HomeMy WebLinkAbout16840 (37) �` C1TY OF DIAMOND BAR
; DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
��` 2i825 E.Copley Drive
(909)860-3I95 Fa.e(909)861-3117 PR ESS
���%��� BUILDiNG PERMIT APPLICATION FlRMLY
¢ DDR'ESS'Z�� � �r�I.I�O��_UJ DATE CATION I� � �I NUMBER�� P/C
�
� ISSUE 2 7YPE OCC
APN T TRACT DATE / D CONST. GROUP
p OWNEfl�.
o ADDRE S 2 � ZONING SETBACKS
z CITY� ZI TE FRONT Ryy p
� APPLICANT TE - REAR p
�� 7 SIDFJSIDESTREEf RW ❑
CONTRACTOR 'Qj� � (�j. SIDE ❑
ADDR SSZ- �
� CITY ZIP9 TE . - '/ PROPOSED USE
o ARCH/ENG/
DESIGNER
t�ii NO.DWEL. NO. NO.
a ADDRESS
� CIN ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER�BUILDER DECLARATION SFRIADD/REM
O
p 1 NEREBY AFFIRM UN�ER VENAL7Y OF VEMIRY 7HAT I MA E%EMPT FROM TME CONTMCTORS LI• G2f8g0/C3ry0tl
W CENSEUWFORTMEFOLIOWINCREA50N(SEC.7071.58USINESSANDYFiOFE5510N5CODE:lWYCITYOR (n
V COUNTYVAIICHREWIRESAPERIAIiTOCONSTRUCT,ALTER,IMoqOVE.DEM0U5N.ORREVAIRANYSTRUC• w
w TURE.PRIDR TO ITS ISSUANCE.�L50 REWIRES THE MttICANT FO(1 SUCN PEiWiT TO FILE A S�GNED W Pdtio/DBGk
� STA7EIA[NT TMAT HE OR SNE lS UCENSED PU0.5UAN7 TO TNE VROVIS:ONS OF 7ME CONT0.4Ct0R5 U- �
� GENSE UW(CHAPTER 0(COMMENCIN�WITN SfCT10N 7000)OF DIYIS�ON 7 0F TME BUSIHESS M'D PRO� POOI/SD3
FESSIONSCOOE)ORiMATMEOR5HE15EX[MPT7HEREFROMANDTMEBAS�SFOR7HEALLEGEDE%EMv (�
� TION.ANYVKKATpNOF3ECT10N70.11.5BYANYAPPLICAN7FORAiERMITSUBJ[GTSTHEAPPLICANTTO Z Re�Rool
!l CML PENALTY OF NOT MORE iHAN FIVE NUNDRED DOlURS(5500).�:
Z04��MNEROFTHEPROPERT/.ORMYEMMOVEESVnTHWAGESASTHEIRSOLECOMPENSATiON, ❑ CpmmBrCial -
Wlll DO iHE WORK M1D TH[STRUCTURE IS NOT IMENOED OR OFFEREO i0f1 S+LLE(SEC.70N.BUSI• J
� N[SS I�NO PiiOfESSIqJS CO�E:TME CONTRACT00.5 U[ENSE LIW OOES NOT��PLY TO�NOWNEAOF ?
CRO�ERTY WV10 BVILDS OR MCROVES THEREON,AND NMO OOES SUpI WOfiK MIA/SCLF OR NERSELFOR
� TNRDUCHNISORHERONTlEMPLOVEES,PROViDEOTHATSUCHMPROVEMEMSARENOTMTENDEDOR m
w OFFEFlEDFORSALEIF,IiOYVEVERTI7EBULDINCOii1MPROVEMEN'ISSOIDWITwNOhEYEAROFCOMVLE•
� TqN.TME OWN[R�BUI�DER YALL HI1VE THE BURCEN OF PROYING THAT ME OR SHE D�D NOT BUIID Oii
Z IMVROVE FOR TME PURPQSE OF SAIE).
= OLASOWNEROFTIIEPROPERTY,AMEXCLIISNELYCONTRACTINGNf7HLICENSEDLONTRACTORS
W
� TO CONSTRUCT THE PR0.IECT ISEC.7aN,BUSINE55 Ml�PROFESS�ONS CODE.THE CONTMCTORS ll• VdluatiOn ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOYMENOFAPROPERTYWMOBUILDSORMVROYESiHEREON.AND
� WVqCONTRACTSFOHSUC310RQIECTSMAhIACONTMCTOR(S)LICCNSEDVURSUANTTOTNECONTMC QUANTITY OESCRIPTION FEE
Y TORSLICENSEUW).
