HomeMy WebLinkAbout17234 (42) � CffY OF DIAMOND BAR '
COMMUNITY DEVELOPMENT DEPARTMENT
-..� 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)86l•3117 . � PRESS
^"'"', BUILDING PERMIT APPLICATION � FI RMLY
� JOBSITE ^ Q /� APPLICATION �ERMIT '�-7—`-`—`—�PlC
o ADDRESS�(I�I�C� �:J�OKL� n 1�(2-0 W D)Z DATE � I� G NUMBER M
� APN LOT TRACT ISSUE � � � TypE p�C
p OWNER I-��ti� DATE � CONST. GROUP
p ADDRESS�_L�OF� Ci�K�l.l h N..1'.e�J D n. ZONING SETBACKS ,
z CRY _�1AHU►.Ib (4h►` ZIP I bC TEL. �6f 1(9�7 FRONT RW ❑
� APPLICANT [�i=n v. /�, t i �� �icr. TEL.ktu�_SG�rc-4; S DAE/SIDE STREET RW ❑
� CONTRACTOR_�L�"l u1- Ya�S l�-c�:t ��Yl.r. {�I(f-tr�i a.�. SIOE p
� ADDRESS�'1 Y !cl h rt M-�-
� CITY 'U1t r..t� ZIP I �O TEL Q�4 .5 f 7 G,S�A PROPOSE�USE
w ARCH/ENG/
DESIGNER
n. ADDRESS NO.DWEL NO. NO.
� CfTY tIP TEL. UNITS STORIES BEDROOMS
�
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BL'ILDER DECLAFiATION
p SFRlADWAEM
p I HEREBV AFFIRAI UNDER iENALTY OF OERAIRY THAT 1 W E71EMOT FROIJ TNE CONTRAC70(SS L4 G8f0QB/CefpOR
W CENSEUWFORiHEFOLLOWWQp[ASON(SEC.70.7I.58VSWESSANOPpOFE5510N5000E:ANYCfi`/OR (n
V COIMTYNM111tlIRE0UtRE5�PFRMITTOCON57RlKT,ALTER�p�VE.DEVOL15H.OfiPEPURANYSTRUG
W 7UNE,Pi1lOR TO ITS ISSUANCE.AL50 R[WIqES THE APVLICANT FOR SUCH FERAIIT TO FIIE A SIGNED w PatiolDeck .,
� STATEMEM THAT HE OR SHE IS UCENSED YURSUAM i0 THE VROVISIONS OF iME CONTMCTpq3 LF
� CENSE UW(CMAPTER i(COMMENCw6 NnM SECTqN 7000)OF Orv15lON]OF THE BUSINE55 AND PRO� LL' POOUSDB
FESSiOM5CO0E)ORTHA7HEORSNEISEXE4PTTHEREFROMANOT�EBASiSFORTHEILLtEGEDEXEUP• (�
TbN.AHYVqUT10NOFSEGT10H7071.5BYANYAVPLICANTfOHAPERAIITSUAlECTSTMEAVPIIGNTiO Z Re-Roof
A C1VIL VENALTY OF!qT A/OliE THAN iIVE 1111N�RED DOLU(i5(tsoa).��
0 ❑I�OwNEROF7NEPROVERTY,OR4vF4oLOYEESVATMWACFSASTHEiR50LECOUPENSATiON, � CpmmB/C181
Z WILL DO THE 1MORK.M10 THE STRUC7URE IS NOT INTENDED OR OFFEREU FOLI SALE(SEC.7a�,BUS�• J
� NE55IlND PROFE5510N5 CODE:TNE CON7MC70R5 UCENS[Uw OOES NOT APPLv TO Ml OWNER OF �
GROPERTY NR10 BV0.D5 Ofi IYGROVCS TMEREON,ANO VYIq DOES SUGI WORN MIMSELF OR HERSELF OR
WTHROUGMNISORHEROWNEYPLOYEES,DROVIOEOTHATSUp11YPROYEIIEMSM[NOTNTENDEDOR m
0 OFFEREOFORS11lEIF,lqWEVERTMEBUIDINCORMVROVEM[NTISSOIDWITMNOHEYEAROFCOMPIE �
Z TqN.THE OWNER�BULDER MnLL NAVE TME BURDEN OF GROVIN6 THAT NE OR SNE DiD NOT 8UM OH
= MPROVE FOR iH[VIIRPeSE OF SAIE)
