HomeMy WebLinkAbout16063 (17) CITY OF DIAMOND BAR
- EXPIRED
' '" �` �� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� Zi�oE.coPi�ynr►Y�s�«i90 JUN 171002
� (909)860.3195 Fax(909)861-3117 . PRE$$
,���^� BUII,DINGPERMITAPPLICATION Fl MLY
o DDRESS 1��� Gt-�F �K�/�„'� �'� DA�CATION NUMBER NfC
� ISSUE TYPE OCC
APN LOT�� TRACT DATE CONST. GROUP
� OWNER `[�,_FK u I`�((�I�H�2 .��-�c
ADDRESS �l � ZONING SEBACKS
�W CITY ZIP TEL REAR RW ❑
APPUCANT TEL.�C=�T SIDE/SIDE STREET RW ❑
� CONTRACTOR � '>'✓(� iiJ SIDE ❑
ADDRESS Dc-A C- �-�- �'�-� pROPOSED USE t �D t NS � Y
� CITY_(,� T ZIP TEL��?�e3 y S
� ARCWENG/ • �_ �. i _ o i!�(cc
DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
y DESCFIIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OVYNER•BUILDER DECLAAATION SFRlADDlREM
O
p I HER�Y AFFIMI UNDER OFNALTY OF PERIURY THAT 1 AI./DfEMVT FROA1 THE CdrtRACTORS LI• Gef8Qe/CdlpOR
[1J CENSEUM�fOR7MEF011UYIN(1REASON(SEC.�0.77.6BUSWESSANDPROFESSIONSCOOE:ANYCIiYOR (n -
� COUNTYWVdGIREpURE4AGEAMRTOCON57RUCT.ALTERMJCROVE,DEAlOL15H2ORREPAIRANY57AUC• w p8tiO/DBCk
� NHE„VRIOR TO R$ISSUANGE,KSO REWIRES 7ME APPLICANT FOR SUCN PERMIT TO FILE A SIGNED
6TATEMEM TUT HE OR SME IS LJCENSED VVitSUANT TO THE PROVISIONS OF TNE CON7MCfORS l4
� GENSE UW(Q/MTFR i�COMMENCWO IN�TM SECTION 7000J OF DIVISION 7 OF THE BUSINE39 M1D PRO� � PaoVSpa
FESSIONSCOO�OfiTNTHEORSHEISEXEMPTiHEREFRqAAN0T11E8A5I5FONTNEALLEDEOEJfE1AP• (ry
TqN.AHYVKK.ATqNOFbECTIONT0.lt.68YANYAPPLICAHTfONAPEfW�TSU&lECT57HEAPVIICANTTO Z Re-Roo} �
� ACIVIL VENALTr OF NO7 A10RE THAN FNE HUNORED DOlU0.S IisoO).g .
O OI��M'NEROFiHEVPOPERT7,ORMYEMVLOYEE3WITHWAdE5AST/EiR50LECOMPENSATpN, O �mmerelal . . -
� YNLL 00 iNE WORK,IWO iHE STii1CfURE IS NOT INTENDE�OH OFFENE�FOq SALE(SEC.70u.BUS4 J
11E53 ANO VFiOFE95�ON3 CODE:i11E CONTMC70ii5 LICEHSE UW OOES NOT ACPLY TO AN OWNER OF �
N 7ROCERfYYINOBUIDSORF1ViL�VESTMERC-0N,MIOVMODOESSUd1WOflKMIMSELFORNEFSEIFOR �
(= TNROUO/IHISOqNEflOVMEMPLOYEES,OROV10EDTW1T5UCNM.�PROVEMENT511RENOTWTFNOEDON m . .
t.1J OFFEqEpWqSALE.IF,IqVhVER7MEBtA�11�X10NIMPf10VEMINfI550lDWIT19NONEYFAHOFCOMPLE�
Z �TION,TME OWTrERBUIIDER 1NLL MAVE TNE BURDEN OF PROV WO 7/UT HE Oq SNE DiD NOT BUiLD OR
= WVi10VEFORTHEWIRPOSEOFCI�Fl
W OL1lSONNEHOFTHEFfWOERTY,AYEXCLUSNELYCOMRACTINGIYTMUCENSEDCONTiLtCfORS .
