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HomeMy WebLinkAbout17849 (17) �\ CITY OF DIAMOND BAR DEPAR'IMENT OF CONIIv1UNITY&DEVELOPMENT SERVICES � �.�c 21825 E.Copley Drive (909)860.3195 Fax(909)861-31 l7 PRESS ��'�� BUILDING PERMIT APPLICATION FIRMLY i; o ADDRIESS �U�d (J' S 1� �s� APPUCATIOJJ. 8� 7�_ PERMIT L P/C DATE �� NUMBER �t ' � APN LOT TRACT ISSUE 7yPE �C �;I p OWNER � �Q/ DATE CONST. GROUP !', o ADDRESS L ZONING SEfBACKS z CITY ZIP y�,�,"t TEL FRONT �� RW ❑ i i g APPLICANT _ TEL �/ REAR � SIDFJSIDESTRE RW ❑ Ii � CONTAACTOR SIDE o ADDRESS � o C�7y �/ Z�p E�,_ /�_ PROPOSED USE i i o ARCFVENG/ � DESIGNER � � ADDRESS UNITS E� NO. ,Z� NO. � C�Ty Z�P TEL STORIES BEDROOMS �� � OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION ',! p� OWNER-BUILDERDECLARATION O SFRlADD/REM 6� � p I HEREBYAFFIRM UNDER PENALTY OF PERJURY 7HAT 1 AM E%EGPT FROM THE CONTMCT00.S l4 Gef9 B/C8 � W CENSEUWfORTHEFOLLOWINOREA50N(SEF7071.68USPlE55MIDPROFE5510N5CO0E:ANVCRYOR (n 0 ��h ;I � COUHTYMMIGIPEOVIRESAPERMRiOCaNSiRUCT,ALTE0.MVROVE,DEMOLISH.ORpEDuqANVSTqUC W PatidDeck TURE PRqR TO RS LSSUANCE,ALSO REOUIqES TME APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W O� �.. � STATEYENT THAT ME OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF TNE CONTMCTOHS l4 CENSEUW�CHAPTERO�CqAMENCINOWITHSECT10N70D0)OFDIYISION]OFTHEBUSINESSANDPRO. V' POOVSw7 � � FESSqNSCOOE�ORTHATHEOR5HEI5EXEMPTiHEREFROMANDTMEBASiSFORiMEALIECiEDEJ(EMP- C7 TION.ANYVIOLATIONOFSECTION7071.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLMJWTTO Z Re-Roo1 �, � AGMLPENALT/OfNOTMORE7MANFIVENUNOREDDOLIARS(f500).�: ; � ❑47150wNEROFTNE7ROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSAi10N, ❑ COrtIrtI0ICi21 .•Z WILL DO THE WORK,AND THE STRUCiURE IS NOT INTENDED OR OFFEREU FOR SAIE(SEQ 7a�,BU51- J � :, � NE55 AND 7HOFESSION3 CODE TME CONTqACTOqS LICENSE Uw DOES NOTAOVLY TO AN OWNER OF ? � PROPERTYNAqBU4D50RUAPROVESTNERfON.ANOWHODOESSUCMVIORKNIMSELFORHERSELfOR � [L 7HROWHHISOi1NERONTlEMPLOVEES,PROViOECTHA75Up11MPROVEMEMSARENOTINTENOE�OR m I � OFFEREOWRSALE.F,I/OWEVER7HEBNlDIN60R41GqOVEMEML550tDWIT1aNONEYEAROFCOMaLE- � ;Z 710N,THE OWNER-BUILDER 1MLL MAVE Tl�E BUROEN OF PROVIN6 TMAT XE OR SHE DID NOT BUILD OR i= MPROVEFONTMEGURVO6EOF5ALE} ❑1.l45 OWNER