HomeMy WebLinkAbout12620 (14) �..,
CITY OF DIAMOND BAR
--- — DEPARTMENT OF COMMUNiTY&DEVELOPMENT SERVICE3 / �
�.�� 216b0 E.Copley Drive Suite 190 �-•`
(909)660-3195 Fax(909)861-311? rRESS
��^�^�+ BUII.DING PERMIT APPLICATION FIRMLY
oJOBSfTE APPLICATION � ,,.� PERMIT 7/� P!C
ADDRESS��►�- 3�13 �o`� �"�A�o'� pATE_ NUMBER `"f/' �I
� ISSUE TYPE OCC
.- APN��- LOT TRACT OATE CONST. GROUP
� OWNER 17►'C� Na� '
ADDRESS� � 't�A 6e'� 6 ZONING SETBACKS
CITY �n�r4 �+"R ZIp 4J?6+r TEL�a9`��'�Z FRONT RW ❑
APPtICANT Grt� /�e. '' TEL. REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADORESS ROPaSEDUSE R�QF • A V�'� �'✓ �.v t
� RCWENG/ ZIP TEL twGwA C���i��S3 �,
� . _' A rM�`l/lCrrC
DESIGNER NO.DWEL. NO. • NO.
ADDRESS UNITS STORIES � BEDROOMS
� CITY ZIP TEL.
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDEH DECLAHATION SFRUDO/REM
O
I NEREBY AFARM UNDER PENK7Y OF PEFiIURY T/NT�AM E%EMVf FROM TNE CONfRAC70R5 LI• Q8�9e��rt
CFNSEUWFORTMEfIXLOWINOREA90N(SEC.7031.681AINE53ANUYROFE5510N5CO0E:ANYCIIYOR (n
COUMYYYHIo1REOUWESAPERMRTO00NSTRUCT.ALTERIMPROVE,DEMOUSH,ORREVAIf1ANY3TAUC- W pgtiolDBdc
TUqE.PqIOR TO ITS ISSUMICE.ALSO REW IRES TlIE MPLICANT FOR SIICH PERMIT TO f0.E�SIONEO W
l7A7EAIEM THAT ME OR 9HE IS L1CBdSEO PUpSU1WT TO THE PROVISIqJS OF THE ODAfTRACTORS Lb
CENSE tAW(C1IAPTER�(f�1AMENCIN0IMTM CECT�ON 7000)OF DMS WN 9 OF 7ME BUSINESS NJD PNO- LL POOVSpB
FESSqN3 COOE)OR T/NT IE Wf SHE IS EXE4PT THEREFiqAI MID THE BASIS FOH hIE ALLEDED EXEMP- ��
TqN.ANYYqUTUNOF6EGf10N7Wt.68YANYAPiLICANTFORAPEflMITBUBJEGTSTFIEAPPLICA�f�TD� �•ppp}
� ACN0.iENJILII'OF NOT MORE TNAN FNE NUVOREO DOl1AR5�t5o0).�: � '
� �tA60WNEROFTlEif10PERTY,OiiMYEMPIAYEESWITHWM7E5A9THE1R90lECOMVENSATION, � (',pmmBfC181 -�
WILL 00 THE WOPoC AND THE STRUCTURE IS NOT INTENOE�OF OFFERED FOH SALE(9EC.1014.8U51- J
N NE55 ANO VROFESSIONS CODE TME OONTRACTORS LICENSE LAW OOES NOT ACPLV TO AN OWNER OF
MOP6RTYNM1IOWID&ORIIAPFiOVE91MEREON,ANDWHO00ESSUCHWORKMIMSELFOpHERSELFOR �
� TFAiWOH HIS OFi MEA ONN EMPLOYEFS.PROVIDED 1'FU1T SUqi IMPROVEMEMS ME NOT IMENDECOR m
OFFEREO FORSALE IF,HOYVEVEF�iNE BUILDINOORMIP110VEMFNT19 SOID WIIHNONEYEMOF COMPIE�
TqN,hIE OIMIER-0URDER YALL W1VE TME BURDEN OF PHOVINO TFUT HE OR 6HE OID Fp78UIL0 OR�
W PIqYE FOR T11E PURPOSE OF SALE}
04�D'NNEROFTHEPROPEHfY,AMEXp.USNElYODNfRAC7W0`MTHLICENSmCONTflACTOfiS �
� TO CONSTRUCT fT1E PROJECT(8EG 7GH,BUSINE58 MA PHOFESSIONS COOE:TME CONTRACTOpS U-' VelU9liOn o o a a ADJ.AREA
CENS[LAW DOES NOTAVPLYTO AN OriNER OF A PROPERTY YYFIO BUILDS OH MPROVES 7HEREON.MD
WIqOONTAACT8PDR8UCMVROJECT9N7h1ACdl�RACTOR(5)LICENSEDPURSl1AMTOTHE00NTMG QUANT�TY DESCRIPTION F�E
� 1bRS LNYN66lAW.�. . . . .
