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HomeMy WebLinkAbout17094 (42) _� CIIY OF DIAMOND BAR � � DEPARTMENT OF COMMUNI'IY&DEVELOPMENT SERVICES \\��\'!� 21825 E.Copley Drive ; �909>s6o-3i9s F��909�s6�-s�i� PRESS y BUILDING PERMIT APPLICATION FIRMLY � JOBSRE � �r /� APPLICATION PERMIT P/C o ADDRESS �l^�L`+���'�'J DATE_�� � NUMBER l n 04�1 N � ' issuE rrPE occ APN LOT TRACT DATE CONST. GROUP p OWNER p ADDFj€5 20NING SETBACKS � cinr 1�71�-if►l.�A/�_ E FRONT RW ❑ g APPLICANT TEL. �3 REAR ❑ SIDEISIDE STREET qW ❑ � CONTRACTO �� SIDE ❑ � ADDRES�S � w R H/ENG/ ��� ZIPg,Q TEL I� � P�NSE//+ri�--II+� � bESIGNER ' � C�ii NO.DWEL. O. NO. �'/ = CnDRESS ZIP TEL. UNITS STORIES BEDROOMS c.s•o � cn DESCRIPTION SQ.Fi. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD�AEM O p I HEREBV AFFIRM UNOER PENALTY OF VERIURY T/U7 I AM E%EM7T FROM TME CONTMCTORS L4 Garoga/Carport W CENSEUWFORTHEFqlOW:NaRE�50N(SFC.7o]t.6BU5:NESSMlDPROFESSIONSCODE:ANVCITVOR (n U �qn.(TyyYH�p1REWIRE5A0ERMITTOCONSTRUCT,ALTEH.MPfi�VE,DEMOLISH,ORREPAIRANY5iRl1C• W W NRE.VRqRTO17S ISSWWCE./LLSO REWIRES THE APPLIWNT FOR SUCM PERMIT TO FILE A SiGNED W Pati01�0Ck STATEMENT THAT HE OR SNE l5 UCENSED FU0.SUANT TO TNE VPAVISiONS OF TME CONTMCTORS L6 � CENSE UW(CHAPiER Y(COMMENCiNO YnTH SECTqN 7a00)OF DIVISION�OF TME BVSINE55 AND PRO• LL' PaoUSpa FESSIONSCODEIORTHA7HEOR5MEISE%EMPTTHEREFNOMANDTMEBASISfORTNEALIEGEDEHEMP• C7 V TION.ANVVIOLA710NOFSECTION70I1.SBVANYADCLICANTFO{iAPEW.aTSUBJ[CTSTHEIIDDLIGWTTO Z Re-Rool � ACMt iENALTY OF NOT MOfiE MAN FNE MJNDRE�DOLURS(fSao)): � ❑Lu��EflOFTHEPROVERiY,ORMYEMVLOYEESWITHW4GE5l15THEIRSOLECOMPCNSATpN, � COmmB�Ci81 VALL DO iME WORK.AND THE STRUCTURE IS NOT IMENDE�OR OFFEHED FOR SALE(SEC.7W�,BU51� � NESS ANO GROFESSIONS CDDE:THE CONTMCTORS LICENSE Uw DOES NOT�GP�Y TO AN OWNER OF ? PROPEHT'I MR�O BU4DS OR IMFROVES THENEON,M10 WMO DOES SVQ/WORK H�MSELF OR MERSELF OR � TMi10UGHHI50RNEqONNEYPLOYEES,CROVIDE�THATSUCHIMPROVE61ENiSAPENOTPlTENDEOOR m w OFFERE�FORSALEIF,/IONIEVEi�iHEBVq,pINCORtlA7F10VEMENTIS50lDWITHINONEYEAROFCOMP�E- � TION.7HE OWNER�BUILDEH WILL HAVE 7HE BURDEN OF PROViNC iMAT XE OR SME DiD NOT BUIID OF Z MDROVE FOR iHE GURPOSE DF SALE). = 04���ENOFTNEPFi7PEfi1Y.AAlEXCIUSNEIVCANTMCTINCWITHIICENSEDCONTRACTORS W [= TO CONSTRUCT THE iROJECT(SEC.70��,BUSINE55 ANO iROFE5510N5 LO�E:TNE CONTMLTORS ll� VaIU3IlOf1 ADJ.AREA W CENSEUWDOESNOTA7PLYTOANONMEROFAVROPEHTVYMOBUILDSORIMPROVESTMERCON.ANO � WHOCOMMCTSiORSUCMVHOJECfSWITNACON7RACTOR{5)UCENSEDVURSUMRTOTHECONTMG OUANTITY OESCRIPTION FEE � TORS UCENSE UW). � O 1 A1A E%E/APT UNDER SEC. B,l D.C.FOR iNIS REASON a � U LL ¢ DATE ONMER V O W � LICENSED COfYTRACTORS D[CLARATION W � IMERCBYIIFFIRMUNDEHPENKiVOFVE0.IURYTNAiIAMUCENS[OU�DERPPOYiS10N50FCNA7TER � � i(COMAIENCWGWITMSECTION7000)OFDIVISION]OFTHEBUSINESSANDVROFESSIONSCOOE,ANO Z X YV LICENSE IS M FU�L FORCE/J�D EFFECT. LL1 /� �^[.y�� [a � LICENSE CIASS� LIC.NO. j V DATE��l'��� CONT CTO�(� _ � a W � � WORKERS'COMPENSATION DECLARATION Q � IHEREBVAFFIRMUNOERGENAITYOFGERIURYONEOFiHEfOLLO'MNGDECUMTIONS. Z 0 �IHAVEANDWiLLIMMTAl4ACERTIFICATEOFCONSENT705E1F-INSUF[FOqWORKERS' 4 � LOMPENSATpN,ASVRWIDEDBY5ECT10N71oDOFTMEU00RCO0E,FOHTMEGERFORM�NCE W OF TNE WORK FOR W111CM MIS GERIAiT LS ISSUED- � � W _IXAVEMIDWILLYAINTAINWORKERS'COAIPENS�TIONINSUHANCE.ASR[OUIREDBYSECTION Q 77o00FTHELNiORCOOE,FORTHEPERFORMANCEOFTIEWOHKFORWHICHTN15GERMITIS I�1�'�� ISSUED.MYNUiL(EHS' IONINSURIWCETC�RR'�ER�AN�OP�O�UCl/NUI/BERME: CONSTRUCTION V 1 4 ��-�(/ PLAN REVIEW � CARRIER _ _ . � � ! � POLICTNUMOER t � � ELECTRIC �_" � � (IFOSSECf17NNEmN0T8ECG41EfEDOfhEPEfMT6fORChLFIWRCD00LLA(6(StOc10pLE551 PLUMOING Z ICEHTIFYTMA7WiHEPERFORMANCEOFTNEWORNFORwHICHiMISPERA1IT6155UE0.1 MECHANICAL C7 SMALL NOT EMFLOV ANV PERSON N ANY M�NNER SOAS TO BECOME SUBJECT TO THE �(j WORKERS'COMPENSATIDNLAWSOFCALIFORNI�ANpACREEiHATIFIS�qUIDBECOIAE INSPECTIONFEE SUBJECT i0 7ME WORKERS'COMPENSATqN VPOVISqNS OF SECTION 170o OF THE UBOR CODE,1 SHALl LORTTIWITH G01dPLV WITH TMOSE GRONSION ! I SSUANCE ,� p DATE:��� APPLICAM: .`1 SMIP ��O J WARNING: AILURETOS[CUREMNRNEHSCOMPENSATiONCpVERAGEISUNUW�ULANDSwLLLBE ENEi7GYP/C �y Su61ECTANEMVLOYENTOCHi1A1NALPENALTIESANOLNIlFWESUPTO0NEINNDREOTMDUSAN� ENERGYPEFIMIT DOLLARS(f 100.000),W 110DITION TO iHE COST OF COMPENS�TqN.DNdAGES►S iROVIDEO FOF IH ¢ SECTpN77oBOFTNEUBORCOOE,IN7ERE57,AnD�TTORNEY5FEE5. �ETENTIONFEE: d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � IH[RCBVAFFl�MUNDERPENALTYOFiEiLNRYTMATTMEREISACON5TRl1CTIONIENDiNGAGENCY �" FORTMEPERFORMMICEOFTMEWOAKFOqWHICMTH15FERMiTISI55UED(SEC.�ov7,LIV.CJ. Z W � LENDER'S NAME F- LErAER5A0�RESS ¢ ICERTffYTHATIMAVEPEADTI6APVLIGTIONAAOSTAiETHATTHEABOVEWFOfUTATpN15COFRECT. TOTAL FEES l�3 W IACR[E?OCAMPLYWITHALLCRYANOLOUNTVOR�INANCESM!'JSTATEUN'SPCUTINOTOBURDINC � CDNSTRUCTqN,ANDHERCOYAUR10R12EREPRESENT�TIVESOFTN15COVN7Yi0ENTEflUPOHTNE Z �BOVE�4ENTIONEDGROPERTYFORINSP CfIONPURP05[5. 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EO"JD_EEFS",1 ; __ _—���sv�_.%_�-a-� �-= l.T` - - - ----1— � FR.At.11tJG!V�NTILIATIO�d � � ' _� ` FIP�AL EO�.D EEr"�P.1 I - �- -- - f -- --- --I- --- ROOF COVER � / � Pii�-GiiA�I;JG j�� ��—�'-� --...._ 1' --- -- I-- —� - ROUGH H�ATING I � I I� gEr�cNi��� I - -�------ - ROUGH ELECTRIC ; � � f;OUGH GF.ADIi�:G ---J--- ROUGH PLUf�"BIPJu � � � � j FCJI�H �R�,DItJG -----E � _ SH�`�^JER:TUETEST ---� '' -,— - - j I _ ___ 1 -- � — ---li � CO�ELECTRI� � EXT. Lf,TH!SIDIfJG _� I � POO�F_E��C1t•.0 _ � I -----_..._ —-• :-- � 4'✓ALL INSULATIO'•t � • " I i f'COL_FIiJAL _ L I _ CEILING IiJSULF,TION � �_ __ I i QrF 51TE I�:"PS. __ I ; DRYI�NALL PJAILING � �_ __I I DEDICF1TIOtyS _ � __ j SEVJER . ! l_ �_� FI"J.�LENG. �� SEPTIC TANK � � ' � L��^,DSCAPE/IRRI�. � � SEEP PIT/L.L ; _ _ ' ��_ON SI7E li,?5. � GAS AIR TEST � � ; FI�JF,I_7_O��ItJG I I FINAL C01�1ST. I , � GInE DCFT. FINh.! I I FINAL HEATIPdG I � _ �_�_HEALTF�i DEP�C FItJAL ; � FIP�AL ELECTRIC � I I I DEV. FFES f'.�ID �—� FINAL PLUP.1F31`dG I I ; � EiJERGI'' � � i � , - --- -- � _ .�..-.-,�..��:.�__.._�- _ . ----- � � �� . _,_, .; , ______.__..� . . _ . ,: , , _ _�._—_1_____'_.'__...___'___—..—_.. ��-.--�r...�=...r�...���.,.Yn. I cor,nr,�IENTS SEPTIC TAfJK SIZE SEEP PIT/U SIZE -- -- - __..,..'�i_____._._. --- — �1►1 � . ,�j � -.. . .