HomeMy WebLinkAbout16724 (37) CITY OF DIAMOND BAR
-�� � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
.-' � 2(825 E.Copley Drive
_ (909)860-3195 Fax(909)861-3117 PRESS
�'-:� BUILDING PERMIT APPLICAT[ON FIRMLY
•o ADDRESS ��� \J wO� DATE CATION � _ ��-��UMBER�►.{� i/C
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER � L
"' AD ZONING SETF3ACKS
gCITY ZIP TEL. �°•5��•ZJ�� FRONT RW ❑
APPLICANT TEL. REAFi ❑
� SIDE/SIDESTREET RW ❑
CONTAACTOR SIDE ❑
p� ADDRESS
� CIN ZIP TEL. PROPOSED USE
w ARCH/ENGI
W DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL.
N DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION
N
Q OWNER-BUILDER OECLARATION SFFVADD/REM
O
, Q 1 HEREBY AFFIRIA 11NDER PENALTY OF VE0.1UR�THAT I AM E%EYP7 FH01,1 7HE CONTiuCTORS LI• G�f89e/C8Ip0lt
W CENSEU'NFORTHEFplOWNGREA50N(SEC.70JI.SBUSINESSu+07ROFF55WN5CODE:ANYCITVOR (n
U pp�JNTYWMIpIRE0U1RE511VERMITTOGONSTRUCT,/�LTER,IMPROVE,DE610LI5H2ORREGAIRANYSTRUG W Patiolpeck
W TURE pp�OR TO 1T5 ISSl1ANCE.ALSO REd11RE5 TNE A7PlICANT FOR SUCH PERM�T TO FILE A SIGNEO W
, .� STATEMENT THAT NE OR SME IS LICENS[U VURSUANT TO TNE PRONSiONS OF TNE CONTMC70R5 LI-
� CENSE l.Aw(CMAP7ER Y(COMMENCINO N7TM SECTqN 70a0)OF DIY�SION 7 OF THE BU51NE55 AMJ PRO� LL POOVSpa
FESSIONS OOOEI OR TUT HE OR SHE IS EXEMPT TNEAEFRW ANO TME BA515 FOR THE ALLEGED E%EAIP•
VTION.AM'Y�OUTIONOFSECTION7071.SBVANY�FPLICANTFOR�PERMITSUBJECTSiMEMPLIGVRTO z Re-Rool
F ACMlOEWLLiYOFHOTMOHETHANfrvEHUNDREODOlUR5�i5oo).�:
� OL��EROFTHfVPOPERT'.ORUYEAIPLOYEESMnTHWAC[SASTHE�RSOLECOUDEN5A710N. � COmmO�Clel
z W:LL DO TH[WOR1(/�ND THE STRUC7URE IS NOT IMENOED OR OFFERED fOR SALE(SEC.70��,BU51- J
N NESS h!0 PNOFESSIONS COOE:TNE CONTMC70R5 LICENSE LAw DOES NO7 APPLY TO AN OWNER OF
PROPEiRYN110BU4DSORPAPROVESiHEREON.AN�WHODOE55UCHWORKMIYSEIFOFH[RSELFOR �
('L 7Nqp/('HMISORHEROWNEMPLOYEES.VROYiDEOT1UTSUCIIVAGROYEMENTSARENOTMENDEDOR m
WQ OFFERE�FORSAIE.IF,/10WEVER7MEBULDINGORIMPpOVEMENTI550lDWfTHINONEYEAROFCOMPLE�
z TION,TH[OWNER-BUIIDER W1LL NAVE TXE BUf1DEN OF PROVINC iNAT HE OR SHE DID NDT BUIID OR
' MPROVEFOHiMEPUP�'OSEOFSKEI.
O l�O WNER OF ME PROPEFlTY.IIM E%CLUSNEL�CONTMCTINO WfTH UCENSED WNTRl1CTORS
� TO CONSTflUCT TME PRQIECT�SEC.70N,BUSIN[SS AND VROfESSiONS CODE:TNE CONTRACTO�S U. ValU8ti0� AOJ.AREA
W CENSEU�NDOESNOTAPPLYTOMlOYINEflOFAiXOPERTYWHOBU1LD50FINvpOVESTMER[ON,AND
� NnqCONTMCiSFOR5IKHORUIECT5WIT/ACONTMCTOR(5)LILENSEOFUFtSUANTTOTNECONTMG OUANTITY DESCRIPTION FEE
� TORSUCENSEUW).
