HomeMy WebLinkAbout12687 (13) i _
.
�� CITYOFDIAMONDBAR ExP��ED
DEPARTMENT OF COMMUNTTY&DE
� 21660 E.Copley Drive Suite 190 '
(909)860-3195 Fax(909)861-3117 • U C T 0 3 i0Q0 PR ESS
����^� BUILDING PERMTI'APPLICATTON FIRMLY
� JOBSITE APPLICATION C PERMR 7 P/C
o ADDRESS 21 LCo o Gc'n'�/ i�rr-�v C OATE ✓ �� � NUMBER `� #
c� ISSUE TYPE OCC
APN LOT TFiACT DATE CONST. GROUP
� OWNER Tc:sa„^.^E�- �^L'u"^�
O
o ADDRESS I�GuS `.. �-��C ��F - 5z-F; Zu ZONING SEBACKS
W CfTy cnY �w �No<<:rr-y ZIP �I��Wg TEL.�lo��9�s--�i FRONT RW ❑
� APPUCANT K.���s"""�""t TEL./��")�y"-r'�"' . REAR ❑
� SIDE/SIDE STREET RW ❑
� CONTRACTOR T�E'�"^Rt'A.2 �"�. SIDE �
ADDRESS �1ur �Ea �� T pROPOSED USE
0 CI7Y ���^�{.�M 21P `��� TEL �'a `�'-'�
w ARCH/ENG/
�� DESIGNER
NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
, � CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFiEANALUATION
�
p� OWNER•BUILDER DECLAFiATION SFR/ADDIREM
O
p I HEREBY AFFlR1.1 UAER GENALiV OF FERIURY TIAT 1 AA1 E%EUPT FNpJ THE CONTRACTO0.5 L4 GafOgB/CU1pOft
LiJ CENSEUwFORTHEiOLLOWb10HGSdJ(SEG70of.sBU5WE55ANDDROiE5510N5COOL:INVCITYOR (n
' "' � COtMYY1F71RIRE0UIRESAPERMfTTOCONSTilUCf,ALTEiLMPROVE,DEMDL191.ORREPAIqANYSTRUC- W Paiio/Deck - � '�' ' � �- � �
TURE.iR10R TO RS ISSUANCE.AL50 REWIRES TME APPLICANT fOR SUCH GERMIT TO FILE A SIGNED w
� STATEMEHT 7HAT HE OR SME IS LICENSED PURSUNlT TO T11E PROYISIONS OF iNE CIXiTMCTDRS U•
� LENSE UW(CHAPTEN�(COMMENCWO VATH SECTION 700DI�DIVISION 7 0F TME BUSINESS AND VRO� u' PoollSpa
FESSONS COD�01t THAT NE OR SHE IS EXEMPT iHEREFR041 MA THE 8�5�5 FOR THE ALLEGED EX[MP•
TION.MlYNOU�TIONOFSECTION70]t.68YAHv�PCIN'JN1TG0l1�PERAIITSUfl1ECT5THEMPLILA11TT0 Z qp•Rpp�
� ACMLPENALTYOFNOTE�ORETIVNFNENNJDREDDOCLARS(f500)}
� O�ASOM�NEROFTHEPROPERTV.ORMYEYPLOYEESVATNWAC[SASMEIRSOLECOMPENSATION, ❑ �pmmBfCiBI
YnLI DO 7i7E MIDNIC AND TME STRUC7UR[IS NOT ttfTENDED OR OFFERED FOR S�LE�SEG 7W�,BU51• �!
NE55 MD PROFESSIONS COOE:iHE COHiMCTORS LICENSE LAW DOES NOTAPP�Y TO A4 OWNEfi OF
N PROPEiCiYYVF10BUqD50RMPROVESTHEREON.ANDN'MODOESSUCHWORKHIMSELFORHERSEIFOR = �
CC T1IRWGHMSORNEROYMEMPIOYFES.VROVIDEDTHATSUCHMPROVEMENTSARENOTMTEKDEDOtt m
� OFFFREDFORS/LLE6,FqVhYERTNEBULdl1�ORn1vROVEUEMI550lDWRMNONEYEAROFCOlAPLE-
� TION,7ME ONT�ER-BUCDER wILL MnVE THE BURDEN OF VROVINO T17Ai HE OR 6NE DD NOT BUIID OR
� tAPROVEFORTHEPURPOSEOFSALE).