OF THE PROPERTY,AA1 E%LLUSNELY COMRACT7J0 VATH LICENSED CONiRACTOtIS I� TO CONSTRUCT THE PR0.IECT(SEG 70N.BUSINESS 1WD PROFESSION9 CODE:hIE CON7MCTORS LI- V01UeS10f1 ADJ.AREA ;L11 CENSELAWOOESNOTAPPLYTOANOWNEROFAPqOPERTYWHOBUItDSORWPROVESTHEREON,AND �� N1qCONTRACTSFOR5Ud/GR0.1ECT4NnTHACONTRACTOR(5)LICENSEDPURSUIWTTOTHECONTMG QUANTITY DESCRIPTION ;� TORSIICENSEUW.�. . FEE � DIAMEXEMPTUNOERSEG J 0 B.6 P.G FOR THIS REASOfI .Q �'y U i - i�=' DATE � Z owraEA V �sF[ LICENSEDCOMRACTORSDECUTAATION w - i[t IHEREBYAFfliUIUNDERPENAL7YOFPERIURYTMATIAMLICENSE�UNDERPRON510N50FCHAVTER � �� �(COMMENqNONAM5ECT10NT00o�OFqVISqN�OFTHEBU51NE55ANDPROFE5510NSCODE,AND Z ��� W UCENSE IS N FULL FOPCE ANO EFiECT. m '_0 UCENSE CLASS � IIC.NO.�'3 � '��j DATE � ��003 CONiMCTOR � a W '� WOfiKERS'COMPENSATION DECLARATION � 'N IHEF�FIRMUNDEROENALTVOFVER1URVdJEOFTHEiOLLOMANCDECUHA7qN5: V �N Z •0 IHAVEANDNILLMAINTAWIICERTIFICATEOFCONSENTTOSELF�NSUREfORWORKERS' „7d- COMFENSATqN,ASCROYNEDBV5ECT10N77000FTHEUBORCODE,fORTNEPERFORMANCE U �I O OF iHE N'ORK FOR WHICH iH15 VERMIT IS ISSUED. � � _IHAVEANDNALLUAINTAINWORKERS'COMPENSAiqNINSUMNGEASRE0U1RED8Y5ECTpN �0 i70o OF 1HE LABOR COOE,FOR 7T7E PEHFORMANCE OF THE WORK FOR WHICH THIS pERMIT 15 � ISSUED.MY WORKER$�IAPE�ION INS CE CARHIER AND VOIICY NUMBER ARE: CONSTRUCTION I�j CARRIER v NI� PU1N REVIEW � �,�� POLICYNUMBER � ELECTRIC �c '0 (n+ssecrcNr�w7eemn�tFrEooFnfvE�r,rrscar�ave�mp�uutsRirofOatEssl PLUM6ING iZ ICERTIFVTHATINTHEPERFOfUAANCEOFT1EWOqKiORWHICNTNi50EfUAITI5155UED,1 MECHANICAL �CJ SHALL NOT Eu7LOV ANV PERSON Ml ANV MANNER 50 AS TO BECOME SUBJECT TOTHE I(q WORI(ERS'COIdPENSATqNUW50FCAlIFORNIA,MJOA6REETHATIFISHOULDBECOME INSPECTIONFEE �� SUBJECTTO THE WOPo(ERS'COMPENSATION PRONSIONS OF SECTqN 77000F TME LABOR ^ / COOE,ISHNIFOHTHN7MCOMPLYWIMTqSEPiqVI510N5. ISSUANCE ` �y � � i 0 ��'p DATE; APPLICANL SMIP I� WARNINO:FARUPETOSECUREVJOHKfRS'COIdPENSAtqNCOVERA�EISUNUN'FUL,ANOSWLLLBE ENERGVP/C !} SU6IECTANEMPLOYERTOGUMiW1LPENALTIE3ANDCMLfWESUPTOONEM1N0aEDiMOUSAND ENERGYPERM�T DOlLM3(iloo,oOD).N+10DITIONTOTMECOSTOFCOMPENSATpN,DAM�GE5115PRDVIDEDFORW �.J SECTION070lOFTNEUBORWDE,�NTEREST,ANOATTORNEY5FEE4. � I� RETENTION FEE: O CONSTRUCTION LEND�NG AGENCY PRE-ALT FEE: ,� I HEREBV AFflRM UNDER PENAL7Y OF VERMiY T11�T iHERE IS ACONSTRULTION LENDINO AGENCY iZ FOR TME PERFORMANCE OF TXE WORN FOR WHlpl THIS PERMIT IS ISSUED(SEC.