HomeMy WebLinkAbout17708 (35) �� C1TY OF DIAMOND BAR C�
,� DEPARTMENT OF COIvIIvIiJNITY&DEVELOPMENT SERVICES
21825 E.Copiey Drive
(909)860.3195 Fax(909)851-3117 PRESS
��� BUILDING PERMIT APPLICATION FIRMLY
{/ f�/� APPLICATION � EMgER IVU k�
o ADDRIESS �� /�O � v%�• DATE �
� ISSUE PE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNE�I�/V ML/�D�J.�t' S
o ADDRESS ZONING SETBACKS
z CITY ZIP TEL ^ � / / FRONT pvy p
g APPLICANT TEL. REAR ❑
� SIDE/SIDESTREET RW ❑
� CONTRACTOR APp�NCE INSTALLEAS{NC, SIDE ❑
AD�RESS
o C�Ty I�I�y,"^nrl rA Q�T�L (i � �(� PROPOSED USE
o ARCH/ENG/
� DESIGNER NO.DWEL NO. NO.
N ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION
p SFRlADD/REM
� 1 HEREBY AFFlRM UNDER PENALTY OF GERRIRY THAT I/UI E%EMPT FROM THE CON7fUCTORS L4 Garage/Carport
W CENSEUWFORTHEFOILOWINOpEA50N(SEC.7o71.6BUSINE55ANOPROFE55qNSC00E:ANYCI7YOR (n
V COUNT'YMICMREWIRESAPERMITTOCONS7RUCT,ALTERIMPROVE,OEMOl15H2ORREPAIRANYSTAUC• W Patlo/Dedc
� TUFE VRqR TO ITS ISSUANCE,ALSO REWIRES TNE AVPLICANT FOR SUpi PERMIT TO FILE A SIGNED W
� STATEMENT THAT HE Ofl SHE IS UCENSED PUViSUANT TO TNE PROVISIONS OF THE CONTRACT00.5 lF �
� CENSE LAW(pUFTER i�COMMENCINO YATH SECTION 7000)OF DMSqN 9 OF THE BUSINESS AND PfiO. POOVSPfl
� FESSIONSCOOE�ORTHATNEORSHEISEXE4PTTHEREGRdAM1DTHE8ASI5FOHTHE/�lLEOEDEXEMP- (�
TION.ANVVIOLATqNOFSECT10N70]1.60VANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Rool
A CML VE WLLTY OF NOT MORE THAN FNE HUNDRED DOLLARS�f SOD)J:
� 04ti'OWNEROFTHEPROPERTV,ORMYEMPIOYEESMnTHWA0E5A5THEIR50LECOMGENSATqN, � CORIIIIBfCIBI -
Z Wlll DO THE WORIC AND THE STNUC7UNE IS NOT IMENDEO OR OFFERE�fOR SALE�SEC.701�,0U54 J
N NE551WD GROFESSWNS COOE:TME CANTMCTORS UCENSE UW DOES NOT�7PLY TO AN ONRlER OF ?