� 70 CONSTRUCT THE 7RO.lECT ISEG 70M.BUSINESS MA VROFESSIONS CODE tHE CONTRACTORS Ll• V01t18tlOff a'� •� AOJ,qpEA
CENSE UW DOES NOTAYPIY TOAN OWNER OF A�AOPERTV MRIO W 4AS OR UAFPAVES TNEAEpL FND
� M11000NiRACiSfORSUGIYPWECTSIM�THACDNiMCTOPlSILICENSEDPUHSV/MTO7HEWNTMG a�Ar.��Ty DESCRIPTION FEE
� TpiSUCENSEUW.).
OINAD(EN7TUNOERSEC B.IP.C.FORiHI5REA50N �
Q
u' WTE QWNER V
� � UCENSED CONTRACTORS OECLARATION W
J
� W
INEREBYAFflR11UNOERPENAL7YOFpER1URYTUTI,WLICENSE�UNDERPROViSIONSOfCHAPTER V.
� Y(COMMENCYAN7THSECTqN70001�OM5lONiOFTMEDUSINESSANDPfiOFE55�ONSCADE,AND z
W IICENSE IS IN FlA1 FORCE AND EFFEC7. /� l
� "',
0 IICENSE CUISS C� �[ LIC.NO. v v � �
� �,,,� r ��,�T�_ -��� �
� WORKERS'COMPENSATION DECLARATION a '
� IMEREBYAFFIRMUNDEHYEwLLiYOFGERAIRYONEOFTHEFOLIOWINODECUMTION4: U -
�j Z
Q
� �INAVEANpNALL�NTAINACEfi��FICATEOFCONSENTTOSELF�NSUREFORWOPKERS' _ - � � �
� CpIPEN5AT10N.A9PROViOED8Y5ECitONa�ooOFTMEU80AC00E,FORTHEPERFORMANCE W
OF THE WORK FOq MMICM TMIS iERMIT 1415SUED. �
O
�_��iAVEANDWILL1.WtRAWWORKERSCOMPENS�TIONINSURANCE,ASREOU�REDB�SECiqN � .i/ /J /\
Q lYOOOFTHEI/BOROO�E.FORTHEPERFORMMlCEOFTM[WORKFORNMIp7THI5PERMITIS �� f'�� �
ISSVED.MYYIUFU(EAS'LOAIPErSAT�ONINSURANCEWIRIERANOPOIICYNUMOERME CONSTRUCTION v�/
�'���
� CARRIER �� L`� ' 9 PLAN REVIEW
� POLICYNUTABER ELECTRIC
� �nassccnor+r��r�oteeo�.n.�IDocnevawrtsFa+a+E�unnm0atarsR�oo�oa�ssl PLUMBING
Z ICERTIFYTIMTWTHEPERfORM/WCEOFiMEWOPKFORWHICNM15VERMITl5153UEO,l MECHANICAL
(�' SHALLNOTEMPLOYANYOERSONNANYMANNERSOASTOBECO�AESUBJECTTOTHE
(n NORKERS'CO�d?ENSATpNUMlSOfCN.�FORNI/�IWDAONEETHA7IFIS��OUlDBE00ME INSPECTIONFEE
S SUBJECTTOTNEWORKERS'COV�ENSATIONPROVISIONSOFSECTION77000Fh1EU80R �SSUANCE � �
CADE I SHALL FOFR�M'�iH COMVLY MnM 7F�OSE PROVISiON4.
