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HomeMy WebLinkAbout16872 1 �� CITY OF DIAMOND BAR � DEPAR7MENT OF CONIlv(UNTTY&DEVELOPMENT SERVICES � � \�� 21825 E.CopleyDrive ' PRESS (909)860-3195 Fax(909)861-3117 � BUILDING PERMIT APPLICATION FI R M LY o ADDFi'ESS �� � C � �2 �2 O�✓.C�! j� Si' DATE CATION i1 1 I Il 1 NUMEi R ��/� p,C I— �, /N _R- c� ISSUE TYPE OCC APN LOT TRACT DATE CONSL GROUP p OWNER � 34 C'.a«�a�-'� c �c�fr "' ADDRESS Q/i4�"� c'^�9 i1/,��[. ZONING SETBACKS z CITY 21P TEL. FRONT RW O g APPLICANT �/• <'LL�2`/ TEL.ClJP�-4��y• REAR ❑ SIDFJSIDE STREET RW ❑ � CONTRACTOR 7 • '��2 y � �o^-S SIDE p ADDRESS �t I t � C s�t !T.B °� PROPOSED USE n E �'` �✓E SH jO��f• ,.��'r�-u• o CIN ��?n ( �-�� ZIQ TEL. t .�s� c� I Cc d � ARCHIENG/ 7�y f t�c^ � c�,S. . 1 / �Y7 .�•i'� s,c..) DESIGNER ��« R k ^-`1A�' � �"<�"�Ed�• NO.DWEL NO. ' "- NO. a ADDRESS UNITS STORIES QEDROOMS � CITY ZIP TEL. � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILOER DECLARATION SFR/ADDlREM C'p. O p 1 HfREBY AFFlRM UNDER PENALTY OF�EfWRY 1H117 1 AA1 E%EMPT FROM iME COHTMCTORS LI• GefOge/CerpOrt W CENSEUWFORTHEFOLLOwINCREA50N�5[C.70.71.SBUSWESSANDPROiE5510N5CO0E:ANYCITYOR (n U CpIMTVNM1/1CMRE0U1RE5AFERIAITTOCONSTAUCT,ALTER��p��.�E410LI5N.ORREVAIRANYSTRUC. W patlo/Deck Z TURE.PR1OH TO ITS ISSUMlCE,ALSO REOUIRES THE APCIICANi FOR SUCM CERMIT TO FILE A SiCNED w STATEMENT THAT HE OR SHE IS LICENSED PUflSUANT i0 TME PRONSIONS OF THE CONTRACTORS L6 W � CENSE UW(CIUPTEH i(LOMMENCWO W17M SECTION 7000)OF DIVISION]OF TNE BUSINE55 AND PRO• LL" P��Pa � FESSION9C00[)ORiMATNEOR5HE15EXEMPTTNEREFPOMANOTHE8A515FORTHEALIEGEDE%EGP• V TpN.ANYVqlAT10NOFSECTION70�1.SBYANYAVPUCANTFOR�PERMIT5U0.1ECT5TMEMPIIC�N770 � 0-R A CIVIL PENALTY OF NOT MORE THAN FNE HUNORED DOLURS(55001): � 04��'NEROFTHEPROFERTY.OR►IVEM7lOYEESWITHWAG[SASTHEIi150LECOMPENSATqN, O � Z YVILL DO TNE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFEREO FOR SAI.E(SEG 70u,9USI- J COTfIf6tCi0I NESS ANO PROFESSIpNS COOE:iHE CONTRACTORS UCENSE LAW DOES NOT APP�V TO AN OWNER OF � PROPERTYYh1�BUM1D50RIMVROVESTNCREON,IWDW1iODOESSUCHWORKHIMSEIFORHERSELFOR � ' Q 711ROUGMNISOftNCROWNEMVLOYEES.iROVIDCDTMATSUd71MPROVEMCMSMENOTWTENOEDOR m W