HomeMy WebLinkAbout17093 (42) �� C1TY OF DIAMOND BAR
� DEPARTMENT OF CO�vfMUNITY&DEVELOPMENT SERVICES
��� 21825 E.Copley Drive
(909)860-3195 Fax(909)861•3117 PRESS
���� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE � c? � " � ��� APPLICATION� i` 0 r PERMIT I^1/�l P!C
ADDRESS �� ��� �
o DATE � NUMBER o
� � c•� ISSUE j j TYPE OCC
APN LOT TRACT Y 7 ✓U DATE � �� �� CONST. GROUP
p OWNE�lIIH/1G'v� , �"�Mc FS L�-C_
p ADD�S '���.0 I�iiR1'�NC� �LV7 ZONING SETBACKS
gCITY I a��A ^': ZIP��C3 TEL���t��'!`l�' FRONT qyy p
APPLICANT TEL. REAR p
zd _ � SIDE/SIDE STREEf RW ❑
� CONTRACTOR `�lr i3 �:•C.ct7'�(G SIDE ❑
ADDRESS f L^2'3 �i 4 •• '� /-t-.
o CIN rY't1.t�iV�T�s Zip�!)7� TEL�t�-�C��I PROPOSED USE .
o ARCH/ENG/
z DESIGNER
a ADDFiESS N0.DWEL. NO. NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
� OESCRIPTION SO.� FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFRlADD/REM
O
Q I HEFEBY AFFIRM UNDER PENALTY OF iERri1RY TH�T I AM EX[MPT FRpA THG CONTMCTORS LI- G8f29BJC3IpOfl
W CENSEUWFOi1TMEFOlLO'MNGREASON(SEC.10.71.5BUSWESSANDiROFES51pN5CO0E:ANYCITYOR (n
V COUNT`lWMICMREOUIFESA7ERMIT7000NS7RUCT,ILLTER��R�vE.DEMOUSH,ORREPAINANYSTRUG•
w NRE.PHqN TO ITS ISSUM7CE.ILSO REOUIR[S THE AP7lILANT FOR SUCM GERMIT TO FILE A SIGNED W Patio/Deck
� STATEAIENT THAT H[OR SHE IS LICENSED VUiiSUANT TO THE PROVISiONS OF TME CON7qACT00.5 LI•
� CENSE LAW(CHAPTER i(CAUM[NCWC YnM SECTION 7oD0)OF DIVISiON]OC TNE 8:151NESS AND PR0- LL" PooUSpa
iE55qN5 COOq OR THATME OR SH[IS E%EMPT THEREFROM AND TME BA5:5 FOA THE ALLEGED ExEMP- �
V TION.ANVVIOIATqNOF6[CiION]071.SBYANVAPPLIG1MfORAPERMIT5U8JECT5THEAPFLIGWTip Z Re-Roof
A CML VENALTY OF NOT YORE THAN FIYE MUNDRED DOLURS(i500J.):
� ❑I,hSOWNEROFTHEPROPERTY,ORMYEMPLOYEESNATHWAGE5A5THEIR50lECDMFENSATION, O COTTBfCl01
Z YnLL 00 THE WOR1C/WD THE S7RUCTURE IS NOT INTEN�EO OR OFFERCO fOR SALE(SEC.70N,BU51• J
y NESSANDPROFESSIONSCODE:TMECONTMC70RSLICENSEIAWDOESNOTAPPLYTDANOWNEROF ?
VfiOPERTY NT108UILD5 OR IMPROVES TFIEREON,AND VMO DOES SUCH WORK HIuSEIF OR NERSELC OR
w7NROUCHHI500.MEFONNE4PLOVEE5,7POVIDEOiHAlSUCHYAVROVEMENTS�RENOTINTENDE'JOR m
O OFFEREDiORSALEG,FqwEVE0.TME8U1LDiNGOnIMPROVEMENTISSOLDWAWNON[YEAROFCOMaLE�
Z TqN,THE OWNEH�BUILDER WILL HAVE THE BURDEN OF 7ROVINO THAi ME OR SHE Dlp NOT BUIID OR
= IMPROVE fORTH[PURPOSE OF$AIE�.
w OLil50MMEROFTMEPflOPEflTY,AIAEXCLUSIVELYLONTMCTI1rGWfTMUCENSEDCONTMCTORS
Q TOODNSTRUCTTHEPR0.IECT�SEG70t�.BU51NES5ANDPAOFESSIONSCODE:iXECONTR�CTORSLi� V21UeSiOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPER7YWHOBURDSORMPROVESTMEREON.�ND
� WNOCONTMCTSFOflSUCHVRQIECiSWITHICONTIUCTOR(S�IiCENSEOVURSUANTTOTMECONTRAC• QUANTITY DESCRIPTION FEE
Y TORS UCENSE UW).