� D I AM E%EMPT UNDER SEC. B,f P.G fOR TMIS REASON Q
� U
LL �
OATE OKTIER U
Z W
FQ LICENSED CONTRACTORS DECLAFATION W
2 1 NEREBY AFFIRM UNOER PENAITY OF DENURY i1iAT IAM UCENSED UNDER PflOVISqNS OF CHAFTER �
p., 9�COMMENpt�OWiTMSEC7pN7000)OFDIVISbN70FTHEBU51NE55u10PROFE55roNSCODE,ArvD Z
X MYLICENSE IS Pl fUll fORCEAND EfFEC7. m
LLI �j Q
� UCENSE CU55� L"��f�LIC.NO. � •' j
V DAiE �7�y Q� CONTRACTORX� �� �
W ^
� WORKERS'COMPENSATIO ECLA I �� a
� IHEREBVIFFIRMUNDERVENALTYOf0EM1RYONEOFTHEFOLLOwNGOC[lARA7DN5: Z
� _IMAVEANOWILLMAiNTAINACERTIFILATEOFCONSENTTOSElFdNSUREFORWOlL(ERS' _
Q COMPENSATqN.ASPROViDEDBYSECTION77ao0FTHELA00HCODE,FONTHEVERFORMANCE W
Q OF i11E WORK FOR NMICH 7HI5 DENIAIT LS IS5UE0. �
_I HAV[AND WILL MAMTAIN WORKER5 CAMPENS�TION INSUiLWCE,AS PEOVIRED BV SECTION
Q 7700 0F TME W30R CODE,FOR THE VERFOfiINANCE OF 7ME WOfiK FOR WNICH TMIS PERMIT 15
ISSUED.IIYWORNERS'COMPENSATIONINSURANCECARR:ERANDPOLICVNUMBERAAE: CONSTRUCTION
� �T�r��s1
7 �f
GRqi[R D PLAN REVIEW
Z pOLICYNUMBER Ll��O/l �T D�.� _ ELECTRIC
Q
0 �rwssEcruancmaoreEaa.ctFr�oFncP[�r.�re�on[�ru€Dm�sR:octw�Ess1. PLUME3iNG
Z ICERTIFVTHATNTHEPERFORIAA4CEOFTHEWORKFORWHICHiH15�ERMITISISSUE�.1 AIECHANICAL .
(.�} SHALLNOTE�PLOYNJVPERSONINANVMANNERSOASTOBECOUESUBJECTTOTNf
� WORKERS'COMPENSATqNLAW50FC/�L�FORNI/�ANDACRC[TIUTIFISHWIDB[COMG INSPECTIONFE � - _ _
S SU0.IECTTOTHEWONKERS'COMPENSpTpNVROY1510N50F$ECTqN�IODOF7MEUBOR �_�-��i�a�\ � I '� ,
cooE,�swut�oarNwin�coe�a�r win�TraSE vaovisroNs. ISSUANCE � � � - .U
� SMIP
p DATE: APPLICANT: —}
J WMNiNG:FA4URETOSEGUH[WORKER:'CAMPENSATIONCOVCMGEISUNUY/FUL.ANDSMALLBE ENERGYPlC �� ' I
� SU&IECTIWEMPLOYENTOCRIMINILLPENALTIESANOCNIIFINESUPTOONENUNDRCOTMDU5AN0 ENERGYPERMIT I
DOLlMS(f10o.000).W ADDITION TO THE COST OF LOMPENSATqN,OAMAGES AS VROV:DED FOR IN
J SEC710N]7oBOFTHELABORCOD[,W7EREST.ANDATTORNEYSFEES. �T. !
¢
RETENTIONFE`3 r
a CONS7RUCTION LENDING AGENCY PRE•ALT FEE: —'—r--�
O
� I NEREBYAFFIitl./UNDER iENALTY OF PE0.NRY TIu7 TMERC IS A CONSTRULTION LEND�NG AGENCV
FOH iHE VERFORMANCE OF TME WOHN fOR WHip1 TMIS VER1Al715ISSUEO(SEC.]097,CIV.C.).
