HomeMy WebLinkAbout17849 (19) �\ 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� '��
�
; ..
,
.....___ '� - :�..�.___., . . ` , _