HomeMy WebLinkAbout16606 (32) �� C1TY OF DIAMOND BAR
� ; DEPARTMENT OF COI�Rv1UNITY&DEVELOPMENT SERVICES
��y 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PR ESS
����� BUILDING PERMIT APPLICATION FI R M LY
o� JOBSITE /�/„/J �',���,r��,/rL 1/), APPLICATION �3 D � PERMIT ( n,^ P/� _'� 'f.
ADDRESS f/`! %Ci/` w// l/l�- DATE NUMBER uX� # "1
� APN OT TRACT D TEE � v ONST. GROUP
p OWNER .�
p ADDR S �> ZONING SETBACKS
Z CITY ZIP n / TEL. • FRONT Ryy p
g APPLICANT t4C/,}i�/�i t/dtiI TEL�7Ly�f6�T SIDE/SIDE STREET RW ❑
� CONTRACTOR ��L ".� 51DE p
ADDRESS ? � /
� CITY � > ZIP TEL.� J� PROPOSEDUSE I =tC
W ARCH/ENG/
z DESIGNER
w NO.DWEL NO. NO.
� AD�RESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-OUILDER D[CLARATION SFRlADDlREM
O
O
1 HEREBV AFFIRM UNDER VENALTY OF PEiUURY THAT I AM E%EMPT iROM TH[CONTMCTORS L4 Garage/Carport
W CENSEIAWFORTHEiOLLOWINCREA50N(SEC.7071.68VSINESSANJFRO�ESSIONSCOOE:ANYCITYOR (n
U �qJI1TyyYHIp1RE0UIRE5A7ERMRTOCONSTRUCT,AITERIMPROVF,�EMOl15H2ORREPtiRANYSTRUC-
w 7UR[,VRIOR TD RS ISSUANCE,Q50 REOUIRES TM[APPIM•ANT fOR SUCH PERMIT TO FILE A SIGNCD w Patio/Deck �
� STA7E�ENT THAT ME OR SME IS LICENSED PURSUANT TO TM[VROViSIONS OF THE COHTMCTORS LI- �
CENSE UW(CHADTER i(COMMENCING WITH SECTION 7000)OF DINSION�OF TME BUSINE55 AND VR0. POOUSpe
� FESSIONSCODE)OHTHA7HEORSHEISEXE1AP77MEREFRdAIVlDTHEBASISFDNTHEALIECEDE%E4P- (�
V TION.AN'IVIOlAT10NOF5ECTION7071.6BYANVAPPLIGWTF011APERMITSU&IECTSTMEAPPUCANTTO Z Re-Roof
A CIVIL iENALTY OF NO7 MORE TwW FNE HUNDREO DOLURS�fsoo)):
ZOl�lSOMMEROFiHEPFOPEHTY,ORMYEMPLOYEE5WI7HwAG[SASTnEIRSOLECOMVEN5A7qN, � COmmBrCi21 �
N�LL 00 T11E WORK,AND TME STRUCTURE IS NOT INTEADEO OR OFFEREO FOR SALE(SEG 7W�,BU51- J
� NE55 AND 7ROFESSIONS C00[:1HE CONTRACTORS LICENSE UW DOES NOT A7P�Y TO AN OWNER OF
PROPEFiTYYAfO&1RDSORIMPROVESTHCREON,MIDMMOOOESSUpiWOFKHIMSEIFORNERSELFOR =
CL THAOUCHHISORHEROKTlEA1PLDYEES.PIiONO[DTNATSUCHIMVROVEVE4TSARENOTPITENDEDOR m
Q OFFfREDFORSILEIF,HOWEVERTM�BUILDINGORIIAPRpV[4[MISSqDWITMINONEYEAROFCOMP�E-
Z TION,TN[OWNER�BUIID[R YnLL HAVE THE BUROEN OF OROYIN(i TMAT ME OR SM[DiD NOT BUIID OFi
� OAPqOVE FOR iHE PURPOSE OF SALE}
W 04�OWNEROFTNEVROPERT�;AMEXCLUSIVELYCONTRACTINGW:THLICENSEDCDNTRACiOfiS
¢ TO CONSTHUCTTi1E YROJECT(SEC.70U,6USINESSAND PROFESSIONS CODE:iME CONiMCT0�i5l1• ValUetlOR � ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAGHOPER7YW/10BURDSOHIMPROVESTHEREON.AND
� W1qCONTMCiSFORSUdIPROJECT5NITHACONTMCTOR(SILICENSEDPURSUANTTOTIIECONTMG QUANTITY DESCFiIPT1ON �E
Y T00.5 LICENSE LAW�.
