTNEREISACONSTRUCTIONIENDINGAGENCY �D �
FOR 7HE PEfliOMMNCE OF THE WO(iK FOR WHICH THIS PERAI�115ISSUED(SEC.3007,CIV.C.�.
Z
W
' � LENOER'S NAME
: H LENDEq'SADORESS
� ICERTIFY7FIATIMAVEREAD7M�5APPLICA710NANDSTATETHATTHEABOVE�NFORMATpNISCORRECT. TOTAL FEES � t� � � /\
� 1 AQREE TO COMPLY`Mhl ALl CITY ANO COUNTY ORDINANCES qND STATE UWS RELATINO TO BUILOINa //L� /
� CONSTpUCTION.ANOHEREBYAUTNDRIZEAEPRESENTATIVE50FTHISCOUNTYTOENTERUPONTHE /��. t / �
ABOVE-MENfIONEO PROPERTY FOR INSPECTqN GURPOSES. COMAAENTS O�T � � ��Nl4 I �
a � OR
� Efw E PFk� �.,��k�F-����U� �7it�,7�R1#
� g �t
�
� ATURE oF PEHMflTEE DATE
� RECPT.NO. PAID BY � VALIDATION
WHITE—DepaAment CopY,YELLOW—Finenca Copy,PINK—Aasesaa Copy,GOIDENROD—File Copy,GREEN—AQplicant's Capy
CI'TY �?F �IAIVidN� �1�R
iNSPECTtC31�! t�tECiDRE�
s���a.: � a�• � :, � • • � � � s � n
S�i' 3AC�� FLOOR JOIST �
_ �
FTC;SIFOR�r1S1STEEL---- 0./;�--- - ---� i FHA REQMTS - �� ?
ELFCT�lC CF?OU�I€� j UNDER FLOOR DUCT �
Ca�iC�UIdD PLUttriE3lf�G UNDER F�(JOR CC�I�IDUIT
SL��G�i�,b� FIREPLACE FOUN�ATION - �
T��G��P{)L'V�i=s FIREPLAC�801VD BEAM
��JATER S��VIC� �---- MID HT. BQND BEAPvI i, i
—__.______ _ ,
Rt�£?F SHcA`1'HiPJG I _ S FT.BQND BEAM I
FRA v,lt���a�'VEtVTiL!ATIC}I� - -- ^ � FINAL BC7ND BEAM � �
R.'.}C}F GC3V�R i PFiE-GRADING ( ,�
ROtJG1-i NEi�T'INCa � BEh1CHING i
FtC3UGH ELEC�'Rl�, ROUGH GRADING #
RC)UCH F'LUP�B1tvG � F!!�liSH GRADING =
SHQW�FitT`E��3 T�S"I" POOL ELECTRlC +
E�1: L.�;THiSiDII�C'a � POC7l�FEfVCENG �
_411r�LL&�SULATi�"i�t POC3L Flt�lAL "
CEiLltv�lI�IuUL�iTIQP� Or=�SiTE lMPS. � �
C7�Y4'M'f�LL N�ad�ilvC; DEDlCA710NS '
'�
.�'s�41t�R FIh:AL c(�G. i
S�F�T`1C�I"€tiV�� ; l_AhIVDSC�PEJIRRICa.
SE'�F'�'13�IL.L. j_ _.._..__ ON Si7'E I�m�P5. -_.�. � `
£�r�;i r�IR TE�T j F(NfIL ZOh31NC� �
�9��a��.C�'ivST. T /j` / :_ FIRE DEPT. �Ilti?r�,L , i
-_____
I�If��,Li-€E:r�Ti��G � ': ^ � HEALT�i (�EPi. Flivr�L �����` ___.___._. �
� II
�Ii���L E��CT1�(C------�j �Ot� --_ ____�_ DEV. FEES PAID f�_ �� i
_F9�t��L F'L�i��o�9�t;a � ENER�Y �
e �c. � �� _� �-� _
i
____`_. ' �' 'r i
_____. - ,
i i
�rv ivi i�1i c:�'�t.�1(� -c�8'�.� Q.Cl1e.,i-i.J -�C,- '�"-t�- �c�c3k ` i
_ i
— (
__�,-- �
_ �
--.—�
Sc�i 9C i"�,P+18i SlZ� j
��Fr� PlTi�7 SI.�� .----�
., ,
a� -
�
4'
ti�t:�_....,.,�'_.�j.�_,S ��_ � ;,
:
r;1-:�t tl�;+'f`r x�ii.i-I�:'`Y'1'.�';
r�f�r�vv - W,...._ .... �'.
'�.l :a� �{��r..' �., •=P •' t_ � _ _ ' . . +