HomeMy WebLinkAbout18043 (19) � ' �` CITY OF DIAMOND BAIt �
DEPARTMENT OF COMMUMTY 8r.DEVELOPMENT SERVICES
' 21�oE.copleyvri�csuim 190 �i ��Sl GS 2 G PRESS
��'��� BUII.DING PERMIT APPLICATION J � ; FIRMLY
� JOBSITE �2 ! 6 APPLICATION � PERMff I L�� p/CQ 1'���
0 ADDRESS ✓��/� ������ ���s��/ DATE NUMBER_11�LL � �
� APN LOT TRACT Z(rj ISSUE s' TYPE . OCC
��_7 DATE CONST. GROUP
� OWNER F
" ADDRESS S ZONING SETHACKS '�
Z CITY „��l1/A/.`�- ZIP��/Z TELg�A �l7�� D FRONT , . . - RW O
� APPLICANT TEL. REAR O
SIDE/SIDE STREET RW O
CONTRACTOR n� iA SIDE O
� ADDRESS �� .
CfTY 21P TEL PROPOSED USE
ARCFUENG/
DESIGNER v� �r � NO.DWEL. NO. : NO.
ADDRESS UNITS STORIES BEDROOMS
N CITY� ZIP� TEL_�UG'f
N F�� OwNER•BUiLDER DECW�e.TION 7 O O�� DESCRIPTION SQ.FT.' FACTOR PSF ADJ.AREANALUATION
0 SFRlADD/REM
1 HEREBY AfFlRM UNDER VENAL7Y OF PEfWRY THAT I AM E%EA1PT iROM iHE CONTAACTORS L4 Garapa�Carport �
B CENSEUWFOfI7HEFOlLOMlN(ii�A50NI5EG7031.6BU5WE45ANDVROFES510NSCODE:ANYCRYOH (n
C,� COUiTYYMICHRE0U1RE3AGERMR7000N5TRUCf.ALTEFtMPROYE,DEMOLISH,ORREPNRNVYSTRUG W PelIOlDBdc ._
� TURf,iR10H TO RS ISSUAHCE AL50 REWIRES TNE AV7LICMlT FOR S11G1 PERMIL TO fILE A SIC3NED w
STATFMEM 1HAT NE OR SHE 6 UCENSEU VURSUANT TO TME PPANSiONS OF THE CONTMCT00.4 l4
� CEN9E UW(CHAPTER 0�COMMFNCNO WITH SECTION 7D00)OF DMS�OH]OF 7ME BUSME55 ANO PR0. � POOUSpB
FESSqHS CODEJ OR THAT ME OR SHE IS EXEMPT TMEREFROM FND TNE BASIS FOR iHE ALLECED E%EMP-
TqN.AHYVI0.ATI0NOFSECf10N70J1.6BYANYAPPLIC/N(TfORAFERMITSU&IECT57HEMPLIC/WTTO Z qe-Roof � �
'„_, ACIVR7ENALTYOFNOTMORETM/J7FIVENUNDREDDOLLMS(36o0).}. . - _
� OI.ASOWNEROFTMEVROPERiY,ORMYEMPLOYEESW�THWWESASTHEIH50LEtOMPENSATION, 0 Commerclal � � � .
YAIL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OA OFFERED FOR SAIE(SEG 7Dtt,BUSI• J
1E55 AND VROFESSIONS COOE:TNE CpfTMCTORS LICEHSE UW DOES NOTAPPLY TO AN OWNER OF � �
N OROPERTVWNO&IKDSORYVROVESTNEREON,MI�MM1IODOESSUCF/VJORKHIMSELFORHERSELFOR = �� �
THROUGHItlSORHERONtIEWlO`/EES,PMVIDEDTNATSUd/WVROVEYENTSARENOTMENDEDOR CD . �
� .OFTEREDFORS/�LEIF.FIOWEYER��dN00RMPROVEAIEMIS50lDMATHWONEYEAROFCOAIPLE� ` . . .
