HomeMy WebLinkAbout18230 �� G1TY OF DIAMOND BAR ' ��
DEPARTMENT OF C�IWvIUNITY&DEVELOPIv�NT SERVICES
21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRESS
`��' BUILDINGPERMITAPPLICATION FIRMLY
JOBSITE "� / APPLICATION �'1PERMIT P/C
o ADDRESS�/� DATE ����1MBER�-�� #
� ISSUE TYPE OCC
APN LOT TRACT pATE CONST. GROUP
p OWNER
" ADDRESS ' �C ZONING SEfBACKS
z CITY I f �'�� FRONT RW �
g APPLICANT TEL. REAR p
� SIDE/SIOE STREET RW ❑
� CONTRACTOFj '� '1� SIDE ❑
� ADDRESS /-_- � -� t + A PROPOSED USE '�-�•' d'���+a�� � '� "
o CITY - _ ZIP l/�L. - r ,L
wo ARCFUENG/ •
z� DESIGNER NO.DWEL NO. NO. �"
n. ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL
� DESCRIPTION Sa.FT. FACTOR PSF A0.1.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADDiAEM
O
W CENSEUWFOR E�OLLOWPlOREASON(SEG1WR38 SWESSAN�PROFESSIONSWD�EMIYCRYOR Garage/Carpon
U COUNTYWMCMfiEOUIRESAGERMITTOQONSTRUC7AlTERM�7ROVE.DEMOLISH,ONREPAIqANYSTRU6 �
� NRE,FRIOR TO RS ISSUANCE,/�L50 REd1�NE5 THE ADVLIG�WT FOR SUCH iER4lT TO FILE A SIGNED � PatidDeck
� STATEMEM THAT NE OR SHE IS UCENSED GUHSUANT TO THE PROViSpN3 OF THE CONTMCTORS L4
$ CENSf UW�d/APTEH Y(C0IAMENCINO WITH SECTiON 7000�Of DIVISION]OF iWE BUSiNESS AND PqO. � PaoUSpa
FESSqNS COOEI��T ME OR SNE IS EXEMPT TXEREFROM AND THE B�SIS iOR TNE�LLLEGED E%EMP-
� TION.ANVVIOLATIONOFSECTION7071.68VANYMPIICANTfORAPEfWITSUBJECTSTHEAPVLIGUlTTO Z Re-Foot
ACML PENALTY OF NOT MORE TNAN FIVE NUNORED OOIUNS(SSoo),I:
� OI�OWNEROFTHEPROPERN.ORMYEMPLOYEE5WI7HWAGfSASTNEIqSOIECOMPENSATWN, ❑ COR1mefC�31 '
Z WRL D�TXE WOi71C,ANO iHE STNUCTURE IS NOi INTENDED OR OFfERED FOR SALE(SEG TMI.BU51• J
NESS AND PROFESSIONS COOE:THE CONTRACTORS UCENSE Uw DOES NO7 MPLY TO AN OWNER OF
� FiIOPEHNVA108ULLO5OHIMDqOVESTHEREON,AN0VY/10DOE55UCHWOqKMIMSELFORHERSELFOR =
Q THMV6HHISORHENOYMEYPLOYEES,iROYIDEDTHATSUCHIMPROVEMEMSARENOTMENDEDOR m
W OFFEREOFORS�LE.G,IIDVVEVERTMEBULD�NOORN�7ROVEMENTISSOLUWI7MNONEYEAROFCOMRE•
0 TpN,THE OWNER�BVILOEH WILL IWVE TME BURDEN OF PROVINa THAT HE Oi1 SHE Oi0 N�T BUILO OR
Z MDROVE FOR T11E VUP7DSE OF S�LE� �
_ ❑L�ONMEROFTHEPqOPERfl;M/EXCLUSIVELYCON7MCTW6WIiHLICENSEUCONTMCTORS
W
¢ TO CONSTRUC'T THE VN0.IECT(SEC.7DU,BUSINE55 ANO PiiOFESSION4 CODE:TME CONIMCTORS LI• V81U8fi011 ADJ.AREA
ltl CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYMTfO8URD50RWPROVE9iHEREON./wD
-T�- ri11000N7iUCiSFORSUCNPR0.1ECT3Wt7HACOMiUCTOWS)LICENSEDPURSUAM70TMELONTiUG QUANTITY DESCRIPTION FEE
� TORSUCENSELAW.1.
