HomeMy WebLinkAbout16974 �� C1TY OF DIAMOND BAR I
� DEPARTMEM OF COMMUNITY&DEVELOPMENT S�RVICES
< �_,� 21825 E.Copley Lhive
(909)860-3195 Fax(909)861-3117 PRESS
��� BUILDING PER1111i'APPLICATION FIRMLY
d ADDRESS•�yy---1 1 � DATECATION c PERMIT q P/C 1 l
� _�J �NUMBEfi I `� p OI -�S�'
� APN _, LOT TRACT �SSUE TYPE OCC
� DATE ,� � CONST. GROUP
0o OWNER
ip ADDR $ � ZONING SETBACKS
FRONT �
� CITY _, IP TEL. REAR RW
APPLICANT TEL. ' p
� Sf�FJSfDE STREET py�/ �
� CONTRACTOR �[� �(�J SI�E p
ADDR S
� C�T�' ZIP TEL. PROPOSED USE X I
o ARCH/ENG/
� DESIGNER
ADDRESS NO.DWEL NO. NO.
tINITS STORIES
� CITY ZIP TEL. BEDROOMS
� DESCRIPTION SQ.Ff. FACTOq PSF ADJ.AREANALUATION
pC OWNER-BUILDER DECLARATI�N
O SFq/ADD/REM
1 NEREBY AFFlRAI UNpEF DENALTY OF DE0.JURV THAT 1 AM EXEM7T FROA1 THE CON7MCTORS LI• Ga�gg/CefpOK
W GENSEUWFORMEiDL10WINOREA50N(SEQ1fu1.58115WES5ANDPqOFE5510N5CODEANVCITVOR (/�
� COUNTYNMK]IREp�IRESAVERIAITTOCONSTRUCT,ALTER,RAPqpyE,OEMOLISH,OFREPAIRAryYSTRUG W patio/DeGc
TURE,PRIOR TO Rg ISSUANCE,ALSO qEpUIRES TNE MPLICANT FOR SUCH PERMIT TO FILE A SIGNED �
� STATEMEHf THAT HE OR SNE LS IICENSE�PUq5UM17 TO TNE VAOVI51045 OF TNE COMM�TOR9 Lt.
CENSE LAW(CIIAPTER Y(COMMENCIN6 MAhI SECTqN 7000)OF OIVISiON]OF THE BUS�NESS AND PRO- LL- PooUSpa
O iE5510N5CODE�ORTHATHEOR5HEI5E%EMPi7MEHEFROMMlDTHEBASISFORTHEAILEGEDE%EMP• (�
V TWN.ANYYqLAiIONpFSEG7fOH7o�t.6BYAHYAD➢�I�ANT[OR,{DERAfIiSU&IECTSTHEAGFLICANTTO Z AB•R00(
� A GVII FENA�TV OF NpT MORE 7HAN FIVE NUNDRED DOlURS(150DJ.):
� OI,ASONTJEROFTHEPROPERTV,OFYVEAAPLOVEESN'ITHWAGESASTNEINSOLECDMPENSATIDN, O COR7R18fC13I
Z WILL DO iHE WORK,IIJO TME STRUL7URE�S NOT IMENOED OR OfGEflED FOR SALE(SEC.70�1 BVSI- J
� NESSAND Pq�Ff55lON5 COpE:TNE COMMCT00.S LICENSE lAW�OES NOT�PPIY 70 AN OWNEH OF �
iROPEHTY MRq 8UL05 OR W PROVE4 TMEREON.ANO WHO OOES SUGH WORK HIMSELF Oq MERSELF OR
w THROUCHHISORNEROWNEM7LOYEES,OpOVIDEOTlUTSUQIIMPROVEMENTSMENOiINTEN�EDOR m
� OFFEREOfOq5�LE1F,IqWEyER7NEBUILD�N60i1tA/PROVEMQJ715501DWITMNONEVfAqOiCOM%.E-
z T10N.h1E OV/NER BUILDER N7LL HAYE iME BVPDEN OF YROVW O 7HA7 ME OR SNE D1D NOT BUILD OR
� QAPROYE FOR TME PURPOSE OF SALfJ.