� O IAM EXEMPT UNDER SEC. B.l V.G FDR TinS REASON Q
� � �
DATE OWNER F-
O �
F LICENSED CONTRACTOFS DECLARATION W
� �HfREBVAFFIRM�NpERPENA�TYOFPER0.IRVTNATIAMLICENSEDUNDERVROYISKKISOF�HApTER �
p., t(COA�MENCP1oN17N5ECTION7000)OFDrv13iON10FTME8u51nES5/�NDiROFE55lON5GODE,ANO Z
X MY LICENSE IS IN iUll FORCE AND EFFECT. m
o �-�o yy�zL-Z �
r. LICENSE CLA S LIC.NO. � �� a�tf �
�j DATE���.� CONTMCTOFi��•�Z a=_Ls-�l F IL pJ.
W
� WORKERS'COMPENSATION DLCLARATION a
� IHEREBYAFFIRMUNOEROENALTYOFOERIURYONEOFh1EFOLLONnNGDECUMfI0N5. Z
O _IHAVEANDM/ILLMAINTAINACERTIFlCATEOFCONSENTTOSELF�INSUR[FORWORKERS' _
Q COAIPENS�TION,AS PROVI�ED BY SELTION 770U OF THE LAOOF OODE,FOH THE YEFFOqMANCE U
Q OFTMEWORKFORWHIp17HISVERMITI5155UED. �
� ,y�IHAVEANOWILLMAIMAINWORKEFS'COIAPENSATIONINSURANCE,ASREOVIREDBYSECTqN
0 i7000FTNEUIBORCOOE,fORTMEPERFORMPNCEOFTHEWORKFORWHip/TNISPERMITIS
ISSUEO.MYNqRNE ENS�TIONINSU ECARRIERANDPOIICYNUMBERARE. CONSTRUCTION
� GRRIER �� t'l��L� PLAN REVIEV!
� �icrr+uueEa�7�1—CI G'1�� ELECTRIC
0 (MSSECI70NNE�NOTBEOOMtETmOFTfPEPo.tt6FOROnLHINDnEDDOLIMSR�a'IORlESSI PLUM6ING
Z I CERTIFV iNAT INTNE PEfiFOR!AANCE OF THE WORN�ON WHICH TMIS PERMIT IS LSSUED,1 MECHANICAL .
(} SNALLNOT E�PLOYANY DERSON PJ ANY MMINER SO�S TO BECOME SU&IECT TO THE
(n WORKERS'COMPENSATIONUWSOfCALIFORNII�ANDAGREETHATIfISMOt,iDBECOAIE INSPECTIONFEE
S SV0.IECTTOTNEWORKERS'COMPEHSATIONCPOYISIONSOFSECTION�70oOFt [UBOR -
COOE,I SWLL iORTMNITH COMP�Y VnM TT105E PROV15lON.^ / ISSU.�`10E
0 �l.L /
p DATE: APPLICANT '..�'(1 I 17L('+Y-'�' `�f SMIP
� ENERGY P!C
WARNINO:FAI�URETOSEWREWORKERS' .NSATKKJCOVERACEISUNUwFUL,ANDSHALLBE
� SU0.IELTANEMPLOYERTOLR:M:NALPEN TI MIOLIVILFNESUP700NEMUNOREDiMW5AN0 ENERGYPERMIT
r OOLLARS�SI00.000),INADDfT10NT07HEC OFCOM7ENSATION,DIWAGESIlSPflOVmEOFORIN �
J� SECTqN770aOFTHEU00RCWE.IN7[AEST,�NDAT70RN[YSFEES. RETENTIONFEE: _
a CONSTRUCT�ON LENDING AGENCY PRE•ALT FEE:
O
� IHEREBVAFFIRMUNDERPENi1LTYOFGERIUNYTMATTHEREISACONSTRUCTIONIENOWCACCNCY
FOR iME VERiORMANCE OF 7HE WORK FOR WMIp1 THIS 7CRMIT IS ISSUEO(SEC.�097,CIV.C.).
Z
w
� IENDER'SNAME
S
F- LENDEiYSADDRE55
� TOTAL FEES , 50
� ICERTIFYTHATIHAVEREhDTMISAPPLICATIONANOSTATETHATTHEA80VEWFORAI�TIONISCAflRECT.
w IAGREETOCOMPLVM7TMALLCITY�NDCIXINTYOR�INANCE5INDSTATEUWSRELATWGTOBUILDINC
� CONSTRUCTION.AI:DMERCBYAUTNORREREPFESENTATNESOFTHISCWNTYTOENTERUGONiHE
ZJ�OOVE�MfMqNEOP0.0PERTYFOHINSPECTbNVURPO5E5.
