HomeMy WebLinkAbout18388 (19) I' C1TY OF DIAMOND BAR �
-�� DEPARTME?`'T OF COIvIIv1UNTfY&�DEVELOPMENT SERVICES �
. �
21825 E.Copley Drive
�"` (909)860-3195 Fax(909)861-3117 PRESS
"%:A'� BUILDINGPERMITAPPLICATION FIRMLY
o ADDRESS l�4.J p Z C'�GLo �� DATECATION -7 3� �-� NUMBER 1f�3gg #/C
c� ISSUE TYPE OCC
APN LOT TRACT OATE � 3� Z— CONST. GROUP
p OWNER ��'' ��1jp��1./7/•
o ADDRESS ZONING SETBACKS
Z CITY ' ZIP TE e/ FRONT RW ❑
� APPLICANT TE REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR "' _ SIDE ❑
� C'DTMDRESS�.�� Z�P��EL � pROPOSED USE �"� ' � ��� � �
O
o ARCH/ENG/`�— ` Q �y�,�(Lc,
� DESIGNER NO.DWEL NO. T� NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ' ZIP TEL.
� OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREAJVALUATION
� i
� OWNER•BUILDER OECLARATION SFR/ADD/REM
O
p 1 MEREBY AFFlRM UNDER PENALTV OF PE0.IURV TwIT�AM E%EMCT FRM/1HE CONTiUCTORS LL � Garope/Carport
W CENSEUWFORTHEFOILOWP�GREASON(SEC.70.7t.58U5ME55ANOi90FE55lON5CODE:I1NYCfTYOR
U COUNTYNT11dIREWIRESAPERMIT(OCONSTRUCT,ALTER��°pOVE.DEAIOLISM.CRREOAIRANYSTRUG W PatiolDeck
Z IURE iRpR TO ITS ISSUANCE,A150 REOUtRE3 TNE APFLIC�NT FOR SUCH FERMIT TO FIIE A SiCNED w
w STATEMENT iNAT HE OR SNE IS LJCENSED PUHSt1ANT TO TME PROVISIONS OF THE fANTRACTORS LI•
� CENSE UW(CMAFTER 9(COMMENGPiO VATN SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO� � PooVSpa
� iESSqNSCOOE)ONTNATHEDRSHEISE%EAIPTTH�REFROMIINOTME6A515FORTHEALlEGEOE%EMV� `'
V TION.l1NYVIOU�TIONOF3ECT�ON70.71.SBYANVA7PUCAN'FORAPERMITSU9JECTSiHEAPPLIGANTTO Z Ra-Roof D(/
� ACMLPfNAITYOFNOTMORETHANiNE11UNOREODOLUR51i5W11:
0 O�ASOWNEFOFiHEPROPERTY,ORMVEMPIOYEESWITMWACESASIMEIR50LECOMCENS�TON, ❑ Commercial
Z WILL 00 TME WOHIC M10 THE STRUCTUHE IS N�T M7ENOED OH OFFENEO FON SAIE(SEL.10a.BUSI• J
NESSANO CROFESSIDNS COOE:iHE CONTMCTORS IICENSE UW DO"e5 NO'AVPiY TO AN OWNER OF
� VROPEHTYWHOBU0.DSqilA1PROVESM[REON.AN�WMODOESSUCNWORKMiMSELFORNENSELFOH =
� THROU6MHiSORHERONMEMPLOYEES,DROVIDE07MAT5UCMIYPROVEYENTS�RENOTIN7ENDE�OR m
L11 OiFEREO FOR SALE�F,/qWEVER TME BUID:NG OR IMP{i0YEA1ENT 15 SOLD NniMiN ONE YEAR Of COMPtE�
Z TION,THf OWNER-BUILDER VnLL HAVE TNE BUHOEN OF CR01flNC:HA7 HE OR SME OiD NOT BURD ON
� N1vROVEFORTMEPUHP0.4EOF5ALE� .