FfOOPEHT7 WHO BUIIDS OR IMPROVES THEREON,AND NM1IO DOES SUCH WORK HIMSELF OR HERSELF OR
WTHFiOUGNHI50RHEROV�NEMPLOYEES,VROV10EDTHAT5Up11MVROVEMENTSMENOTWTEN�EDOR m
0 OFFEREDfORSALEIF,NOWEVERTHEBUiLDINOOflIMPROVEMENTISSOLDWITMINONEVEAROFCOMPLE•
Z TION.TME OWNER�BUItDER YALL H�YE hlE BUROEN OF PNOViNO 7HA7 HE OR SHE DiD NO7 BUILD OR
= MPROVE FORTNE VURVOSE OF S�LE}
W OI��M/NfROFTHEVROPERT;AMEXCLU5IVE�VCONTMCTINQ1MTHlICEN5E000NTMCTOR3
Q TO CONSTRVCTTIIE PROJECT(SE0.7aa,BUSINE55 AND PROFESSIONS CODE:iHE CONiMCTOHS LI• V3108i1Of1 ADJ.AREA
W CENSEUWOOESNOTAPPLYTOANOWNEROFAFROPEflTYWMOBUI�DSORIMPROVESTMEREON,MlD
� W11000MMCTSFORSUpIPRWEGTSWITHACONTMCTOR(S�UCENSEDPURSUANTTOTHECONTMG �UANTITY DESCRIPTION FEE
� TORS UGENSE UW.I�
� O IAM EXEAIPT UNDEH SEC. B.8 P.C,iOR THiS REASON Q
� U
lL. ¢
DATE OWNER F-
� W
�Q UCENSED CONTRACTORS DECLARATION W
S IMEREBYAFFIRIIUNOERPENKTYOFGERIURYTHATIAMUCENSEDUNDEHPROVISIONSOFCNAPTER Z 7 � y f
p� Y(COI�IMENCCIOWITNSECTION7000)OFDMSION70FTHEBUSINESSANDGROFESS�ONSCODE,AND L J
X YY LICENSE IS IN FULL�7FORCE M10 EFFECT. m
� UCENSE CLA 5 �/ • UC.NO. J�f� ^ � j
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION a
NI HEREBYAFFIRM UNOER PEWLLTY OF VERIURY ONE OF THE FOlLON1N6 DECLAMTIONS: Z
� _IHAVEANDWILLIANNTAINACER7IFICATEOFCONSENTTOSELFaNSUPEFORWORKERS a
COMPENSATION.ASPROVIOEDBYSECTON]7000FiHE�ABORCODE,FORTHEPERFORMANCE W
Q OF iME WORK FDR WHICH iHIS VERMIT I5155UED. �
"�V _IHAVEANOWILLMAIMAINWOPXERS'COAIPENSA7qNINSURANCE,ASREOVIREDBVSECTION
Q 3MOOFTMELABORWOE,FORTHEPERFORMANCEOFTHEWOFKFORWHICHTNiSPERMITIS
� ISSUED.MYriORKERS'/CO�M/PJENTSA710NINSURM/IC�ECARRiEHIWOPOLICYNU/ABERARE: CONSTRUCTION
CARRIEH I"1/G / �L�F!J PLAN REVIEW
Z0 POLICYNUMBER �: �C.J ��l l/O� ELECTRIC
Q
o f�sEcnwuE�raoieecaa��ccnEaEa�.�rs�or��ooaUas�siro�on�ss�. PLUMBING
Z ICERTIiYTHATINTHEPERFOiiMANCEOFTHEWORKFOHWHIp1THI5PERMiTI5�S5UE0,1 MECHANICAL
U' SNALINOiEMPLOVANYVER50NINANYMANNERSOASTOBECOMESU8JEC7TOTHE
� WORNERSCOMPENSATIONUWSOFCAUFORNIA,AND�GREETHATIFIS/i0ULD8ECAME INSPECTIONFEE
S SUBJEGTTOTHEWORKERS'COMPENSATIONiROV1510NSOFSECT10N77000FTHElA80R
COOE,I 51uLL fORTHNn7H COAIPLV WITN T��:�,prnnsaHs. ISSUANCE
� � SMIP
p DATE; APPLICAMT: _
� ENERGV P/C
W�RNINO:FARURE TO SECUflE WORNERS'COMPENSATqN COVER�GE IS UNUWFU4MID SHALlBE
LL SUBJECTANEMPIOYERTOCRIMWALPEWLLTIESANOCMLfWESUPTOONEMUN�REDT110USAND ENERGYPERMIT
DOLLAFiS(SI OO.00D).W►DDITION TO THE COST OF CAMPENSATION.DAMACES AS VROVIDED FOR IN
� 6EC7�ON�7aeOFTNEU80nCODE,r1iEaE5T.uu0ATroaNEv'SFEES. REfENTIONFEE:
pCONSTRUCTION LENDINGAGENCY PRE�ALT FEE:
� IHERfBV�GFIRMUN�ERPENALTYOFPERtt1RVTHATTHEREISACONSTRUCTIONLEN01N6AGENCY
FOfi TNE VEHFORMANCE OF TME WORK FOR WNICN TMIS PERMIT IS ISSUE�(SEC.70G7,CIV.C.�.
