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HomeMy WebLinkAbout16742 (42) � J� C1TY OF DIAMOND BAR ' �h � DEPARTMENT OF COAM4UNfCY&DEVELOPMENT SERVICES w 21625 E.Copley Drive i (909)860-3193 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE a ' 3� ���,�)��O� DATE CATION ������ �I NUMBER ��`I� �f/C ADDRESS iv � ISSUE TYPE OCC APN LaT TRACT DATE CONST. GROUP p OWNER 5�e L A�i��[E110 o ADDRESS 13 .VkiUt� L!✓ ZONING SETBACKS gcmr 1��� ZIPf//7�i TEL. FRONT RW p APPLICANT TEL. REAR p z� SIDE/SIDESTREET RW O � CONTRACTOR�d � AIR- Cvti1J�T10r.�.:x -F- H't"C SIDE ❑ ADDRE S ` - -- �I�SS3 Mt f�D�'St � CIN fc 1� Zlp 2 FJ`� TEL ''3 GO-3)(�b PROPOSED USE o ARCFVENG/ z DESIGNER w NO.DWEL. NO. NO. n. ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEFi DECLARATION gFWADD/REM O p 1 FILREBY AfFIqM UNDER PENILLTY OF PEfLLRY TH�T I AM EXEGPT iRpA TME CON7RACTORS LI• G82gBIC81POR W CENSEUWFORi}1EFO�LOWINGNEASON(SEC,70.71.SBUSINESSMIDVROfE5510h5CO0E:ANYCITYOR (n U COUNttK'HICHREWIRESAVERMiTTOCONSTFUCjALTERMAPR0YE,0EMOLISM,ORHEPNNANYSTRUC• W w TURE.�RqR TO RS ISSUIWCE.IL50 REOUIR[5 THE APFLICAM FOR SUCM VERMIT TO FIIE A SiCNED W PatiolDeck . � STATEMENT THAT HE OR SHE IS 110EN5E0 pURSUANT TO TNE PiiON510N5 OF TME CONTRACTORS LI- � � CENSE LAW(CHAPTER Y(COIAMCNCINO N7TM SECTION 7aoa)OF DIVISipN]OF TME BUSINESS AND PRO- POOVSP2 FESSIONSCOOE)Of17HA7 HE Oq SME 15 EXEMPT THEREfROM AND 7ME BA515 FOA TNE ALLEGED ExEMP• (ry TION.ANYVqUTqNOFSEGT10N7o]I.SBYANYAOpV��1N{FORAVEPMRSUBJECTSTNEAPPLIWNTTO Z qe•Rool A CML PENALTY pF NOT MORE iHAN FIVE MUNDRED DOlURS�f5oo).): 0 ��ASOwNEROFiME7aOPERTY,OHUYEMv�OYEESW�THWAG[SASTHEIRSOLECOIAPENSATION, ❑ COmmBrCi11 Z YALL DO THE WONC M70 THE STIiUCTURE IS NOT INTENJCO OR OFFEREO FOR SALE ISEC.70��.BUSI� J N NESS AND VROFESSIONS CODE:TME CONTMC70RS IICENSE LAw DOES NOT AVPLY 7D AN OWNER OF PROPERTYNM1iOBUlD50RIlAPROVESTHEREON,ANDWHODOESSUCHVlOfiKHIUSEIFORMERSELLOR = Q TXROUCHHISORHEFONMEIAPLOYEES,PROVIDEDI7NTSUCHIAIPROVEMEMSIIR[NOTttJTENDEDOR m Q OFFEREDiORSKEIF,FIOWEVERiNEBUIIDMCORIMPROVEMEN'ISSOIDWRMiNONEYEAROFCOMGLE• Z T10N,THE OwNER�BUILDER YnLL MAVE TNE BURDEN OF VROViNG TMAT ME OR SN[DIO NOT BUILD OR � IAIPROVE iORTME PURPOSEOF SALE). W OI,ASOWNEROFTHEVROPERTY.AME%CLUSNELYCANTMGTIAGWITMLKEHSEDCONTHAGTORS CC TO CONSTRUCT TH[VRQIECT