HomeMy WebLinkAbout17906 (19) �� C1TY OF DIAMOND BAR ��
DEPARTMENT OF CO[vflvtUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drivc
(909)860-3195 Fax(909)861-3117 PRESS
'<� BUILDING PERMIT APPLICATION FIRMLY
} JOBSITE q APPLICATION PERMIT � h P/C
o ADDRESS �-1 N • ���,���r,�,t/ �D• OATE______� / " / �pL NUMBER � �/ q
$ ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �
� ADDRESS ZONING SETBACKS
0
z CITY ZIP TEL. FRONT qyy ❑
g APPLICANT TEL. REAR �
� SIDE/SIDE STREET pyy ❑
� CONTRACTOR � c SIDE ❑
o ADDRESS 1
CITY_ P q� TEL��� PROPOSED USE 6 �
o ARCH/ENG/ � '��/ -►r���-�
DESI�NER
lzia NO.DWEL. ��N�. NO.
a ADDRESS
� CITY � ZIP TEL UNITS STORIES �_BEDROOMS
�
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION
p SFR/ADD/REM
p 1 HEREBY AFFIMI UNDER PENAITV OF PEiWRY THAT 1 MI E%EMFT FqOM iHE GONTMCTORS Lb G812 JB/C81p011
W CENSEUWFOflTHEFOLLOWINOREA50N(SEC.70.71.68USINESSANDPROFESSqN5CO0E:ANYGITYOR (n
U COUNTYVR11p1REWIRESAPERMRTOCONSTRUCT,ALTEf�IMPROVE.�EMOl.ISH,OHFE7NRANYSTRUC• W
W 7URE,PRqR TO I75 RSUANGE,AL50 REWIRES THE APPUGWT FOR SUCH PEFMIT TO flLE A SIGNED w Patio/Deck
� STATEMENT iHAT HE OR SHE IS LICENSED PURSUMR TO THE PROVISIONS OF iME CONTMCTORS ll• �
� CENSE UW(pUPTER i(COMMENCIN�WITH SECTION 7000)OF OINSION]OF THE BUSINESS ANO PHO• POOVSPa
FESSpNSCO�E)ORTHATHEOHSHEISE%EMPT7HEREFROA./ANDTNEBASISFORTNEALLECEDE%EAIP• (�
7qN.AN`/VIOLATIONpFSECTION10J1.68VANVAPPUCANTFORAVERMITSUBJECTSTMEA➢PLI�ANTTp Z qe-Roof
A CML QENALTY OF NOT MOqE TW W FNE HUNORED OOlUAS(f SDO).):
0 OI.�SOYMEROFTHEPROPERN,OqMVEM�LOYEESWITHWACESASTHEIR50LECOMPENSIUION, 0 COf11ffIBfCl2I -
Z VnLL 00 THE WORK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SILE(SEG TW�,BU51� J
� NE33 AND PROFESSIONS GODE:THE GONTMGTORS UCENSE UW DOES NOT MPIY TO�IV OWNER OF �
iROPERTYMIMOBUILD50RIMPROVESTMEREON,ANUWHO00E55Up/WORKHIMSEIFORMERSELFOR
Cr TMROUCMH150RHEROriT1EMROYEES,VROVIOEDiT1AT5Up/1MPROYEMENTSARENOTMENDEDOR m
� OFFEREDFORSILEIF,HOWEVERTMEBUILDINGORIMFROVEMENTISSOLDWI7MNONEVEAROFCAMPIE-
Z TqN,iHE OWNER�BURDER WILL NAVE THE BUROEN OF VROYIN6 MAT HE OR SHE 010 NOT Bu1LD OR
= IMPROVEFORTHEVIlNPOSEOFSALEJ.