O 1 AM IXEIAPT WIDER 9EG. 8.!P.C.FOR THIS REASON 4
U
� – '�� �
DATE OWNER .�
� L�CENSED CONTRACTORS DECLARATION W
� I HEREBYAFFiVA UbER PENKTY OF PERNJRV TH�71 AM LICENSE�UNDER PROVISION9 OFCNMTER �
� f(COMMENCNO YATf SECTION TaoD)OF OMSION 9 OF THE BUSINE55 AMD PROFESSIONS COOE,AND Z
�V W LICENSE IS W FULL FOHCE AND EFFEC7, m
� Uf;ENSE CLA33 LIC.NO. �
� pATE CONTAACTOR d
WORKERS'COMPENSATION DECLARATION �
� I NEREBV AFFIRN 11MDER DEWLLTY OF PE0.IURV dJE OF THE FOLLDWING DECLARATIONS: Z
� _IHAVEMIDMIILLMAMITNNACERTIFICATEOFCON9ENTT08ElF-INSUREFORWOHKER9' _
CpIPEN5A7pN,A3PROV10B8Y8EC710NS7000FTHEUBOACOOE,WNTHEPERFORIMNCE `U
OF THE WORK FOR WHICH 1HI3 PEpYIT 18 ISSUED. �
eF _I FUVE AND WILL YAIMAIN YVORKER6'CCMPENSATION IN6URJW CE.AS RECUIREO BV BECTION /]
Q870o OF T/fE LABOR OODE,FON 7HE iERFOXMANCE OF THE YNOR1c FOH WHICH THIS PEHMIT IS . 2 v+
J ISSUED.MYNpRKERS'COMPENSATIONINSUFUNCECARRIERMDPOLICYNUMBERME: CONSTRUCTION �4)t, Y
� CARRIER PLAN REVIEW
� ra.�cYNUMeER ELECTRIC
� �nfssEcna��woreeca.R�DOFnerendrt�xAor�eM�moau�Rim�art�ss� PLUMBING
Z I CENTIiYTHA7 N THE PEHFORAIANCE OF THE NIORK FOR YNilpi THIS PERMITIS ISSIIE�.I MECHANICAL
(� SHALL NOT EMPLOY ANY PEASdJ IN ANY YI,AINER 60 AS 70 BECOME SUBJEC7 TO TNE
�j WORNERS'COMPENSA?qN UWS OF CALIFORNI,�AHD A4REE THAT IF 1 SNOULD BECOME INSPECTION FEE
� 8U&IECT70 THE WORKERS'COMPENSI1TqN PROYISIONS OF SECTION�700 OF THE UBOR
OODE,I SMALL FOR7MVA7N COMPLY WIh1 TIqSE PROVISIONS. �SSUANCE ♦
� DATE: APPLICANT. SMIP
WMMNO:fALURETOSECURENKNV(ERS'COMPENSAipNWVERAOEI&UNLAWFLL,MIDSHALLBE ENERGYP/C�rt.�..��.,,�
�y BUBJEGTANEMPLOYERTOCRIMINILLPENALTIESANOCIVILFINESUPTOONENUNDREDTYKKISMID j
OOLlAN3(ilOD,000J,INKIDITIpVTOT1ECA5TOFCONPENS11TqN.DAMAGESlSPROVIOEDFORIN ENERGYPER
¢ SECTI�N370eOFTNELABORCOOE.NJTEREST,ANDATTORNEYSFEES. RETENTIONF
OCANSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 XEREBVAFFlRM UNDER PENALTY OF PERJURY THAT THERE 19 hGONSTRUCTION{.ENOINQ AOENCY
Z fOfl 7HE PERFOflMIWCE OF TME WORK FIXi VIMIGI TTi15 PEflN1T IS ISSUEO�SEC.709'/,CIV.CJ.