ISEC.70��.BUSINCSS MMJ VFOFESSIONS COOE:TXE CONTHACTORS LI• V21U2tion ADJ.AREA -� L11 CENSEUWDOESNOTIPPLYTOANONTIEROFAPROPEN7YWHOBURDSORMVRDVE57MERE0N./u�� � NM1qCONTRACT5FOR5UCHDR0.IECTSW1iH�CONfRACTOR(S�LICENSEDVURSUANTTOTHECONTMG QUANTITY DESCFIPTION F Y TORS UCENSE Uw.). �� 0 IAM ExEMPT UNOER SEC. B.i P.G FOfl TMIS REASON Q U/!N � " ` CJ . u.. ¢ OATE ONMER U Z W � LICENSED CONTRACTORS DECLAHATION W IHEREBYAFFIRM�NpERPENKTYOFFERJURYTHATIAM�ICENSEDUNDEflCROY15pN50FCMAPTER � p„ Y(COMMENCINGyATH5ECT10N7000)OFDIVISpN70FTHEBU51NE55ANOPflOFE55lON5CODL,AYD Z X ►1r LILENSE IS Pi Ml FOHCE AND EFFEC7. � UCENSECUSS /����-b LIC.NO. �I�Z'�� � . U DATE��`Y�I CONTRACTOR d W _ . WORKERS'COMPENSATION DECLARATION a . �� _ / /'�/ � IHERE9VAFF6WUNDEROENALTYOFDE0.IURYONEOFTNEFOLLOt+nNG0ECL11RATpNS: Z � � _IHAVEANDWiLLMAINTAIN�CERTIFICATEOFCONSENTTOSELFaNSUREFORWORKERS' a 2 COMPENS�TpN,AS GROViOED BY SECTION 7700 OF TME LA[iOR CODE,FOR THE VERFOqMANCE �U Q OF 1HE WORK FOR WHIq1 iH15 PERMIT IS ISSUED. � � �IMAVEANDW:LIMAIMAINWORKERS'CdAPENSATqNMSURANCE,ASR[WIREDBVSECTION � �,,,����. Q ]7000FTHEU90RCODE,fORTMEPERFORMMICEOFTHEWORKFORWHKHTH15FERMITIS ��i ISSUED.MY WORK RSA'C,O�MPENSA7qN INSURANLE CARRIER AND POLICY NUMB[R ARE: CONSTRUCTION i JJ j CARRiER S�,'T,G �"�� _ _ PLAN R[VIEW Z POLICYNUMBER O/ � D ELECTRIC Q � (fM65EGf10NNEmNOTBE47�iLEfE�OFTIEPEfi.fTbFQ70NEM1�17REDOQIARS(ftOCl��ul PLUM�ING W Z I CERTIFY TNAT IN THE GERFORIAANCE OC THE WORN GOR WHI�H THIS PERNiT I5155UED,l MECHANICAL C7 SMALLNOTEMPIOYANYOERSONWANYIAANNER50A5TOBECO�ESV0.IECTTOTHE —�� N WORKERS'COMPENSATIONUWSOFCAIIFORNIAAN�l1CREETHATIFISHOIADBECOME FEE _— S SU[iJECTTO7MEM/ORKERS'COMPENSATqNVROVI5ioN50F5ECTION�7ooOFTnEUBOX ��7 CAOE,I SHALL FORTMVITM LOIJP�V YnTM TMOSE PROVISIONS. SSUANCE / • 0 f ' p DATE: �`�S� APPLICAM. — SMIP J WARNING:FAlURE TO SECURE KOHKERS'COMPENSA1qN COYEAAGE IS UNUWF�I{.,ANO SHALL BE ENERGY P1C � LL SUBJECTANEMPLOYERTOGRIMINALPENALTIESMIOCMLFWESUPTOONEMUNOREDiMOUSRND � � DOlURS(f I00.000),W ADDITION TO THE C0.5T OF CAMPENSATION.DAMAGES AS VROVIOED FOR IN ' � � SECTION77aeOFTHEU80RCODE,INTERESL�KDATiORYEY5FEE5. �7ENTIONFE ' a CONSTRUCTION LENDING AGENCY • PRE•ALT FEE: O � IHEREBVAFFIRMUNOER7ENALTYOFiE0.A1RYTHATTNEHEISACONSTRUCTIONLEN0INGAGENCY FORTHE PERFORMANCE OF THE WORK FOR WMIGN TNiS PE WAIT IS ISSUEO(SEC.]097,CIV.C.1. Z W � LENDERSN�ME H LENDEN'SADORE55 � TOTAL FEES ¢ I CERTIfY iHAT 1 HAVE RF�1D THIS APVLICATIONAN�STATE TMAi THE ABOV[INFORAIATION IS fARRECi � '� W IAGREETOCd.