HomeMy WebLinkAbout18338 (21) �` CTTY OF DIAMOND BAR .
DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
"-�� BUILDING PERMITAPPLICATION FIRMLY
} JOBSITE "JO( ��� n-•`• � � APPLICATION I� (�.. PERMR ��j�n D P/C
o ADDRESS ! �l�+'aL7 DATE NUMBER v�/U x
$ ISSUE� 'q � TYPE OCC
APN LOT TRACT DATE � CONST. GROUP
p OWNER NE�
"' ADDRESS - ZONING SETBACKS
gCITY�/1LN�1� ZI TEL�'l 5�15 O�K#� R�RT RW o
APPLICANT TEL. SIDE/SIDE STREET RW p
� CONTRACTOR����"� 1�A4 L SIDE ❑
o ADDRESS`\� � . � _
CITY�. F�SPRINC,S ZIP�Q(�I�, TEI�L Z�F'�S PROPOSED USE "+= '�QC � �{'
o ARCH/ENG/ '
z� DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY 21P TEL.
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFRlADD1REM
O
p I MEFEBY AFFlRM UNOER PENiIITY OF VER1UqY TH�T 1 AM EXEMPT FROM THE CONTMCTORS LI• � Garage/Carport
W CENSEUWFORTHEFOLLO'MNGRFASp�(SECJ077.SBUSMESSANDPROFESSIONSCOOE:ANYCIiYOR
U COUNTYWHICNREWIRESAVERMITTOCONSTRULT,/LTERUA7ROVE.DEMOLISH,ORHEGAIRANYS7FUC• W PdS10/DBCk
Z TURE.PRqR TO RS ISSUANCE ALSO REOUIRES THE APPIICANT FOi15UCH GERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS UCENSED OURSUANT TO iHE PRONSIONS OF TME CONTMCTOfiS ll- W
� CENSE UW(CFUIPTER 9(COMMENCINO N77M SECTION 7o0a)OF DIVISION�OF THE BUSINESS Ml�Pfl0- u" PooVSpa
FESSIONSCOOE)ORTNATHEDRSHEISEXEMPTIHEREfROMM1DTMEBA515FORTHEALLEOEDE%EMP• (� /��
TION.ANYVpUT10NOFSECT10N7071.S8YANYAPGUCANTFORAFERMITSUBJECTSiT1EMPLICMlTTO Z Re•Roof WO
A CIVIL VENALTY OF NQi MORE 7HAN FIVE HUNDRED DOlURS�f5a0)):
ZOL���EROFTHEVROVERTY.OHMYEM7LOYEES`MTHWAGESAS7HEIRSOLECOIAPENSATqN. ❑ COmmefCi01
MALL DO THE WORK.Ml�TNE STRUCTURE IS NOT INTEN�EO OR OFFERED FOR SALE(SEC.701�.BU51• J
� NE55 AND GROFESSIONS COOE.7HE COn7MCTORS UCENSE UW DOES NOi A7VLY TO AN OwNER OF �
pROPERTY NM1iO BUiLDS 017IUPROVES h1EREON,AND WHO DOES SUCH WORN HiA15ELF OR HERSEIF OR
2 THROUCFIHISORMERONT7EAIPLOYEES,PROVIDEDTFIATSt1G1MPROVEMENTSAHENOTINTENOEDOR m
� OFFEREDFORS.LLEtF,/1dNEVE0.TMEBUtIDINGORIMPROVEMENTI55dDMlITlIMONEYEAROFCOMvIE•
Z TION.TME OWNER�BUILDER 1MLL HAVE THE BUROEN OF VROIl;NO THAT HE OR SHE DID NOT BUILD OR
� MPFiOYE FORTME VUR705E OF SALE�
w OtASDNMEROFTMEVROPERTY,AME7(LLUSNEIYCONTRACTINOWITHLICENSEDCONTMCTORS
� TO CONSiRUCT THE iRQ1ECT ISEC.7WI.BUSMESS AYO PROFESSIONS CODE:iHE CONTMCTORS LI• V31ueUOf1 ADJ.AREA
W CENSE UW DOES NOTMPLYTOAN 015T1ER OFAPROPERT/NT10 BUILDS OR IMPROVESTMEREON.ANO
F W/tlCOMRACTSFORSUd1iROJECTSMATHACONTRACTOq(S�UCENSEOPURSUANTTOTNECONiMC. QUANTITY DESCRIPT�ON FEE
� TOiiS UCENSE UW.�.
