HomeMy WebLinkAbout17192 J� CiTX OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
2182i E.Copley Drive j
'" (909)860-3195 Fex(909)861-3117 j' PRE$S
"'%�� BUILDING PERMIT APPLICATION ' FIRMLY
aN JOBSITE t I � („{ �� Q j_�C� APPLICATION �0�3.��NUMBE �� I��JC
ADDRESS � n DATE
c� ISSUE TYPE OCC
APN LOT ACT DATE CON T. GROUP
p OWNER W1b2RA.�•! A�G3-���.
"' ADDRE C+�S (.�I.- 'F��:�'�+t�� � IOY ZONING SEfBACKS
gCIN V.��- 21Pqs}t� TEL..gSy-1�c13 PRONT RW O
APPLICANT TEL. REAR p
� SIDE/SIDE STFEET RW ❑
aCONTRACTOR�Jn� n d�1 r`�- l7 SIDE p
ADDRE �i �. r - �zC.� � PROPOSEO USE �'��L � �i= LJ'�>17 it Lf Ic�S
� cmr �n�� ziP gy�G� TeC�", K o o- F � S
o ARCWENG/ �4q Q � ��-
� DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS STORIES � BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
OOWNEF-BUILDER DECLAFATION SFR/ADDlREM
W CENSEUWFORTHEFOLLOWMCPEASO�EC.70.716BUSINESSMIOGPROF SSIdJSCODETM�ICYC�ttOR Garega/Caryort
U LOUNTYWHICHREOUIflESACERMRiOCONSTRULT.ALTEfLIMPROVE,OEMOLISH,ORHEGNflANY57PUG W patio/Deck
� TUHE,PR WR ID RS ISSUANCE,AL50 RE W IRES T11E�PPUCANT FOR SUCH PERM�T TO flLE A S�GNED w
� STATEMENT TWU HE OH 5ME IS LICENSEO WRSUANT TO TME PflOV1510N5 OF TNE WNTRACTORS LI-
,� CENSE UW(CMAPTER 0(COMMENCWa WITH SECTION 7000)OF D�V�SION f OF THE BUSINESSAND PFiO- LL' POOUSQB
FESSIONS COOE)OR THAT HE OR SHE IS EXEYPT TNEFEFHOM I1ND TME B/SIS FOR TNE ALLEGE�EXEMP-
VTION.ANYVIOLAiqNOFSECfION70.77.6BYANYAPPLICAMiOliAPENMITSUBJECTSTNEAPPLICANTTO Z qe-Rao1 (]�f�
� AdV�LVENALTYOFNOTNORETNANFNEMINDREDDOLLAR5�S500).�:
0 041130NTlEROFiMEPROPERTY,ORMYEMVIOYEESYYITHWACESASTHEiR50lECOMPENSATION, O COrtlrtfefCl31 ��
Z WiLL DO THE WORN,M1D THE STRUCTURE IS NO7 INTENOED OR OFFERE�FOR S�LE(SECJou,BUSI. J
� NESS IWD Pi9�FE5510N5 CODE:THE CONTMCTORS UCENSE UW DOES NOT APPLY TO AN OWNEfl OF ?
PqOPENTY N110 BUi1.O5 ON�MPROVES TNEREON,AND YYNO OOES SUCH WORK HIMSELF OH HERSEIF Oq
� THROVGM MIS OH MER OwN EMVLOYEES,VROYIDED TMAT SUp1 YAPROYEMENTS ARE NOT MTENDED OR �
0 OFFEREDiORSALEIF.110WEVER7HE8NLDINQONI1dPROVEMEMI550LDWITMNONEYE�ROFO0IAPLE•
Z iION.THE OWNEH•BUILOER WILL HAVE TME BUiiDEN OF PROViNQ ThUT NE Ofi SHE DID NOT BUiLO OR
� IUPROVE FOR THE PURPOSE OF S11E�.
