HomeMy WebLinkAbout17077 (42) �` CTfY OF DIAMOND BAR �
i DEPARTMENT OF COIvIIv1UNITY&DEVELOPMENT SERVICES �
��� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��%�� BLTILDING PERMIT APPLICATION FIRMLY
¢ DDRIESS I .�`(ZQQ DATECATION ' ,,���, NUME3ER �� p/C
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
4" ADD SS D ZONING SETBACKS
Z CITY ZIP�]]�q, TEL� ".SSR(� FRONT RW ❑
S APPLICANT TEL REAFl ❑
SIDE/SIDE STREET RW p
� CONTRACTOR 3 S SIDE ❑
ADD SS \
� CfTY 1 ZIP���II�1_ TEL. ' -[jl PROPOSED USE
o ARCH/ENG/
W DESIGNER NO.DWEL. NO. NO.
a AD�RESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/AD0/FiEM
O
p I HEREBY AFFIRM UNDER VENALTY OF VERAIRV THAT I AA1 E%EA1Pi FPAM TNE CONiMCTORSII� � Garago/Carport
W CENSEUWFORTHEFOIIOWiNGREA50N(SEL.7o]1.6BUSiNESSANOPROFE5510N5CODE:ANYCITYOR
U GOUMYWHICHREOUIRESAOERAIITTOCANSTRUCT,ALTER�E�7ROVE.OEl10USM,ORRE�AIRA4YSTWUG W Patio/peck
7URE.PRIOR TO RS ISSUMKE.AL50 REW IRES TNE ACVLIC�NT FOR SUdi VERIAIT TO FILE A SICNED
W STATFI.�ENT THAT HE OR SHE IS LICENSEO PURSUANT TO TME PPOVISIONS OF THE CONTMC70R5 LI- W
� CENSE Uw(CHAPiER Y(CpAMENCINO MATH SECTqN 700D)OF DIV151ON]OP TH[BUSINESS IV1D GRP � POOVSpO
0 FESSqNSCODE)ORTHATHEORSnE15E%EMPT7MERCFROr.�AND7MEBA515FORTHE�LLEGEDEXEMP- (�
V TION.IWYYIOIATIONOFSECTION7071.58YAYYAPRiGANTiORl1PEFMITSUBJECTSTNEAPP�ICANT70 Z F�B-ROOI
A CML VENALTY OF NOi A10qE TIAN FIVE MUNDNED�OlUR5If5oCI.1:
� OLASOW4EROFTHEPiiOPEFTY.ORMYEMPLOYfESWI7MWAGE5A5THEIRSOLEfAMPENSATK)N. � COmmBrCi01
Z WILL DO iH[W�R1(�NO TME STRUCTURE IS NO7INTENDED OR OFFEREU FOR SALE(SEC.7ou.BU56 J
� NESSAND GROFESSIONS WDE:i11E CONTMCTORS UCENSE UW DOES HOTAPPLY TO AN OwNER OF ?
PROPERTY'Mf0 8 VILDS OR MPROVES TNEREON,AND WHO DOES SUCH WORK NIMSELF OR HERSELF OR
('L THRIXICH HIS OR HER O1M1 EM7�OYEES,GROYIOED THAT SIKH IMPROVEMEMSARE NOT INTENDEOOR m
� OFFEREDFOq5ALE1F.NOWEVER117E8UILDINGORIMPROVEMEMI550lDWITMNONEYE�ROFCOMP�E-
Z TIDN,TME OWNER�BUILDER mLL MAVE THE BURDEN OF PflOVWO TMAT ME OH SHE 01�NOT BUIID OR
= MPROVE FOR TME PURPOSE OF S�LE).
w OIASOMMEROFTHEPROPERTY.AMEXCWSNELYCONTRACTWOWR11lICENSEDCONTRACTORS
� TO CONSTPUCT T11E DNOJECT(SEC.7ou.BUSINE55 uJD PNOFE55ION5 CODE�TME CON7iUCTORS ll� VelUation ADJ.AR[A
W CENSEUWOOESNOI�PPLYTOIWOVINEROFAVqpvERTYWFqBUILD50RI1JPROVFSTNEREON,Ah9
� NhqCOMMCTSFOqSUCHPRO,IECiSWITNACONTMCTOR�S)LKENS[DPU0.,UA.`RTOTHECONTMG ounNnn OESCRIPTION FEE
Y TORSLICENSEUw).
