HomeMy WebLinkAbout12450 (14) _.,
;�.�-,...�.�
_1� CITY OF DIAMOND BAR
DEPARTMENT QF COMMUNITY&DEVE�,OPMENT SERVICES
� 216b0 E.Copley Drive Suite 190
(909)860-3195 Fa�c(9U9)861-3117 PRESS
��.nnvc r�rr Arr�€,zcn�c��v FtRM4V'
r JOBSITE " � i APPIICATlON t/�r'�� PERMIT iZ P!C
4� ADDRESS DATE (,,1./ NUMBE4� �
c� ISSUE TYPE OCC
APN �OT TRACT DATE CONST. GROUP
� OWNER
ADDRESS �.'_� (�J i .� ZO�11NG SETBACKS
� CITY ZIP TEL. � FRONT RW ❑
� � APPtICANT �wC�— TE�(„j� s DE/SIQE STREET RW ❑
� CONTRACT R S1DE ❑
°C ���� c PROPOSED USE � -� �
� CITY �ri�f�o['�a ZIPQ[�7� TEL " ,y
� ARCH!€NG/
Z DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS_l STORIES�BEDRDOMS�_
� C1TY ZIP TEL.
� DESCRIPTlON SQ.FT. FACTOR PSF ADJ.AREANALUAT{
�
� OWNER-BUIIDERDECLAfiAT10N SFR/AW/REM �
O
� I HEREflY AFFRW UHDER PEN�.LTV OF PERIUqY THIR 1 AM EXEMVT FAOA1 THF COMRACTOflS LI- (a`y��((�`81POR
W CENSEUWFORTHEFOLIOWAIGRFJ�50N(SEC.70.91.59US�NESSIWOPROFESSIONSCOOE:ANVCITY00. (J�
� COUHTYVhYCHAEWIRESAPEAMfi'TOCONSTf1UM,AL7FR�P��E,DEMOLISN,ORHEP/YRANYSTAUG W Patio/Dgck
7Wi�.P�W�R TO ITS ISSUAMCE,ALSO PEQU�RES TNE APpLICAPlT FOR Sl/q1 PERMIT TO iILE A&C+NFO
ST�T61�kM THAT HE Ofl SHE IS IICENSEO PUFSUANT TO THE PROVISIONS OF TNE CONiAACTOHS l4
� CENSE UW(CV/�PTER 0(COLWFNC�NO MTH SECTKKd 7aao)OF�IVIS�ON]OF TNE BUSINF.SSl1N�PRO• � POOVS(.78
FES910NSGDDE}OA7NATHEORSHEISEXENP7TNE{7EFR04ANDTHE9ASISFORiMEALLEGEDEX6NP• �
TIDN.ANYVIOLATIDNOFSECilON703/.58V�NYAPPLICANTFORAVERIdITSU&IECTSTHEAPPLIC0.NiTD z Re-RooF
F ACMl PENJILN OF NOT MORE TiAN FNE HUN�RED DOLLAFS(�500))�
� �4ASDNRIEROFTNEPROPEHTY,ORMYENPLOYEESWI7MWRGESASTHE1HSOlEWMPEL151.TW�, ❑ COrtIrt1BfC18I
WILLDO iHE WdLC,AND THE STRIICTURE IS NOT IME�ED Ofl OFfERED Wfl SALE�SEC.)CIN,9U51- J
M668,WD P11OF6SSION8 CODE:7HE WNTMCTOPS 110ENSE LAW DOES NOT APPIY TO MI OWMEN OF
N pp0lFlfTYyM10BUltDSONNPqOVESTNEREON,ANDWNOD�ESSUCMWt7RKHIMSELFORHERSELfOR m
Q 7/WOIHYiHlSONHEROWNEWLOVEES.PROVIDEDTIATSUCHIMPFOYEMENTSAREM�TWTENOEOOP
QOiifpEDFOqS/LEIF,NOWEVEil1HEBU�LDRdGOqiYPpOVEMEMISSOLOWITHINIXJEVEAFOFC0471E-
z TION,THE WqiER�BU1lDER N7LL FU�VE THE BURDEN OF RROVUIG THAT HE�R SNE UIO NOT BU1LD OR
� W�YiDYE FOA THf PUPPOSE OF SALE).