� O IAIA EXE4PT UNDER SEC. B.8 P.C.FOR TFIIS REASON U
u' OATE OWNER r
Z W
�Q LICENSED CONTRACTORS DECLARATION W
¢ I HEREBYAFFIRAI UNDER PEN/LLTV OF PEiWRY TlUT IAM LICENSED UNOER PROVISIONS OF CMAPTER �
� •(COMMENdNOWITHSECTWN�0oo10fDM510N�OFTHEBUSINESSANDPROFE55lONSCAOE.�ND Z
�� W LICENSE IS IN NLL FORCE ANO EFFECL m
� LICENSE CLASS L�C.NO. �
V OA7E CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION �
N IHEREBYAFflRMUNDERPENALTVOFPERNRVON60FTHEFOILOWINODECUiU7qN5: U
� 4
� �IHAYEANDN1LLMNNTAINACERTIFICI1tEOfCONSENTTOSELFaNSUREFOqWOAKERS' _
COMPENSAipN,AS PIIOVIOED BY SECTON 17aoOFTME LABOR[ODE,�OR THE PERFORMANCE U
�4 OF TXE WORK FOR WHlpl iH15 PERMIT IS ISSUED. �
G
�I HAVE AND MnLL MAINTAW WORKERS'C01AVEN5ATqN INSUMNCE,AS PEOUIFED BV SECiION �\
� J700 OF TXE UBOR COOE.FOR TME PERFORMANCE OF TME WORK FOR WHICH THIS iERMIT�5 1,
ISSUED.MY WORKEAS'COMPENSATION INSUi1ANCE GViiUEF AN�POLICY NUMBERME: CONSTRUCTION �
j tARRIER �7��`2'� r � PLAN REVIEW
� Dq.ICYN�us€R ���1�7 ELECTRIC
� (fF655ECi�ONNEFDNOTBE00�f�FImOFhEPEPMT6Pof10NEHl�DREDDOl1AR9R100�di1E551 PLUMBING
"Z ICERTIFYTH�TINTHEPERFOIUAANCEOFTiIEWORKFORWHICNTHISGERMITI5155UED,l MECNANICAL
� SHALLNOTEMPLOYANYPERSONWANYYANNERSOASTOBECOMESUBJECTTOTHE
N WORKERS'COA/PENSATIONUWSOFCALIFORNIA,ANDAOREE7MATIFISHOULDBEfAME INSPECTIONFEE
S SU&IECTTOiHEWORKERS'CqAPENS�TqNPiqV15�N80F5ECTION]700 UBOA
CAOE,ISHALLFOi7TMMTHCOMPLYWiTHTIWSE R�y�Md . ISSUNNCE - �
�
p DATF: � ICANT: SMIP
� WAiWINO:iA1LURETO5EQIREWORNERS'C01dPENSRT RA�EISUNUN/FU4MIDSMALLBE ENERGYP/C �
� SU&IECTMIEMPIOYERTOCRiMiWLLPENALTIESANOCMLFiNESUPTOONEHUNOREDT/qUSAND
� OOlUR5fS100.0001.NA0DRIONTDiHECASTOFCOMPENSATpN,DAMAGE511SPROVIDEDFORIN ENERGYPERMIT
J SECTIONi7uoOfT17ELABORCOOE,IHTEREST,ANOATfOfWEYSFEES. RETENTIONFEE:
2
pw., CONSTRUCT�ON LENDING AGENCY pqE-ALT FEE:
� IHEREBVAFFIRMUNDERPENi1LTYOFOERJURVTHATTNEREISACONSTRUCTIONIENOWOAGENCY
aZ- FORTNEPERiOiiMANGEOF711EWORNFOflWHIp1THI3VEPA��TI5155UED(SEC.]ov7,CIV.C.�. -
W
� LEN�ER'SNAAIE
� LENOERS ADDRESS 1
� ICERTIFYTMRTIHAVEREADTMISAPPUCATIONANDSTATETHATTIEABOVEMlFORMATqNISCO(1R[CL TOTAL FEES