Z
w
� LENDER'SNAME
C LENDERSADDRE55
� I CEHTIFYTHAT I HAYE READ iHISAPPUCATIONANO STATE THATiHE 11BOVE MiORMATIDN IS COflRECi. TOTAL FEES G� ��
W IAGREETOCOMPLYWRHALICITYANOCOlR7TYORDINANCE5ANO5TATEUwSREUTWGTOBU0.�IN6
� CONSTRUCTION,ANDHEREBYAUflIORIZEPEPRESENTA7IVESOFTHISCWNTYTOEMERUPONiHE
Z ABOVE�MENT DGROPEHTYFORINSPECTION�URPOSES.
� SC, lI COMMENTS
_
m DERMiTTEENAAIE(DWt.fT)
d
[n I/�,�L
(n SiGNATUREOFPERMITTEE DATE
� RECPT.NO. _PAID BY VALIDATION
WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessw Copy,GOLDENROD—File Copy,GREEN—Apqicanl's opy
. .._ ......., ........: ,,,.,..... ,, ...:, ,.r.�' -'.,. -' -., , . , � . � . ._ � ....
. .. . . , r'.L:"lw' .. .�,p.....a�,�n--�.'v�.�.�. .I�..l'. m-T— . . . .. . w . ' . � . � .
�i� i i' oQ� ���'��.�Q7�� �3IZf i
IfvSF��C i 1C)F� Rb�CC)r[�
__._____. ----_� __._ _�____.�. �_ ___^�_____
' I���'i����e`��Cc�;I r� ���_ I�'ti'i '=i�' �'�a�; (►�}7��-�c ���c�►�� c����=� I►'4-'����`.�o):{
__ . _ _ __._____.... __. . ._ .-------_ ...__.
_..__.___.._-- --- ._.: _.._.__ ,____._ _.___..,.___y..____
SE7 BACI: - ---_. _—..___. ..---- —_— — — I FLOOR JOIST ` i l --
FTGS!FORPJI5/STEEL � � FHA REQMTS � "
ELECTRIC GROUND !� UNDER FLOOR DUCT �
GR�UND PLUMBING 1 � I UNDER FLOOR CUNDUIT __
SLAB GRADE 1 I FIREPLACE FOU�JDATIO�d I
TEMP P�WER _ � ___ _ I_ FIREPLACE BOND BEAM
WATER SERVICE I i P�11D HT. BOND BEADri
� ROOF SHEA7HING � 1_ 8 Fl". BOPJ�BEA���1 �
FRAMINGNENTILIATION FINAL E30PJD BEAh1 I
ROOF COVER PRE-GRADING j
ROUGH HEATIPdG BENCHING
ROUGH ELECTRIC I ROUGFI GFiADING
ROUGH PLUMBWG j FINISH GRADING
SHOWER/TU9 TEST I POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATIOPJ POOL�INAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.l�. ON SITE I�APS.
GAS AIR TEST FINAL ZOPdItJG
FINAL CONST. FIRE DEPT. FINAL
FIPJAL HEATING HEALTH DEPT. FIPJAL
F1NAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ;�ENERG'f _ ^
0:9/f r✓.1��/�- !f'�t_ �,_/�+c� ` : �
— _t�`._pr:.�r__._`.�4�e_..-----___�.,�' �
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�Rr�
I
��`� I F,,
_,
�
: , ��
� i
,, ,
_`_ , ,