�y,� ❑4�30WNEROFTHEVROPEHTY,MIE%ClUSIVELYCOMRAC7INOWITHIICENSEDCON7MCTORS
� TO CONS7RVCT TME PR0.IECT(SEC.7a�,BUSiNE551N0 PROFESSiONS CODE:7ME CONTMC70R5 LI� VelUetiofl f v � � A0.1.AREA
W CENSELAWDOESNOTAPP�YTOANOYMEROFAPROI'ENTVNT108ULLDSORIMPROVESTHEREON,ANO
� VMOCONTHl1CTSiORSUpIPRQ7ECTS'MTHACONTMCTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY D SCRIPTION FEE
Y TORSUCENSEUW.j,
� ❑1 M1 E%E4PT UNDER SEC. B.t P.C.FOR THIS REASON Q
?� U
� DATE OWNER F—
� W
�Q UCENSED CONTRACTORS DECUIRATION W
C� I HEREBYAFFIRM UNDEN PENALTY OF PEM1M TMAT I M1 LICENSEO UNDER PROVISIONS OF CH�VTEq �
p_, i�COMMENCWOWRHSECTION100a)OFDMSION70FTMEBUSINESSANOPflOFE5510N5COOE,AND Z
�X MYLICENSEISINFULLFORCEANDEFfECT. m
0 UCENSE CUSS LIC.NO.__.1/_�'f�� ..
V MTE���CONTRACTOR � � d
W
� WOFiKERS'COMPENSATION DECLARATION ¢
NIHEREBYI�FFIRMUNDERPENALTYOFPEFJUMONEOFTHEFOLLOWIN6DECUfL1TI0N5: z
� �IHAVEAN�WILLMAINTNNACERTIFICATEOFCONSEHTTOSELF-INSUREFORWORICERS' _
COMPENSATION,ASPROViDEDBYSECTON71000FTHEUBORCOOE.fORTHEPERFORMANCE `U
Q OFTIIEWORICFORWHICHTHISPERMITISISSUED. �
W _IHAYEAN�WILL►/AINTAINWORKERS'COM7ENSATIONINSURANCE,ASPEWIREOBVSECTqN
Q 770oOF THE LABOR CODE,FOR THE PERFORIAANCE OF THE WORK iOR WH�C11 TMIS PEHMIT IS J�}
ISSUEO.MY N9RKERS'COMPENSATION INSUFANCE CARRIER M!�POIICY NUMBER�RE: CONSTRUCTION 0� � �J
� CARRIER_S�����,�.�b PLAN REVIEW
Z vo��crNun�a¢n_ �.J ELECTRIC
d —7
0 (f/aSSECTtlNNEmN�Tf��acn� sFor+ax�moau��s+aa)oa� PLUMBING
Z ICERTIFYTHATNTHEPERFORMANCEOFTHEWORKFORWHICHTHISFERMITISISSUED.1 MECHANICAL
(;} SWLLLNOTEMPLOYIWYVERSONNANYMANNER50115TOBECOMESUBJECTTOTME
(/j WORNERS'C01.17ENSATIONUWSOFCALIFORNI/�IWDACREETIUTIFISNOULABECOME INSPECT�ONFEE
S SUBJECiTOTHEWORKEFS'COMPENSATqNYqOVI510N50F5ECTIDN37000FTHELA80R
CODE, SHALLFORTMYITHCdAPLYWIMTHOSEPROVISIONS, . ISSUANCE � �
� SMIP ` i
p DA7E: �w��ICANT. �
W / �
� WARNIN(i:F ILUI�ETOSECUREWORKERS'C01.1PENSAT COVEMGEISUNUWFUI,ANDSHILLLBE ENERGYP/C
� SUBJECT/WENPLOYERTOCHPAINA�PENPLTIESANDCM FINESUPTOONEHUh9REOTH0U5AN0 ENERGYPERMIT
DOLURS(t100.000),IN ADDITION TO THE CAST OF COMGENSATION.DMIAGES AS PROVIDED FOR IN
� SECTION 770!OF THE UBOR CODE,INTEREST.ANDATfORNEYS FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IMEREBYAFFIRIIUN�ERPENALTYOFPEfLNRYTIIATTHEREISACONSTRUCTIONLENDINCACENCY
fOR iHE PEHWflMANCE OF TME WOfU(FOR YY/11CH THIS VEfiMIT IS ISSUED�SEG 3097,CIV.G�.
Z
w
� LENDERS NAME
� IENDERSADDHE55
W ICEflTIFYTHATIHAVERFIDTMSAPPLICATqNANOSTATEi1MTTHEA80VENFORMATpNISCORRECT. TOTAL FEES . C\J
� IAGREETOCCMPLYWITNALLCITVANDCOUNTYORDINANCESANDSiATEUWSPEUTIN6TOBUILDING I �/ �1 O
V. CONSTRUGTION,ANOHEREBVAUTMOiU2EREPHESENTATIVESOFTHISCOUN7Yi0EMERUPONTHE ._,
Z ABOYE-MENTIONEDVROPERTVFORINSPECTION URPOSES. COMMENTS
0 �
J
�
m PERMITTEE N
� �
�Jj SIGNATU - ITT E OAT
� RECPT.NO. _PAID BY � VALIDATION
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENRO iie Copy,GFEEN—ApplicanCs Copy
.:.:tif i.�i . �. ..,,. �.. � � r�a, „. a . �;i�. � .� r ".�.z ..',� . . ..�'} l.•, �C.�: � ,.��:1'. ;.1��'�t: ... .. "� - .. ' . . . . :r. . . .
ci��� oF oiAr,nor�� 8�.�
If�dSPEC i(0��! RECOF�'D
._____ _�
il►!�:a�c�j'Xo]�.M i��.:.�e�l� I'������a''�°e��t 1►.�'f;��c`�c't��r� Q►:n�:�, �,1���-�1�ac`i�ol:� �
--_ --=--.___________�._.._--------__—___._—..r��_.____._�__�__�___�W___---._.__..______�_...__------------ '
SET BACK FLOOR JOIST ��`� �,, .,� �+
FTGS/FORM5/STEEL FHA REaMTS
ELECTRIC GROUND UNDER FLQOR DUCT
GROUND PLUP,ABING UNDER FLOOR CUf�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM �
ROOF SHEATHING f�j 8 FT'. BOND BEAP�1 � �
FRAMINGNENTILIATION � FINAL BOND BEAM I _
ROOF COVER � ��� �� PRE-GFiADING
ROUGH HEATING BENGHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT.L{�TH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING � DEDICATIOP�S
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING EIJERGY
� �_ �� ���;, ��n �z. �
;
__._ _ ,`.,
�__. ..0 � ..____. — -- -
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I�N
�
�;�af� i�;
, ,
_.----_--_._.-'�--------�--• '