O L�l5 OWNER OFTHE PROPEHTY,AA1 E%CLUSNELY CDHTMCTIPW NrtTFI LICENSED CONTMCTORS
� ro ea+srr+ucr n�v�cr�sEc.�oa..eus�r+�ss u+o vaovess�a+s cooe:n+e cor+rw�cloas u- VaWation ADJ.AREA
W CEMSEUWOOESNOTA7VLYTOANOWNEROFAPROPERTYY�TqBVILU50HMPROVESiHEHEON.AND
� NR,OCONTMCf5GOR5UCJiVRQIECTSWIT!AOONTiUCTOR(5)LILENSEDPURSUANTTOTHECONTMG OUANTITY DESCRIPTION FEE
� TORSLICENSEUw.).
J �.St. .�1�.= `��o1...0 'L
0 O I AM EXEMPT UNOEH SEG B.1 P.C.FORhliS REASON - Q �
� U
¢ �'i Z�.,o0o J
u" D�TE OWNER �
W
F6 LICENSED CONTRACTORS DECLARATION w �
[� IMEREBYAFFIRIAUNDERFENKTYOFPENUAYTilAT1A1AL�CENSEDUNDEROROVIS10N50FCHAPTER �
d /(GVMYENCPq rifTM 5ECT70N 700010F DIVI510N 7 0F iME 8U51NE55AN0 iROFE3510N5 C00E,AND Z
X IAYLICENSEISNFULLFORCEMIDEFfECT. m
LL1
� LICENSE CUSS G Z'� LIC.NO. �'Z�� 7
� �� 11�/4 .8 cornancron �� , a
w ���� WORKERS'COMPENSAYION DECLAFiAT10N 4 •
� IHEREBYAFFIMIUNDERPEfULT/OFPERNRYONEOFTHEFOLIAWINGDECLAMTqNS: V � � � �
N . Z
Q
O _IHAVE/J7DWILLIAAMTNNACEHTIFICATEOFCONSEMTOSELF•INSUR[FORWONKERS' 2
� COUPENSATiON.ASPHOVIDEDBYSECT10Ni7000FTMEUBORC00E,FORTHEGERFORMANCE U
Q OFT/ENORKFORVAIIGITHiSPER1/ITI5155UfD. �
� �J
�fj,�l HAVE AND N7LL MAINTARI N'ORKERS COMPENSATION INSUMNCE,AS flCOViRED BY SEL?qN
Q ]70aOFT1/EUFiORCOOE,FOATHEPERFORM.WCEOFTHEWORKiORWNIpITHISVEPMITIS
ISSUED.A�YWORKEHS'CdA7EN5ATIONINSURANCEGRRIERIW�VOLICYMIMBCR/WE: CONSTRUCTION
�� -- -� . .,wa �Ga.✓�1 s L� ao T�E1w��.F I�
] CARRIER A .Jt-� G0. - PLAN REVIEW - . _. . _ .. .. ... .. .__... ._
� PoIICYMIMOER � �7 ELECTRIC
� (no^.,SECroNrgFnNo78Efri.stE7�OFTEPEMtt6WRdd[Mf�Di�£DOo � iacyMLE55? PLUM01
W /
W `,,
Z ICEHTIF'ITHATNiMEPERFORMANCEOF7HEWONCFORYMICNTH15PER1/1TI5155UED,1 Mt�.FfANIC _D�
, (,'} SHALLNOT IMPLOTANY PERSON N ANY MANNER SO�S TO BECOME SUDJECT TO 7ME
� WOHNERS'LdAPENSATIONUN50FGALIFORNV�AND�GREE7H�TIFISHOUIDBECOME INSPECTIONFEE
S SUBJECTTOTHEMKKiKERS'Cd.�PENSATIDNPROVISqNSOFSECTI0N17D00FiMElABOR '
caoc.�sx' iORMW1T11Cd.�PLVN7iN7TK15EV s ISSUANCE (�(� �
� Il �9 q APPUCANL � ,. SMIP �-�.�-3:��3.7V
p OA7E:
w ENERGY P/C
WAPNING:FARURE TO SECURE WORKERS'COFAOENSATION AGE IS UNLAWFUL.AND SMALIBE
�y 6V&lECTANEMPLOVERTOCNIAiN,1�VENALTIESANDCMLFINESUPTOONEMUNDRE�THOUSANO ENERGYPERMIT C'ITY nF DIAMOND BAR
DOl1AR+(f1oo.0oU).�N/�DITIONTO7MECOSTOFCqAPFNSAT�ON,D�M�GESASVRO�nDEDiORIN n---�7–T– �t A��7� ---
¢ SECfiON�7oeOF7T1ElABOflCODE,PlTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: 17tJ11•1/TNIJ t'�\l!SA�Y
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IMERCBYAFFINAUNDERPENNTYOFPE0.JUqYTHATTHEREISACONSTRUCTIONLENDINCACENCV
Z FOfi ME FERFORMANGE OF iM[WOP1C FOR N?1lpi TMiS PEiW IT IS ISSUED(SEC.]Ov�.CN.C.1.