� ❑�A60WHFflOfTHEPROPEHfY.AME%ClU5N6LYCONiRACTMGWITNLICENSEUCOHTAACTdiS
70 CCN„TpUCT YH�PROIECT(5EC.)a/�,BUSINESS AND PROGESSIONS CODE:THE CONiRACioRS LI� VeIl18ti0f1 ADJ.AREA
CEN&E UW DOE8110T MPLYTtl Ifd OWl1ER QF APRQPERTY WM�6UNDS OR IMPpOVES TIEREOM.NiD
�1RIOCONTMCT6FOflSUCHPROJECTSWI71fACp17MCTpi(S�LICENSEOPUflSUMITTOTNE�tTRAG QUANTITY OESCEItPTION FEE
� ra�s uc�uw.�
O�MI E%EMPf UNpER SEC. 8.a PG FOR THIS REASON Q
U
�
LL DATE OWNEF F
W
� �4 UCENSEO CONTRACTORS DECLARATION �j
I ¢ INEltEAYAFFiRMUNOERPENAI,ttOFPER1UfiMtHATtNAUCENSEDUNDEAPROVI510NSOFCHAPTER �
a, Y�ODMIIENCW0IMTHSECTIDN7000)OFDMSpN30FhIEBU5ME55ANDPROFE55taN5COOE,AND Z
MY LICENSE lS M Fl1LL iOfiCE ANO EFFfCT. �
� LICENSE CUSS LIC.NO.� ' �
V p�7E��` coNrPucTOA_ .
�
WORKERS'CpMPENSATION DECLARATION �,/��� �
a
I � IHEREBVAFFIRMUNOERPENALiYOF7ERIUMONEOFTHEFOILOW!NODECLARATION$'. U
k � Z
I � a
^_I HAVE M!D VNLI MA!NTAIN A CEHIIFlCATE OF CONSENT Ta SklF.MSURE FOA VfURKERS' _
Cdl�ENSATION./V5 PROViDED BYSECTION 37000F THE UBOR GOOE,FOR THE PERFORIAANCE �
OF lHE WORK FOR WHIGH 1HIS 4ERM1�IS t55UE0. �
^ 1 NPVE l�J W1LL MANiTAiN N'OA%EAS COMPEN3ATION INSUMNCE,AS REWIRE�BY SECTION
Q �37ooOFTHEIABONCOOE,WRiHEPERFORAIANCEOFTHEWOfiKPoRWNIq1THI5PERM1T15
Q ISSUED,MY ERS' PEN ION NJSU CE CARRIER AND POL�CV NUMB£R 11RE C�NSTRUCTION
� CAARIER ^ PLAN REVIEW
Q� eo�kYrwMeER� � � y ELECTRIC
Q
o �Ss�crc�xEIDNpTgEooM�.�'rmoFtrEpEpersFoqar��urpqEn�mm)oa�ss} PLUMBING w
I W ICE1iTIhYT11ATINTiEPERFOHMM'CEOFTNEWOflKFORWHICHTHISPERMRI&ISSUE0,1 MECHANICAL YA�
Z
(� SHAILNOTEMVIOYANYPERSONtNPNYM/NtJERSOAST08ECAMESU&IECTTOTi£ �NSPECTIONFEE
N YAwcER5'COMVENSATpNLAW50FCRUFORNIqAN0A0REE7HATIFI DBECOME
S SVfiJECTTOTHEWaRKERS'COMPEM4 IONPROVi5fON50 EECTKIN� tMEtABOR ISSUANCE
CODE,I SHAIl FORTHM9TH COMPLY WI SE PPOYIS S. ^ e i
� SMIP 1�79Q �
� p DAIE:,�—�� APPLICAM: .
