HomeMy WebLinkAbout17940 �� CITY OF DIAMOND BAR �r- '
� DEPARTMENT OF COIvQ�1UNITY&DEVELOPMEM SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS- .
"'-��' BUILDING PERMIT APPLICATION FIRMLY
JOBSITE /� � APPLICATION , PERMIT � P/ �� ,
o ADDRESS Z��C/D W p � ��' ��I DATE � NUMBER �i ��
c� ISSUE E OCC In
APN LOT TR CT DATE " � ONST.,� �� GROUP «
°C OWNER G � •
O
" ADDRESS 5 I �SCD !.. ZONING SETBACKS
Z CITY L• H�I�S ZIP EL. �l1f�i FRONT RW ❑
g APPLICANT G f�]L� �4�OGL�EL9�vi•�! REAR ❑
� SIDE/SIDESTREET RW ❑
m¢ CONTRACTOR SIDE ❑
o ADDRESS PROPOSED USE �M�n!�h���— ��'��
C(TY ZIP TEL
W ARCH/ENG/ G�� �1
z DESIGNER NO.DWEL NO. NO.
a ADDRESS D! � � UNITS STORIES 3 BEDROOMS
� CIT1( �` ZIP T S
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFRlADD/REM
O
p I MEREBV AFFlRIA UNDER FENALTY OF iERNRY THAT I AA1 EXEMM FROM TME CONTMCTORS LF Garage/Carport
W CENSEUWFORTHEGOLLOWIN(3REASON(SEG70.71.SBUSINESSANDPROFESSIONSODDE:ANYCRYOR (n
U COUNTYWHICHREWIHESAVERuIiTOCONSTAUCT,ALTER.11.1PROVE.0ElA0U5H2ORREPA1qANYSTRUG W Patio/Deck
� TURE,PRqR TO ITS ISSUANCE ALSO REaUIiiES THE APPLICANT FOR SUCM PERMR TO FllE A SIGNED W
STATEMENT THAT HE OR SHE IS 110ENSED GURSUANT TO THE PROVISIONS OF iHE CdfTMCTORS ll•
� CENSE LAri(GNCTER 9(COMMENGMQ YATH SECTION 7000)OF ONISION 7 0F TNE BUSINESS M!D PRO• V' Pool/Spa
FESSIONS�E)ORIHIITMEORSMEISEXEMPTTHEREFROIAANDiHEBA515FORTT1EAlLEGEDE%EMV• (�
VTION.ANYVqUT10NOFSECTIONTDJI.SBYANYAPPIICANTFORAVERAlITSUBJECTSiHEAPPUCANTTO Z qe•Roo1
A CML VENALTY OF N0T MORE iHAN FNE HUNDNf D DOlURS(f500).1:
ZO1A50'NNEROFTHEVROPERTV,ORYYEIAPLOVEESWITMWAGESASTHEIRSOLEGOMPENSATION, (',pmmBfCIOI � -
WILL DO iHE WORK.AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED GOR S1LLE(SEC.70��,BU51•
NESS AND PqOFE5510N5 CODE:THE COHTMCTORS LiCENSE UW OOES NOT APPLY TO AN OWNER OF
� VflOPERTYVYHO8U0.�50RIMPROVESTHEREON,ANDVMO00ESSUCHWORNHIMSCLFOf7NCR5ELFOR �
� TNROUC/IMISORHEROWNEMPIOYEES,iROVIDEDTHATSUCHMPROVEMEMSARENOTMENOEDOR m
pOFFEHEDFORSAIEIF,FIO�VEVERIMEBULDWCORIMPROVEMENTISSOIDWITHINONEYEAiIOFCOM7LE•
Z TION.iHE OWNER�BUILDER WILL MI1VE TME BUR�EN OF PROVIN�THAT ME OR SHE DIO NOT BUILD OR
= pAPHOVE FOR THE PURPOSE OF SALE�
O L��N/NER Of THE PROVERTV,AM El(CLUSNELY CONTMCTWa WIiH IICENSED CONTRACTORS
� TO CDNSTRUCT THE CRQ7ECT(SEC.70«.BUSiNESS AND VflOFES5IONS CADE:TNE CONTMCTORS LI• V0IU8110(1 J V A0.I.AqEA
