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HomeMy WebLinkAbout17289 • J� CITY OF DIAMOND BAR DEPARTMENT OF COIvIIvtUNI7Y&DEVELOPI�NT SERVICES EXPIRED 2I825 E.Coplcy Drive '�" (909)860.3195Fax(909)861-3117 �UN 1�I ?OOZ PRESS ��''�� BUILDING PERMITAPPLICATION FIRMLY oN JOBSITE 1�3►-� �ee D ADDRESS �I��� /L3 DATE CATI �Z7,��� NUMB R �� N,C $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER o ADDRES ZONING SETBACKS FRONT RW ❑ Z CITY � � IP � TEL. — REAR g APPLICANT TEL. SIDE/SIDE STREET RW O � CONTRACTOR ���a'►t e+n .%+— a SIDE ❑ ADDRESS � CITY 21P TEL. PROPOSED USE � �'�P 1 o ARCH/ENG/ , z DESIGNER w NO.DWEL NO. NO. � ADDAESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUIL�ER DECLARATION SFfi/ADDlREM O I HEFEBY AFflRM UNDER PENPLTY OF GERJURY TiU7 I AM EXEMPT FROM THE CONTMCTORS L4 GaragelCarport W CENSEUWFORTNEFOLLOWIN(iREASON(SEC.70Jt.68U51NE5SAN�PROFE55lON5CO0E:MlYCRYOR (n U COUNTYMMICMREOUIRESAPERMITTOCONSTRUCT,ALTER�PROVE.DEIAOLISN,DRREPAIRINVSTRUG W P3110/D9Ck � TURE.VRIDN TO ITS ISSUMlCE,ALSO REOUIRES THE APPLICANT FOR SUpf VERMIT TO FILE A SiGNED w � STATEMENT THAT HE OR SHE IS t10EN5ED PURSUANT TO THE VROVISIONS DF THE CONTRAC70i1S L4 � .� CENSE UW(CHAPTER 0(COMMENCWO WITH SECTION 7000)OF DMSION]OF THE BUSINESS AND VR0. PaoVSpa � fE5S10N5COO�ORMA7HEOqSNE�SE%EMPTTHEREFH0IAANDTHEBASISFORiHEALLE0EDE7(EMP- C7 V TION.ANYVIOUTIONOFSECTION7WI.SBVANVAPPLICAHTFOHAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � ACIVILFENALTYOFNOTIAOqETHANFIVEMUNDRED�OLIAHS(f500).�: � ❑I,ASOWNEROFTMEPNOPERTY,Oi1MYEMPLOVEESNATNWAGE5A5TNEIRSOLECAMPENSATqN, COTTBfCi81 � 1MLL DO TME WORK,Ml�iHE STRUCTURE IS NO7 INrENDEO OR OFFEREO FOR SALE(SEC.701�,BU51• O N NE55 AND PROFESSIONS CODE:TME CON7nACfORS LICENSF lAW DOES NO7 APPLV TO AN OWNER OF ? VROPERiY NRiO BUILOS OR IMPROVES THEREON.AND VhiO DOES SUCH WOFK NIMSELF OR HERSELF OR wTHROUGHHISORHEFOWNEMPLOYEES,VROVIDEDT/UTSUd1ilAPROYEMENTSARENOTINTENDED�R m p OFFEREDiORSALEF,MOWEVERi1�EBUIL�INOORIMPROVEMENTI55IXDYATF9NDNEYEAROFCqAPLE- z TION.THE OWNER�fiUILDER WILL HAVE THE BURDEN OF VROVWa hUT HE OR SHE DIO NOT BUIID OR � WPROVE iORTHE FURGOSE OF SALE�. W O1�50NMEROFiNE0R07ERTV,AME%CLUSNELYCANTMCTINCWITMUCENSEDCONTMCTORS [t TO CONSTRUCT THE PROJECT(SEG)Oa�,BUSME55 AND PipFE5510N5 CODE:THE CONTMCTORS LI• V8IU3lI0f1 `� ��� ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAFROPERTYYRIOBUILDSORIMPROVEgT1fERE0N,AND � WIqCONTMCTSFONSUCFiPR0.1ECTSWRMACONTRACTOR(5)UCENSEDiURSUANTTOTMEWNTMF QUANTITY DESCRIPTION FEE Y 70RSUGENSEUw.). � O 1 AM IXEMPT UNDER SEG B.�P.G FOR THIS REASON Q � U LL" DATE OWNEH f- O W � �ICENSED CONTRACTORS DECLARATION W � INEREBYAFFIRMUNDERPENALttOFPERNRYTMATIAMUCENSEDUNDERFROV1510N50FC1UP7ER � p� f(COMMENCINC3WIT115ECTqN7000)OFDIV�SION70FTHEBUSINESSANOPROFESSIONSCODE,ANO Z X MY UCENSE IS N Ml FORCE AND EFFECT. �f' � LICENSECUSS _UC.NO.��/�� />�,T�h��� j V DATE��� � CONTMCTOR d W � WORKERS'COMPC-NSATION DECLARATION d � INEREBYAFFlRMUNDERPENALTYOFPE0.)URYONEOF7HEFOLLOWINGDECUMTpNS: Z � _IHAVEANDWILLMAINTAINACEqTIFlCATEOFCONSENTTOSEIF-INSUREFORWORNERS' _ COMPENSATION,ASCROVIDEDBv5ECT10N]7ooOFTHEUIBORCODE,FOHTMECERFORMANCE W Q OF7HEWONKFORWHIp1iHI5VEPMITISI55UED. ,� _IHAVEANDWILLWIMAINWORNEHS'CdAPENSATIONINSURANCE,ASREOUIREOBVSECTION �y O Q �7oaOFTNELA80RCODE,fORTMEPERf-0RIAMICEOFTNEWORICFORYMICHiHISPERM1T15 �09 �k• J ISSUED.MY WORKERS'COMPENS�TION INSURANCE CARRIER AND VOLICY NUMBERME CONSTRUCTION � CARRIER PLAN REVIEW 0 POLICY NUMBER � � ELECTRIC � (nussEcnoNr�r+oreEm.s�ErmocnEVEw.trsroaa.