HomeMy WebLinkAbout18109 (17) �` CITY OF DIAMOND BAR ( �,.�
� DEPARTMENT OF COIvIIvIUNITY&DEVELOPMENT SERVICES �j�' �
21825 E.Copley Drive —�
(909)860-3195 Fax(909)861-3117 PRESS
�`•� BUILDING PERMIT APPLICATION FI R M LY
} JOBSITE /'� APPLICATION PERMIT P/C
o ADDRESS /6 l�- Zfi fr�/l�0 � � DATE �U V L NUMBER I d� #
� APN LOT TRA T ISSUE TVPE OCC
DATE 3� 02- CONST. GROUP
p OWNER
p A�DRESS ZONING SETBACKS
gCITY . ZIP TEL`� - � FRONT RW ❑
APPLICANT TEL. SID SIDE STREET RW ❑
� CONTRACTO SIDE p
ADDRESS �
� CITY • ZIP TEL. -- PROPO ED U E
o ARCWENG/ �'�� �
DESIGNER
C�ii NO. NO. NO.
n. ADDRESS •
� CITY ZIP TEL. UNITS STORIES BEDROOMS
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
p SFR/ADD/REM
p I HEREBY AFFIMI UNDER 7ENALTY OF PERIURY THAT I AM E%EMaT FROM TME CONTMCTORS LL Garege/Carport
W GENSELAWFORTMEFOI�OWwOREA50N(SEG7031.6BUSiNESSAND7ROFESSIONSCODE:M1Vq7YOR (n
V CaUNTI'NMIGIREOUIRESAGERMiTTOCIXJ57RUCT,ALTER.0.1PqOVE.pEMOUSH,OHREPAIRANYSTRUG w
W TURE VNiOR TO ITS ISSUMlCE,ALSO REOUIRES TNE MVLICANT FOR SUpI VERMIT TO FILE A SIGNED W Patiol�eck
� STATEMENT THAT HE OR SHE IS UGENSED PURSUANT TO THE VROVISIONS OF THE CONTMCTORS l4 �
CENSE UW(CHAPiER Y(COMMENCINO WITH SECTqN 7000)OF DIVISION]OF TME BUSINESS AND 7R0 POOVSpB
� FESSqNSCODEIOATHATHEOR5HEI5E%EMPTTHEHEFRqAANDTIIEBA5I5FOR7HEALLEOEDEXEMP• C7
TqN.ANVVIOLATIONpFSECTION7W1.6BVANYAPCLICANTFORADEFMITSU&IECTSTHEAPPLICANTiO Z Re•Roof
F A CML VfNALTV OF NpT MORE iHAN FIVE HUN�RED OOLURS(f5a0).�:
Z04�OVMEROFTHEPROPERTY,OFMYEAIVLOYEESNATMVIA6ESASTHEIfl50lECOMFENSATqN, 0 COflIR1BfC13I -
WILL DO THE WORK,AND h1E STRUCTURE IS NOT�NTENDED OH OFFEREO FOR SALE(SEG)0��.BUSI• J
� NE55 AND PROFESSIONS COOE:ME CONTMCTORS UCENSE UW DOES NOTAPPLY TO MI OWNER OF ?
VfqPERTY 1M1D Bu1LD5 OF IMaROVES TIEREON,ANDN'MO DOES SUCH WURN HIMSELF OR HERSELF Ofl
WTHROIJCMHISONNEROYMEMPLOVEES,PROVIDfDTHATSUCHIMPROVEA/EMSARENOTINTENOEDOR m
� OFFEREDPDRSALEIF,NOWEVE0.TNEBUILDINGOHIMPROYEMENTISSOI�WITHINONEYEAROFCOMPLE
Z iqN,THE OWNEH�BUILDER WILL HAVE THE BUR�EN OF PROVINO 7HA7 HE OR SHE�iD NOT BUILD OR
= UAVROVEFORTXEPURPOSEOFSAIE�.
