Loading...
HomeMy WebLinkAbout16741 (37) �1j � /� 1 '� CITY OF DIAMOND BAR � j �� �'-� DEPARTMENT OF CO'vIIvIUN1TY&DEVELOPMENT SERVICES "—' ��� y 21825 E.Copley Drive (909)860.3195 Fax(909)861-31 l7 PRESS � BUILDING PERMIT APPLICATION FiRMLY � JOBSITE ,,f� APPLICATION l PERMIT � P/C o ADDRESS--�IZSS CD/ iBR'�✓DvI� �' DATE__ ��� +�1 NUME3ER ��� R $ ISSUE TYPE OCC APN--�y�L T TRACT DATE CONST. GROUP p OWNER �//'� �f o ADDRESS Li:j' �4>GAQ v • ZONING SEIE3ACKS gCITY <� ZIP 9i>cq rE�.26�3 332 FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDEJSIDE STREET RW O � CONTRACTOFi �E' � �'� .v� SIDE ❑ A�DRESS il �• � � CITY -!O ZIP�lTG/ TEL. .2 � PROPOSED USE w ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. n. ADDflESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cr� cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECUIRATION SFR/AD0/REM O p 1 NEREBY AFFIRAI UNDER PENALT/OF PEiWRY THAT 1/V.1 EXEAIPT FROM THE CONTMC70RS ll- Gaf2gelCarpOR � W CENSEUWfORiHEFOILOWINGREA50N(SEL.T031.58USWESSAKDVHOFESSi0N5CODE:ANVC1iYOR (n U COIMTVWHILHREOUIRESAPEHAIRTOCONSTAUCT,ALiEfLMPROVE.DCAA0U5M,ORREGAIq�VYSTRl1G W PaIiO/DBCI( W TURE,PRqH TO ITS�SSUANCE,AL50 REWIRES TME 11VVLICANT FOR SUCH VEWAIT TO FILE A SiGNCD w STATFMENT THAT HE OR SHE IS LICENSEO PURSUANT 70 TME PRONSIONS OF TM[CONiMCTORS U- � CENSE LAW(CHAPTER Y(CqAMENC�NO WITH SECTqN 7000jOF DIV:510N 70FTHE BUSME$SANO VRO- LL- PooUSpa FESSqNSLODE)DRTTIATMEORSNEISEXEMPTTMEREFROMMDTMEBASISFORTHEA.LEGEDE%EMP• (7 � iqN.A4YV10UTIONOFSECilON7071.S8�ANYAPP�ICANTfORl1VERM1T5VBJECT57MLAPPUCANTiO Z �Q.Rpp! A CM.L PENAITY OF NOT MORE TIAN FIVE MINDRED DOIURS(7500�.�: � O1�50MNEqOFTHEPROPERT/.ORMYEMPLOYEESWITNWAGCSASTHCIRSOLECA1dPENSATION. � COmmBfCi01 1M.LL 00 THE WOR1(,AND TNE STRUCTt1RE LS NOT INTENOED OR OFFEAEU FOR SAIE(SEC.7W�.BU51- � NESS M!D DROFESSIONS CODE:TME CONTRACTORS UCENSE LAW DOES NOTAPPLY TO AN OWNER OF ? PROPERTY VYFIO BU0.D5 OR IMPRpVES TN[REON./V:D YMO DOES SUp1 MqFK HI1.15C1F OR HCRSELF OR CC THROUCH HIS OR HER OMM EMPLOYEES,VROV:DED THAT SUCH VAPROYEMCNTSARE NOT WTENDEO OR m w OiTERCDFORSKE.IF,i10WEVER7MEBUILDIKCORIMPROVEM[MISSOLDWITMINq:EYEAROFWMI'LE- 0 TION,THE OWNEN�BUILDEN N'�LL MAVE THE BURDCN OF PROYING iHAT HE ON SNE�ID NOT BUIID OR Z W PROVE FOR TME PURPOSE OF SALE). = OI.ASOWNEROFTMEPROPERTY./UIEXLLUSNELVCANTMCTINGNnTHLICENSEDCONTMCTOf15 W (= TO CONSTRUC'T TME VRQIECT(SEC.)Ol�.BlI51NE55 