p OIAME%EMPTUNDERSEC. B.iP.C.FORTH15REA50N Q ��-'�Y GN
� � .. L.�lNY�1�'1
u" DATE OwNER F-
p W
�¢ LICENSED CONTRACTORS DECLARATION W
2 IMERCBVAFFIRAIUNDERPENlLLTVOFPERIURYTNATIAIAUCENSEOUkDERPROV1510N50FLHAPTER �
d i(COMMENCINCWRHSECTqN700o)OFDIV1510N70FTHEBVSINESSANDPFiOFE55iON5CODE.ANO Z
X YY�ICENSE IS W FULI FOIiCE AND EFFECT. m
0 LICENSE CU55 � L' � LIC.NO.�/Z 07� j
V DATE Z CONTHACTOR�� ,� d
W
� WORKERS'COMPENSATION DECLARATION �O
NI HERE�FiRM UNDER PENALTY OF GERIURY ONE OF iNE FOLIOW.NG OECLAMTIONS:I� Z
Q
� IHAYEANDWILL►IAINTAINACERiIFICATEOFCONSEMiOSElFaNSUREFORWORKERS' _
COMPENSATqN,ASGROV10EDBYSECTION7I000FiMEU�DORCODE.FOR7MEVERfpM1ANCE �U
O �OF THE WORK FOR WHiCH iHIS VERAIIT IS ISSUED. �
W _IMAVEANDWI�lE�A1NTA:NWORKERS'COIAGENSATIDNINSUNANCE.ASREOUTAEDBVSECTION \ I 1
� ]7000FTHEUtfORWDE.fORTHEPERiORMANCEOFTHCWORKFORWHICNTM15PENd1T15 �{ �( 1 1
ISSUED.MY '('AMPENS qN INSUR/fKE GARR�IC7F AN�70lICY NUMDER ARE: CONSTRUCTION , ! ��+� 1 �l����
� CARHIER � "t' �y Er � PUN REVIEW �
o va�crr+uMeEA ' �
Z ELECTRIC
¢ D
� (Tfn55ECTI0NNCmNOTB[Ca.6�ETEDOFhEPERMT6Po(tONEHf�l1EDOOlUiLiR� )��FSS? PLUM�ING
Z I CERTIFVTHAT NTHE PERfOfUAANCE OF TNE WORK FOR WH:dI THIS GERUIT15155UED.1 MECHANICAL
C,'} SHALI NOT EMPLOY ANY VERSON IN ANY MANNER 50I15 70 BECd.IE SU0.IECT TO THE
(n WORNERS'COMPENSATIONUWSOFCAL�FORNI,LANDAGREET IFISNIXILDBECOME INSPECTIONFEE
S SUBJ[CTTOTHEWORKERS'Cp.1PEN5ATqNPRO ON OFSfC7 N77000FTMELABOR
cooe sHu Fonnn+nn+ca�a�rwm�THos �or+s. / ISSUANCE i
p DATE: �'" 0 APPLICANT: f/ SMIP �
� WARNINC:F�hUREiOSEWREWOFlNERS'COUPENSATIONCOVFR�EISUNLAwFUI,ANDSHALLBE ENERGYP/C
� SU&IEGTANEMPLOVEHTOCHIMINALPENALlIESAN�CNILFWE5UP700NEHUNDREDi/qUSAND ENERGVPERAAIT �
DOLURS(Sf 00.000).W/�DDITION i0 THE COST OF COMPENS�TqN,DAMAGES�5 iROVECED FOR IN
¢ SECTIDNI70EOFTNELABORCODE,RJTERESi,MI�ATTORNEY5FEE5. {��ENTIONFEE:
a CONSTRUCTION IENDING AGENCY pqE.���E; I ����i�Y;_ __j_�
O �j -�
� IHEREBY11FFiRMUN�ERGENALTYOFVERIURYiNATTMEREISALONSTRVCTqNLENDINCAGENCI'
ZFORiMEVERFORMANCEOFTMEWORKFORWHIGMTMiSPERMITI5155UE�(SEG709�,CIV.C.). -1T `�-
W '
� LENOER'SNAME �
S i
F- LENDER'SAODR[55
W ICERTIFYTNATINAVEREADhIISAPPLIGTqNANDSTATETNATTNE�BOVEINfORMATIONISCORRECi TOTAL FEES � _ ,
d IAGREETOCONPLYWI7HPLLCI7`/MDCOUH7VOR0'NANLESANOSTATEUw5REU71NGTO8UILDMG
CONSTRUCTION.ANDNEREBYAUTIK)R' ENEPRESENTA7IVESOFTHISCOUNTYTOENTERUDONTNE
AOOVE�uENT�ONEODR ERTVFOHINS 'CTqNVURPO5E5. �
z COMMENT �
� � �7�� � i
� �
m PERMITTEENAM —..