w IAQREETOCOMFLYWITH�LLCT'ANDCOt1NiYOR01NANCESINOSTATEUIWSREUTIN(iTO6UM1OIN6 �I
� LONSTRUCTqN,IWDNEREBYAUTMOW2EPEPRESEMATIVE50FTH�SCOUt1TYTOENTEAUPONTNE �
Z /�BOVE-MENTIDNED7ROVERTYFORINSVECTqNVIIRPO5E5. COMMENTS
0 �
�
m PERMITTEE NAME(0
Q
C/�
N SIG REOFPEflMITT ` DATE
� RECPT.NO. P1UD BY VALIDAT�ON
WHITE-0epartment Copy.YELLOW—Finance Copy,PINK—A95essor Copy,GOLDENROD—File Copy,GREEN—Applican s Copy
�,.�.......n^.vr.•.-.r-��a+.�.^-+rt:��ur•.�•w_..rawp•rr-.�.x"g".':t A^�..^.►orcL•��7'��;Gt:"'..�:•�S;r�-�ar'?r,�'Jr•�.��. ^r.q'r«r+.,ro�+..,re����srr�wca•.:r.��w;,,...w^..+n.�...{,n ,�- .- .,r... ,., .z�..,�;.
ClTi' Q�' [�IAM��D BaR �
Ic�SPEC e!O�! RECOPD
_ �-,p.__...._..,...�..-.,-.....�._,
� ���������t���. : ,����� :.i��--�,����e�.� �,)���.��,.�.c����l� . ' a�'��.i�� . �1►��-��:�i���
...... ._�. ..��__._.._ ._ __ _.____ _ .�...�!' �'
�.� �....�..�_...____....� _�._.._ __.. .._.._._ �....�._._._ . . . . ., .
SET BACK �`�_ , ': FLO�R JOIST..'._�.. - - �
FTGS/FOR��15/STEEL � � FHA REQMTS
ELECTRIC GRdUND ; j UNDER FLOOR DUCT �
GROUND PLUMBING � I UNDER FLOOR CUPIDU(T •
SLAB GRADE I ', FIREPLACE FOUNDATION ( �
TEMP POWER i � � I FIREPLACE BOND F3EAM
WATER SERVICE ' I h11D HT.BOND BEAM
ROOF SHEATHING � `�i�,� '/ __� i $ FT.BOND BEAb1- � � ,` � ,
FRAMINGNENTILIATION� � I, FINAL BOND BEAM
ROOF COVER i�� _l?����' � PRE-GRADING
ROUGH HEATING � BENCNING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWEFi�TUB TEST � � � POOL ELECTRIC
EXT. LATH/SIDING � j POOL FENCING
WALL INSULATIOP� ; POOL FINAL i
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER . FINAL ENG.
SEPTICTANK i'•, LANDSCAPE/IRRIG.
SEEP PITlL.L. "� ', � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � I , FlRE DEPT. FINA�
FINAL HEATING i HEALTH DEPT. FINAL �
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING � ENERGY
I
!,E�(i'*�;FA E(4n.; - — . ._. (
� COMMENTS �
SEPTIC TANK SIZE
SEEP PIT/U SIZE
, _ .
`��'j :
_ _ ;,
�
�
���������� � � � � � �. ���9�i
_ �� .
. ; .
. _ ,
,
�.:.�_�.�._'�.._� ---.� . . � '
X:— . �__