O 4�ONMER OF rilE VROPERTY,AM E%CLUSIVELY CONTMCiN�WiTN LICENSEO CONiMCTORS
� TO CONSTRUGT TME PR0.1EC7(SEC.7oN,BUSiNE55 AND PROFESSIONS COOE:TNE CONTMCTORS LI• V3IU3ti011 � r ADJ.AREA
W CENSEUWOOESNOTMPLYTDANOWNEROF�VROPERTYW�+OdVe.090RIMPM�VESTMEAEON.AND
Z W/qLONiMCTSFORSUpIPROJECTSWITMACONTiuCTdilS)LICEhSfDPUASUANTTOTMECONTRAG QUANTITY DESCRIPTION FEE
F— TORS LICENSE UW). ,
� I
� ❑1 AM EXEMPT UNDER SEC. B.a O.C.FOR THIS REASON U
� �
LL" DATE � OWNER V
Z W
� LICENSED CONTRACTORS DECLAFiATION �j
� �
IHEREBYAFfIRMUKDfRPEN�LTVOfOERJU�TNAT1AMLiCENSEDUNDERVROVi51ON50FCi1APTER �
d i(GOMMENC4HiWITM5ECT10N7000IOFDiV15�ON70FTMEBUSINE55ANOPP.OFE55�ON5CdJE,AND Z
X MY LICENSE IS IN FUII FORCE hND EFFECL m
LJJ
�
� LICENSE CLA55 �I����_UC.NO. ,� � �
►--
V DATE CONTMCTOH � 7J d _
W '
� WORKERS'COMPENSATION DECLARATION —�
<
� U
N INEFEBYAFFIRMUNDERFENALT'OFPER1UiiYONEOFTNEfOLLOwINCDELURA710NS: Z
O �I MAYE ANO MALL MNNTAIN A CERiIFICATE OF CONSENT TO SELF-INSUNE FOR N�DfiKEHS' 2
Q COI.IPENSATqN,A4VNOVIOEDBVSECTION]7000FTHEUBORCOOE.FORTHEPERiORMANCE W
OF TME WORK iOR WHiCM T1n5 FERMiT IS ISSUED. �
O
W _IHAVEIWDW�LLMAINTNNWORNERS'GOMPENSATIONINSURANCE.ASREOUIREDBVSECTION
Q i7ooOFTHElA80HCODE,FORTHEPERFORIAANCEOFTIIEWORKFORWHICHTHISVERAl1T15 q � 3Q
ISSUED.4IVWORNE0.5'COMPENSAT INSURANCEG�RRIER DVOLIGYNUMBERARE: CONSTRUCTION
� CARRIER��� � PU1N REVIEW
� po��crnuMaEn /L '� - -^ _� ELECTRIC
— /
0 �fM55ECfL7JNEmtATB[OOM1PLE7FDOFI�EPERMfT5FO�7U�E1M�F�D�1�R+�%���`? PLUM0ING
Z 1 CEFTIFY TNAT IN THE PERFORMANCE OF TNE WORK fOR WMICH iHiS 7ERMIT IS ISSUE0.1 MECHANICAL
(,�} SNAL�NOTEMVLOVANYPERSONINANVI.�ANNfR50ASlOBECOMESUflIECTTOTHE
� 1MORKERS'COI.IPENSATIONLAWSOFGILIFORNIAANDAGREETHATIfISHOUlD8E00ME INS?ECTIONFEE
�� SUBJEGTTOTHEWONKERS'CdAVENSA710NOPOV15KKI50F5ECiqN77ooOFiMEU80R �SSUANCE •DJ
CODE.I SNALL FOFT1wiTH COMPIY WiTH jMOSE FROVIS�ONS.
./ ,,����� �� o
WDATE:�� /_�PPLICAM:���f��� � � SMIP
� WARMNG:FAILLIRE TO SECl1PE WORKERS'COMPENSA7qN COVERAGE IS UNUWFUL.ANO HAlLOE ENERGY P/C
J SUBIECTANEMPLOYERTOCRIUINALPENALTIESANDqVILiINESUPTOONENl1NOREDT OUSMID
� OOlU0.S(5100.00D�INAO�ITIONTOTMECOSTOFCOMPENSATqN.0�1AACE5ASFR0 DFORIN ENERGYPERMIT
J SECTION770eOFTHELABORCOOE,INTEREST,ANDAT70RNEY'SiEES RETENTIONFEE: t�OO
W '
� '�. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� INEREBVAFF�RMUNOERGENALTYOFPER7URYTHATTHEREISACONSTRUCTIONLfNDINGIGENCV
n- FORTIE�ERFORMANCEOF7HEN'OFKFOHNMiCMTNi5PEf1M�T�51S5UED(SEC.7Dv7,GV.C.1.