TION,T/E OM11ER-BULDER MALL HAVE 7HE BVFOEN OF VROVNO THAT HE OR SME DiD NOT BUIID OR
W PRDVE FOR T1E PUFPOSE OF SALEF
O4�3 D`M7ER OF THE VROPEiSTY,AM IXCLUSNEIY CONTMCTHO YrtTH LICENSED COHTMCTOR3
� TO CONSTRUCT 7HE VROJECT(SEC.70a1.BUSINE55 MA PROFESSIONS COOE:TME CONTMCTORS Lb V8�UO2bf1 ADJ.AREA
CENSE UW DOES NOT MPIY TOAN ON'NER OF A VROPEN7Y Yn108UILDS OR MPROVES TMEREON./iND
Z� N?qOOHTpACTSFORSUGMGRO.lECT5VA7HACONiMCTOR(S)LICENSEDPURSUAHTTOTMECONTMG QUANTITY DESCRIPTION . . FEE' .
� 7DRS LICENSE UW.y � �
O 1 MI E%EMPT UNDER SEQ B.t i.G FOR TNIS REASON � CY� � .C Y�
oC A�1 '
�= MTE OWNER V •
� LICENSED CONTRACTORS DECLARATION � Z w�, r �� `
� W
INER£BYAFiIiWUMDERPENALNOFVE0.AIRYTHATIAMLICENSEDUNDERPROVISIONSOfCNAPTER Vr /" ^ ti
s Y(CqWENCIM3MAiN5ECTIDN70o0)OFDM510NlO�THEBUSINESSANDPROFESSIONSCODE,AND Z �
X MYUCENSEtSNFUILFORCEANO FECL m ; /. , �
tlJ
o ucvasE cuss uc.r+o. J 2
� o�rE � corrtrucroa � a � l c '
�
� WORKERS'COMPENSATION DECLARATION U V
N IHERE�j'AFFIRMUNDEFFENALTYOFiE0.1URYONEOFTHEFOLLO'MNOOECLAR�TKKJS:
f/) /J�1 Q , �
O �lTIIUYEAHOWILLWUNTAINACERTiF1G�TEOFCONSEMTOSELFaNSUREFORYAPI(ERS' S , RTJ �
7d. � pp1DENSAT10N,/1SFROVDE08YSECTON]7000FTHEUBORCOOE.FOi1TNEPERFORMANCE W �v
TME WOFK FOR WHIp/THIS PENIIIT IS ISSUED. �
C
NAVEANOWILLLWMAWWONCERS'COMPENSATpNINSUR.WCE,IUREWIflEDBYSECTqN ��� (�O
O �7000F iHEUBOR CO0[,FOR iHE VERFORMANCE OFTNE WOPoC FOR WHICM THIS PER/AIT IS �1
� t55UED.W CO/AGENSALON INSUMNCE CARRIER ANO POLICY NUA18E ME: CONSTRUCTION �
� �yqiEq W���i ��u�I _L/`�S� PLAN REVIEW
ICYMAIBER � ��� ELECTRIC �
a f%�` �v o u.
0 (n65[ �+E�noieEOo�.KEiEoOFnEv6yAi5Poa0tEM.�DaIDOa.WISR�oo)oRIE� PLUMBING _ 1
Z ICERTIiVTHATINTHEVEIIFORAUWCEOFTIEWORKFORWNICHTHiSPERA/�TI5155UED.l MECHANICAL OO � �J
'� S/iALLNOTEMPLOYMIYVERSONWANYl1ANNER50A5T08ECOMESU&IECTTO7HE '�
� M/ORNER5CdAPENSATpN�AwSOFCAUFOHNI�/NDI.GREETNATIFISHOIADBECOlAE INSPECTIONFEE
S SUBIECTNTNEWON(ERS'CO�APENSATIONPRONSION50F5ECTION�7ooOFTMEUBOR �SSUANCE �O G
COOE.1 SNALL FORT1�wRN CO�APLY WR/I TI/� E Fi10VIS�OHS. ,� Q
� DATE:.,�=10-0/ �/�_� �lylL� SMIP . .
p APPLIGINT: � .
W ENERGY P/C �
� WAANiNO:FAIIURE TO SE W RE WOf1KER5'C0IAPENSATION COVERAGE IS UNLAwFU�M10 SHALL BE
SUBIECTANEMPLOYERTOCHiMINA�PENALTIESIWDqNLFNESUPTOONEM/NOREATMOU5IWD ENERGYPERMIT (�
DOl1AftS(f t0o.0ooJ,IN ADDRION TO iNE CAST OF COMPENSA7iON.DAMA�ES AS PNOViDEO FOR IN �
� SECf10N�70tOFil1EUBORCOOE,INTEREST,IWDATiORNEY4FEE5. RETENTIONFEE:
a CONSTRUCTION LENDING AGENCY PREALT FEE �
� IHEREBYAFflRA1UH0EHPENALTVOFPERIURYTMATTHEREISACONSTRUCTIONLENDINCAGENCY �
FOR1HEiERFORMANCEOFiMEWORKFORWH ISPERMITISISSUR(SEC.7o97,CN.CJ.
