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HomeMy WebLinkAbout12796 (13) � n CITY OF DIAMUND BAR ---�� DEPARTMENT OF COMMUNITY&DEVE�.OPMENT SERVICES �? � 21660 E.Copley Drive Suite 190 � � (909)860-3195 Fax(909)861-3117 �` PRESS $UA,DING l'ERM1T APPI.I�A�'IQN FIRML,Y } JOBSITE APPLiCATlO PERMIT P/C � ADORESS Z��Z- DATE Z" � NUMBER �� # ' � APN LOT TRACT Z DATE '� a CONST. GROUP p OWNER�1 r.tivt,4. LL ADDR ZONING SEfBACKS � w C�N ZIP _�� TEL� FROMT RW ❑ � APPUCANT TEL. REAH ❑ � SIDE/51DE STREET HW ❑ COMTRACTOR �l- LL SIDE ❑ O AOD CSS ' PROPOSED USE p C�TY ?�r�L.�l�"'�t�,','� ZIP� TEL.'Z � t� ARCWENG/ / z DESIGNER�� l�r�.j l� !`� S[7G k' ADDRESS NO.DWEL. NO. N0. � UNITS STORIES BEDROOMS � CIN ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION SFp/ADO/REM � �'� t � p i�r�ev�ccirw ur�oFa vENeL1v oF vEaum nur i�u��cMar�n�E cartaAcrons u- Garage/Carport tL C@16ElAWFaFiHEFOL10W1NOPEASON�SEC.7031.58U3INE33ANDVflOFE5510N5CO0E:IWYqT'OH (Jj 17 CO�Wf1Wl9pIqB0UIREgAPERtIRTOCONSTRUCT.ALTEF,IIWROVE.DEMOlISH.ORREPIIFANY3TRUG W ��� �Z T1RE,WiIDN TO RS ISSUANCE.AL50 REOUIqES iHE MPLICIN7 FOH SUCH PEFlIAIT TO FILE A�ONEU W .� STATBAENT THAT HE OR SHE IS LICEN6EO PURSUANT TO 7HE PROVISIONS OF THE CONTRACAORB LI- � � CEHSE U1M�(C7MPTEF V(COM4RdCW(i YATM SEC�ION 7000)OF OIVISION 3 OF T}g BUS7NES5 AND PRO- PooUSpa FESBqNSCOO�ORiHATHEORSHEISFJ�AIPTTHEREFRWANDTHE8A515FORTHEALLEGEDE%EMP- � TlON.ANYNOlAT10NOfSECT10N7W1.58YM1VAPPLICAMFORAPEHMiTSU&IECTSTHEAPPLICANTTO Z Rg.R00� � A CML PENALTY QF N�T YOf1E 7HM/FIVE HUNDRED DOLURS If500).Y � ❑I,I450WNEROLTHEPFOPER7V,ORMVEIAPLOVEESWITHWAGESASTHEiR50LECOMPENSATbN, � �mmerdal - _ WILL DO THE WDNK.AND TME STRUCTUqE IS NOT IMENOEO OR OFfERED FOR SALE(SEC.7041,BU51- ,J � HESS ti4D PIqFE5510N5 COOE:TNE CONTRACTORB LJCEqSE LAW DOES NOT APPLY TO 11N OIYNEq pF � PiqPENTY YNIO&1p.D5 ai NAPROYES 7NEREdJ.AND MR10 DOES Su0/WORN Hi1LSELFOR HERBELF OR (Z lY1R[M10HWSOANEROVMp1DLOYEFS,PROVIDEDTHATSUWIMPROVEMEMSARENOtINTEH�EDOq N �O DiFEHEDPo�FiS�LEIFHOriEYEt�11iE8URDiNOORN1PipVEMINTI350lDW1THINONEYEAROFCOlI,P�E- Z 710N,iHE OYYNER�BURDER WILL HAVE THE BUi�EN OF PROVIN6 7HAT NE OR SHE DID NOT BUILD OP = WPIIDVE fOR iliE