W �
� LEMJEfi'S NAME
� LENOER'SADORESS
� ICEFTIFYTHATIMAVEREADTMiSAPPLICATIONANDSTAlETHATTME/180VENFORM�TIONISCORREC2 TOTAL FEES � 2�C Q
W IAGfiEETOCOMPLVWITNALICT'ANDCOUN7YOROINANCESN�DSTATEUWSREUTINGTOBULLOING
� CONSTRUtt10N.ANONEREBY�UTMOR2EREGFESENTA71VF50FTM15COUN7`lTbENTERUFONTHE
ZrBOVE•MEMIONEDVROVERtYFORINSPECTIONWRPO5E5. COMMENTS
� ��M !� 1C'.fi►�►�
J
� �/;�—+
QPERId1TT NAMf(P .4MJn / \
N �
N SIGN�TUFEOFPER ' - J OATE �
RECPL N0. �PAID BY VALIOATION
� �. WHITE—DeDanmmt Copy,YELLOW—Fnanee Copy,PINK—Assessor Copy.GOLDENROD—File Copy.GR plieanl'a Copy
' C6�'s` QF D1�1iJi:?�tii� B�Fs
� . f��l�FE�'7'�fli� €?��C�:�D
;Ci[�`..���'�i.C����a����._`_,�_n�r�� .��laC��µ��Ql�°�R1,� Y�'1►r�-.J^�?c�"F�O�i ..'... 4��J��"�,...y`���►���'���o !. �' i
._---�--^ -- --• -�._ ..�..__ __._ �„_. _ . ..._. _.:._.... - ._
SET BACK � ,� � � FLCOR J��IST - ' �
_ __ __ -------�--�-------
FTGS/FORMS/STEEL __�_____ ; I FHk REQP,�1T5 �
ELECTRIC GROUND _ � ___ �.� � ! UfJD�R ;=L�OR DUCT �
GROUND PLUMBING � I Utl�E:R FLOOR.CUP,IDUIT � ;
SLAB GRADE _�_ I_FIREf�LA�E�FOUNDATI�N �
-� ^- ---- —-
TEP�1P POWER I � i�IREPLACE f30fJD BEAM
— ----• ----- '--
WATER SERVICE �—i _/. — ' " ------.----:-�_h11D HT. EiONbf3EF,PA-------
ROOFSHEATHING !�/(/02- /�._��___� i f� �. BO"1U B�APJ1 � _ _
FRAMING/VENTILIATION I � � � FIhJAL E30�JD 6EAM _ _� _ _
ROOFC�VER I��/o: _�� I_ PRE-GR/1�ING ;
ROUGH HEATING �r ��--BENCHIiJG I
ROUGH ELECTRIC �� ROUGH UR_�DIN� �
ROUGH PLUMBING _ I ___ ___:� FINlSH GRADWG
SHOWER.�UB i EST � : i POOL ELECTRIG
-•;----
E}�T. Lf1TH�SIDING ! i ; POOL FENCIfJG
WALL INSULATION �— I ; POOL FINAL
CEILING WSULA710N j_ __ �_ OFF SITE Ih1PS. _I
DRYWALL NAILING � ' i DEOICATIONS i _
SEWER � _ __� � FINAL ENG, �
SEP�i IC TANK • ' � LANDSCAPE;IRRIG. j
SEEP PIT/L.L. � i_i�ON SITE IPAPS. —�—
GAS AIR TEST 1 � FINAL ZON�NG
FINAL CONSL � _-_-� ' T F1RE-_DEPT. FINAL
FINl�L HEATING _�_, � HEAL7H DEPT. FINAL I
FiNAL ELECTRIC � � � DFV. FEES PAID
FIPIAL PLUh1BING �— ; i ENERGY �
_ — _ _—J ���.�I.,�1�'a �'
�..:.,.,. .t.;.�. :�.;...0.v.
CUMMENTS
`
, •
\ ,�
---- --�`----�-- —
. ,` .
SEPTIC TAfJK SIZE ^
SEEP PIT/U SIZE �
�.. ._.....,--�-�
� �!���� � I� -� - - .
;� �
,
}��� .'='' .----- —
_ af�r �
. :` s .� j _
.`.� .__..�_J.�+��....�� 1 J