�a97,qV.C.�, �W ,'� LENDER'SWWE � �� LEN�ER'SADDRESS iw ICER71fYTNATIYI�VEREADTHISAPVUCATIONANOSTATETHATTHEABOVENIFOFUqTqNISCORRECT. TOTALFEES / id IAGREETOCOMPLYN77HILLC/TYANDCOUNTYOROINMlCESANDSUTELAWSRELATWfITOBU0.�IN6 CONSTRUCTION.ANDHEREOVAUTHORREREPRESENTATIVESOFTHISCOUNTVTOENTERUVONTHE � � jZ /�BOVE•YENTIONEDPibOPEHiVFORINSPECTIONVURPOSES. COMMENTS I� �f�f�� I m ERAIITTEENAME �( / �{J� w I(n SIGNATUREOFPERMITfEE ATE �� RECPT.N0. PAID BY � VALIDATION . WHITE-0epartmenl Copy.YELLOW—Finance Copy,PINK—Assessa Copy,GOIDENFOD—Fi1e Copy,GREEN—ApplicanYs Copy . ._ ;.t.> ��,� . ,: �t,� ,.. rs; w� r+>. • •r.��:��.«� r; � c': � ;r;�:,�+ �G • Y' �J"�t..A.. .Y ' t � �- . .. . .� a 11, 'i,. •�� � ..;.Y t^.i"��i ".d- �ti«.�, ,� r Y'i"!crA!•e�—t�.�'1e"�wt'.y -tr:.. • -•.t -r.. `� � CIT?� �F DIAtJiO1�D BAR - , . it�S�PE�:"iC�Pd RE�COF�J : � � _. .�. ... y , � y :y ':�i�1.�-����.�,a..�l.� . ...._ '���1,�, a,�►��-�i��.E3'E���� . 11� ����.�`r�b�+� o���.l�� '.�Y�-�.��ra — -�..__.��_ _�.___.... ._..,.,..�...._ ........�.. _._...._._.. __._�._,._...,._.._._ _ _ W.� __._�_ _y. •_ . 5ET BACK 14 .. � FLOOR JOIST • I • FTGS/FORMSISTEEL I FHA REQMTS ELECTR►C GAOUND � UPJOEFi FLQOR DUC� . • GROUND PLUMBING I UPdDER FLOOR'CUf�IDUIT - SLAB GRADE � I �FIREPLACE FOUNDATI�N • ' TEMP POWER I - I FIREPLACE BOND BEAM WATER SERVICE - I MID HT.BOND BEAM ROOF SHEATHING I 8 FG BOND BEAM FRAMINGNENTILIATION ' FINAL BOND BEAM ROOF COVER I PRE-GRADING ! ROUGH HEATING BENCHING I ROUGH ELECTRIC I ROUGH GRADING ROUGH PLUMBING � FINISH GRADING SH�WEH/TUB TEST ; i POOL ELECTRIC EXT.LATH/SI�ING � P�OL FENCING WALL INSULATION � POOL FINAL I CEILING IN�ULATION j OFF SITE IMPS. DRYWALI NAILING I � j DEDICATIONS SEWER. ( � FINAI.ENG. SEP71C TANK j LANDSCAPE/IRRIG. SEEP PITlL.L. I � ON SITE IMPS. GAS AIR TEST � ; � FINAL ZONING FINAL CONST. �' , I � : �!RE DEPT. FINA� FINAL HEATING I �_ � HEALTH DEPT. FINA� FINAL ELECTRIC '^�J��"�••"`S`���-�.'��i I DEV. FEES PAID FINAL PLUMBING � � � ; � � ENERGY � I � � ` �•l,c���� ���Q""tc �°,:. , � � � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE _ i�� . I ��r�r� '�� � ; .. , .....___ '� - :�..�.___., . . ` , _