❑4 AS OwNER OF TME PROPERTI.AM EXGlU51VELY(pNTMCTWG N�TM LICENSED CONTMLTORS
� TO CONSTRUCT h1E FROJECT(SEG 7ou,BUSINESS AND PROFESSIONS CODE:TNE CONTMCTORS LI- Ve�UeS�Ofl A0.1.AREA
W CENSEUWOOESNOTA7VLYTOMlOYMEROFAPROPER7YWHOBUILDSOflIMPflOYESiMEREON.IWD
� WHOCOMMCTSFORSUCHPRO.IECTSWIiHACONTR�CTOR(5)LICENSEDPURSUMITTOTNfCONTMO QUANTIN DESCRIPTION FEE
� TOfiSUCENSEUw)-
a OIAME%EYPTUNDERSEC. 6.iP.GFORTNI5REA50N U
3
¢
LL' OATE OwT1ER U
W
�Q LICENSED COHTRACTORS DECLARATION �y
CC IHEREBVAFFIRAIUNDERGENAITVOFVERIURYTHATIAAILICENSEDUNOEAPROVI510NSOFCNAPTER �
p„ Y(LOMMENCINONnTHSECTION7oDolOFDP/ISiON70FTHEBU51NE59ANDPROFE5510NSCODE,AND Z
MY IICENSE IS N NLL FOPCE AND EFFECi m
0 UCENSE CUSS `�J� �S'C ���.No. `-{r 3�G� j
V o�� -f�A S-3 f-J� ca+raacroa 1QF]Yo.�= a
w GJ.
� WORKERS'COMPENSATION DECLARATION a
� IHEREOYAFFIqMUNDERPENAL7YOFPEiLM11RYONEOFTHEFOILOwiNGDECUMT10N5; U
� z
4
G _IXAVEANDWILLMAINTAMACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKERS' Z
� COMPENSATqN,ASPROV10EDBVSECT10N770DOFTMELABORCODE,iOHTHEVERFORM�NCE �U
�TXE WOiiK FOR WHItl17HIS PERMITlSISSUED. �
0
Q �HAVE AND WILL MAINTAIN WORKERS'COIAPENSATION INSURANCE.AS NEMIIRED BY SECTION
J7000FiNEUfiORCOOE.FORTHE7ERiORMANCEOFTNEWORKFORYMIp1THI5PERM1T15
� ISSUED.MY WORKERS COMPENSATION INSURANCE CAqRIER AND POIIG'I NUMBEH ME: CONSTRUCTION
� CAflHIER CCxP��s� _�AiS�NA_L PLANREVIEW
� POLICYNl1MBER �� ►J� (a�+�9— A ELECTRIC
p (iHsSEcfql+DEmw78ECa.�tEimoFnEPEmxiSroaa+EM1�A7ED�awls6�oqOrtLES.�? PLUMBING _
Z ICEArFYTMATINTNEPERFORAIANCEOFTHEWORKFORriR11p1THI5PERMITI5155UE0.1 MECHANICAL �^� � �
('J SNALLNOTEMPLOYMlYPERSONINANYM�NNERSOASTOBECOMESUBJECTTOTHE L�- ��' . .. .. . . . ...,.i
� WORKERS'fAMVENS�TIONlAW50FCALILORNIA,ANOAGHEETI/�TIFISNOULDBECOME INSPECTIONFEE �'• ~
S SV&IECTT07HEWONKERS'COMPENSA710NPROYISIONSOFSECTION77000FiMElA80R
cooE.�sHnuFoarHvnnrcano�rwin�riaseoarnnswr+s. ISSUANCE AnT (1 �7 7fi(1'1 .\�
p DATE: APPLICANi: SMIP —II��` {S,]� -
W ENERGY P/C
� WARNINO:FAIWNE TO SECURE YR7fU(ERS'COMPENSATION COVERAGE IS UNUWFUL.NJO SHALLBE �_,�,r•
� SUBJECTMlEMPLOYERTOCfUMINALPENAITIESMDCMLFWE5UP700NEMUNDREDTNWSAND ENERGYPERMIT C'�� -
OOI.URS(f��D00).N ADOITION TO TXE COST OF COMPENSATpN,DAMAGES AS PROVIOE�fOR IN
' ¢ SECTqN77aeOFTHEUIBORCODE.NTEREST,�NDATTORNEY5fEE5. RETENTIONFEE: �Y�
pW„ CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
CC I MEREBV AFFlqM UNDER PENALTV OF PE0.NRY iHAT7NERE IS A CONSTPUCTION LENDINO�GENCY
0- FOPTHEiERFORMANCEOFTHEN'OHKFORWHiCN7MI5PERMITI5155VED(SEC.70u1.dV.C).