w OI.�.SOWNEROFT1EGi10PERTY,AME%CLUSNELYtOMMCTp1GWITHLICENSEDtONTMCTORS
Q TO CONSTRUCT THE PR0.JECT(SE4 7oN,BUSINE55 ANO PROiE55lON3 COOE:TNE CONTMCTOnS U• VelU0t10f1 ADJ.AFiEA
W GENSEUWDOESNOTAPPLYTO/WOWNEROFAPROGERTYWMOBUILOSORIMPROVESTHEREIXJ.AND
� WIWCONTMCTSiORSUpIPRq1ECTSWiTHACANTMGTOR(S�LICENSEDiURSVANTTOTMECONTMG OUAMIN DESCRIPTION
FEE
Y �auucer+seuw.�.
Q ❑IMIENEMPTUNDERSEC. B.BP.C.fORT115REASON a
� U
li.. �
DATE OWNER F-'
� W
� LICENSED CONTRACTORS DECUIRATION W
� IHEREBYAFFIRMUNDERGENALTYOfVERNRYilUT1AMLICENSEDUNDERPROV15�ON50FCHAP7ER �
a. Y(COMMENLM6WITHSECTION1000)OFDMSION70FTME9USINE55MlDPROFESSIONSCODE,AND Z
OMYLICENSEISNFIAIFORCEMIOEFFECf. ����r ?
LICE�N�SE C�IA/SS_� UC.NO.
V DAT� r CONTRACTO d
W
� WORKERS'COMPENSATION DECLAMTION 4
� IHEREBYAFFIRMUNDEHPENALTYOFPERIURYONEOFTHEFOLIOWINGDEQAMT10N5: Z
� �IHAVEANOVALLMNNTNNACEHTIFIGITEOFfANSEMTOSELF-INSUREiORWOPKERS' _
COMPENSATION,AS PROVIDEO BYSECT�ON]�oo OFTME LI�BOR LODE,iOHTME PERFORMANCE w
Q OF ME WORK FORMIHIpITHIS GEHMR I5155UEU. ,�
W �IHAYEANOWILLMAIMAINWORKERS'fAMPENSATIONINSURANCE,�SREWIREDBYSECTION
Q 770oOFTHEUBORCOOE,FORiHEPERFORMANCEOFTNEWORKFORWHICHTM15PERMRIS �+ �D
i55UED.MYWO ERS' P SATIONIN GEC�A7R�RiERANDPOLICYNUMBERARE: CONSTRUCTION �C7'•
jCARRIEN�����a"4A��Fv/ PIAN REVIEW
¢ raicrr�9ER 7 �� ELECTRIC
Q (MSSELTIONNEmNOTBE0D6i�£fEDOFTEFERRlT6PoRONEHLRDi7EDDOLL�liS(S�Oo)OFLESS) PLUM8ING
W -
Z ICERTIFYMATMTHEPERFOMIANCEOFTMEYlORKFORWIiIp1TMI5iERMITI5155UED,l MECHANICAL �^^�� �� �T I ��11
(;} SMALLNOTEMPLOVIINYPERSONINANYMANNERSO�STOBECOMESUBJECTTOTME •��
(n WORKERS'GOMPENSATqNLAWSOFCALIFOqN1�MlDAGREETIIATIFISHOULOBECOME INSPECTIONFEE
SUBJECT TO THE WORKEfiS'COMPENSATION VROYISIONS OF SECTION 7700 OF THE UBOR c� �
OOODE.ISHALLFORiHWITHCOMVLYWITHTHOSEPROVI 5. ISSUANCE •� � �/]
W DA � � APPLICANT. �I / $MIP ' t�
� WAiWIN6:FMUHETOSECUREWOflKERSCOMPENSATIONCOYEflAGEI5UNUIWFUL.ANDSHALLBE ENERGYP/C Tti�r
� SU&IECTANEAAPLOYERTOCRIAIWQVENQTIESANDCMLFWESU7700NEMUNDREDTFKKISAND ENEFiGYPERMIT � -
D�LLAfi31f 700.000).N ADDITON TO THE COST OF COAIPENSATqN,DMUGES AS PROVIDE�FOR M -
J SECT1DN770lOGTMEUBORCOOE,WTEREST,AND�TTORNEV'SiEES. RETENTIONFEE: /�N
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREBYAFFIRMUNDER7ENAlTYOFPERIURVTHATTHEREISACONSTRUCTIONLENDINGAGENCY
Z fOR TNE FERFORMANCE OF THE VIORK FOR WHICH TM�S PERMIT IS ISSUED(SEC.]aY7,q¢C.1.