0 O I�E%E1APT UNDER SEC. B.{V.C.FOR THIS REASON 4
� � Q
� DATE ��EA - ~
U
F LICENSEO CONT T RS DECLARATION W
� IHEREBYAFFIRMUNOERPENALT/OFFERJUIiYTMAi1M1LICEN5E0UNDERVROVi510N50FLMAPiER �
d 0(COM1AENpNG WITH SECf10N 7000J OF DIN510N 7 0F iHE BUSINESS AN�PROFESSfOKS CODE,AN0 �
X IA'fLICEN5E15MfUlLFORCEANDEFFECT. m
IJJ �
� LICENSE CLA55 LIC.NO. �
V DATE CONTRACTOR
W
� WORKERS'COMPENSA710N DECLARATION 4
= U
� IHEREBYAFFIRMUNOERPENALNOFPE0.IUFYONEOFTHEFOLLANf.NGOLQARPTIONS. �
(� Q
� IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSEIF-INSUHEFORYIORKERS' Z
� COMPENSATION,AS VROVIDED BY SECTION 7�OOOF THE LMOR COOE,FOR THE OERFpp1AANCE `U
OF TNE WORK FOR WHICH iH15 GERMIT IS ISSUED. �
Q
W _IHAYEM:UWILLMAINTA�NWOAKERS'COMPENSATqNINSUMNCE,A9PE0UIREDBYSECTION
Q ]70o OF 7HE LABOR ODO[.FOR iHE�ERGORWNCE OF THE WORK FOR WHId/7H15 DERMIT IS
ISSU[D.MYWO�KERS'COMPENSATIONINSURANCECARRIERANDPOULYNUMOERARE: CONSTRUCTION
� CARRIER PIAN PEVIEW
� ra�crNun�ecn E�ECTFIC
� (fN$$ECfqNNEmND7BECDM�'l£ffOOFTrEP[FMT6FORC�:EMUDl1EDDd1AR�lt'0o)ONLE55? PLUMDING
Z ICERTIFYTHATINTML�ERFORMANLEOFTNEWONKfORWMiCHiMSPERMIT15155vED,l �+1ECHANICAL —
C7 SNPLL NOT EAIPLOV ANv VEHSON IN ANY uANNER 50 AS TO BECOM[SUBJECT TO THE
� WORKERS'COMVENSATIONUWSOFCAL�FO�NII�AhOAGREFTMATIFISHOVLDBECOIAE INSPEGTIONFEE
S SU0.IECTTOTHEWORKERS'CW�PENSATIONPROVISiON50F5ELTqN]7000FTHELABOF ISSUANCE _ -- - -- �
CODE,I SHALI FORTNWITH CONW.�MATM i1105E CROVIS�ONS.
0 SMIP � ' - i
DATE: APPL�M:
� WARNiNC�,fA1LURE TO SECUHE WORKERS'COMPENSATION COVERAGE IS UNUWFUL.AND SMKL BE ENERGY P/C I
LL SU6JECfANEMP�OYEHTOCR:MINALPENALtIESANDCIVILFIN[SUPTOONEHUNOHEDTNOUSAN'J ENERGYPERMIT � u
DOLURS(f 100.0001.W 11DDRION TO TME GOST OF COMPENSATqN.Ol1MA6E5 AS PROVIDED iOR IN
� SECTION170lOFTHELABORCODE.INTEAEST,ANDATfORNEYSiEES. RETENTIONFEE:
� CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O —�--�•----
� IHCREBYAGGIRUUNDERGENALTVDFPC0.NRVTNATTHEREISACANSTRUCTIONlEN01NGAGENCY
� FORTHEPERFORMANCEOFTNEWOPKfORWHICHTMISVERMITISI55UED�5EG.70V7.CIV.G�.
Z
W
� LEN�EFS NAA1E
� LENDEFfSADDRE55 ,.(` �^S
¢ ICERTIFYM4TIHAVERE/D7HISA77LICATIONAN'JSTATETMATTMEABOYEMfONA�TIONISCORRELT, TOTAL FEES v ��
W IAGREE70LOI.IPLYY/1THilL�CITYANDCIXINTYORDINANCE5AND5TATEUWSHELATWGTOBUILDING
� CONSTHUCT�ON,ANDMEREBYAUTMORIZERCPR[SENTATIVESOFTH�SCWNTYTOEMERUPONTNE .