Z
W
� LENDEiYS NAME
F_- LENDER'SADOf1E55
¢ ICERTIFYT7AT1/UYEREADTr113MPLIGTIONANDST�TET14tTTME�BOVENFOFAIATION15CORRECT. TOTAL F'EES 1 la�O
W IACREETOCOMP�YWITHILLCRVANOCOl1NTYORDINMlCESANOSTATEUWSRELAiIN6TO8UIL�INC
� CONSTRUC710N.ANDHEREBYAUTNORREFEPRESEN7ATNESOFTHISCOUN7YTOfNTERUPON7HE
Z ABOVE•4EMIONE�PRO�ERNFOflINSPECTIONVURPO5E5. COMMENTS
� �)w'�^^ � �^� 1 �l
� v
¢ VEiWiTTEENAAI (VRI
� Q (c�,3-��
(J� SIGNATUflEOFVERAIITfEE � DATE
� RECPT.NO. _PAID BY VALIDATION
WHI7E—Department Copy,YELLOW—Finanw Copy.PINK—Assessor Copy.GOLDENRO ile Copy,GREEN—Applicant's Copy
., ,..... ..� .� �. ........... . ..�. .. . .... .�.�r.a...,,�Yr.f^✓'9'•41.ua�:�.��'.�•;�J:.w. ��:4:' �"7..}..'., i . ♦ . ` . ♦ .. � .. .�.�. .. � . �_.. .
C�i:' C_1F �1la«iD�FvD Bl�R
1Pzi��=EC'�s i(Jt�! RECGRD
__._____ ___ ___.__� ____.�_...__.-..__,_______�
I��-�7.d�f.�' .�i�,�►`.6 �����p:_. f��k-'�.!='•�;t�a:� I���-�r�-t�:�'l!"'1►i! C�'�;i":: il►'F..�.a�ic`'�a�.a: I
.____.__._-------_. . _ .. .__.._.__.-------__..____.�__,.
._. _.___...�_�.._.__�___.___ __..
SETBACY "-_._.-----__ _.i . i � � I FLOORJOIST . � �
FTGS/FORPJISISTEEL ' I , FHA REQP�1TS
ELECTRIC GROUND � ; � UfJDER FLOOR DUCT ��� -�
GROUND PLUMBING UNDER FLOOR'CUMDUIT �
SLAB GRADE I �� FIREPLACE FOUNDATION �
TEPAP POWER �__ i FIREPLACE BOND BEAD! _
\NATER SERVICE ,I � I MID HT. �OND E3EAPA
ROOF SHEATHING /�o je� �_/'i-�.zX� B FT. 60NQ f3EAP�1
FRAMINGNEN7ILIATION � � FINAL 60ND BEAR1 I
ROOF COVER I�J�-�'I ,�� PRE-GRADitdG I
ROUGH HEATiNG I BENCHING (
ROUGH ELECTRIC ROUGH GRADIPJG
ROUGH PLl1MBiNG � FINISH GRADIP�G
SHDWER/TU8 7EST POOL ELECTRIC
EXT.LATH!SIDING I POOL FENCING
WALL INSULAT(�N i POOL FINAL
CEILING INSULATION OFF SITE IPJIPS.
DHYWALL NAILING DEDICATIOfJS
SEVVER FIPJAL ENG.
SEPT(CTANh LANDSCAPE/IRRIG. � �
SEEP PIT/L.L. � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. lZ_y-C! ' �!RE DEPT. FINA! .
FINAL HEATING � HEALTH DEPT. FIP�AL
FI��AL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY �
J .. I
.�..�..,�_.....,.-.�-.-,-.r-.
cj:� �, €��� �1+ ,E.: I
CUMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
AV� ��.
�LF�
— ,
I
�, . .
.a