W CENSEUWDOESNOTA7FLYTO/WOWNEROFAPROVERTVNn100UiLD50RIMPRWESTMEREON.ANO
� WFIOCANTMCTSFORSUCHPPO.IECTSWITHACONTRACTOR(S)LICENSEDPURSUM7TTOiHECONTMP QUANTITY DESCRIPTION FEE
Y TORSl10EN5EUW). ,�{`
� O I MA E% DER SEG &a P.C,fOR TNIS REASON Q ����? f
�j . �_ CC V �� �
u" DATE_ —OWNER �'
Z _ _ —__--_ W
� •LICENSED CONTRACTORS DECLARATION W
� IHEREBYAFFlRMUNDERPENALT/OFPERlURYTHATI�MIICENSEDUNOERPROVI5lON50FCHAPTER �
d 9�COMMENpN(iWITNSECfI0NT000)OFDIVISION70FTHEBUSINESSIIN�PFiOFESSiONSC E,AND Z �
� MY LICENSE IS N FULL FO E EFFECT. / /w � �
. �
� UCENSE SS LIC.NO. � J
V OATE � � OMRACTOR a
W � �
� ' Ofi 'COMPENSATIONDECLARATION U G '�L
N IHEREBVAFFIRIAUNDERVENALTYOFPERIURYONEOFTHEFOLLAWINODECLARATIONS:
`�' a
� �INAVEANDWILLMAINT�INACERTIFlCATEOFCONSEN7TOSElFiNSUNEFORN/ORKERS' _
� COMPENSATqN,�57ROVIDEDBYSECTION7)OOOFTHELIBORCOOE,FORTMEFERFORMANCE U
Q OF THE WORK FOR WHICH iHiS VERMIT IS ISSVED. �
- �
'� �I HAVE ANDIMLL AWMAM WORNERS'COMPENSATION INSURANCE,AS REOUIRED BV SECiWN
4 97000FTMElABORGOOE,FOR7HEPERFORMRNCEOFTHEWORKiORWMIp17HI5PERMITIS
ISSUEO.M`/WORKE ' ENSATIONWSUMN�C ARRIEHAN� CYNUM9ERME: CONSTRUCTION
(��1�J � '
� CARRIER � — ', r. ` �—• � PLAN REVIEW �— — '
0 VOLICY NUAIBER�y`� � � .
� � ` - ELECTRIC
¢ `
� (IHsSEcnoNNEmraiBELCfmETEDOF71fvEw.ii6PoRONEIutHEDD]ltuiSlitoo�oRtEssl PLUMBING \
Z 1 CEqTiFYTHAT N TME GERFORMANCE OF THE WORK FOR WHiCH TNIS PERMIT 4S�SSUED.I MECHANICAL �+
(,•} SHALLNOTEMPLOVANYVEHSONWANY4ANNERSOA5T08ECOAIESUB.IEGT70TNE f ^ /�
� WORKERSCOMPENSATqNUWSOFCALIFORNI0.�NDAGREETMATIfI5/1IXhDBECOIAE INSPECTIONFEE l� `
S SUBJECT TD THE VIORKERS'ODMOEN5AT10N PROVISIONS OF SECTION 370o OF THE 1A80R
CODE SH/�LL OFTMWiTHCOMPLYWITNTNOSEPROV151 5. ISSUANCE
� f (�r�'PPCICANT: -SMIP
p DATE:
W ENERGYP/C � ��1-
� WARNING.iNLUftETOSECUREVJOFiKERS'LOMPENSATIDNCOVEMCEISUNUWFUL.ANDSHAL�BE
'� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREOTHOVSAND ENERGYPERMIT
OOLUHS(f t0a.aoal.IN ADDITqN TO TME COST OF OJMPENSATION.DAMAGES AS PPOVIDED FOR IN /�"]'�
¢ SECi1DN370lOFTHELABORCODE,IN7ERESLIWD�TTORNE7'SFEES. RETEMIONFEE: � y1 j.—
a . CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IMEREBVAFFIR/AUNOERPENALTYOFPERJURYTNATTMEREISACONSTPUCTIONLENOWGAGENCY
0- fORTNEPERf9RMANGEOFTNEWORKFORYAIIGHTH15PERMIT15155UED(SEG.]o97,C1V.C.�.