� O I AM EXEMPT UN�ER SEC. B.t Y.G FOR TNIS RUSON Q
� U
li. �
OATE OwNER V
2 W
� LICENSED CONTRACTORS DECLARATION W
I HERE81'AFfIfiM UNDER PENILLTV OF VERJURY TH�T 111M L10EN5E0 UNDER PROVi5�ON5 0F CMAPTEF Vr
p_, Y fCOMMENCINO WITH SEGTION TOOOIOF DiViSION 70F THE BUSINCSSAN�PROFESSiONS CODC,IJ:D Z
X IAY LICEHSE IS W FULL FONCE Ah9 EFFEC7. m
LLI
� UCENSECU55 Cl���LIG.NO.��� j
V DATE '�I'4�Ii CONTRACTOR�� a
W
� WORKERS'COMPENSATIONDECLARATIO � ¢ /
NIHEREBYAFFI{pAVNpERPENKTYDFPERRIRYONEOFTHEFOIIAYfN4DECUMTKKJS. Z
0 _IHAVEANDNALL4AINTAIN�CERTIFICATEOFCONSCNTTOSELF�NSUREFORYARNERS' _
� COMPENSATIDN.AS PROVIDED BY SECTION 77000F TNE UBOR CO�E.�OR THE PERfORMM10E W
OF THE N'OfiK FOR WHICH THIS DERMIT IS ISSUED. �
�
W 111AYEANDIMLLMAINTIINWORNERS'COMPENSATIONINSURANCE.�SREOVIREDBYSECiION
Q 77000F THE LABOR OOOE.FOFl TME PERFORMANCE OF iME WORK FOR WHlpl THIS PEFMiT15
ISSUED.YY WORKERS'C�0A4GENSATION��INSUfffUNCE CARq:ER MD VOLICV NUMBERME: CONSTRUCTION
� CARFIER �T� W�� PLAN REVIEVJ
Z POIICVNUTADER�'��_11�W � Z „ ELECTRIC
¢
� (1}�SECiIONNCmNOTB[00.1REiIDOF11EPEfb.1T6iOROh[H11t%iE00.LLAfi.IStOC)OqLESSI PLUMBING
Z 1 CERTIFY THAT IN 7HE 7ERFORMANCE Of'THE WOAK iOR WHICH TMS PERAnT IS ISSUED.I MECHANICAL
(J SHALL NOT EAIPLOY M!Y GERSON P1/wV MANNER 30 AS TO BECOME SUBJECT 70THE
(J� K9RNER5'COMPENSATIONUWSOFGILIFORNI�IW�AGREETHATIFISHOULOB[COML INSPECTIONFEE
S SU&:ECTTOTHEWORNERS'COMPENSATqN7ROVISIONSOFSECT10N77000FTMCU001i �- �.
CODE,I SWLLL FOi1THwI7H COMVLV WITH T1105E PROVi5iON5. �SSUANGE 1 }' ���-� ��`� ��' ` .U
Q '� �� l�sa�' �� `
0 DATE:�_ APPIICAN. � SMIP - ... .. . .".- .
� WAqN14G:FAtURETOSECUREWON(ERS'COM�ENSATIDNCOVERAGEISUNUWFUL.IWOSH�ILBE ENERGVP/C � J�T�II'1
LL SUBJECTANEMPLOVERTOCRIMiNILLVENALTIESANDCMLiWE5UVi00NEMUNDREDiHOUSA�D ENERGYPERMIT '
OOIURS(f f 00.00C�.IN ADOITION TO TXE COST OF COMPENSATKKJ.DMIAGES AS VROV�DED fON IN
J SECf10N 77oe OF TME LAB00.WDE,NTEREST,AND ATTOnNEY'S FEES. RETENTION FEE:
a CONSTRUCTIONLENDINGAGENCY PRE•ALTFEE: 'S'i'—
O -
� INEREO�AFFIMIUNDERPENALTVOFPERIURYiNATTMERELSACdNSTRUCTIONLENDINGACENLY
FOR TNE GERFORAIANCE OF TNE WOiiN FORK'HICH TMIS VERMIT IS ISSUED(SEC.]CYI,CIV G).