OiFEHE0FOR5KE.IF,NOVlEVERTMEBUILDINGORRAPfqVEMENTI550lDWITMINONE7EAROF�q,1P�E• � TION.THE OWNER�BUILDER WILL NRVE TME BUR�CN OF VROV:NC TlUT NE OR SHE D�O NDi BURD Ofi Z MPROVE FOR THE PURPOSE OF SILLE). = Ot��wNEROF1HEVROPERTV.AUExCLUSIVEIYCANTMLTPJGWITMIICENSEDCONTMCTORS W [t TO CONSIRVCTTME VRO.IECT(SEC.7041.BUSINCSSAND GROFESSiONS CODE TME[ONiRACTORS U. V01{131i0f1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROOERTVWNOBUILD50RIA1VROVESTHER[ON,AND � WHOCOMMCTSFORSUCH7RQIECTSW17HACONTMCTOR�S�UCEHSEDPURSUJWTTOTHECONTiUG� QUANTITY oescaianoN FEE Y TOqSUCENSEUw.�. � ❑1 AM EXEMPT UNDER SEC. B.6 P.G FOR THIS RE�SON Q � U � LL" OATE OwNEF �"' Z w �Q LICENSED COI�fTRACTORS DECLARATION w [r IHEREBYAFFIRMUNDERPENAITYOFDERJURYT/UTIMILICENSEDUNOERVHOV151ON50FCMAPTER � ' � Y�COMMENCINO WITH SECTION 700D)OF DIVISqN]OF TME BUSINESS AND PROFES510NS CADC,AND Z uY LICENSE lS IN FUl FORCE IND EFFECT. � UCENSECUSS '�7•����t�• ���L7C�N0. ��S`L<� • � V DATE T• 2.� • 2 00/ �CON7aAcion _ a W � WORKERS'COMPENSATION DECLARATI01�1�2'I O� ¢ � '7 (7 1 � � IHEREBVII�FIRMUNDERPENALTYOFVERIURVONEOFTHEFOLLOW!NCDE�'f rar�s.� � [A a O _INAVEM101MlLAUINTAINACERTiFIGTEOFCONSENT705ELF•INSUREFORWORICEFYS' _ � Cp1APENSAT10N,115PRONDEDBVSECTION77000FTHEUBORCODE.FORTHEVERFOAMANCE w OF THE WORK iOR WHICH THIS PENAIT IS ISSUED. � G W �IHAVEANOW4LMAINTIIINWORKERS'COMPENSATIONINSUfiANCE.ASREWIREDBYSECTqN O 77000FTMELAl30RCODE.FOFiTHE7ERFORIAANCEOFTHEWORKFORNMICMiHISPERMITIS � ISSUCD.MVV✓ORl(ERS'CO�IGENSATIONINSUfiANCEWARIERANDPOIICYNUV.CENARE: CONSTRUCTION � CARRIER PUUJ REVIEW � � G,� �r ' � PakvNuuoea C X C� K ' ELECTRIC � 0 (M55CCi1WNEmNOTBLCd.4RE7EDOFTlE7£iU.1T6FOROnEMI.OHCD00lU�A5R+0olOfiLE551 PLUM�ING z 1 CERTIFV THAT IN 7HE OERFORMANCE OF THE WORK FOR WHICN TMIS PER41T IS ISSUED,I MECHANICAL (•} SHALL NOT EM�l.OY ANY PENSON W�NY MANNER 50 AS TO BECOME SUBJECT 70TNE '��I� � WORKERS'GOMVENSATpNUWSOFCALIFORNIA,ANDAGREETHATIFISMWlDOECOME INSPECTIONFEE S SUBJECTTOTHEWORKERS'COMPENSATpNPROV15qN50F5ECT10N]10oOF LABOR �SSUANCE ��� -----�� OD��I S FORTNATHCOMPLV WIiN TMOSE PROVISqNS./� V � � /� � SMIP � . /�'•.� ..j.... t:J ! a p �ATE: � APPLICANT:_�� . 