w OI�SOwNEROFTHEOROPEPTY,AMEXCLUSNEIYCON7RACTNOK'ITNLICENSEDCONTMC70RS
(t TO CONSTRVCT iNE PROJECT(SEG 7DM,BUSINESS/WD PROFESSIONS CODE:THE CONTRACTOAS LF V31U8IIp1 ADJ.AFEA
w CENSEUWOOESNOT11PPlYi0AN04VNEROFACROPERTYYM1iDBURDSORWPROVESIHERE0f1/V!�
� YAqCONTRACT$FORSUCMGROJEGTSWIi17ACOHTMCTpR(5)I�CENSEDPURSUANTTOiHECONTMG ounrmrr DESCRIPTION
� ToasucENSEuw.y FEE
� OIM1E%EIIPTUNDERSEG B�V.C.FOqT1u4pEA50N Q
� U
u" DATE OWNER 1—
Z U
�¢ LICENSED CONTRACTORS DECLAWITION W
¢ I HEREOY IifFIRY UNOER PENALTV OF PERttJHV THAT IAA1 LILENSED UNDER PROVISIONS OF CHADTER 1 '' �y
� �(CO4MENCWO MnT11 SECT�DN 70ao)Oc DIVISION!OF TME BUSINE95 AND iHOFE45qNS COOE,/ND Z �L �yJ C� TL'�t. "t.�}'f�f�-
W LICENSE IS Rl FULL FORCE AND ELiECT. m
11J
� UCENSECUSS �-' -.3L uc.No. 3"1�rf367 � �
V DATE � -3(-O V � CONTfUCTOR ���ITL7�-� AU.SI/-tS.f C�l1% a
�W Y^�ll�-/Jti
WORKERS'COMPENSATION DECLARATION �
� IHEREBYAiFIRMUNOERVENAITYOFiEfWRVONEOFTMEFOLLOw7J00ECUM710N5: z �
� _IHAVEAMJWILL►IAMTAINACERTIFICATEOFCONSENfiOSELFaNSUREFORWORIfERS' a
CqAPENSATION.AS PpOVIDEO Br SECTION l700 OF THE LAOOq COOE,FOR THE PERfORAWICE U
Q / OF T/1E WORK FOR WMidl T115 VERMIT IS ISSUED. �
l--- ,
� I MAVE AND WILL MAINTAN WOANE0.5'CdAPEN5A710N INSUqANCE,AS PEOUIqED BY SECTION
� 77000FTHEUIBO{iCAOE,FORTHEVEHiOfUAANCEOFiHEWOHKFORWNICHTHtSpEiWIT15
ISSUED.MYNKNiNERS'CONPENSATqNQ15URAHCEGARRIERANDPOIICYNUMOLRME: CONSTRUCTION
j CARRIER S�l/�t�= rUr—�� PLANREVIEW
Z ru�crnuuaen_O�Q€�3'1 — U V ELECTRIC
4
p (1fas5EcilONNEIDNOTe[WMLErIDCFn[PEpwiwwRa+E�u�RmDa1wRSR+rolOalESS? GLUMDING �
W '
Z ICERTIFliHAiWTHEVERFOR4ANCEOFTHEW0i1KFORWMiC/1TH15PfFU1ITIS155Uf0,1 ��ECHANICAL
C•} SHALLNOT EMPLOYANY VERSON N ANY MANNER SOAS TO BECOME SUBJECTTO THE
(n WORKERSCOMPENSATqNUWSOFCALIFORNIA.AND�GREETMAi1FISHOULOBE[DUE �NSPECTIONFEE
S SU9)ECTTOTHENIORKERS'C011PENSATIONPROVISIONSOFSEC710N)70oOFTMEUBOR
COOE,ISHALLFORTMN7HCWJPLVN'1T1 EP1iOV1510N5. � ISSUANCE ��
� J—IU-G� `
W w�: 1 APPLICANL �r!a��-�., SMIP
� WAANIN�:FA�LURETOSECURENWLCERS'tOA1P.S�TIONCOVERAGEISUNUWFUL,AND6HALLBE ENERGYP/C
� SUBJECTANEUPLOYEHTOCNMWALPENALTIESIwDCNILFWESUPTOON[HUNDAEDir�WSAND ENERGYPERMIT
¢ DOUAR9 p 100.0001.N ADOITION TO THE COST OF LpAPENSATON,DIMAGES AS PFOVIpED FOR IN
SECTION]7oe OF 7ME UBOR LOOE.NTEREST,IWDAT'fORNEY'S FEES. RETENTION FEE:
oCONSTRUCTION LENDING AGENCY pqE-ALT FEE: '