W
� LENDER'S NM1E
� LENDER'SAODRE55
W� TOTAL FEES ,.
ICERi1FYTNAT111MEREAD77115AVPLIGTIONAN03T11TETHATTMEA90VEWFORM�T10N1900fiflECT.
d IA�RE�NCOMGIYWRHALLCRYANDCOUNTYOROMLWCESANDSTATELANSREUTNO7OBUILDINO ,
"� CONSTRUCTION.M1D MEREBY AUTIIOHRE REPRESENTATIVES OF iHIS COUNTY TO EMER UPON THE
� ABOVE-AAENTbNEO VHOPERTY FOH NSPECTqN PURPOSES. COMMENTS
� Grt�j fVo�lb�+N
� PERMITTEENNAE(PHINT� .
�, � �,� N—d-s'� 1 �cC
Vj iNiNA7URE0 7MIT�EE OATE ��/� - � /
� RECPT NO. PaD BY _LQ VAL1DAl10N
4VFIITE-0epartment Copy,YEILON!—Finance Copy,PINK—Assescor Copy,GOIDENROD--File Copy,GREEN�ApplioanPa Copy
CITY OF DIAF�tOf�lD BAR
� INSPECTION RECOFiD � � .,
•'� � i + ' � ' ' � � + ' t '
SET BACK R. ' i I FLOOR JOIST ;,. ,, ;., �., ;„w�•�, ••�
1' r, :;,..
FTGS/FORMS/STEEL � FHA REflMTS
ELECTRIC GROUND . UNDER FLOOR DUCT �, ,,, ; .
GROUND PLUMBING UND�R FLOOR COI�IDUt7' • ` '•'• �'=�� ' ' 1'r.'
SLAB GRADE FIREPLACE�C3UNDA710N '- `' ` � '``' •
TEMP POWER � FIREPLACE BOND BEAM `
WATER SEFIVICE MID�MT.BOND BEAM
R OFv�'H�ATHI�fG � : ��� =14+� ��"a��x� � S.F7.BOND BEAM
FFiAMINGNENTILIATION � �•�� �f •' '•� � �4� i FINAL BOND BEAM
ROOF COVER /�-e13 PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING �
SNOWER/TUB TEST POOL ELECTRIC
EXT. LATHISIDING P(�OL FENCING '
WALL iNSULATION •1 j.�', 'POOL FINAL
CElLING INSULATiON OFF SITE IMPS. �
DRYWALL NAILiNG DEDICATIONS �
SEWER� FINAL ENG.
SEP7iC TANK LANDSCAPE/lRRIG.
SEEP PIT/L.L. � ON SITE IMPS. `
GAS AIR TEST FINAL ZONING
FINAL CDNSi'. l�-a3�4' I FIRE DEPT. F1NAL �
FINAL HERTING � HEALTH DEPT. FIMAL+ "��'. �'- 7' � �i
FIh1AL ELECTRIC ; DEV. FEES PAID
FINAL PLUM8ING � ENERGY
i
� � — -- - -
CONi�V1ENTS _
; , .
�� , . ��
�;Ar�--- - - -
� . 3t?�' � C'� �,(i r -- --�
�,�i��.�i��}lv'113�._�'��:.% �'����l�.e — 1
SEPTIC TANK SIZE �'''�':�`1�+�''=r�<"-,Y31{.,_t,:;;Tf� E
SEEP PIT/U Sl2E
�, . _
,, :-,�_�` --
, �.�-� �t '�... �, ,t:, -.