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COMMENTS 0 J � m VE(UAITTEE NMndE IPWNn � /J, N _.L�L�4�YS. ��� ��� � S�GNATUHEUFPERMITTEE OATE c � RECPT.NO. �J� PAID BY VALIDATION WHITE-0epartment Copy,YELLOW—Finance Copy.PINK—AssessaCopy.GOLDENROD—Fite Copy.GREEN—Applicant's Copy ._. .. . _ . . . . . .. . ..-: . , ...... .... .... _ . _ . . . . , ... ......... .. - - . ... . . . . , �. .. . .. . . ..... _ , . , .��-r . ... ...._. . . . , .. . ��i;� r.��- ��t��:�ot�� �l"iC; . �C��;�F��C i IC�i�� �:i=�L;i,�i-i J � � ------�-_,�-.-_----- 1 - _..-- -�'--_.. '1��_ - -,____ ____ ___.._ li�-`1�-'=�f"Cl�l►I e1_.. I►l=i;,�;.�'. F. .� _ . :i:.�= �. �(ci� � __�'_�._���.t:r� `� I►��-7���r�eay:� _.._____.._...--— --.._._..... .. ._ . . - _. ... _ .. ... . .- ... . .. . ... . . . ... .. . .. .. . ....... . ._ .....,... ..-- ------...._._..... 5ET�3ACf: � j ' � ! FL�OR J�IST . � I ------ — —+-----�-- F-?GS/FOFi�.15;STEEL 1---.----.� --__-.---- •------�-�-f-Ht;_RE:G�':'T� _ � _ ELECTRIC GROUfJD_ I ___ I { I U�JD�R FLC�R DUCT ! ___ � GROU�JD PLUP�.IBIPJG ~ � � Ut�lD�R PLCO�CUP�ID'JIT 1 SLAB GRF;DE I_I FIREPL�',CE FOUNDf�TIo"J ! - I _ TE��AP POWER I _ __�� FIHEPL.ACF 60`JD E�EAP�" __ � __1 INATER SERVICE I --� � I h"JD HT E3D"�D E3�/',r.1 � � ROOF SHEATHRJG��,.�(a,6( I . ---- ---_ ---_�,8 F7. E30,`�D EiFF�!.1-- --- --� --- FRAhlINGNE�JTILIATION � � FIPJF�L Gp"JD E3EhF.1 � �— -1--------� ROOF COVER 7-j��.�� j FR�-GFsF;DIi`'�,,� ; I ROUGH HEATIf•!G � � B�fJCh�iI�JG I � ROUGH ELECTRIC � I � I R�UuH GRADIiJG �_ I _ f70UGH PLU�.'EING � � �� FI��;ISH uR�DI�JG � SFi01,:'ER/TUe�TEST � j i POOL ELECTRI: � � EXT.L.ATHlSIDING � � I f'OOL FEP�CIt•JG � L"JALL INSULATI�N -r -- - +� PGOL F=1hlAL I-- ---- CEILIP�G IN�ULATION � � OFF SITE IP'PS. i ; DRY�"lALL PJAILING � � �_ DEDICATIOi�S � SEl'JER j � FINAL EfJG. �_ _�—. SEPTIC TANK � i LA.PJDSCI',PE/IRRIG, � � SEEP PITIL.L. � • 1 � I ��OfJ SITE 1�.1PS. I I GAS AIR TEST �_� _ _� FINAL ZO"Ji�JG _ � FINAL CONST. (l 3�-p � ; ! �IRc D�PT. FIFJl1L I FINAL FIEATI^JG i � HEALTH DEr T. FI"dl1L � FINAL ELECTRIC I I j ; DEV. FEES PAID � FINAL PLUP.1BING � � � EhJERGY _ � � � -- � � �_-y�'� {---�� .�__._._.�.�^�----I— ---- CUt:�IMENTS ' SEPTIC TAPJK SIZE SEEP PIT/U SIZE -- — _-----�--'��------ . ��rf �, , .