� LENDERSNNAE_____.�G�,L{L�'-��PUIT„/• - � �
�
� LENDER'SADDRESS .
� ICERTIFYTHATIIUIVEREAOTHISAPVIICATpNANDSTATE7HAT7MEABOVE�NiOR11AT10NISfARFECL TOTAL FEES _ ��� I
� 1 ADREE TO COGPLY YATH�Ll CRY AND COUNT'ORD�NANCES N!O STATE UN5 RELATIN�TO BU0.DIN6 .
CqISTRUCTION,AND HEREBv AUT/IORRE RE�RESENTATIVES OF THIS COUNTY TO ENTER UPON iME
� /1BOYE•MEMIONEDVROFERTYFORMSP wavosEs. COMMENTS �
� �� ' � . . . . .
m PERMIiT HNAE(P n . .'
a — D D/
� -
y SIo EOFPEiU11 DATE '
� RECPT.NO. PAID 0Y VALIDATION �
WHITE-0epeRment Copy.YELLOW—Finante Copy.PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—Applicant's Copy
" '� . . . '6� •.r' _ .. - .. . `�a ��� - . .�. "�"i7v�. .. .. .. . . . .. �7.,: .. . . . . . .. � _ . . . � � ..-�. . ., , ..
CITY OF DIAMOND BAR .
- � �-- .
� INSPECTlUN RECORD
� � , ,
_ . �,
• • � � ' • � ��. �'�r= :(!yf-�'1�3[ ��l�t
: . �_...._..._...�.,,....,_�...._,.,..,� .:..- ...:-.,.- ----
SEf BACK � � FLOOR JOI$T..,,' . � -
FfGS/FORMSlSTEEL ' - FHA REQh1TS
ELECTRIC GROUNO ' ' ' UNDER FLOOR'Dl1CT -- . - -
�GROUND PLUMBING � UNDER.FLOOR CdMDUIT
_ 'SLAB GRADE - ` � ' '� FIREPLACE FOUNDATION
TEMP POWER � FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
:ROOF SHEATHING ,_� 8�.BOND BEAM ' - `
FRAMINGNENTILIATION �� . / FINAL BOND BEAM - '
:ROOF COVER �.� PRE-GRADING , , .� . '
ROUGH HEATING BENCHING ' � �
'ROUGH ELECTRIC ROUGH,GRADING -
ROUGH PLUMBING' FINISH GRADING '
SHOWER/TUB TEST � POOL ELECTRIC
EXT.LATH/SIDiNG /� � POOL FENCING ;
WALL INSULATION � �.�y POOL FINAL � �_ _ _
CEILING INSULATION � � ` OFF SITE IMPS. I
DRYWALL NAILING ' DEDICATI�NS I ___!__�
SEWER �J'!' FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. �� -'
I
SEEP PIT/L.L. � � 1 " � ON SITE IMPS. ^ �
GAS AIR TEST �• .. � FINAL ZONING 1
FINAL C.ONST. • � FIRE DEPT. FINAL 1
F1NAL HEATING �� • : - . HEALTH DEPT. FINAL __ __ �
FINAL ELECTRIC ' ti ti � DEV. FEES PAID l
FI�JAL PLUMBING � -- ENERGY —� j
----- --�--,
_ -E'''.� - Z ^1,�� �` ' �- -`--
'� YIM:
1 1 • .. �.�, �?���:�,ti::.._� .., J I
_ . , -- , �-- - `- . __ ,
COMMENTS '
. �
. . _ � � . - --- ----I
r � . . . - .. -_____
.�� , �. , . .
------ � �
, i
_ SEPTIC TANK SIZE ' �.
,
�SEEP PIT/U SIZE --
; . � . � ' f .
, , . , - -------- - --
,
, ,. _,_ - -------
� � �� � . � ---.