¢ � �2�p`-- -
�
y SIGNATURE I c DATE
� FlECF'T.AO. _ .�PPJD BY • VALIDATION
WHITE—Depanment Copy.YELLOW—Finance Copy.PINK—Assessa Copy.GOLDENROD—F�le CoCY.GREEN—Applicant's Copy
� • . - ''�� �' � ' • ��'"�'' ... . . . .... ��'.' • ' .. � -. :_... ;r�.-. :, . . -. , - ., . .. ... .- . . , � ,
��i'; J�= i?i�!f,�lUi,'.� �=��i�: �
�< ..,�._�,....,. 3 ,-r ,. �.r
<��:i"Ct.., s` I�.�I�. o..:L'L.CE-�U
..� -_^....._._-_--.___....._._�.__.._.------ --- ---- - -�--•-�---•-^-••--------- ----�----------- ---- - _.�...-._. ______
'�►rE7��=�;P��11�R �,'�ti:'- �i'E=i:�C;f.,,��1:t I�'t�i:•!=i�.'E;l�l►`! CiG1:6'G I�����=[;:'I�el:d
--.. -_ . .. ....:::.:...... _ ... .. . � . : . . .. . . . _ _. _.. ..._ __.__...._.. ._ _.._._.._.._---_
SET 6ACY. - --- i I-. . .._. I I� FLOOR JOIS7 .. . I. i
-- ----- .-_ ....- � --- --- ---•--- -----�
FTGS'FORP�IS'STEEL �(?��p" � ' Ft I',R'�Q'.?TS - -�--�— --- �- --------
ELECTRiC GRD'JiJD � � ' ', . UiJD�f? FLOJR DUCT � I
, �
GR�Ui�D PLU?.iBli�G �__ --�—_--- ._ �Ut1D�Fi f=LOJ�i CU?���UIT ! ; -- ---
SLAE3 GRADE I � I I FI;���L;,Cr FOUP:DATIO�J �
TE���P PO4VER I ____ � __ __�_I_FI:�EF'LACE BO"JD E3EF,�•A _ _ �
1VATER S�RVIC� 1� � � � F:"•1D HT. f30":D B�=l'�"" �
ROOFSHEATHING t i---- ------ I i 81-T. �0"J7 �E;�,�;,---------�- ---- � --
FR/lPl,it•!G!VE�JTILIATIOPJ I`_�-'�I ___ _ I I_FI�:.AL E;OtJD F���,�:' __I � _
ROOF COVER 1I � � I FR�-GRADIh:G I I
FiOUGH H�Ftii I"JG I �_ � 6Ei•:CHUJu _�� �
ROUGH ELECTRIC ', I ___ �_� RC�UGH GRi,DI�•JG __ I j
R�UGH PLU�.'BiPJG ; j � i rRJIS!-1 uRlIDIhJ; � �
SHUVJER,�TU3 TEST � � POO�ELECTRIG
� � _ �� �
EXT. LATH!SIDIfJG � i ' POO�FE�'�CI'•JG � �
'---------------
4'lALL INSULATION � � � f'00�Fli•;AL � I
CEILING I�•JSULATION 1 �i OFF SITE Ih:'PS. �
DHYIPJALI�lAILIPJG � � ; DEDICATIO�JS � �
SEVIER � 1 � FIiJA!E�JG. --�-- —
SEPTIC TAt�1K � . I I LANDSCF,P�lIRRI�. � I ._
SEEP PIT/L.L � � ' r� ON SITE Ih:"PS. j �
GF�S F,IR TEST � � �FI�JAL ZOPJIida �
F1NAL CONST. ' � � i i �'!RE DEr T. FINl�L �
�— �� _ ... _
FINAL HEl�TING � � � j HL-F;LTIi DEPT. FIfdAL I I
-�---
FINAL ELECTRIC I I_) DEV. FEES P<;ID I I
FINf1L PLU^.181NG � � I E�dERGY
� I —��_ — ._�_�_.__�f.__ i —
�.�;;F�s__�r,�.F_
---1—---�--------------- -----1_ ��.'. .
. . . -------------!_.—_,.__. ._
co���r,nEr�Ts
SEPTIC TAPJK SIZE
SEEP PIT/U SIZE — ---
_._..___;1�.._�.__._.._._
tij,�� _
t .
._ . �� ...... � . . �' .