� O IAA1 E%EMPT UNDER SEC. B.1 V.C.FORTMIS PEASON Q
� U
t� ¢
DATE ONMER V
Z W
� LICENSED CONTRACTORS DECLARATION W
� IHEREBYAGFIRMUNOEIIPENALTYOfPER1UHYTHATIAMtICENSEDUN0E11PPAVI5�ON50FCHAPTER �
p„ i(LOA/MENCINOWfTH5EC710N7000)OFOMSION70FTNE8USINESSANOPROFESSIONSOODE,AND Z
X MY LICENSE IS W FULL FORCE M70 EFFECT.
� UCENSECLASS C �� UC.NO. �� V,� �
�
v o�re 7-�q�O Z cornrucroR BLiL�f1 �U Ff C a
- w
� WORKERS'COMPENSATION DECLARATION a
� I HEREBY AiFIRM UNOER GENALTY OF FERJVfiY ONE OFTHE FOLLOYANC DECUMTIONS: Z
� _IHAVE/WDWILIIMINTAINACERTIFICATEOFWNSENTTOSELFaNSUflEFORWORKERS' _
� GOMPENSATqN,AS PROVIDED BY SECTION�700 OF THE LABOR CODE.FOR THE PERFORMANCE U
Q Of THE WORI(FOR WHICH h115 VERMIT IS ISSUED. � �
0
� ��I HAVE M1D WILI LUINTAIN WORKERS'COMPENSATION INSURANCE.AS PEIXI�REO BV SECTION '�J
Q 770oOFTMELABORO00E,FORTHEPERFORMANCEOFIHEWOHKFOAYAiIGMTHISPERMRIS /�� ' H
ISSUED.MY WORKEHS COMPENSATIOtN�INSURANCE GRFUEH M1D POLICY NUMBEH ARE: CONSTRUCTION � w �I
j LAFiR1EH �`TE'Ft�IUt.JS PUW REVIEW
Z FOLICVNUMBER ��i�LI�/1?_ ELECTRIC
¢
0 (fYt55EC1101iNE�NOTBE00hpLEfEDOF7YEPEPoNf6FC(30NEL1.lOF7EDDOlUiiS(S�OOJORLESS). PLUMBING
Z I CERTIFV THAT Nl THE PERFOqMANCE OF THE WONK FOR WHICH 7H15 PEFMITIS ISSUE0.1 MECHANICAL
('} SMALL NOT EMPLOY ANY iERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
N 1MORKERSCOIA7ENSATpNUW50FG1LIFORNI0.�N�AGREETMATIFISMDULD8ECDIAE INSPECTIONFEE
S SUBJECT TO THE WORNERS'COMPENS�T HOVi5iON5 OF SECiqN 770o OF iNE LABOR .
cooe,�s�w.�roAn+enn�c�n�a�rwi visi ISSUANCE �
O 1
p DATE: � '1� 'UZ APPLICANL SMIP � L
� ENERGY P/C
WAqNINO:FNLUPETOSEIXIREWORKERS' PENSATqNCOVERAGEISUNUIWFULAND5WLLL8E
� SU&IECTANEMPLOYERTOCRIMINA�PEN TIESANDdNLFMESUPTOONEHUNDHED7MOU5AN� ENERGYPERMIT
DOLLARS(f 700,000),IN MDITION TO THE COST OF COIAPENSATION.DAMAGES!15 PqOV10ED FOfl IN
� SECTION770EOfTMEUBORWOE,INTEREST,ANDATTORNEY5FEE5. RETENTIONFEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREBYAFFIRMUNDEHOENALTYOFPEiWRY7HATTHEREISACONSTRUCTIONLENDINGACENCY
Z FOR THE FERFOPMANCE OF THE WORK FORNMICH THiS VERMIT IS ISSUEO(SEC.]OY1,pY.C.).
