HomeMy WebLinkAbout17873 �� CITY OF DIAMOND BAR
� DEPARTMENT OF COhIIvIiJNTfY 8c DEVELOPMENT 5ERVICES
21825 E.Copley Drive •
(909}860-3I95 Fax(909)861-3117 PRESS
"%��' ' BUILDING PERMIT P[.icA'r�ox FIRMLY
o ADDRESS `� w�Y �� r I DATE CATION u� �� PEMBEfl I�! #,�'�'�,�
1 `�
c� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER `t�
ADDRESS�.[q SC7 ZONING SETBACKS
Z CITY�Xr4(w�n' ��� ZIP TEL. R�RT RW O
g APPLICANT TEL. SIDElSIDESTREET RW ❑
� CONTRACT R d.J SIDE ❑
� ADD S
� CITY �._. 21 �� TEI7 PROPOSED USE
o AFiCH/ENGI
� DESIGNER ND.DWEL. . NO.
AOD ESS UNITS STORIES BEDROOMS
� CI ZI TE
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFWADD/REM
O
p I HEREBY AFFIRM UNDER PENAITY OF FERNRV iHAT I AM E%FMPT FRO�THE CONTMCTORS LI- G8f89�8�pOft
. CL CENSELAWPoHiHEFd.IOWWOREA50N(SEG70J7.6BUSMESSANOPROfES510N5000E:ANYCfTYOR (n
U COVHryWH�p1HE0UIRESAFERMRTOCONSTRUCT,AlTE0.MPROVE,DEMOUSH.ORREPNRANYSTRUO W patfD/OBCk
� TURE,VRIOR TO RS ISSUANCE,AlSO REQU�NES TME APPLICANT FOR SULM PENMIi TO FlLE A SIGNED
� ETATEMEHT TNAT HE OR SME IS UCENSEO MIRSUANT 10 TNE PROVISIONS OF THE CONiMCTOqS LI-
� CENSEUW(dUPTER Y(CdAMENdNO WITH SECi�ON 7000)OFOM5IDN]OF TNE 6USINESS AND PR0- u' POOVSpB
fESSIONS GOD�OR iH�T ME OR SME IS EXEMPTTHEREFHOM ANO THE BASIS FOR 7HE ALLEGEO EXEMP•
VTION.ANVVKKATIONOFSECTION7071.6B��NYIIPVLICANTFORAiENATSUBJECTSTHEAPFLICA17TT0 Z qe-Root
� A pVIL PENiLLTY OF NOT MORE TW�N FIVE MUNDRE�DOLURS(is0o)J:
p O4��EROFTHEPROPERiY.ORMVEAICLOYfESWIhIWAGESASTHEIRSOLECOIAPENSATION, O (jpTRlBfCl01 -
Z WILL DD iHE WOHK,AND TME STRUCfURE�5 NOT INTENDED OR OFFERED FOR SALE(SEC.7a�,BU51• J
NESS ANO PROFESSIONS COOE:TME CONT�uCTORS LICENSE UW OOES NOT�7VL�TD AN OWNER OF
� PROPEHTYYYHOWLDSORIMPROVESTMEREON,ANDMMOOOESSUCMWORNHIMSELFORNERSELFOR �
Q THROIKHH130RMERONRIEMPLOVEES,PROV10EOTMATSUCHIMPROYEIAEMSARENOTMENDE00R m
QOFFEREOiORSALEIF,IpWEYERIMEBUIIDMCOIiIMPROVEMEMIS50lDWRMNONEYE�ROFGOMPLE•
Z TION,T7E OWNER-0VILDER VALL luVE THE BUROEN OF PqOVWO TNAT HE OR SHE DID NOT BURD Oq
= MPROVE FOR ME Pl1RP0.5E OF SALE}
O 4�+OWNER OF THE PROPEN7Y,AM E%CLUSNELY CONTMCTWa WITH IICENSED CONTMCTORS
Q TO ODNSTHUCT THE ORO.IECf(SEG 7M1,BUSINE55 11N0 PROFESSIONS CO�E TME WNT�MLTORS U• V9W821011 ADJ.AREA
W CEN9EUWOOE9NOTMPLYTOANONT�EROFAPflOPERTI'1NHOBU0.ASORIMPROVESh1EREON.MO
� WVqCOMRACT5fOF5Ud�ORQ1ECT5NAiMACONiMCTOR(S�LICENSEOWRSUANTTO7HECOrlTMG OUANTRY DESCRIPTION F
TORS UCENSE UlW}
� ❑IAA1E%EMPTUNOERSEG B.�P.C.FORTHISREASON Q Z �
� � l
LL' DATE 0ti9NER V � �
� UCENSED CONTRACTORS DECLAfiATION �
¢ W