AN�PROFESSIONS CODE TNE CONTRAC70R5 LL V8IU8Ii0t1 ADJ.AR[A W CENSEL/�WDOESNOTAPVLYTOANOWNEROFAVRODEHTYWMDBUILDSORMPpOVESTMEREON.AN'� � W/pCOMMCT5FOR5UCHPRQlECTSMATHAQOMiUCTORjS)LiCENSEDPURSUANTTOTHECONTRAG QUANTITY OESCRIPTION FEE � TORSIICENSELAw�. � O I AM EXEMPT UNOER SEC. B.i P.C.fORTH:S REASON Q 3 � � � OATE OVVNER U . Z W � LICENSED CONTRAC70RS DECLARATION W � IHEREBYAFFIRMUNDERVEN/LLTYDFVERNRYTIUTIAMLICENSEDUNO[RVROVISIONSOFCMAPTER � d f�LOYMENGWOWITHSEGTION700070FDMS10N]OFh1E8USINE55AN�ifiOFE55KK:5CODC,MID Z X MYLICENSEISINFULLFORCEANOEFFELL m � LICENSE CU55 r�� C�� LIC.NO. ��`� �[�_�t� J V DATE � `Z���a� CONTFiACTOFi�� �/cR/�W7ICJT a . �'-' �7 ✓l � Z:�G � WORKERS'COMPENSATION DEC tA71�N ¢ —U��(l�j� � �'' G'.f'H � IHEREBYAFFIRMUNOERPENAL7YOFPE�LM1IRYONEOFTH[FOLLOWINCDEQARATIONS: Z � _IHAVEAh9VNLLMNNTAMIICERTIFICATEOFCONSEMTqSEIF�INSUR[FORMAFKEPS' _ COMPENSATIDH.115 PROYIDED BY SEGTION 770o OF TNE LA.90R CODE,FOR TNE VERFORMANCE W OF T1E WORK FOR W11ICH THiS VE WAIT IS ISSUED. � � �I XAVE M!�WILL MAINTAIN WOW(ERS'WMVEN511TqN INSURANCE,AS PEOl1iRED Bv SEGTpN Q 37000FiHELA80RCADE.FOR7HEPERFORA/ANCEOFTHEWORKFORriN:CHiHISCEfIMIT15 0 ISSUEO.MVWORKERS' P NSATIONWSURANCECARRIERAMJPOLICVNIJM�ERAHE' CONSTRUCTION Q � CARRiER _��-� PLAN REVIEVJ Z POLICYNUTABER�_.a,..�f ��,Z,4/-�— ELECTRIC ¢ 0 (Ila55ECf�Or+NEmt+OiBLOCAstETEDOFnEVEt�.fi6�ORoniH�lYi[�O�t1Afi�^R+aIOHlE551 PLUM6ING W (� Z ICERTIFYTHATNTHEPERFORMANCEOFTHEWORNFORWHICHTNISPERAUTi5155UED,l MECHANICAL •U ('J SHALLNOTEMPLOYANYGERSONNANYMANNCRSOASTOBECOMESUBJCCT70THE (n WORKERS'GJMPENSATIONUWSOFCALIFOfiNI�ANOAGREETMATIFISHOULDBECOME INSPECTIONFEE S SUBJECTTOTM[YIOAKERS'COMPENSATIONFf10V15qN50F5ECTION77000FTHCU[iOR �SSUANCE ��U CODE.I SMALL FORTHMATH COMPLY WiTN T1b5E PROYISIONS. � SMIP p DATE: APRICANi: J WARNING:FARUR[TOSECUREIWRKERS'COMVENSATIONCOVERAGEISUNUwNL.ANOSNALLBE ENERGVP/C �y SU6IECTANEMPLOYERTOCRIMWALPENALTIESMIDCMLLWESUVTOONEHUNDRCDTHOUSANO ENERGYPERMIT DOLLA0.51S1 m.oao7.N AD�ITiON TO THE COST OF COMPENSATION.DAMAGES AS PROViDE�FOR IN J SECTqN770eOFTHEIA[iORCODE,NTEREST,MIDATTOiWEY'SFEES. RETENTIONFEE: Q a CONSTRUCTION LENDING AGENGY PRE•ALT FEE: - O � IHERE8v11Gi1{UIUN�ER7ENALTYOFOERIURVTXATTMEREISALONSTRUCTIONIENDMGAGENCY FOR THE PERFORMANCE OF TH[WOHK FOR WHICH TNIS VER41T IS ISSUED�SEC.7W 7.CIV.C.