uJ OI.ASOWNEqOFTHEPROPERTI;AME%LLUSNELYCONTMCTINOWITFIULENSEDCONTMCTORS
(r TO LON57R:/CT iNE YROJECT(SEC.76c.t,BUS1NE55 ANO DROiE5510N5 CODE:TNE�NTHAC70RS LI- VaNB(10� AOJ.AREA
� CENSELAWOOESNOTMp�YtOANONIJEROFAPROVERTYWFqBUILO50RIMPppYESTHEflCON,ANO
N'11000NTMCTSFORSUCH7ROJECTSWITHACONTMCTOR(S�LILENSEDPURSU.UVTTOTHELONTM6 Q�qM�7y DESCRIP710N FEE
� TOR3 UCENSELAW).
� ❑IAM E7cEMPT UNDER SEC. a
O B.6 P.C.FOq TN15 REASON
�'y U
� OATE OWNER �
U
�Q LICENSED CONTRACTOHS DECLAAATION W
[L I HEFEBY�FFIqM UNDER PENAITV OF 7E0.1URY iNAT IA4 LICENSED UN�ER PqOVI5qN5 OF CMAPTER �
p. Y(COMMENCPqWITMSECTION7000)OFDMSKKiJpfTHEBU51NE55ANOPROfESSiON CODf,AND Z
X IAY UCEHSE IS IN i�FORCE AN�EFFEC2 L�., .` � m
� LICENSE CU55 C� LIC.NO. v �
V �AiE��j�'�O J CONTRAC70R a
W
� WOAKERS'COMPENSATION DE ��� � a
N IHENEBYAFitRMUNDERPENAITYOfPEfWRYONEOFTHEFOLLOW�NGDECUlH�1TqN5: V
N Z
0 �IHAVEANOWILLMAINTAINACERTILICATEOFCONSENTTOSELF-INSUREfORVpqNERS' ¢
'� C0617ENSATqN,ASDROViDE�BYSECTION77000FTNEUHORCOOE.FOfiTHEPERFORMANCE U
Q OF TT1E WORK FOR WMIq1 TMIS PEflMIT 19155UE0. �
�I HAYE ANO WILL MAINtAM WOPXERS'GOMPENSATqH INSUHANCE,AS REOUIREO BV 5ECT10N
Q 77000FTHEVDOFiCODE.FORTHEPERFORMMICEOFn{EWORKiORNM111CN71115DEi1MIT15 .
� ISSUED.W ERS' AIPEN�iqNINSURANCECARqIERIINDDOIICYNUMBERARE: CONSTRUCTION � p U
> ��ER PLAN REVIEW
� POLICYNUMBER,,,i�� � ELECTRIC .
�
0 (iF�S5ECf10NrEmNOtBEO7�.iLFfEDOFhEPERMTSfOHONEF11f,OfiEDDOl1Mo(ii007diLi55} PLUMBING
Z I CENTIFV TMA7 PlTME PERFORMANCE OF TME WOWf FOR WMIpi iM15 FERMR IS I55UE0,l MECHANICAL
G7 SFIAILNOTEMPLOyANYpER50NNANYMANNENSOA5iO6EGOME5l1UJECTTOTME
(q N'OW(ERS'GOMPENSATqNLAWSOFCALIFORNIqANDAGREETNATIFI5F10UlOBECOME INSPECTIONFEE
SUB.IECT 10 7HE WORKEPS'[OMPENSATION GqOY!510N5 OF SECTION]]00 OF iHE Lt80fl
S coaE.�sn�uFoarNwm�corev�rwm�nrosevnohsarrs. ISSUANCE �
o �—
,p DATE: APPLICAM: SMIP e
� WAANIN6:FAILURETOSECUPEWDRNERS'COMPENSA710NCOVERAGEISUNUWFUI.IWDSMALLBE ENERGYP/C
�y„ SUBIECTPlIEMROYERTOCWMINALPENALTIESAIJ�CNILFWESUPtOONQNUNOREDTNOUSMID ENERGYPERMIT
JWLLARS(S 1 pp,p00�,W/,pDRION 70 7HE COST OF�OMPENSATqN,D/MAGES AS FROYIDED FOR IN �
SECTqNJ70EOfTHE1A80RCODE,INTEREST,MlDATTORNEY$FEES.