OC IHEREBYAFFIRMUNOERPENAL7YOFPERNRI'iHATIAMLICENSEDUNDERVpDVISIONSOFCHAPTER �
d 9(CONMENCNO WI1T1 SECTqN 700o)Of DMSION�OF THE BUSINESSANO VROFESSqNS CODE,MID Z
X W LICENSE l5 W FUl FOFCE AND EfFECL m
LLI Q
� LICENS 5 v LIC.NO.� �� � '
1---
.._..V DATE COMTMCTOR. . _ - . .` � �
W
� WORKERS'COMPENSATION DECLARATION U V
�
� IXEREB�AFFlRAIUNDEROENALTYOFVE0.MiYONEOF7NEFOLLOWINGDECLAMTI0f15:
C� ¢
G �INAVEANDNnLLIMMiNNACERTIfICAiEOFCONSEMTOSELF•INSUi1EFOi1YKliUfERS' S
� CdAPENSATION,AS PRONDEO BY SECTION J7000F iT1E LABOR COOE,FORTHE PERFORMANCE w
OFTHE WORK FOR WHICM THIS 7ERMIT�S ISSUEO. �
0 )
_IMAVEANDWILLMAINTNNWORKERS'COMPENSATIONINSURANCE,ASREWIREDBYSECTION ��Y�
Q J70oOFTtEUBOHCOOE.FORiHEVERFORMNKEOFTH[WORKiOHWHICHTHISPERMIT�S
ISSUE0.�.MWOFKERSCWIDFNSATIONINSl1RM10ECAqRIEFAN�POLICYNUMBERIIRE: CONSTRUCTION
jCARRIER�Ct���.� PLAN REVIEW
Z POLICYNUM9ER�r C rY1 /J�I'� R ELECTRIC
.t
� (MSSEC170NNEFpNOTBEOd.RETEDOF7IEFFRMTSFORd�EMJ�ED00tU�SR�0�0iiLESS} PLUMBING
Z I GEqT1FY TNAT IN iHE PERFORMANCE OF THE WORK FOR NM1tlp{THtS 7ERMITIS ISSUE�,1 MECHANICAL � �
(} SHALLNOtEMPLOYANVVERSdJWMlVMANNERSOASTOBECOMESUBJECTTOTHE
� WONKER5 COMPENSRION UWS OF CALIFpRNIA,AND AGREE TNAT IF I SHOVLD BECOME INSPECTION FEE
S SU0JEC1T07HEV✓ONCERS'COAIPENSATqNPROVIS�ONSOFSECTION»OOOF7MElABOR ISSUANCE � ��
COOE.I SNALI FORTNWITN COMPLI'W17M 7F�OSE P(iOV1510N5.
� MIP - 3�2_�
p DATE: AVPLICANT: �
W GY P/C
WARNIIM:FIULURE TO SE WRE WOHKERS'OOMPENSATpN COVEMGE IS UNUwFUL.AND SHAL{.BE
� SUB.IECTANEMPIOVERTOCPIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREOTNOUSANO ENERGYPERMIT
DOLLARS(5100,OOoZ IN IDOITON TO THE CAST OF COMPENSATION.D�110E3 AS PROVI�FD FOq IN [�'�
� SECTION�70C OFTME UBOR CODE,INTEREST,AND ATTORNEYS FEES. RETENTION FEE: �D V
[Wi. CONSTRUCT�ON LENDING AGENCY PREAIT FEE:
� INEREBYI1Fi1RMUNDERVENAITVOFPENUflYT1UTTHEREISACANSTRUCTIONIENOW6ACENCY
Za- FORTHEPERFORMANCfOFTMEWORKFORwHICHTMISGEiWITI5155UED�5EC.]oG7,CIV.G4
W
� IENDER'SNAUE �
� IENDER'SADDRESS
w ICERTI%MATIHAVEREADTHISAOPUCATIDNANDSTATETHATTHEI90VENFORMATIONISCOPFlECL TOTAL FEES
� IAGREETOCOMPLYWI7HKLCRYANOCOVNTYOROINANCESANDSTATEUWSREUTIN6TOBU�LDIN6
CONSiPUC710N,ANO HENEBV AUTHORIZE REVRESEM/,TIVES OF THIS COUMV 70 ENTER UPON THE
ZABOVE•MEHTIONEDPROVERTYFORINSPECTqNFUFPOSES. COMMENTS
� � �sS��xJ1�c.� �
_
m �' N Iry
�
� �TE
� pECPL NO. PAID BY VAUDATION
WHITE-0epanment Copy,YELLOW—Finance Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—,4pplicanC Copy
:y..��l: •?P.t�^.; ayir�gs�,�.',r.'V.!MrR.� :..M +Ri,.p.r!ltiX4?:X`.F.�.ne �ro.nr:�' _. ":.�C.;' t'1i•,WC;�':ifw,����• M � w.� i � ��n.�,�.