�. Z w � LENOER'SNM1E S - F_ IENDER'SAODNE55 ¢ ICERTIFYTFUTINAVEREADTHISAPPLICATIONANDSTATETHATTNEABOVEINFOIWATIONIS��E�,. TOTAL FEES , ^�J� w IACfl[ETOCOMP�YN7T1i1LLLCT'ANDLOUNTYORDWANCESANDSTATELAWSRCUTINGTOBUILDINC � CONSTRVCTION.ANDHEREDYAUTlIORIZEREPRESENTATNESOFTHIS�ITVTOENTERUPONTHE V ZPBOVE�MENTpNED PROPERTY fORINSPECTION iVRVOSE . CONMENTS = G������..�d �� /� ��2. m CERUITTEE NAYE�PRIN7) a G �Z���� � � SICNATUHEOFPERMITTEE DATE � RECPT.N0. PAID BY VALIDATION WHITE—Departmenl Copy.YELLOW—Fnance Copy.PINK—Assessor Copy,GOIDENROD—File Capy,GREEN—Appl�cant's Copy . . .., . -... .. .. ;.. � -,�•.•. - +.,� -.. , � �. . . , . � i ] - Lnti�. . . .. .. .. , . . �.. , _ . .� . . ,-. .. . - iil � ~o �4" ���i�1Qi��1.� C3/�l i a - 1r.��,-�c:-f��r,: �:��:��-�� ' .�_._._ __..._____-- _------------..- -- --------- ..__ .... ------- - ----------------�------------------__-- ------- ;li'Ni����'".�1�)�k �i_:�E'= 1►E=1:���r'-►'ram:. Ii�E:;��..`;f �lcJ�'. Es�'t:r: I��E=iC.!�c;�Ccl.l _. ..--i...__-_....._. ::._. ... i ----.., ... ... . _:. . . . . . _...._ _ . ... ... .. .............. ....._._....-�---..__.._ . .... . SET BACK --. � ' 1 ; F1.00R JOI�T. ; j FTGS;FOR��IS,STEEL �, I I FH,1 REa`•.'TS i I ELECTRIC GAOUN� � I �t I U�•JD�R FLOrJ^n DUCT _l � __ GROUfvD PLUi�1BI�JG �_ I _ I I UI��ER FLOO�i'CUi•!D'JIT 1 � ___ SLAB GRADE I I I_I_FI�rPLF�CE FOU'.DA710^�� I ___ TEPAP POUVcR I � I FIREPLF;CF E30ND BEA�," � _� -- �-� -- - - �NATER SERVICE � � I ! r^!�E�1. eo?:� BEA�.1 � I —+-•- —�-- ----- ROOF SHEf�THiNG -- I--- — I I 8 'r-T. 6�,"�D EE,�"�,t _�- ----� -- FRF�P.IINGNENTILIATION I � _�_ FIP�AL 60td7 FE��.1 � � ROOF COVER I I I 1 Ff?�-G�P�DR.G I ROUGH HEkTING � BE�•:CHIiJG � �1--� -- ROJGH ELECTRIC I ; Fi�UuH GRADIi•dG � —�--- ---�� -- ROUGH PLUt�"BIPJG I � � FI�'�ISF1 GRADIPJG � SH01,�✓ER,n-UB TEST � I_I POOL ELECTRIC � [XT. U1TH/SIDING I I I POOL FEi•.CIFJ�a b'JALL IfJ5UL�ITI�N I -- -� POOL FI^:�`iL -- -- -- � CEILI�dG IfJSULATIOfJ � l � OFF 51TE I�.iPS. _ � D:�Yb^:ALL NAILIiJG � I I DEDIC�ITIO��S j SE�"JER j� FI�J!'iL EhJG. � SEPTIC TANK � Ll�PJDSCAPE/IRRIG. � � SEEP PITlL.L. Of•� SITE I'.1pS. � GAS kIR TEST � FItJAL ZOPJI�JG FINAL CONST. � ' � F!RE DEPT. FI�JA! � FINAL HEATI"JG "/'�,�� � _ I I FiEtiLTf-i D�PT, FIfdAL I FINAL ELECTRIC � � � u�\':FEES P:1ID FINAL PLU"•ABIP�G � � � EPl�RGY I . - --�L�..:_.'.�_____....-- -.'..--.....-•___,__._.� I -- - conrr,�ErvTs � SEPTIC TANK SIZE S�EP PITIU SIZE - _�_M� __.___._ -- ��rr� � �j