� IMEREBVAFFlMIUNDERVENALTYOFPERRIR'/T1IATTNEREISIICONSTRUCTIONLEHOWCAGENCY
Z fOq TME VER WR4ANCE OF iME WO(71(FOR WHIp1 TMIS iERAIIT IS ISSUE��SEG 70Y7,CN.G�
W
� IENDER'3 NIA�E �
� LENDERS ADORE55
W TOTAL FEES ��, �
1 CERTIf'/THAT I IUVE READ THIS APiLIGITIDN AND STATE THAT iHE ABOYE WFORYATIDN IS CONRECT.
p, IAOREETOCAYPLyMATHAILLRYANDCOU�TYORDWANCESANOSTATEUWSREIATWGTOBUILDIHG '
� CONS7 TION.AIA HEREBY♦ ZE REOiiESEMATNES OF Tw5 COUNTV 70 fMER UPON THE
Z /BOV[ NTqNE PERTY NSPECTION WRPOSES. COMIAENTS
� ��_
�� iE �� NAMEryRi -
cn /1 f' /1���CJ7�CJ �U!G�-�
y b10 OF pERMITTEE OATE
� A[CPT.NO. PAID BY VALIDATION
- VYHITE—Dapanment Copy.YELLOW—Fnenee Copy,PINK—Asaessor Capy,GOLDENROD--File Copy,GREEN kmCa Copy
„ -. -...... . . . .r�i . � _ _ . ,. �. -� ,
. . :o, •-.•,� .
. . . . ' .: :.� .�l.� _ y r u _ ��}l . . . .. . �"Y�.."': , _ w .. . ..- . .. � . ..
. ..� .. . . . .:I i.� •� _ . .
.„ „
� ...�.-. . ��
. - � ' � . �. �' ” .. . �. . ' . .. . ..� . . . . .
� CIT�'. OF DI�PJJOf�lD G,�:i� ' � ; �
• .. R�!SPECTIOF�! RCCOR� � �
I��-����iJt��l�e.J►�4 ��1;f`= �►�.k=�.1=c.F F'o.1.1 � '1��1-'f;a�ct,r(�)►'`� �),t��;= I���ti..�:�c'�e��i� .
----�------- ._....---:._.._�_._....._.._.._...._. --------__�_.._-------........-•--�--^—_� .. •.._...�...:.._ ... __.__:_ .... _ .. . _ ...:�.... _ . _
- ..... �
_ .
SET BACK - , - -' . • ' ` FLOOR JOIST _ - . . -
FTGS/FORMS/STEEL � • � FF�F1 REQ,JITS � - � �
ELECTRIC GROUP�D UNDER FLOOR DUCT l .
GROUND PLUG1E31PJG ' I UPdDER FLOOFi CU�,IDUIT . ' . -�
SL.AB GRADE I FIREPLACE F�Ut•ldATlO�! -' �- - � "" " - •
TEP�1P POti":ER -- -�IREPLACE�O�JD 6EAh� � • • .
1h�A7ER SERVICE PAID HT..E�DPJD BEF,P.1 � � � � � - ', .
R00�SHEATHING - &Fi. EiOND E3EA�A � '
FRAPJIINGNENTIUATION FI�•lAL E30ND BEAP.4 - - : �
ROOF COVER -- PRF•GRADING � • _ _. -
ROUGH HEATIN; f3[PdCHING L
ROUGH ELECTRIC - ; f�OUCH GRADING J I
ROUGH PLUh"BiP1G- - ' FINISH GRADIrJG � �
�SHOL"JERIfUB TEST � "� � POOL ELECTRIC l � �
EXT.LATH/SIDING - � � PODL FEP�CIr�G � . � -
INALL INSULATION _� � FOOL FINAL � �. �
CEILING INSULATION � OFF SITE I",9PS. � '
DRYWALL NAILING DEDICATIO�JS ,
SEWER FINAL EPJG.
SEPTICTANK � LANDSCF,FE/IRRIG.
SEEP PIT/L.L. ON SITE I".1PS.
GAS AIR TEST FINr1L 7_ONING
FINAL CONST. Ftf�E DEPT. FINAL I _ �
FINAL HEATING - H�AL7H DEPT.F(NAL f �
FItJAt ELECTRIC i EV. FEES PAID � . , ;
FINAL PLUP�IBING ��•;.�� '� EP:ERGY _� �� �
__f Ti � . I
---- I �i�'r,'_ ��'i�_--�------._.
_.... . .
COMMENTS
_ _ _ , ,.
SEPTIC TANK SIZE ; --
SEEP PIT/U SIZE '
, � � . �
.��� — _
�,y�y� _ ' .
� ' . �
�� _