HomeMy WebLinkAbout16414 _��\ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES EXP�RED
21660 E.Copley Drive Suitc 190
(909)860-3195 Fau(909)861-3117 APR 2,5 2�3 PRESS
���^'� BUILDING PERMTT APPLICATION . FIRMLY
} JOBSITE ry n �� APPLICATION���D,�Q J PERMfT�/^ � P/C
o ADDRESS �'f���C �l'GDQ� DATE f NUMBE �EJ p
� ISSUE TYPE OCC
APN LOT �TRACT DATE CONST. GROUP'
p OWNER I �7^��1 f
� ADDRES o�1. ' C� • ZONING SETBACKS
Z CITY �� ZIP 9�� TEL. - � FRONT RW ❑
g APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE p
q� ADDRESS PROPOSED USE
� CITY ZIP TEL.
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAAATION SFR/ADD/REM
O
8 1 HEREBV AFFIiM UNDER PENPLT'OF PERJUFiV THAT I MI E%EMPT FROM THE COMRACTORS LI� G8f9QB/C9fpOR
� CENSELAWFORTHEFOLLOWMOREASON(SEC.7031.6BUSMESSANDPROFESSqNSCAOE:ANVqTYOR (n
COIMTYVAiK]iREODUiESAPERAIRTOCONSTRUCT,ALTER�MPpOVE,DEMOLISH,ORREPAIRMlYSTRUG W P8f10/DBCI(
TURE,PRqR TO ITS ISSUANCE,ALSO REIX11RE5 THE APPIICANT fOR SUCN PERMI7 70 FlLE A SIONED w
� STATEMENT 7}L1T HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOR3 LF � .
� CENSE UW(CHAPTER G(COMMENCWO WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS IND PR0. PooUSpa .
FESSqNSCOD�ORTHATHEOR3HEISIXEAIPTTHEREFROMANDTHEBASISFORTHEALLEQEDE%EMP- (�
TION.AM'VIOlAT10NOFSECTION7031.6BYANVMPLICANTFORAPEqMITSU&IECTSTHEMPLICANTTO Z Re-Roof
� A CML PENALTY OF NOT MORE hIAN FNE MUNDREO DOLLARS(i60D)J:
� ❑I,A60WNEROfTHEPROPERTY,ORMVEMPLOVEESWITHWAQESASTHEIR50LECOMPENSA710N, � COmmBfCl81 � ' �
MALL DO THE WOPo(AND THE STRUCfUfiE IS NOT IMENDED OR OFFERED f-0R S�LE(SEC.7W4,BUSI- J
NESS AHD PqOFE591qJ3 CODE:THE CONTMCTOR9 LICENSE Uw DOES NO7 APPLV TO AN OWNER OF
� PNOPERTYVM1iOBU4D50RIMPROVESTMEREON,ANDW110DOESSUCHMIORKHIMSELFORMERSELFOR � '
� 7HROUGH HIS OR HER OWN E1IPLOVEES,PROVIDED THAT SIX:H IMPROVEMENTS ME NOT INTENDED OR m
OFFHim PDR SALE IF.HOWEVER n1E BUILDBIOOR IMPROVEMFNT I$SOLD WfTHIN ONE YEAR OFCOMRE-
Z �'TION,THE OWNER-BUIIDER WILL HAVE 7HE BURDEN OF PROVPIO THAT HE OR SME DID NO7 BUILD OR
� MPROVE FOR TNE PURPOSE Of SALEI. .
❑4��N�NER OF iHE PROPEHTV,M1 EJ(CIUSNELY CONTRACT W O WITH LICENSEo 001lTRAC70R3
� TO COHSTRUC'f TNE PRQIEC7(SEC.70M,BUSINESS IND PROFESSIONS CODE:iHE CONTRACTORS LI- V81UetI0f1 ADJ.AREA
W CENgEUWDOE5NO7APPLVTOMIOWNEROFAPROPERTYW/10BUILD90RIMPROVESTHEHEOH,AND
� M?7000NTRACT6FORSUCHPRQIECTSWITHACOHTRAC70R(S)UCENSEDPURSUAHT70iHECONTRAG QUANTITY DESCRIPTION �E .
TORS LJCENSE UW.).
� �DlEA1PT UNDER SEC. B.8 P.C.FOR THIS REASON �O O /K s�-'f(1IC e Q�
3 �
� DATE—i-�r�0^- OI OWNE -� ¢
O � W
F LICENSED CONTRACTORS RATION w -
� 1 HEREBV AFFWM UNDER PENALTV OF PEfUURY THAT I AM LICENSED UN�ER PROVIS S OF CHAPTER .
