HomeMy WebLinkAbout16903 _
�x� � r��1
� CITY OF DIAMOND BAR
DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES
�, 2165o E.copley 1�rive suice i90 PRESS
(909)860-3195 Fax(909)861-3117
`�'^�'��-' . 'BUII.DING PERNIIT APPLICATION � ' FIRMLY
�' JOBSITE Q
>- ^ APPLICATION
o ADDRESS�� 7SO �, l OPLE y AZI✓E 3QQ�-(. � pq� ��`'�� NUMB R #/C � ~
$ ISSUE TYpE p�C
APN LOT TRACT DATE CONST. GROUP
p OWNER .
p ADDRESS ZONING SETBACKS
Z CITY ZIP TEL. � R�R RW o
g APPLICANT TEL. SIDE/SIDE STREEf RW �• ❑
� CONTRACTOR — SIDE ❑
Q ADDR SS / ' PROPOSED USE F /
� CITY �NY1f5�9 ZIP TE D
� o A G/ /�
� ESIGNE � �- '�' /7�'I.dltZ NO.DWEL. NO. NO.
� CITY S ZIP TEL S7a p� UNITS STORIES BEDROOMS
N
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
,Q OWNER-BUILDER DECLARATION � SFR/ADD/REM
O '
p I HEREBV/�FIFW UNDEH PENAL7Y OF 7ERJURv THAT I AM E%EMPr FROM 7HE CONTRACTORS LJ- Gef6 6K�,8 ft � •,
lil CQISELAWFOR7HEFOLLOWINf3REA,AN(SEC.7o31.6BUSINESSANDPROFESSIONSCODEANVCIIYOR (n g �
C.� COVHTV�NIIp1REOUWESAPERMR7000N3TRUCT.PL7ER�PROVE.DEMOUSH.ORREPNRMIVSTRUC• W
Z TURE,PRIDR 70 RS ISSUANCE,AL50 REOUIRES 7HE APPLICANT FOR SUCH PERMfT TO FILE A SIONED W � Patlo/Deck
� S7ATEMQfT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI� �
CENSE UW(CHAPTER Y(COIAMENCINO WI7H SECTION 7000)OF DMSION 3 OF TME BUSINE55 AND PRO- PooUSpa �
FE&410HSCOOE)ORTHATHEORSHEISE%EAIP7THEREFROMMIDTME9ASISfORTHE�LLEOEDEXEMP- (�
TION.AH1'VIOLATIONOFSECTION7W1.6BVMIVAPPLICANTFORAPERMITSU&IECT57HEMPLICMITTO Z Re-Root
� ACIVIL PEN/�LTV OF NOT MOHE THAN F(VE HUNDRED DOLLAHS(i600).j: :
� 04A80WNEROFTHEPROPERTY.ORMVEM7LOYEESW1hIWA(3ESASTMEIRSOLECOMPENSATION,' � ComTBfCI61 . � � .
.NN.L DO THE WORK MA THE STRUCTURE IS NOT INTENUED.OR OFFERED FOR SALE(SEC.7aI,BUSI- J
N NESS AND PROFE99lON9 CODE THE CONTRACTOR.4 LICENSE UW DOES NOT MPLV TO AN OWHER OF �
Vf10PEAfV WHO BU4D$OR IMPROVES THEREON,AND MM1IO DOES SUp1 WORK HIMSELF OR HERSELF OR
� TWi(%KiHMI30RHERON7JEMPLOYEES,PROVIDED7HATSUGIIMPROVEMENT9MENOTINTENDEDOR m ' . .. .
OFFERED FOq 8KE�F.IpN�EVER TME BULD W�OR YPROVEAIBfT 19 SOLD WIT11N ONE YEAR OF COMPLE-
� Z �TION,THE OVYNER-BUILDER WILL HAVE THE WRDEN OF PROVWO THAT ME OR SHE DID NOT BUILD OR . . _
� GIPROVE FOR 7HE PUHPOSE OF 9N.E). ,
UJ ❑LA80WNEROFTHEFROVEHTY,MIEXCLU9IVELVCONTRACTNOWI7HLICENSmCONTMC70R5
Cr ���1CT THE PR0.IECT(9EC.76N,BU91NE93 AND PROFESSqN3 CODE THE CONTRACTORS lJ- V01U8IIOf1 ADJ.AREA
LL1 CQISE UW DOE9 NOTMPLY TO AN OMMER OF A PflOPERTY MT10 BURDS OR IMPROVE$7HEREON,AND
� �NpCONTRACTBFORSUp1PRO.lECTSWITHACONTRACTOR(9)UCENSEDPURSUANiTO7HECONTRAG QUANTITY DESCRIPTION �
Y roqs ucersE uw.�. FEE _
¢ ❑I AM IXEIAPT UNDER SEC. 8.i P.C.FOR 7HIS REASON �
� V
�Z DATE OWNER ' U . � �'
� w
LICENSED CONTRACTORS DECLARATION �
� W
I HEAEBYAFFWY UNDER PENPLTY OF PERAIM TMAT I AM LICENSED UNDER PROVISIONS OF CHMTER �
� Y(OO/AMENCPq NTTH SECTION 7000)OF DMSION 9 OF TNE BUSINE55 AND PROFESSIONS CODE,AND Z � '
MY LICEHSE IS RI FULI FORCE AND EFFECT.