Z
W
� � LENDERS NIJaE �
� LENDER'SA�DRESS
W ICERTIFYTHATINAVEHEADTHI511PPLICATIONANDSTATETIUTTHEABOVEWFONMATIONISCARFECT. TOTAL FEES ��S •
� IAGREETOCOMPLYMATHAILCfTYANDCOUN7YOFiDiNivICESMI�STA7EUw5REUTWOTOBUILDING
CONSTRUCTION,AND HEREBY AUiHOR12E REPRESENTATIVES OF THIS COUN7Y TO EMER UPON TnE
Z ABOVE�►IEMIONEDGR07ERTYFORINSPECTIONVURPOSES. COMMENTS �
9 L 2 r,rf;t ^� _ -
m PEAMITiEE NAM )
¢ Z. Zw�_ �y�,.� , �
�
� 5 UHE�F VERMITiEE DAT I I
� RECPT.NO. V — VALIDATI
WHITE—DepaAmenl Copy.YELLOW—Finance Copy,PINK—AssessorCopy.GOLDENRO�File Copy,GRE
._ ��
, ._........_. -_ .__ « -. . . .- .._.-.. .."' ' "'.-,'_. •"`-:.Y - � ,...3...�. _ . . ._.. _ ._. ... . . .
�� _ ' � . .. . ti.. . �S;. � '�+a::' ' .. . ..r. � � � ..... .. .. . - i . .
' CI!�` �DE= i�1�`e����IQ F�f�F� .
I�t�PEG"�'it36��! F=�ECO�c.� '
�...�.._ _.�_�_._. ..__._ __M.�....___ _._ _...�._.
_.�____.._.___________�.___�______
'�1►rE-'��a�c, C�E.j►�� G6`��r= i►�l�`��►�Ir F`c�.{ I�'k�`l:� c.��`��y►�z �� t�:.'. i►��-�..l�e'�I'�1..�
..---_�__.---.-�-_-----.__. ___ . . _______.__. . . . ._ ..�_ __. ..._... _�_-._.._ _�...._ __.._ _.._.__._ _�_._._ ______._____._.______�W
SET BACK -- � � � --- --• �- I � FLOOR J0157 �— � � -1-- �
FTGSiFORMS,'STEEL ' � FHA REQ?,9TS ' �
ELECTRIC GROUND j j � UPdDER FLOOR DUCT �} !
GROUND PLUMBING I U���DER FLOO(�CU��!DUIT ; �
SLAB GRADE _ � FIREPLI'�GE F'OUI�JDATION' I
TEFlP POWER ' i FIREPLACE BOND BEAM
WATcR SERVICE I � h^ID HT. BO^dD BEAPJI __ I
ROOF SHEATHING �_ Jl i 8 FT. BOND BEAh�t i
FRAMINGNENTILIATION ��/6y� � � I FIfaAL EOND BEAr�1 I.
ROOF COVER � I � PRE-GR�DING
ROUGH HEATING BENCHING' ' � �
ROUGH ELECTRIC 7� �� ROUGH GRADING
R�UGH PLUMBING � � FI�dISH GFiADI�JG
SHOWER/TUB TEST I POOL ELECTRIC
EXT. LATH/SIDING (_ l POOL FENCING
WALL INSULATION I POUL FINAL �
CEILWG INSULATiON � _ OFF S17E IMPS.
DFYb'VALL NAILING �3Q�f� DEDICATIONS
SEWER FIfJAL ENG. I
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PIT/LL. I OfJ SiTE IfAPS.
GAS AIR TEST ' FINAL ZONIfJG
FINAL CONST. .-(�-'�'L ` • , � � �!RE DEFT. FINAL
FINAL HEATiNG � ' '� � HEAI.TH DEPT. FINAL
FI�JAL ELECTRIC DEV. F�ES PAID
FINAL PLUPv161NG � EhdERGY
- i �. iw.. U. ._....__._... - --- --- — ---
� P!> t
". . . _. .. __. .._._ .... . .1 .__. _ _.. _�_.___.__. �.._.___ ` . . . _...�_.._..,.
..+.....__�...�..�_,_.......w_._.�,..______.._.�
COM��IENTS ����.;� .�,-M,�l - .�,.� .( �,_� l�1�
t ,
SEPTIC TANK SIZE
SEEP PIT/U SIZE -- —
''�� .,_._�__.____
����f -_
�
04 , , - — .
�. ,
__---__._.__..____.__----_.__...,
r---
.