W
� LENDER'SNNAE � '
� LENDEi#SADDR[55
W ICERTIFYTNATINAVEREAO7MISAPVUCATIONANOSTATETUTTIE�BOVEINFORMATIONI9CORRECL TOTAL FEES 7 ,
� IAGREETOWIdPLYWRHALICfTY11N�CIXMTYOR0INANCE5�ND5TATEUwSRCUTNGTOBVdDINO
CONSTRUGTION.AND NEflEBY AUfYlOR2E PEPRESEN7A7IVE5 OF TW S COUNiY TO ENTER UPON TME
� ABOVE.YEMiONE00ROPERTYFORWSPECfqNVURPO5E5. COMMENTS
� ��� s 3. S►wrr+� d
m GEfUAfTTEENAME(PNIDlT) \
� �� ` � �/ �� ��
N
y SIGNA7UHEOFPERMiTTEE DATE
� RECPT.NO. PAID BY VAUDATION
WHITE-0epaRment Copy,YELLOW--Flnence Copy,PINK—Assessor Copy,GOLDENROD--Fila Copy,GREEN—ApplicanPa Copy
. �. � • . .. . . . .. .. . ...,. . . � • � . .,.. . . , . . -. . . '?. -. . . . ' ., . . . . � . , . • - .. - , r -.. , .
,,.:��- �-- • IT F DIAtJIOND BAR . �
�:•::�'�I"1�._, ' . .
� I CTION RECORD � '
. . .. _ ��,,; �, � T��l! �, _
IF ! B � • ' � � + � -
SET BACK � • ' . '. FLOOR J015T � � ,
FTGS/FORMS/STEEL . �� FHA REQMTS �
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CO�IDUIT �
SLAB GRADE - � - � FIREPLACE FOUNDATION =
TEMP POWER � � ' ' � FIREPLACE B�ND BEAM � �
WATER SEflVICE MID HT, BOND BEAM ' � "' � �
ROOF SHEATHING - - 8 FT.BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM �
ROOF COVER PRE-GRADING •
ROUGH HEATING - BENCHING -- - �
ROUGH ELECTRIC ' ROUGH GRADING •
ROUGH PLUMBING- - " FINISH GRADING - ,
SHOWER/TUB:7EST POOL ELECTRIC
EXT.LATH/SIDIIVG POOL FENCING
WALL INSULATION . POOL FINAL
CEILING INSULATfON OFF SITE IMPS. �
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANK. . LAN�SCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS. ;
GAS AIR TEST � FIPJAL ZONING
FINAL CONST. - - ' ' FIRE DEPT. FINAL
FINAL HEATING • HEALTH DEPT. FINAL ;_
FINAI:ELECTRIC - - DEV. FEES PAID
FINAL PLUMBING ENERGY
. =i;� • • �
COMMENTS��1�.�� t �T�. .
; ,
_ . . . . .:!f r 1 _. - .
� . r
,�,)�i �-'���!�r. ,
r A � �.A
SEPTIC TANK St��i:;r..���•r,,�,� :=j,�;r; ,���:; .
SEEP PIT/U SIZE .
.I�t � , '
, ,
�} ^; , ..
� . � ; , . . . � ,_