� uc�cuss C.�lD ' j
��.No._ZS`�93 b
� o�t� S OJ-b� caKraacToa a
� WORKERS'COMPENSATION DECLARATION �
� I HEREBY AFFIRM UMDER PENALTV OF PE0.0.1RY ONE OFTHE FOLLOW WO DE0.ARATIONS: Z � �
� _IMAVEANDWILLAIAIH7Ap1ACEliTIFlGTEOFCONSENTTOSELF-INSUREFORNORKERS' a
COMPENSATION,AS PROVIDED BV SECTION 770o OF THE LABOR COOE,FOq 7HE PERFORMANCE W
Q -'OF THE WORK FOR WHKk1 THIS VERMIT 19 ISSUED. � �
� v 1 HAVE AND WILL MNNTNN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION . ,
Q37000FTHE LABOR CODE,FORTHE PERFORMANCE OFTHE WORK FOR WMICHhiIS VERMI7IS
ISSUED.MY W�Dii10ERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ME: CONSTRUCTION
j �R������Tj� �V� PLAN REVIEW '�' � �
� POUCYMII,�ER 7L�S�OL7
ELECTFIC
¢
p' (nassEcrp�r�t�oTeEaor�aErIDaFnEPEw.�Tswaar��uot�noaloas�Sirol�LEss1 PLUMBING
w
Z I CERTIFV 7HA7 P17HE PERFORAIMICE OF 7HE WORN FOR WHICH THIS PERAIIT IS ISSUEO,I MECHANICAL
SHALL NOT EMPLOY ANY PERSON M ANY MANNER SO AS TO BECOME SU&IECT TO THE
(C/�j WOfiKERS'COMPENSATqN UWS OF CALIFORNIA,AND AOREE THAT IF I SFqUTA BECOME INSPECTION F I
SU&IECT TO iHE K'ORKEAS'COMVENSATION PROVISIONS OF SECTION 37000F THE LABOR ,J:�,
rj cooe,i sw�u wrrrHNnn�coiav�v w�i7��/iO5 E aRov�sroNs/.► ISSUANCE _ . � . . I �� .
O _O�Q)� 'J� L_ Z— SMIP A
p DATE: APRICANT. ��JG7Z� U�0�.77A�-� .
W ENERGY P/C
� WARNINO:FAILURE TO SECURE MlORKERS'COMPENSATION COVERAGE IS UNUWFUL.AND SHALL BE
� SUBIECTANEMP�OVERTOCRIMINALPENALTIESANDC7VILFWESUP700NEHUNORED7MWSAND. ENERGYPER IT
DOLLAFtS(i100,000).W ADOITION TO THE COST OF COA/PENSATION,DAMA�ES AS PROVIDED FOR IN
� SECTION 370e OF THE UBOR CODE,INTEREST,AND ATTORNEVS FEES. RETENTION F �
OCONSTRUCTION LENDING AGENCY PHE•ALT FEE: �
� I HEREBV AFFlRM UNDER PENAL7V OF PERIURV iMAT THERE IS A CONSTRUCTION LENDWO AGENCV . .
Z FOR THE PERFOFiMANCE OF THE WORK FOR WHICH TMIS PERMR IS ISSUED(SEC.]OY7,qV.C.). .
W � � ,
� � IENDERS NAA1E . . ' , �
F— LENDER'SADORESS
g TOTAL FEES .o
� I CERTIFY THAT I HAVE READ 7HIS APPLICATION ANO STATE 7//AT 7NE ABOVE INFOflMAT10N 19 CORRECT. • '
� I AOREE TO COMPLV WfTH ALL C1iV NID COUNTV ORDMANCES MID STATE UWS RELATINO TO&IRAINO . • �
. � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON 7HE - . � �
ABOVEdAENT10NED PROCERTV FOR INSPECTION PURPOSES.
COMMENTS '
� �;o��Z�a �iotirz-oc�Z
m PE N�„ . . . .
a q--p/-o I
�
� DATE
- RECPT.N0. . PAID BY VALIDATION
� WHITE=DepaAmenCCapy,YELLOW�Inence Copy,PINK—Aese9sa Copy,GOLDENROD--FlIe Copy,pREEN--Applicanps Cppy
CITY OF DIAMOND BAR, ,
INSPECTION RECOF�D' � � '
�+ � � D + • � . • � � � � � �
SET BACK FLOOR J015T ' .
FTGSlFORMS/STEEL� FHA REQMTS'
ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING � UNDER FLOOR CORIDUIT
SLAB GRADE FIREPLACE FOUNDATION �
TEMP POWER FIREPLACE BOND BEAM '
WATER SERVICE � 'MID HT. BOND BEAM • � -- • ��•�" �
ROOF�SHEATNING' ` �� �• � ` S FT, BOND BEAM , �� ��` '
FRAMINGNENTILIATION � � FINAL BOND BEAM --..
ROOF COVER PRE-GRADING "�� -
ROUGH HEATING � - BENCHING - •
ROUGH ELECTRIC - �-• ROUGH GRADING .
ROUGH Pl.UMBING ' ' FINISH GRADlNG
SHOWERlfUB TEST � POOL ELECTRIC •
EXT.�LA7H/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION UFF SITE IMPS. •
DRYWALL NAILING DEDICATIONS .
SEWER . FINAL ENG. .
SEPTIC TANK . . LANDSCAPE/IRRIG. •
SEEP PIT/L..L. � � -- . ON SITE tMPS. •
GAS AfR TEST FINAL ZONING .
FINAL CONST. � FIRE DEPT. FINAL - "
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC ' DEV. FEES PAID
FINAL PLUMBING ENERGY �
o ,:� � , �
. . �.� -. �� , '�
COiVIME(VTS
. .
SEPTIC TANK SIZE � � '
SEEP PIT/U SIZE �
�3_:,':�i+.r�; �f t >�w. - , .
V
� 1� .�r - - . .. _. .
-���.:k -' -a ' � `- . . . .
��... �� 'a��. ' _ ,
- -:��-: i • .. . . ,. . .. ' .
, i
• �