�Mranmoaius�s+aqoa� PLUMBING Z ICER7IFYTMATINTHEPERFORMANCEOFiMEWORKFORwMICHTHISPERMITI5155UED.l MECHANICAL LJ' SIULLNOT EMPLOYANY YERSON W ANV MMlNER 50115 TO BECOME SU&1ECTTO THE ..._-1 .�� �-�•.i.i='--' (n YJORKERS'COMPENSATION UWS OF CAUFORNI/�AND 11GREE THAT IF I SMOULD BECOME INSPECTION FEE - S SUBJECTTOTHEWORKERS'COMPENSATIONVROVISIONSOFSECTION97000FTHEUBOR J � -� � �� - ....._- COOE.1 SHALL F0171HWITH CdAP�Y WITH TFIOSE PROVIS�ONS. ISSUANCE ) � SMIP Q�_�_���'� •6 Z p DATE: APPLICANT: � ENERGY P/C W�RNINO:FAILUHE TO SEf.11RE WOHKERS'COMPENS�TpN COVEHAGE IS UNUWFUI.AND SMALI BE � SIAJECTANEMPIOYERTOCHIMPlALFENALTIESMlOCMLFINESUPTOONEHUNDREOT110USJW� ENERGYPERMIT � DOlLARS(SI00.000).W ADDI7ION TO THE COST OF COMPENSATqN,DRMAGES AS PROVIDED iOR IN J SECTION7)0lOFtNELA84RCODE,MTEREST,�NOATtORNEV'SFEEI � RETENTION FEE: - -- OO OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: � INEREBVAFFIiiAIUN�ERPENALTYOFPfRNRVTHATTHEREISACONSTRUCTIONLEN01N6AGENCY FORTHE PERiORMANCE OF ME WORK FOR N1iip1 THIS GERMITIS ISSUEO(SEC.]oY7,CIV.C.). Z W � IENDERSNAME � LENOER'SIDDRESS � TOTAL FEES I 36 O � I CERTIFY TMAT I HAVE READ THISAPVLICATION ANO STATE THATTMEABOVE PlFORMATION IS CORRECT. � I AGREE TO COMPLY WITH ALL CfTY ANO CWNTY OR�INANCES AND STATE UWS NEUTINO TO BUILDIN6 � CONSTRUCTION.MIDHEREBYAUf/10R2ENEPRESfMATNE50FTHISCOUNTVTOENTEHUPONTHE Z �BOVE�MENTIOHEDVROPERTVFORIN57ECTqNPURPOSES. COMMENTS � �a/lJ� �' , l�,�t'�'/� s m PE TT NAIAE(PRINn � ���- .,��� �D--�3 --v� ZSIG TU EOFPE ITTEE DATE RECPT.�O. � PAID BY � �VALIDATION F WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessa Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy , . , _. . .,. .., .. _ . __. _ ... . , ... , „ . . �r. . .r.:i.- .... ., .. . }.._...s i ,_ ... � ..�.I�..,. . . . . ,. � � . •I.. , ... ,, .. .. . _. . . , �i��� or-� �ai�;r,rors� B�-�� � ir����:��i���� ��.�car;� _ .,T.�..._ .._ _._.�.�...___._.�____.. , _ _._� _ _ _ _ _ _ . _ _. lli��y:a��.'1C1�7��p c,g ti:t'.= I►�E-'����., ►:c9�� I►`�.`i�awt,.�Cl�?)►�! �E���;��. ;1�.�-7���'�1��1.G ' - ------ _ ._.___-------..._ .__.____ ____ . __ --_._.._--_ ___- _____ __.---- ---- - — — SET BACK---�~--- - --�_ � . ,, � FLOOR JOIST ' _ � FTGS;FORMSlSTEEL 1 � ! FHA REQMTS � � ELECTRIC GR�UND � _ �_� UNDER FLOOR QUCT � GRQUND PLUPdIBING UPJDER FLOOR CC)(�IDUIT SLAB GRADE FIA�PLACE FOU�lDATIOPd ,I TEFAP POWER I I FIREPLACE F30ND BEAh1 I WATER SERVICE � � MID HT. BOND BEAhA ROQF SHEATHING p`ay/p� �__�2.��� &FT. BOUD BEA��1 ; FRAMINGNENTILIATION � FINAL BOND BEAP.d ROOF COVER PRE-GRADING I ROUGH HEATING BEP�JCHIPJG ROUGH ELECTRIC I ROUGH GRADI�JG � ROUGH PLUMBING � FINISH uRADING SHOWER�i"UB TEST POOL ELECTRIC EXT.LATH/SIDING � I POOL FEUCING WALL INSULATION POOL FINAL CEILING IN�ULATION 1 OFF 51TE IPAPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PITlL.L. � � ON SITE It.�PS. GAS AIR TEST FINAL ZONItJG FINAL CONST. i FIRE DEPT. FINAL FINAL HEATING � HEALTH DEPT. FINAL FINAL ELECTRIC ' � DEV. FEES PAID FWAL PLUM9IPJG � ENERGY � i;�c�,r'r s�s el�i' — CUMMENTS SEPTIC TANK SIZE SEEP PIT/U 51ZE ��� . jl��. -- :', .