Z
W
� LENDERS NAME
y
F-- LENDER'SADDRE55
W ICERTIFYTHATIXAVEREADTXISAPPLICATIONAN�ST�TETHATTXEABOVEWFORM�1qNISCORRECL TOTAL FEES � 6�
� IAGREETOfAIAPlYN7TNALlCrtVANDCOUNTVORDiNANCESANDSUTEUNSRCIATIN4TOBUIIDING
� CONSTRVCTION.ANDHEREBYAUTMOR12EREPRFSENTATNESOFiMISCWNTYTOENTERUVONTHE
Z ADOVE�4LNTIONEO VROPERTY FOR MSVECTbN PVRPOSES. COMMENTS
�
J
_ .
� VEflMIiTEENAM a
¢ -�7 D1
�
y SIGNATUREOFFEHMITiE DATE �^
� RECPL NQ ,�(/� - PAID BY VALIDATION
Wh t—Department Copy,YEILOW—F�ance Copy,PINK—Assessor Copy.GOLDENR06—File Copy.GREEN—Applicant's Copy
. . .-. ,....�•"- -,..,. _.. -. .. t ..' - . . � . . ... ..,. -._..� .. ... ...,..... . ... .... .
. , .... .. ... , . . . . ^ . �- .. . . .... . . ,.�':.... . .,� :�•.. .. , ... �.. . '.���'�• . � .
�IT'� ���- �J1��f�.�OiLD r�f��
�r.�r�c���o��� ��co^�
__.�_._�___._____,_ - . - -- - --_..
1►l-'��=�;�t�J►'I �t�`;�' (►`F=]:a"c-,r�,�^�---.._—.Ii�E:t:1_c`��1�.�►�: ^ �i���'r=� I��l-7J�c��'c�:t
- -- - - - -
-- ---�--�-- --- ----- ------ . ... .. ..._. _ ......._...._... . ..._...._ _ ............. .... . . . ......_. ....... ....... .. ...._.. .--- -- -� -- -----------�----
SET BACY, � � ' __I_I_ FLOOR JOIST � . !
-! - - --r------
FTGS!FORP�IS/STEEL I I i F=H�,F�EQ".1T5 I i
ELECTRIC GROUfJD I � I UPJDER �LO�R DUCT ; i
+---- ---—
GFiOUND PLU��1BIfJG � I I_I UiJDER FLOOR CUP�DUIT __l_ i ___ '
SLF,B GRADE I I �_i FIR=PLACE FGJUND�"�TIO^: I I � _
TE�4P POb^!ER � I___ j FIR�PLr,CE E30PdD�EAP:1 I__ 1 _
�^lATER SERVICE � _ � ___�_, P.",I�tiT. �i0"db Ci:'A�." _ - i--- �— ---
RO�F SHEATHIfJG �__ I ! E3 FT. 60.`JD L1�'r",i.t --- � -- ----
FRAMING/VENTILIATIOPJ I � i� I F=1iJAL E�PJD 6rF,t," � ; ____
ROOF COVER � I I PliE-G�liD!�•,; � ;
ROUGH H�ATING � ! � E3EfdCHING I I
ROUGH ELECTRIC l ! � �� ROUuFI G'i�;DffJG _ I I
R�UGH PLU�ABIPJG i ' FI?�ISH uRt1DE^JG _ I I
SFiO�"JER/TUB TEST I � I POOL ELECT'RIC I �
EXT. LATH/SIDING � i i POOL FENC•.":G � � �
L"JALL INSULF,TION —� I I Pa�L F1�1AL i I
�
CEILING IN�ULATION I I � OFF SITE IPAPS. i __ I
DRY4"lALL PJAIL.ING � I I DE�ICATIOidS ! —�
SE1"JER I I FI�JAL E�Ju. i
SEPTIC TF.NK � � LAPJDSCl;PElIRRIG. I I
� SEEP PITlL.L. � I � OfJ SITE 1�.4PS. j '
GAS AIR TEST I I I FI�JAL ZOP�RJG
� FINAL CONST. � � FIR�DEPT. FINAI_
FINAL HEATING � � i1 HEF,LTH DEPT. FIPJF.L � .
FIPJAL ELECTRIC I I I DEV. FEES P�;ID
FI�JAL PLUMBING I I I Ehd�RGY � �
� ( �
. � � .� _.. :. . ..._�:..'.......,..T._�__ �_
I�
cor�r��ENTs � . �, .
SEPTIC TF,PJK SIZE
SEEP PIT/U SIZE —
�7 f_.�_.._._..
���� -
� _ � , —
.,� .