�CLVWITH/.��CITVIW'JCWNTYORDINANLESWOSTATEUvSRELATWGTOBURDING � CONSTRUCTKKJ,ANDNER[BVAUTMORREREP0.ESENTATIVESOFTHiSCWNTYTOFNTERUPONTHE Z MOVE�NENTIONEDPRO�ERTVFORINSPECTqNPVNP0.5E5. COMMENTS � J � 4 PERMITTEENAM[�PRINn N � SIGNATUREOFVERAIITTEE DATE � RECPT.�0. _PAID BY VALIDATION L� WHITE—Department Copy.YELLOW—Finance Copy.PINI(—Assessor Copy,GOLDENRO�File Copy,GREEN—Applieanl's Copy ;�ITy' �� CLr.`.rOf;'..Q t3r'-.�; . I��'Sr e�G�iG��± t=;cGC)F:J - ---- ----._...,� --- -- - ------_...�,.___._ . ____.�.._.____._._.— - -_.. _. _�. ._.__.. .._ _ .._ . . _ - - - - .. i►°�-'�:�=:z;.Cl�:1►�I �Y�':;= (►��i:7=��,�•+'l.i fi�E7:5C.C..f[�1►�t F�1_i:P� Ii�Fy.��c::i'c)�i ._. ..... ....... ....----........._.... . . . .. _ ..... ..... . ._ ...__ . ._ .... _... . _.... --- - - - . ' ---..._...--_.._.----------- _. . ..._............ �� SET 6�CK i � � f=LOOR.1JI�T ; - � � ------- ...---- - - - -- —1-- FTGS!FORP.IS'STEEL—� -------�— —- � � f=HA REQ'.1TS -- -�----__� ELEGTRIC GROUND � I i i U�'�DER FLOOR DUCT ! I GROU��1D PLU��1oItJG i � U!1DCR FLCOn CO?•!DUIT � . SLAF GRF,DE � _� I FIR�PLACE FOUi•1DATIOt� I �_ TEPAP PO4"JER I _I_.l FIREPLACE EO�JD GEAP�1 I � VJATER SERVICE � I I I �•"ID HT.•DOP1D BEf,h: i._ . - . I . ROOF SHEATHING _� �_J 8 f-L BO'�D EEA�.1 _ �__ � FRAMRJG,`VENTILIATION I I I FI��JAL BOIJD BEF,�:1 I I ROOF COVER I �� PRc-GRADRJ�� � i AOUGH HEATIfJG I I I BE�•JCHIPJG � ROUGH ELECTRIC I ; I (�OUGH GRt:D!PJG � ROUGH PLU���E31fJG I � � � FI�'JIS,i GFiNDIPJu —� ; ' SHObVER,rfUB TEST � POOL ELECTRIC �J � EXT.LF�TH!SIDING �_I POOL FEP:Cit:G I I �"JALL RJSULATIDN rPOOL Fli•1AL � I CEILING WSULATION � _ I OFF SITE IP.^,PS. ; DRYVVALL NAILIPJG � � DEDICATIO'JS � � SEWER FIi�AL EP�G. �_I SEPTICTAhdK I-I LAFJDSCAPE/IRRIG_ � I SEEP PIT/L..L. � � � O�J SITE I^.4PS. GAS AIR TEST � FINAL ZO�.ItJG FINAL CONST. � I,,�� ' � FIRE DcrT. FIPJF,L FINAL HEATING I'��Zr���._.a�,y �_ � H�FiLTH DEPT. FIiJAL FINAL ELECTRIC � � � DEV. FEES PAID � FINF,L PLUDlBING I I I EhJERGY � II I T -�=._.�'.- `..� ,a-,„-_.. .�- -- - � cor,nr,��tvT�s - -- - - - -- . 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