0 SMIP C�
p OATE: APPIICANT. � —�–
� WARNIN�:FAILUREtOSECUREMpRKERS'COYPENSATIONLOVEM EISUNUWFULANOSM�118E ENERGYP/C
[–y SUBJECfM1EMP�0YERTOCAiM7NN.FENALT�ESANDCIVILFINESUPTOONEHUNDREOTHWSANO ENERGYPEHMIT
OOLLARS(f 100,000�.IN ADqT10N TO TNE CO57 OF COMPEN511TpN.OAAIAGES AS PflOYIDEO FOq IN
.-}J SECTqN]70eOFTMEUBORCODE,INTEREST,ANOATTORNEYSFEES. RETENTIONFEE:
Q
pW., CONSTRl1CTION LENDING AGENCY PRE-ALT FEE:
� IHEREBYAFFIRMUNDERPENALTYOFVEFUURYTHATTHERE�ACONSTRUCTIONLENDWOAGENCY �
Z FOR TNE PERFORMANCE OF iNE WORK FOR WHlpl iHIS VENuiT IS ISSUED(SEC.�01,dV.C.). .
U]
� LENOER'S WWE
C LENDER'S�DDRESS
� ICERTIfYT/UTIHAVEREA�THISAPPLICATIONANDSTATETW�TT1EA90VEWF0(iMAT10N15CORREGT. TOTAL FEES � � �23� ��
� IAOREETOCOMP�VN7TMALLCRYAN�COIMiYOAD�NIWCESANDST�TEUWSPEUTW6TOBUlA1N0
Cd15TRUCTION,ANO HENEBV AUfIqRRE REFRESENTATIVES OF 7H15 GWNTY TO EMER UPON iHE .
Z /1BOVE�MENTIONEDPROPERTYFORMSVEMIONPURVOSES. COMMENTS
9 ��-��� �.c�
� VEWAiTTE� EI / A/ :1 ��
(/� SIGNATU ��� a' DI1TE �
� RECPT.NO. PAID BY �VALJDATION
WHITE-OeGarlment Copy,YELLOW-Financa Copy,PINK-Asaeuor Copy,GOLDENRO ite Copy.GREEN-Applicant s Copy
, , . . - . �
i.i::,: �;'=;: _�� CITY OF DIAMOND BAR , . �
It�SPECTIO�J RECOF�D . ' ` '
. , 1 : ., . - -
°'��j�:� � � � � � ��.�,�°�.�v�_...�...... .-�!'�I�� �-�1�.�-`�r���+'��`��1�� ._
�=
SET BACK�� :. ,\ , .` i � - r , FLOORJQIST . - ;
,FTGSlFORMS/STEEL� ' '� ''�� FHA REQMTS �
ELECTRIC GROUND ' UNDER FLOOR DUCT
' GROUND PLUMBING UNDER FLOOR CONDUIT '
!SLAB GRADE- - FIREPL'AC�FOUNDATION
TEMP POWER FIREPLY�CE BON�BEAM � ��-� .
WATER SERVICE MID HT. BUND'BEAM � • �
' ROOF SHEATHING� - O,?-o��oi 8 FT.BOND BEAM � - -
� FRAMINGNENTILIATION ' � � � � FINAL BOND BEAM�
ROOF COVER � PRE-GRADING
'ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING -
!ROUGH PLUMBING FINISH GRADING
�SHOVVER�I'UB TEST POOL'ELECTRIC
EXT.LATHlSIDING POOL FENCING
iWALL INSULATION POOL FINAL .
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING OEDICATIONS
SEWER FINAL ENG.
'SEPTIC TANK lANDSCAPE/IRRIG.
SEEP PIT/LL ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST, FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT. FINAL �
F(NAL ELECTRIC - - DEV. FEES PAID
F=1`JAL PIUMBlNG ENERGY
' ._ - -
- +�xC -^-.._,.�,....-.,.,_
;.i47'� ��':�'.T`-Wr,��.c�+�:._ � ..., . . � — -- --
, COMMENTS _ _ _. , ,,__ _ �
�. , --
�` .
i _
r-�� �
_� ' ' 1
SEPTIC TANK SIZE '
SEEP P1TlU SIZE
—�^,
�.�. *� `:�
t� � ,
. �
�.��� � � � �
��.1
, . s ' . . . „ ,� , ,
� : . I _
. . . �`..�. .... :.,� • ' -f - . , ' ._� ..