HomeMy WebLinkAbout17957 �` CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
��� 21825 E.Copley Drive
(909)860-3195 Fax(909)661-3117 PRESS
"'-� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE �� ,/} /� APPLICATION / /e� NUMB R 1 fllC
ADDRESS_I S �(/C�/L/�a7� DATE S/
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
o ADDRESS ZONING SETBACKS
z CITY ZIP TEL. FRONT RW O
g APPLICANT TEL. REAR �
� SIDE/SIDE STREET RW ❑
� CONTRACTOR fl��'N /1E OFi�t/ /NG SIDE p
ADOR SS
� CITY L ZI�J�7�7 TE � PROPOSED USE fl
Pa� ARCH/ENG/ ' �
�� DESIGNER '
ADDRESS NO.DWEL. NO. ' NO. '
= CITY ZIP TEL. UNITS STORIES BEDROOMS
�
�n DESCFIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
O
p I NEREBV AFFIRM UNDER FENALTY OF iERR1RY TMAT 1 M1 E%EMPT FROM iHE CONTMCTORS LI• Gaf898JC8fpOR
W CENSEUWFORiMEFOLLOW1NaREA50N(SEC.70.71.6BUSINESSMDPROFESSIONSCODE:ANYCIiYON (n
U CpUNTYNMIRIREOUIRESAPERMI7TOCONSTRUGi,A:TEFt,IMPROVE.DEMOLISH,ORREPAIRANYSTRUG w
W TURE,GNiOR TO ITS ISSVANCE,AL50 REWIRES TME APPLICANi fOR SUp1 PERMITTO F4E A SIGNED w P8110/06Ck
STATEMEM THAT HE OR SHE IS LICENSED PURSUMli TO iHE VROVISIONS OF 7HE CONTRACTORS LI•
� CENSE L�W(CNAPTER Y(COAIMENCINO WITN SECTION)000)OF�IVISION�OF THE BUSINESS AND PRO u- PooVSpa �
FESSqN5CO0E)ORTHATHEORSHEISEXEIAPTiNEREFqOMAN�THEBA515FORTMEALLECEDE%EMP� C7
� iqN.lNYVIOLATIONOFSECTKKJ)071.68VANVMPLICANTFORAPERMITSU&IECTSTHEAPPL�CANTTO Z Re-Roof
A CML PENALTY OF NOT MORE TVW i1VE HUNORED DOLtARS(f Soo).):
ZOI,ASOYMEROFTHEPROPERTY,ORMYEMVLOYEESNn7HWAGESASTHEIRSOLECAMPEN5AT10N, O COf11rt10fC181
WILL DO T1E WORK,AND iHE STNUCTURE IS NOT INTENDE�OR OFFERED FOR SALE(SEG 70�t,BUSI• J
N NESS AND VROFESSIONS CO�E:THE CANTMCTORS LICENSE UW DOES NOTAPPL�TO AN OWNER OF ?
VROPERiY WHO BURDS OR MPROVES THEREON,AND N110 DOES SUCH WORK HIMSELFOR HERSELF OR
CL THROIX;HHI50RHEROYIMEMPLOVEES.PROVIOEDTMAT5Up11MPROVEMEMSARENOiINTENOEDOR m
QOFFEREOLORS/LEIF,NOWEVEit,THEBUIL0INGONIMPROVEMENTI55011)WITHINONEYEAROFWAdP�E•
z 710N,TME OWNER�BUILDER WILL HAVE THE BURDEN OF PROVIN�THAT ME OR SNE DID NOT BUIID OR
� UAPROVEFORTIIEPURP0.5EOFSALEI.
O�Il5 OWNER OF THE PflOPERTY,AM EXCLUSNELY CONiRACTPlG 4nTH LICENSED CdfTMCTORS
� TO COHSTRt1CT 7HE PROJECT(SEG 7oN,BUSINESS/J1D FROFESSIONS CODE:THE CONTRACTOR3 U• VelUa110n ADJ.AREA
W CENSEUWOOESNOTAPVLYTOMlOWNEROFAPROFERTYWHOBUILDSORIAIPROVESTMEREON.AND
F YMOCONTMCTSFORSUCMVR0.IECTSWITHACANTMCTOR(S�UCENSEDPURSUANTTO7HECONTMG QUANTITY DESCRIPT�ON FEE
� iORSUCENSEUW.).