ZADOVE�NEMIONEDiRDPEflTVfORIN57ECTqNVURPO5E5. COMM[NTS
� J b - �'v�P-v A-�/}�rv
m VERMITTEENAME(PWM)
Q
U7 �� • '
(/] SIGNATUREOFPERMITTEE DATE
� RECPT.NO._ _PAID BY _VAlIDA710N
WHITE—Department Copy.YELLOW—Finance CopY.PINK—Assnssor Copy,GOLDENRO de Copy,GREEN—Applicant's Copy
..., .. . ... �.• • . � . .� �.,,r.. .... ,....... . . ._. .: , .,... .. .- . , , . . .. .. � . . „_ . . .-.
C:�:` �J►�� f�l�',G±i���.'�" �ft[?
r .�=, -..
il�:1i�._ : I�i�� �i_�. �:=y �
- -_._._____....�... - -- - - -- --
___..=.._.._----
(i`E-:i•��f.`'I"(�]i`9 E;���., = li.'f`i��.-r�r:�'.l:, __---------li�:•`I.�':� ? lE'I�'! ���,�i�'= .I►��.1:�►��.[,,-4'e).� .
.
.. ------ .. _..__. .._.. ...- - _..._... .. .. .... - i i .. .... .. .. ,._.. _ .. ..---.... ..- - ..._---.._........._
SET BACY. I ----- � ------------- � � FLOOn JOl;l -._. , I . �..._....._--i -----
FTGS!FOR��IS�STEEL � I _ _I I FHA REQ.',?TS ! _
I ' U'rJD�R FLO�R DUCT -I---
ELECTRICGR�UfJD � __ I ____.___ ___ i _ i ____
GROUND PLUi.931�JG i I � UP:7E:R FLOOR CUf��DUIT
. •
I ;
l-----•-- -----•--- -._ - -- - ---
SLAB GR�,DE I i I i FIi��PLAC� FOUh.DAi 1��^J �
TEP,4P POVVER � i �� FIR�P.:,CE EON:)E3E�,t,1 -- j --
4'lATER SERVICE � � I t."iD FiT. E?OPd7 Ei�;�t.1 � �
ROOF SH�ATHR�IG I -- ---;-� £ fT. GO�J!)GEA":' ---I � ---
: - —`--- - ----
FR.AP:1INGNENTILIATION � � I f FIPJAL EO��D E3EAF,1 �____ I __
ROOF COVER I i PRE-G��ADI�:G I I
ROUGH HEATIWG � � I 3LNCH!NG I (
ROJGH ELECTRI.r, I � t ROUGH GP,ADihJG I _ I
ROUGH PLUiv1BIP•13 �—;_ _ _ ; FIPJISN G���DI"d; � _ --
SHOb"✓EFi�i"U3 TEST � _ I I �'�'�L El_ECTRiC _ � _
EXT. LATH!SIDRJG � j �l_j�oo��Fr:CRda ;
1"JALL IPJSULATIOP•J J � � � POOL FIPJAL I
CEILItJG li JSULATIUN � O�F SITE IP.1PS. j
URY�b'ALL NAILIfJG � _ I DEDIC�'�TIO�•1S _� _
SE�"JER � � FIPd!�L'EPJG. � I
SEPTIC TANK I � Lf,PJDSCF;PE/IRRIG. J •
SEEP PIT/L.L. � � � C�J SITE liir S. � �
GAS AIR TEST I � FI�JAL 7_O�JI�JG I I
FINAL COPJST. � , F!R�DEPT. FIPJP,L I
f-1N,4L HE/'iTING '(�-�.q � �r:� �1 FiEALTH D�t T. FIN.=,L � I
FINF,L ELECTRIC 1 � " I j DE\'. FEES P:,ID _ I
FI��I;L PLUP.I�IPJG � � j ! ENER�Y� r ^^— � -
i--i --�-- �
-
I I � ��-;--• ��- : ,
1• � �
� . _ _ ._ �.
COt��MENTS
SEPTIC TA�JK 51ZE
SEEP PIT/U SIZE ---- —
- ��f ------ --
��;� _