W
� LENDER5 NAME
� LENDER'SADDRfi55
¢ TOTAL FEES l 3�,��
W ICERTIFV THAT I HAVE READTHIS APPUCATION AND STAiE THATTHE A80VE WFORMATqN IS CORRECT.
� IAGNEETOCOMVLVWITHAILCITYANDCOUNTYORDINl1NLESANDSTATEUWSREUTWGTOBU0.DIN0
�. CONSTRUCTION.ANDHEREBYAUTiqRIZEREPRESENTATIVE50FTHISCWNTYTOEMERUPONTHE
Z A80VE�MENTIONEOiHOPERTYfORINSPECTIONVURPOSES. COMMENTS
O �
J - � r,�
�
m OER61ITf N iNn .
� -�-��, �r,.-��--?,t�
(J� SIGNA flE0 EE 0 E � �
� RECPT.n0. I PAID BY ��� VALIDATION /
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENROD—File Copy,GREEN—Applicanl's Copy
... .. . , , ... ... ,- .( ' ., .-.. .. . . � ,�r^ r.-v. ' � ., ,� ... ,:1•:.- . , .. -_. '. �- ,-.,.t, . ,. . . � . , � �
c�i�� or- o�Ac���o�� er��
lt�t��'��G3'iOru (�f�C�6��
1�����=�.����'.Ji'� eY�:G'= �f►�F-`i:��l�'`C�'l.c.___.__r--.Ii�fsi;�I�;c�°�!C"�J�ip�______�.����t'r� � �I��E.y:l�c'�do�:� I
_.r. ______.._____._..__.._ � . . .._.__.._.___...�.. ._. _ ._.._.._.__._..,. .__��_._._._--,--.----._ . ----=_-_-__--_.�_._---._..� - -�_.___
5ET BACK I I I FLOOR J015T i
FTGS/FORP�iS/STEEL � ! � FHA REQI��TS I
ELECTRIC GROUND ^ ' UNDER FLOOR DUCT j_ (
GROUND PLUMBI�JG I_�`_ -� i UNDER FLOO�i CUi�IDUiT �
SLAB GRADE I FIREPLACE FOUND.ATIO�d
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE ` MID HT. EOND BEAF.1
ROOF SHEATHRJG �0� �' ' t3 FT. BOND BEA'vt �—
FRAMINGNEt�TILIA—T—ION�-� � ~ FINAL F�OiJD E3EAPA
ROOF COVER �(,/SeZ liCl� PRE-GRADING I
ROUGH HEATING � / BENCHIhJG �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMeING � � FL"JISH GRAUING
SHOWER/TUB TEST � � POOL ELECTRIC
EXT. LATH;SIDWG j i P00'_FENCING
WALL INSULATI�N '�i-POO�FINAL
CEILING IN�ULATION � OFF 51TE IMPS.
DRYWALL NAILING � OEDICATIONS
SEWER FINAL EPJG.
SEPTIC TAfVK LAPJDSCAPE/IRRIG.
SEEP PITlL.L. ' OP�SITE Iti1PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � �!RE DEPT. FINA!
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTFIIC DEV. FEES PAID
FINAL PLUMBING Ef•JERGY �
-t.,,�.,�.•.,,.,�--.,..,.......�...._.:__.....
--�_ �I'''"� t l. fi,lcf�_' _ _.__..
COMPJIENTS
SEPTIC TANK SIZE
SEEP PITIU SIZE
r� _�_�.
��►�1
i
._. ____._ ...�a _._______..__� � _