(� Y(COAOAENCWO WITH SECTION 700D)OF ONISION 7 OF THE BUSIHESS AND PROFESSIONS CODE,AND �
X, MV LICENSE IS Pl FUIL FOHCE MW EFFECT. m
Llt
� UCENSE CLASS LIC.NQ � �
U DATE CONTRACTOR a ,
LL
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFlqM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWINO DECLARATIONS: Z
� _I NAVE AMD WILL MAMTAIN A CEfiTIFlCATE OF CONSENT TO SELF-INSURE FOR NqRKERS' a ,
S
COMPENSATqN,AS PROVIDED BV SECTION 3]00 OF THE LABOR COOE,FOF THE PERf-0RMANCE U
Q. OF 7HE WORI(FOR WHlpl TM45 PERMR 19 ISSUED. �
_I HAVE AND WILL MAIMNN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ^� 1•��y-�'�I
Q 37000F THE LABOR COOE,FOR TME PERFOfiMANCE OF THE WOPo(FOR WHICH THIS PERMIT IS ' � " " � r
ISSUED.MY YfORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ME CONSTRUCTION n
� c�w+iER PLAN REVIEW LCI`1 !
�Z POLICYNl1MBER ELECTRIC !
Q
p'. (nassEcrbr+r�IDr�oTeEm.wtFTmoFn�a�ar.iTs�aor�Mroi+moounas(siaoloa�. PLUMBING �
Z �CEHTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHlpi THIS PERMIT IS ISSUED,I MECHANICAL - -^�
(} SWLLL NOT EMP�Ov ANV PERSON IN ANY MANNER 50 AS 70 9ECOME SUBJEC7 TO THE
(n WORKERS COMVENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHIXILD BECOME INSPECTION FEE
S SU&IECT TO THE WORKERS'COMPENSATION PROVISbNS OF SECTqN 3700 OF THE LABOR
cooe,i sHu.�Foanavnn�coMv�r vnn�n�wsE Pao�siows. ISSUANCE
O
p DATE: � APPLICANT. �SMIP �
W
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECT AN EMPLOVER TO CRIM WAL PENALTIES AND CML FINES UP TO ONE HUNORED T}KK15ANO ENERGY PERMIT
DOLURS(i100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 370e Of 7HE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
Q RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PFE-ALT FEE: '
� I MEREBV AFFIRM UNOER PENALTV OF PERIURY THAT THERE IS ACONSTRUCTION IENDWO ADENCV . ' - . - ..
Z FOH THE PERWRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). ,
W
� LENDER'SNAME '� � . - � '
� LENDER'SADDRESS �
� 1 CERTIFV THAT 1 HAVE READ THIS MPLICATqN AND STATE THAT TiE ABOVE WFORMATION IS CORAECT. TOTAL FE ES ' �� � ���
� I AOREE TO CAA/PLV N7TH PLl CITY AND COUNTV ORDINANCES MID STATE lAWS RELA71N0 TO BUILDINO ' �
� fANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF h115 COl1N7V TO ENTER UPON THE ' ' � � '
Z ABOVE-MENTIONED VROFERTV FOR INSPECTqN PURPOSES. , . , . .
COMMENTS
0 _
J
�
m VERMf7TEENAMElP ' , ' � � . .
� ' ! / .. . ':. ' ' ;..1„' �..
s L
Uj 10 EOFPER DATE RECPT.NO. p.n_ingy �✓ L � VALIDATION �-
� WHITE—Dep ent Copy,YELLOW�Inance Copy,PINK—Assessor Copy,GOLDENRO�FlIe Copy,GREEN—ApplicanYs Copy
Cil'V O� C�IA61�0t�1[� �A�
. �����`�`;�' OfVSPECT9�� F�EC�9�D
"'�li` ;� ic("
,
, ` � ��,` ,., p ; �c s � � . ;� '. '�.•,�;�Lr' .�� }�i.,.� �' .�.� B . s_ o �-�:,.
... „
. . � � ' O
'' � F' '_'>.
SET BACK ' � � FLOQR JOIST
FTGS/FORMS/STEEL FNA REG�MTS ' � �
ELEC7RIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CUt�IDUIT '
SLAB GRAQE FIREPLACE FOUNDATION �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. B�ND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMiNGNENT(LIATION FINAL BOND BEAM
ROOF COVER PFiE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRlC ROUGH GRADING
ROUGH PLUNiBING FINISH GRADING ~
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEIUNG INSULATION OFF S1TE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTiC TANK LANDSCAPE/IRRIG.
SEEP PIULL. ON SITE IMPS. i
GAS AIR l'EST FINAI ZONING
FINAL GONST. � FiRE DEPT. FINAL �
F1NAL HEATING - HEALTH DEPT. FINAL
FiNAL ELECTRIC DEV. �EES PAID
i�1tJAL PLUMBING ENERGY �
.a ,.� .� � .� �.__—__ �_�
•a -�,„ ,�o�„
COf�IMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE —
�.z,� � � , >
�'���-+�� �.����.�,�.,; � � � � ____
,�'��",��`��,��� �. ._.______
� �'r
4,�,��'�'`�,�"� . �,'2�`�c� �'�,; —
sr• �`"���� i �'"�-��?�.
i��"�*'dC�"�Y��«3�'a�
� ���'���d�'K%�' - ____��__._._
-�- s�,
��������
��; �+ - ---___
a� �� y
.'; �.',,�,�_
5, �'�_��..fi{�����.`� �.._�
t iyl.y'���! , , �W� .Z�l��,• � , ' � '