PURDOSE OF SALEU �yJ ❑4�aMMENOFiNEPROPER�`/.AME%CLUSIYELYCONTMCTNJOWRHLICENSEDCOpffRACTORS [� 1U CONS7NUCT 7F�PIqJECT(SEG.7oM,BUSINESS MI�PROFE5510N5 CODE:7HE CONTHACTOP3 LI- VelUBtiOf1 ADJ.AFEA Cl7 Cl�]iSELAWDOE.4NOTMPLVTO�HOVMEROFAPROPERTYWM09UILD50RWPROVEShIEqEON.AND � YVFq00MAACTbFORSUCHPROJECTSVATiACONTRACT01i(S)LICENSEOPURSUANTTOTHECONTMG �(JJU.JT�r DESCRIPTION FEE lOFB L1CH16E UWY.�. 1 � O I AM EXEYPT UAOER SEC. B.6 P,C.FOfl THIS REaSON sJ( vc/ -�AA. V( �r�y�Q �'=�' UATE OVYNEH F � �� � � � . � W G � 4 q UCENSED CONTRACTORS DECLARATION W U 3� Q ¢ 1 XEqEBY 11FFIRM UNDER PENALTY OF PERJURY TH�T 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � O�OOItl1ENCMIO N'ITFI SECTION 7000)OF DMSION 90f THE BUSINESSANO VPOfESSIONS CODE,AND � MY LICENSE 44 BI FULL FORCE AND EFFECT. ��li�— � �•C - I �.� ��� LICENSE CU �^ �'� LIC.NO. J JL�(l t S L�� `I�O t' DATE �7^ � CONTR4C70R �C.. a � . L�l �/�a = WORKERS'COMPENSATION DECLARATION a � I HEREBV�FFIRM UNDER PENALTV OF PERIURY ONE OF TNE iOLLOWING UECLAMT10N5: Z � _I HME AND WILL MAMTAM A CERTIflCATE OF COIJSENT TO SELf-INSUPE FOH WORKERS' _ COMPENSATqN,ASPRQVIDE09Y5ECfiIXi37000FTMELA90RCO0E,FORTHEPERWFMANCE W OF THE VYORK FOR NMICH THIS PERMIT IS ISSUED. � W r �1 NAVE JIMI NflLL MAMTAM WORKERS'CdA7EN5AT10N INSUMNCE,AS REIXIIRED 8Y SECTION Q 3700 OFTHE IABOR CODE,FOR TNE PERFORMMlCE OF TF1E WORK FOR NMIG1 THIS PERMIT IS � ISSUEO.MYNORK-�}q�5'� ENSATI�O-N I�NS`URMI CARRIER AND POLICY NUMBER ARE: CONSTRUCTION ] CARRtEH S 1c�. �"V�.� PLAN REVlEW � ��cr Nur.,eea��� •OO f 3�t b�- . �Ecrn� � • � (iVusEct�oNNE�NOT8E00AFtElFnoF7HEPEw�fflSfaRouEHUraRE000�luLS�Etoo)oRLFSS} PLUMBING � I CERTIFYTMAT IN TME PERFORIAANCE OFTHE NK1RK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL ('j SHALL NOT EMVLOY MIY PERSON Nl ANY IA,4NNER 50 AS To 6ECOME Sufl1ECT Ta 7HE � WORKERS'COMPENSATION UN50F GLLIFOHNI0.N�/1CREE TMAT IF 1 SHOVI�9ECOME INSPECTION FEE SUBJECT TO TNE WOfa(ERS'OOMPENSRTION PROVISIONS OF SECTION 970o OF THE UBOR � coo�,i sH�u Foar�n�ca+v�r win�nase raohsions. ANCE ` O iP 0 oA�: arR�caNr: � WMNIN�:FALURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSWILLBE ENERGYP/C � SUBJECTANEMPLOVERTOCRWINIILPENALTIESANDCNIIFiNESUPTOONEHUADPEDTHOUSAND ENERGYPERMI'hYT�r nr r�r��i 7�� } DOLLARS�i100,D00),INMOITONTOTNECOSTOFCOMPENSATqN,DMUGESASPRW10E0FORIN ���A-Qi��-n�.P(-��i���` �+Y J SECT10N970BOFTHEtA80HCODE,MTEREST,ANOA7TORNETSFEES RETENTIONF���I,j��_n�TV LLJ V 1L1../ Y i!:,a d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBVAFFlRMUNDERPENALTYOFPERJURYTHATTMEREISACONSTRUCTIONIENDINOAGENCV FOR 7HE PERFOHMANCEOF THE WOiiK wR WMICH 7MI5 PERMIT IS ISSUED(SEC.30Y7,GIY.G�. Z W � LENDERS NAME F- LENDEiYSODDRE55 � ICERTIFYTHATIHAVENEMTHISMPLICATqNNJDSTATEhIATTHEABOVEINFORMATKKlISCORRECT. TOTAL FEES /),, � 1 AGPEE TO WMPLY N7TH/�LLCT'ANO COUNTYORDINANGES ANO STATE LAWS REUTINO TO BULDING �J � CONSTRUCTION,ANO HEREBV AUTHOF�ZE REPRESENTATNES OF TMIS COUN7Y TO EMER UPON THE G/�/ ABOVE-MENTIONEO PROVERTV FOH INSPECTION 7URPOSES. COMMENTS �J`s �./� �,�, �avr�.s L, I oa�`e '�' � PEl1AA EE WVAE(PRINf) / � � � � OFPERMI E D E � RECPT.NO. PAIO BY VA41OAT10 4YHITE—Depertment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,GREEN—Applicant's Copy � i C�TY �F D1AMt'�ND BAR fN����Tl4N RECC1�iD i - - i � � t � - � . � � -._. � ���gq�}( FLQOR JOIST FTGStFt7FiMStSTEEL FHA FtEQlUIT5- i E�ECTi�IC GRC}Uf�1D UN'DER FLdO DUCT " ! GRC�UYVD PLUfv181NG I Ut�YDER FLOOft CG�4DUIT I SLA�GRADE FIREPLA�CE F011NDAT1'ON TEMP PQWER FIREPLACE BOND BEAM , 1N�TER SERVICE MID HT.B014Q BEAM � RddF SHERTH11�4'G C S FT.SUI�D BEAM - - - FRA(�1NG/VENTiLIATION FIMAL BOND BEAM ROC7F CQVER I�RE-GRADING R{?U�ii FiEt�TING BEhlCNiNG ROUGN ELECT�dC ROUGH GRADING ROt1GN PLUNlB1NG FINISH GRAQING SHOWER(fUB 7EST POC?L ELECTR[C EXT.LATN/SIDING POC�L FENGING WA�L 9NSULATIOEU P(70L FINAL CEILING INSULATIOt� OFF SITE IMPS. DRYVJALL NAILIN� I DEDICATIC7NS I, �_ --- j SEttyER FlNAL ENG. � SEPTIC T,0.�lK LANDSCAPf-JI�fiRlG, � SEEP Pii'1L.L. ON 51TE It�1PS. �---_.___.� �_.— � G�S Aift TEST FINAL ZON{NG �tF��l.CQS+157. FIr�E DEPT. FINAL � � FiN�l.H�ATING . HEALTH DEPT. F9NAL ; FiN,�L EE��CT�IC � DEV, FEES PAID ; �� �IIVAL PLUivt�IiVG ENERGY � � . . . , � � ' w � . i t.J�IY!lVi�IV I L7 �..�.�.���� ..�� � ' .. :,'. SEPTIG TANK SiZE;'� ; � ` � ' � ' SEEP PITtU SIZE �-~�nr ,.', .:.�,,- . '.