�e`_ � :[,' d "'R7 "ta r l.r:�Rk� . -�;i�., .. .'v'n.:.t�. • � �:l^.t.::.
e. , . � ���.r�' } .ti.�., 'h �' .�ati�.,u ;� ti.,.,•x..•r ...
CIT�' UF LZIAMCf�Q BAR �
IF�SPEC�"aON RECOF�D
' ::�������1����.:-,.�.°������ Y:_���-�n�� ��� �,�►�����C��� �`e�"R�1�, �.. '��! .�....�,�� '
� � —�' 4 i �n'� _.._. .._ _
�SET EiACK• - � � , �, � �._� FLOOR JOIST � �� _:; l.: ,�_ �__� �,�_
FfGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND I UNDER FLOOR DUCT , ;��.,+• � •; ;`j �_
GROUND PLUMBING I UN�ER FLOOR CUhIDUIT��•`•�:�-. � �": �. '•:' :-':
SLAB GRADE � FIREPLACE FOUNDATION '� �° ^ '""""'' '
TEMP POWER i i I FIREPLACE BOND BEAM •
WATER SERVICE i MID HT. Bd,� ATJ�.''';• `• i.;''��:i.�.�:_`� -`,.� ,
,�:;.�. �;:i, z � . �
RQOF SHEATHING � ' ! _ � 8 Ff. BOC�D pE,0.t�x. ^r,;:`' .::�..�'..�,:;•::., ,
FRAMINGNENTILIATION �_� I FINAL BOND BEAM r� .•.�•�.' �
ROOFCOVER I I PRE-GRADI�f �•. � ;.•,:;'g':� s ;`;':',' ,
ROUGH HEATiNG � BENCt�fIdG� ' ��,�'�•- . . •,•='';, . �'j••!i.:
FiOUGH ELECTRIC 1 ROUGH GRADING y
,
ROUGH PLl1NiBING j ! FINISH GRADING
SHOWERlTUB TEST i ' POOL ELECTRIC
EXT.LATHlSIDING � � POOL FENCING �
WALL INSULATION POOL FINAL
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS �
SEWER FINAL ENG.
SEPTIC TANK ' LANDSCAPEIIRRiG.
SEEP PIT/L.L � • ; ON SITE IMPS.
GAS AIR TEST _ _, 1 __ .• •,i ; FINAL ZONING
FINAL CONST: �• '"'" �' �.FIRE DEPT. FINA!
FINAL HEATING ..��� '_ '` ` _ `_',��HEALTH DEPT. FINAI
FINAL ELECTRIC /� _ � ' DEV. FEES PAID
FINAL PLUMBING t� � � ENERGY I
. . I �..
I � !^-s e�r_._�'.r=�r. e. �. �° , _. I '- - .,: 4"
; . , ..
-- _. _ . -- —�_ ___ __�.: _.,
-- . . . ;.,
. •„
� COMMENTS ' ' %�'- = �
. . .. �P s : _ Y �„ . .. • �
. .�"' , 1...�...i �'...f� .
. " • . • :-R �, � ,_t �ti
SEPTIC TANK SIZE • -�
SEEP PITIU SIZE �
�_ �.� . ,
' �
�
;����r �.i
. � �. _
' _.
_ � „_ .�•., ,�... . �. . _ .,y_:,.�.:�. . .
.__ �
_�._~�..�_.._.�._...�i i . . '�-- � .,. �, . ,.