HomeMy WebLinkAbout16794 (17) J� CITY OF DIAMOND BAR
� ,i DEPARTMENT OF COMMUNITY 8c DEVEIAPMENT SERVICES EXPIRED
� ��� 21825 E.Copley Drive
(909)860-3195Fax(9�9)861-3117 �UN 1H ZOO2 PRESS
`��� BUILDING PERMIT APPLICATION FIRMLY
o ADDRESS 2.3�SS ,QCGp�^p!j �p� APPLICATION�� 1��l NUMBEF�� �� k�
DATE
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
o ADDRE S � �SS f��I��j �� ZONING SETBACKS
z CITY � ZIP�EL. LD 7"1� FRONT RW O
g APPLICANT TEL. REAR ❑
� SIDElSIDE STREEi RW O
� CONTRACTOR I � C SIDE ❑
� ADDRE�SS PROPOSED USE �
� CITYrY L ZIP�1. TEL.
Pa� ARCH/ENG/
�� DESIGNER
ADDRESS NO.DWEL. NO. NO.
� CITY Z�p TE� UNITS STORIES BEDROOMS
�
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER�ECLARATION SFRlADD/REM
O
1 HEREBY AFFIRM UNDER GENAITY OF PEiWRY THAT I M1 E%EMPT FROM iHE CONTMCTORS LI• G8f8gB/C81pOR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.70.71.58USINESSANDPROFESSIONSCODE:MIYpTVOR (/�
U COUHTYWHIp1RE0UIRE5APERMI7TOCON57RUCT,ALTERIMPROVE.OEMOLISN.ORRE7AIRANYSTRUC• uf
W N0.E,iRIOR TO tTS ISSUANCE,ASO REWIRES THE AGiLICANT FOR SUCH PEHMiT TO FILE A SIGNED W PdtiOIDBCk
STATEMEM THAT HE OR SME IS LICENSED VUFSUiWT TO THE PflOVISiONS OF TNE CONTHACTORS LI•
� CENSE UW(CHAPiER Y(QOMMENqNO WITH SECTION 70001 OF OIVIS�ON�Df THE BUSINESS AND PRO• LL' PooUSpa
FESSIONSCOD�ORTNATHEORSNEISE%EYPTTHEREFRpAANDTMEBASISFOfiTHEALIEGEDE%E4P• (�
710N.ANVVIOIATIONOFSECTIONto71.6BYANYMPLICANifORAGENAiTSU&IECTSTHEAPPLICM17T0 Z Re-Roof
A CML PENALTY OF�JOT MORE iNAN FNE HUNORED DOLURS(f 500�.):
0 ❑4ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITMWACESASiHEIRSOIECOMPENSATqN, � �mmercial -
Z WILL00 THE WORK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7M�,BUSI� J
N NESS AND VROFESSIONS COOE:TME CONTMCTORS LICENSE UW DOES NOT APPI�TO AN OriNEq OF �
FROPEKTY NTO BUILOS ON MPqOVES THEREON,ANO NTfO DOES SUCM WORK HIMSELF OH MERSELF OR
Q iHROl7CHHI50RMERONMEMPLOYEES,PROVIDEDTHATSUp11MPROVEAIENTSARENOTMTENDEDOR m
W OFFEREDFORSALEIF.IIOWEVE0.TMEBUILDINOORIMDqOYEMENTISSOIDN'ITHINONEYEAROFCOMPLE
� 710N,THE OWNER�BURDER NALL HAVE THE BUROEN OF PROVINU TMAT HE OR SHE DID NOT BUIID OH
Z 14PROVEFORTNECURPOSEOFS�LE4
= OL���EROFTIEPROVERTY,AAIEXCLUSNELYCOMNACTNGYATHLICENSEDCONTRACTOHS
W
Q TO CONSTRUCT THE PRQIECT(SEG 70N,BUSWE55 N!0 PROFESSIONS CODE:THE CONTMCTORS LI- VdIU8110f1 ADJ.AREA
W CENSEUWDOESNOTAP7LYTOMlOWNEROFAPROPEflT/WMOBUM1DSORIMPROYESTMEREON,AND
F�• WFIOCOMMCTSFORSUdiVRQIECTSNnTHACANTMCiOR(S�UCENSEDPURSUANTTOTV/ECONTMG QUANTITY DESCRIPTION FEE
� TORSLICENSELAW.).
0 ❑IMIIXEMPTUNDERSEG B.IP.C.FORTHISREA50N U
� �
LL' DATE OWNER V
Z W
¢ UCENSED CONTRACTORS DECLARATION W
OC IHEREBYAFFlRAIUNDERPENALTYOFGERIURYMATIAMLICENSEOUNDERPRONSqN50FCMAPTER �
a 9(COMMENCINOWIiMSELTION)OOO�OFOIVISION70FTMEBUSINESSIWOPROFESSIONSCOOE,AND Z
X MY LICENSE IS W fULL FORCEAND EFFECT.