J ENERGY P/C
, J WARNINO:FA2URETO SECUFE 1WRKEAS'COMPENSATION VEftAGE I5 UMJ�WFUI.�NO SHALL BE V^���,���/���
� � S1�JECf�NEYPLOYERTOCN�MINPLPENALT�ESANDCNII NESUPTOONENUNDREDTHOUSAND ENERGYP�Tl ,lJ' F ���.L,��-�--�RAR
Oq_I,ARS(f 1oo,aD]),IN AD�IiION t0 THE COSTOF COIAPENSATION,DAMAGES AS PROVI�ED FOR IN i�T /''� �j
� SECTIONs�o90FTHELABORCODE,IN7EHEST,AND11TroRNEY'SFEE6. RETENTIO�j��j,�{,J��, �],
4 CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
�
I HENEBYAFFIflM UNDEfl PENALTY OF PLRJURV THAT THENE IS ACONSTRUC710N LENDING AGENCY
FQR iHE PERW R4MlGE�F THE WORK WR MMICH TH1S PERMIT IS 155UED�SEC.309],L1V.C).
�
� LENDER'S NAME
F-- LENDEH'9ADDflESS
Q ICERTIfYTMATIHAVEREADTHI3APPLJCATIONANOSiATETHATTHEPBOYEINFORMATIONISCORRECT. TOTAL FEES �
� IAGqEETOWMPLVWITMALLCRYANDCWNTYORUINANCESANOSTATEUWSPELATINOTOBUILDING ���
� CONSTRUCTIOlyNJDNEREBVAUiHOfl1ZEFEPRESEN7AT1VE50FTHI5COUMYTOENfERUPONiHE 20�3
1190VE-MENTIONED CROPERTY FOR INSPECTION PuaVOSES. COMMENTS
�
J
_
m P NANE(P
N O
� O ERMITT DA E
RECPL NO. PA1D 8Y VA�pATOM
� WHITE—Deoartment Copy,VELLOW—Finence CoQy,P!NK—Asses�w Copy,GOLDEiJiiOD—File Cop�r,GREEN—Applicant's Cnpy
ctT� o� ota�no�n BA� �
s
IN��+ECTION REGCIRD ?
I
�
,� i � . x � � • , � . . ` ; m...s._ . ' t
S�T BACK FLdOR JOIST
FTGS/FORMS/STEEL FHA REQMTS �
E�ECTRIC GROUND UNDER FLdOR DtlCT �
GRdUND PLUMBING UNDER FLOOR CG�IDU{T �
g�,,qg�Rqp� FIREPLACE FOUNDATION
u
TEPv1P POWER FIREPLACE BOND BEAM � �
WATER SERVICE MID HT.BOND BEAM
ROOF S�i�ATHIhiG t0�13 Z� 8 Fi.BOND BEAM
FR�VfitTINGN'ENTIL(ATtC}N FINAL BOND BEAM
ROOF GOVER !� •' -4E PRE-GftADING ;:
ROUGH HEf1TfNG BENCHING &
s:
ROUGH ELECTRIC RDUGH GRADING
ROUGH PIUMBING � FINISH GRADING
SHOWEF?ITUB TEST POOL ELECTRIC ;
�
EXl'.LATH/SIDING POOI.FENCING sq
WA�L INS�ULATIC7N POOL FfNAL �'
:
CEiL(N�fNSUlfiTiC3�! OFF SITE IMPS.
DRYWALL,NAILiNG DEDICATIONS �
BEWER , FlNAL ENG. i
SEPTIC TANK I LANDSCAPE!{RRIG. I,
SEEP PiTlL..I.. ON SITE{MPS. €
GAS AfR TEST FINAt ZONfNG ;
�tNAL CQNST. fo�-� � FlRE DEPT. FlNAL �
FiNAI HEA7ING HEALTN DEPT,FINAL {
FSiVAI.ELECTRIC DEV.FEES PAID 3,
FINA�PLUMBING ENERGY
. � �
�0������
' ;a.31,,j;..
;t;
i
. i
1
SEPTIC 1"kiVK SiZE �:;�;T.,;' ; , il�:i�:.?I;Y�� � ��'
SEEP PIT'i�SIZE � �
' �
A
f
g