� �. COMM[NTS
� n�vLe� C.. 1�' c S
m --',- '
¢ CERMITTE ANE(VRiM) n �`^
� ���� � �' '�
Uj Si eOFPERMiT1EE DATE
� RECPT.NO. . PAID�Y __VAUDATION
WHITE—Department CoOY.YELLOW—F�nanee Copy,PINK—Assessor Copy.GOLDENFOD—Fila Copy,GfiEEN—Applicant's Copy
.
C; � '� ��- �l�•,���r:i�'1? r�;��
11'k��C..�'�� . e�:� CiL'Cr.l�'�L�
���E_=.��e��t���i'� —___..f_)w.t;_._..__ -+�,f=i.i�:�:;�'�'1�.._._...._...__.,i►�►=�:�- F '�i�F;l►`:�'---____�...,c�_�_.— _T__I►�f+'i�l:�c=r�):�
. .___......�....... -'--.... ..--- �-- .�.. :' _.._. .. ... _ _-' . ... _ . . . _---. _.._. . .:..:----•-------
SET 6ACK . � . �• .` --
,�' ; ! , ; � � i � FLO�R J�IST _� ,� � .
.
----...—...---._...------- - - -- -� --�-•— --- - ----- — ,------------
FTGS!FORh1S!STEEL � I I ! FHA FiE��.1TS � ( I
--�------- �=---�------r-=--- ——.----- - -
EIEGTRIC GR�U�dD � I, ' i ! Ui1J��R FLOO,R t7UCl" � I
-----•--------..---=- ---�-
---�---------�----------- I r
GROUi•JD PLUt�131��JG � , U��1D�R FLCO�;CO��IJUIT , • �
-- � --•--------....-�-1-=— ----:--------- *— ----—
SLP,B GRADE I 1 � ' ;�IR�F�°,C� �vUi•!D!•,TIO�: ;
TEP.4P PO4VER I I i I FIR�'PL;,CE BO"YD E?EA��1 I
1iJATER SERVICE �-- --- ------I j i.1ED HT. LO"JD BEP,�"---_� ---•— -
ROOF SH�ATHIf•13 --I---- -------,..I-&FT. Fi0`J:;� �=�r� — --I�---------- -
FRP�MING.NENTILIATIOiJ I I I ! FI^�!iL GOhJD 6�AP.i � ` i
----------- -------�-._--�— --- ---•- --
ROOF COVER � ----I� F'R�-G��,DIt�G _ � j -----
ROUGH HEATIiJG � I � i � 6E�JCHIi1C, ___ �
ROUGH ELECTRIC � j � fi0U3H GF'�,DIi�JG
. �
, I
ROUGH PLUtJaR�G � � � � ( I�•JISH G'r',AD;iJ� � I ---
i
SH�VdER/TUB TES i �—. �---- - � � f'COL EL��C i f-iiC --� �
—1-•------ —
EXT. LATH/SIDING i I I ! F'OOL FEP.CIPJ,�
�'JALL INSULATiOf•1 T� l�— �I_—
� � 1-F'OOL F=RJAL ---_..._-�� I _
CEILING IfJ�ULATIOP•� j � _ �_l O�r SITE I:�?S. ___ �_ _ i
DRY�"JALL fJAILIPJG � I ; DEDICATIOiJS � �
SEt'JER — ---� —;-- _--{ � FINAL EP•1G. — - — -
SEPTICTF;Nt� I � _ I I LAPJDSCF,PEIIr-�RI�; � �___
SEEP PIT/L.L. � _,_ � i OfJ SITE I�,"r'S. ^ I I
GAS f,IR TEST I ; I I FI�JF,L 7_GPJI�dG _� I
FINAL CONcT, � i� r!RE D�PT. FI'JA.!. I I
—=-�--�--
FIPJAL HEATIPdG � � �-`_ ' � � IIEALTfI DEPT. FIiJ.AL � � _
FINAL ELECTRIC . � L—., ' DEV. FEES F';;iD
� ������=-- 1-i------- --
FINAL PLUPd181iJG I i f � Ei•JERG`r
� � I � �
� � _—�,T��".".... �!^_�._:�_--___~__^. �
L1 .i ��.�.,. —
cor,rr,nENTs __
t ---
y .
SEPTICT�',NK SIZE
SEEP PIT/U SIZE - -
_� ',� __�__ — - —
��.�r� - .
.
�� � . . _ , , :, , _` - _