�� u��,SE�Uss c— ��.No. 64 238 _ �
V OATE B� corrtrucro a
w
� WORKERS'COMPENSATION DECLARATION Q a a u
� IHEREBYAFFIRMUNDERPENALTYOFVERNRYONEOFTHEiOLLOWIN(iDECURAT10N5: Z / 0e �
� _IHAVEANDWILLMNNTAINACERTIFICATEOFCONSEMTOSELF-INSURE�ORN+DRNERS' _
CdAPENSATqN,ASPROVIDEDBY5ECT10N�70oOFTHELA80RCO0E.FORTHEGERFORMANCE W
OF TME WORK FOR WNICM THIS GERMIT IS ISSUED. �
0
W �,IIUVEANDNALLMAIMAINWORKERS'CdAPEYSATbNINSURANCE,ASflEWIREDBYSECTqN
Q 77000FTNELABORCODE,LORTHECERFORMANCEOFTHEWORKFORWMIpITHISVERY1T15
65UED.MYWORHERS'COMPENSATqNINSURANCEURRi RANDPOIICYNUMBERARE: CONSTRUCTION
jCARRIER �i� �� �n PLAN REVIEW
� POLICYNVAIBER . JCAII�VU ELECTRIC
o �nessEcnor+rgmwreem.��noFnfvEwarrsropa���oouuua�ro�oR�ssl PLUMBING i
Z ICERitFYiNATPiTNEPERFORMhNCEOfTHEWONCFORNT9CHTHISPERIARISISSUED,I MECHANIC I
C7 SHALLNOT EMPLOYANY iER50N W ANY MANNER SOAS TO BECOME SUBJECT TO THE ��
(n N"ORKERS'COMPENSATiON UWS OF CALIFOHNI/�AND IIGREE THAT IF I SHOULD BECOME I TION FEE
S SU9JEC�TO TF1E WORKERS'C01.�PENSATION FHOVISIONS OF SECTION 7700 OF 7NE UBOR ,
CAOE,1 SHALL FORTMMTH COMPLV WITf TFqSE VROVISIONS. ISSUANCE
O '��roL /A' L
p DATE:!!_� APPLICANT: SMIP
/
,.Wj • ENERGY P/C
J WARNIN6:F�ILURE TO SECURE WORNERS'LOAIPENS�TION GOVEMGE IS UNLAWFUL,AND SH/�LLBE
�y„ SUNEC�ANEMPLOYERTOCHIMINALPENALTIESIWDCMLFWESUPTOONEMUNOREDTHOUSANO ENERGYPERMIT �
DOLUf35(f100.000�,IN ADDITION TO THE COST OF COMCENSATION.DAAIAGES AS PROViDEO FOH IN
� SECf10Na7oeOFiHEUBORCOOE.INTEREST.ANOATTORNEYSFEES. RETENTIONFEE:
a CONSTHUCTION LENDING AGENCY PRE-ALT FEE:
O
� INEREBVAFGIRMUNOEHPEN�LTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY
Z FOR iHE PERFORMANCE OF iHE WORK FOfl N71K�M THR PERMITIS ISSUEO(SEC.7097.CIV.C.).
W
� LENDERSNAME
� LFNOER'SADDRESS
� TOTAL FEES („7� lj�
� I CERTIFY T11AT I HAVE READ THIS APPLICATION ANO STATE TNAT THE ABOVE W FOHMATION IS CORRECT.
� IAGREETOCOMPLYWRMALLCITYIWOCWNTYOROINANCESANDSTATfU'NSRELATIN6TOBUILDINO
LONSTRUCTION,ANU HEREBY AUTHORRE REPRESENTATIVES OF THIS CWNTY TO ENTEH UPON THE ,��/
Z ABOVE-MENTIDNEDGROPENiVFORINSPECTIONPURPOSES. COMMENTS
� 5L61�I/� C. l�d��i�
QPERMI7TEEWWE(PRI �
� ' :
(rj VH Of P ITT E DAT
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assesso�Copy,GOLDENROD—File Copy.GREEN�Applicanl'm Copy
� � � �...;�...,... ....�.•r : .�-:.' '_�n...-.-.,....._....., ,�.....�.�,.. _"___.L.__". _.Y5'^'.. -,1xW^�. .�-.Y,r. ..w ._'.- .�„ � r.l,' .�: .. j, . .' �,'. . .. , . '.. . n. .,•.7-s
��I i� �J� ���,P�oiti� B��'e�
IPv�P�C"i IOP� [�ECC7R�
�.____.___�_ .�__
' _�_._____.____ _ �q I��� ; _ ., _ .� _
_�..__
_ _ _ _
1►+k-'�� =�,`4'C���m �} � "_ ���k-`f a.���. �'�� -� � ,��c-;[o'�� el,�ti�'� I��}.�t� �c t�����
----_...__.__-.-- ---.-- .,..._.. ._. _ ___ _--- ,----.. _._ ._ ... _._------_.___�..__.________ I__ ---___._ ___________________.__--.--
SET BACK _ I _ _� � FLOOR JOIST � . ' , ; ' �
FTGS/FORMSlSTEEL � FHA REQMTS
ELECTRIC GROUND j UNDER FLOOR DUCT {� �
GROUND PLUMBING UfdDER FLOOR CUP�IDUIT - I .� � '
SLAB GRADE FIREPLACE FOUNDATION '" ' �
TEMP POWER I � I FIREPLACE BOP�D 6EAM
WATER SERVICE I I MID HT. BOND BEArJI� '
ROOF SHEATHING '' � ' • ' � £3 FT'.BONC�6EAPA .• . ' � • � .
FFiAMINGNENTILIATIOPJ � FINAL E30ND BEAh4
ROOF COVER PRE-GRADING I
ROUGH HEATING BENCHING I
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUh4BRJG I i FI�11SH GRADING
SHOWERRUB TEST j POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAI
CEILING IN�ULATION OFF 51TE IMPS.
DRYWALL NAILING � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK L.�NDSCAPE/IRRIG.
SEEP PIT/L.L. OfJ SITE IMPS.
GAS AIR TEST FINAL ZONING -
FINAL CONST. F1RE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
.',j's:+!'" sl.�CI,.�'� 4_�.�__
. . _ .. - -- - - - ..
coMnnEr�-rs . � . � �.
�
, . _
SEPTIC TANK SIZE
SEEP PITIU SIZE
,'�� ---,
�
�;��+� ;a
� . ; ,
. . �
, , .
_ _.___. . ----..__ _____._____, � '