W
� LENDER'S NAME
� LENDER'SADDRESS
W ICERTIFYiHAT�HAVEREADTHISAPiLICATqNANDSTATETHATTHEABOVEINFORMATqNISCOFRECT. TOTAL FEES �OZ � �O
d IAGFEETOCOMVLYWITHALLCITYMlDLOIMTYORDINANCESMlDSTATEUWSREUTINGTOBUILDINO
� WNSTRUCTION.MIOHEREBYAUT110RREREPR'eSENTATIYE50FTHI5GOl/NTYTOENTERUPONTME
Z ABOVE�MENTIONED VROPERiY FOR INSVECTION PURGOSES COMMENTS
O 1
J
_ ��
Q E A1 N E( � 7��7-D,2
�
� 51 URE F P RMITTEE �ATE
� RECPT.N PAID BY VALIDAT�ON
WHITE—Department Copy,YELLOW—Finanee Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
.... ... , . .. - ,r ., ,�,. � ..,- . .. .,. _ .. . :
�;i���� �� r�5j.r:�or�� �j��
I(�"5�����a f�f�� f��CC1�;G
i►�k-'i:��=��;'Ck¢��►+�-._._.._..•�Y�i �..-:l�.�-`���:jE�_P'�')�.��_...�._ --������'��:t:��fC��l►'4 � �9.°i'e'=. �I���.'1:��c?��'c�,S��
_. .
...____�____ ....___.___. ___ .. . .. _. .. . - ---. .... . ._._._.-----..---- . . ___�.._ . . . , ._..__._._.�-_------. _._.._.�_,.y..._�.__._
SET BACK � _ ! ' � ; FLOOR JOIST j ,
FTGS,�FORP�IS/STEEL _ � _ ;_� FH!`,REQ4ATS _ � � ^
ELECTRIC GROUND ' I ; U��D�R FLOOR DUCT i • �
�------
GROUND PLUid1BING ^__�_ __ 1 � Uf�1DER FLOOR CU°�IDUIT � � ' _
SLAB GRADE FIREPLA�E FOUtr'DATION '
TEMP POWER I FIREPLACE BOND BEAM �
WATER SERVICE MID HT. BOND BEAP�1 l , �
ROOF SHEATHING � 2Z �,� 8 FT. BO�1D`BEAll�1 '
�--�— — � ��
FRAMINGNENTILIATION � � FINAL BOND 6EAPA _
ROOFCOVER �/ Ij_�_� I PRE-GRADINU '
ROUGH HEATING �� BENCHING I
FiOUGH ELECTRIC ROUGH GFiADiP�G j
ROUGH PLUDABIfJG � FINISH uRADING �
SHOWER/TU8 TEST POOL ELECTRIC
EXT. Ll1TH/SIDING ( I POOL Fc�dCING
WALL INSULATION � POOL FINAL �
CEILING INSULATION _1 Or=F SITE IMPS.
DRYWALL NAILING � DEDICATIOPdS �
SEV'JER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PITf�.L. ' ON SITE IMPS.
GAS AIR TEST � FINAL ZOPJING
FiNAL COtJST. 8�y/o Z � � ! ; �IRE DEPT. FINF,L
FINAL HEATING j l j HEALTH DEPT. FINAL
FINAL ELECTRIC � � i DEV. FEES PAID
FINAL PLUMBING � i ENERGY
ck:�r^ ��I' i�'ft��
connr,�Er�Ts
SEPTIC TANK SIZE
SEEP Pll"lU SIZE
�y�;
_ ;
i
y��� ,�;
�
�
�� : . ._ . .
�A