w RETENTION FEE:
� CONSTRUCTION LENDING ACENCY PRE-AL7 FEE:
� IHEAEBYAFFIRMUNDERPENALTYOFpERJURYTHATTH[REISACOHSTqVCi10NlENDIN�ACENCY
� FOA TMEDERCONMANCE OF 7NE WOAN FOH WHIp�7H�5 VEAAIIT IS�SSUED(SEC.]OD�,CN.CJ.
� 1
� LENDEit5NM/E
� LENDER'S�DDRESS
`/�y{��� / /�
� ICERTIFVTIATIMAVER[ADTMISMPLICATqNANOSTAIETNATTHEABOVEINFOR4AT10ry15fARPEGT. TOTAL FEES v -Q O \ `/�•�
IACREETOWMPL'lWITMALLCrtYANDCOUNTYORDINANCE3ANOSTATEUWSREUTINCTOBVILDMp � Lr(iJ
� CONSiRUCTqN,ANDHEqE6VAVTHOFIZEHEPRESENTAT1VE50FTH15COUNTy70ENTEflUPONiME
Z �POYE�MENTqNED PROPERTY FOR INSPECTION PURPOSES. �/
� t COMMENTS
�
�
¢ PE I E iNT) � �
N �
y SI NA UREOFPERMI i DAIE
� RECP7.NO. pAID BY V0.LIDATION
WFiITE—DeOertmenl Copy,YELLOW—Finance Copy,PINF(—Assessor Capy,GOLDENROD—File Copy,GREEN—Appl�eanl's Copy
/ y, ti:, i?'�r:�•.�r�.r; �k.-n..i�.�� ?4.�, .. �-�..�j.,•pn-`��.`•, .�'; :��'i.';f.'; . :'�.�,'.;:�.'., .r.�.� . , . ,. � .. x-.. .� ,., ;-� ,_... � ' . .. -., ... .. . .. „ �
l .. ` .
CITI•' OF DIAPJ]O��l� BAR
IPs�P�Gi'IU��1 F�'ECOF;D
� e� .� _�_ �____ i _�' c� e' i �c, c '
_,� __ _ - --`_'� �.._ � �-��_ �'�.
II_`��:���:'�I:Cu�1�� :c� �n: :I►��-`I.d��,'�" _�^--. _,(���i:�� `'a'1 li4V _ _.—___��..�W�1= ._'� �.._ `'t ���_
_.,
_�..---------=----- —--- - -- - - —_.._.__ .______. _ ___-_
SET BACK � I I FLOOR JOIST ! ,,� � ; � '. _
FTGS/FORMS/STEEL FHA REQMTS �
ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING i UNDER FLOOR CUP,iDWT • � -
SLAB GRADE FIREPLACE FOUNDATION ' ' •
TEMP POWER FIREPLA�CE BOND BEAM � �
WATER SERVICE MID HT. BOND BEAM _� ' � '
ROOF SHEATHING ' ` ' ' II FT. BOf4D BEAM I '
FRAMINGNENTILIATION _ ��/�j —ik`�v ' � FINAL BOhdD BEAM
ROOF COVER � PRE-GRADING
ROUGH HEATtNG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FEPdCING I
VVALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIdNS
SEl^JER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IP�IPS.
GAS AIR TEST FINAL ZONING
� FINAL CONST. . �Z FIRE DEPT. FINAL
FINAL HEATIPdG HEALTH DEPT. FINAL
FINAL ELECTRIC ����� DEV. FEES PAID
FINAL PLUMBING � ENERGY
� - - �3C�;CF ay]� '_Ir..c. ' . I . . \s . .
,_ ____..____ .
cor,nnnEr�-rs �
SEPTIC TANK SIZE
SEEP PlT/U SIZE
I w�
,��,�� �
� �
--�_'�_.��------