Z
W
� LENDER'S NM1E
F- lEN0ER5ADDHE55
� I CERTIFV TNAT I HAVE REAO T115 APPL1CAiqN AND STATE TNATTHE ABOVE WFOR1AATqN IS COFfiECT. TOTAL FEES ��
w I AGN[E TO COMPLY WITH ILLL CRY/ND COUNTY ORDINANCES M1D STATE UwS RCLATINC TO BUILDING
� CANSTRUCTION.ANOMEREBYAVTqNIZERE0RE5ENTATIVE50FTHI5COUNTYTOEHTERUPOHiHE
Z ABOVE�MENTIONEDVR07,E�RT(fORINSPECTIONWRPOSCS. CONMENTS
� ��1(1$�t Y��G�OI�i.hQS'
m PERMiTiF N E i Tl
¢ �'�Q�� �"��
�
� Au�cOFPE ITTEE DATE
� RECPT.N0. �� _PAID�Y __VALIDATION
WHITE—Departmant Copy.YELLOW—Finanee Copy.PINK—Assnssor Copy.GOLDENROD—File Capy,GREEN—Applicanl's Copy
Cii'�' Q[= �1�"�ftiD(�'[� i�-;�
ii�'C�� ��:-'a I��i�� �=���'CJt:ri
_. .. ..._ ..
—__-------- -
--- -_.
I►'E a��=c,���ra,r ry_�:E'- 1►'E:f.�=:�.::f.�1�: iR�f�i: = c:�,��1e1�'i r;��:r= ;1��.7:.���:'rej��
- ........ ........_ .. .....
_. .... .... ._._. . ..._. . _.._._.._..___.___.._...._._.._----
_.......... .. .... ..__.---- .-�-- - -
.._ ...
-- ---...._ .. ... .--
SET 6ACK , .�. : ; � � ; FL00?JOIST � � I
FTGS'F�Rh1S'STEEL �---•- -�-�-------- —�-I FH;REa'"T5 -- �----�-------
ELECTRIC GROUf�1� � I I I Uf•lD�R FLOOF. DUCT � ! ___
GROUND PLUiAoING l I I I Ui1D�R FLOOR CU?•�DUIT � i __ __
SL�`,5 GRF�DE I I I I FIR�PLAC� FO���JD�TIO��� � � •
7ED:1P POb"JCR I � _� �_FIR�PLACE 60��D_6CAP:1 ___ i —�
��JATER SERVICE I I _ _� P:11D HT. B�^JD�Q"F.F.; :__ _ � _ I
ROOF SHEATHING I I �i FT. E3�PJ�GEAt:i, i
FRAh11�dGNEPJTILIATIOPd � . I _ � FINAL EOiJD E3EAP:" I
ROOF COVER I ' FRE-GRADII�G I j
ROUGH H�ATIfJG � EE��:CHi�JG �
ROUGH ELECTRIC I ROUGH GRADIf•JG
ROUGH PLUMBING �~ FI^JISH GRADIPJG �
SHJI,"✓ER.rfUB TEST � � � POOL ELECTRIC �
EXT_ Ll�TH!SIDING � I I I POOL FFNGhJ;:,
�":ALL INSULATIOPJ � � POOL FINAL I
CEILIPJG If•JSULATION I �� OFF 51TE i�lPS. �_
DRYLVALL NAILING � I DEDICATIO�dS
SEIVER } + FI�VAL EPJG. I
SEPTIC TANK � LANDSCAPE/IRRIG.
SEEP PITlL.L. OfJ SITE IP:1PS. �
G.AS AIR TEST I I I � FI"JAL ZONING
FI�:FiL CONST. � � � FIRE DEPT. FIt�A!
FI;JAL HEATING '' '' ' "
(���-QI I .� I HEALTH DEPT. FI�JF,L �
FI�dF.L ELECTFIC � � �_I DEV. FEES PAID __ �
FIiJAL PLU"�1BWG 1 I _I I EPJER�,Y r � _
� � �
— I £_.,.�.�_,—(_I: �1�, .__..-.-._____�.� '—
cor�ir,nENTs � � ' . " '
r .� � _ .
_J .' �.
SEPTfC TANK SIZE
SEEP PITlU SIZE --- -
:�,I �
��f�; _
`, � . — , —
-i