� ❑IAM E7(EMPTUNDER SEC. B.i P.G FOR THIS REASON Q �
� U
lt� ¢
OATE OWNER U
Z W
F LICENSED CONTRACTORS DECLAFlATION W
� IMEREBYAFFIRMUNDERPENALTYOFVEFJUFYTXA7IAMLICENSEDUN�ERPROYISIONSOFCHAPTEH �
p. 9(COMMENqN6WIiM5ECTION7000)OFD�VISqN70FTHEBUSINE55MlDPPOFESSIONSCODE.AND Z
X GfY LICENSE IS W fULL FORCEAND EFFECT.
`0 UCENSE CUS c a 9 IIC,NO. � • •� �
�
V DATE CONTRACTO � �
� WORKERS'COMPENSATION DECLARATION �yG a
NIHEREBVAGFIRMUNDERFENALTVOFCERIUHVONEOFTHEFOLL01MN�0EClANATIONS: Z
� - � �IHAVEANDNnLLMAINTNNACERTFIC�TEOFCONSENTTOSELF-INSUREFORYVORI(ERS' _
COMPENSAiqN,AS PROVIDEO BV SEC710N ROOOF TME UBOR COOE,FORTHE FERFORMANCE W
OF THE WORK FOR NMICH THtS GERMIT IS ISSUED. �
0
1HAVEANO WILLMAIMAIN WORNERS'COMPENSATqN INSURANCE,AS HEWIqED BYSECiqN �
Q �7o00FTME4BORO00E,FORTNEGERPDFiMANCEOFTHEWORKFORWHIp/7H15PERMITIS �
� ISSUEO.MYWORKERS'COMPENSATqNIN UNANCECARRIERANDGOULYNUMBERARE: CONSTRUCTION �
j CARRIEH 5���� �v� - PLAN pEVIEW
� POLICYNl1MBER O3 �L� ELECTRIC
0 �nusEcraaruEmnoreEmn+c��ocnEVEcurrswaon+E�ooaw�sa+mloq�Ess} PLUMBING
Z I CERTIF/THAT W TME PERFORMANCE OF TI+E WORK FOR N71Ip7 THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALLNOT EMVLOYANV PERSON W ANY MANNER SOAS T0 6ECOME SV&1ECTTO iHE
� WORKERSCOMPENSATqNLAW50FCAlIFOHM0.�D�GREETHATIFISHOULDBECOME INSPECTIONFEE
S Sl10JEGTTOTHEWORKER5COMPENSATIONiHOVISIONSOFSECT10N�7000FTNEUBOR -
wo.i wutcoanm�n�coua�rvnnrThOSEVROVISION ISSUANCE _
O �� �
p DATE:s APPLICANT.`/� (�f SMIP �_�
� WARNIN�:FAILURETOSEWREWOIiKERS'COMPENSATqf�EOVERAGEISUNUWFUL.ANDSH/1L�BE ENERGYP/C
(—y SUaIECTANEUPIOVFRTOCPnAINALPENALTIES1WOpVILFWESUVTOONEHUNOREDiH0U5AN0 ENERGYPERMIT
OOLL�FS�f 100.000).IN ADORION TO THE COST OF CpAPENSATION,DAMAGES AS PROVIDEO iOR IN
� SECTION770eOFTHEU00RCODE,IN7EREST,IWOATiORNEY'SFEES. RETENTIONFEE:
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
0
� IHEREBVAGF6i4UN0ERPENALTYOFVE0.NRYTHATTHEREISAfANSTRUC710NLEN0INGAGENCY
FOR ME GERf-0{UAANCE OF 1HE WORK FOR WMIp1 THIS PERMIT IS ISSUED(SEC.70Y7.CIV.C.).
Z
W
� LENDER'SNM1E
H LENOER'S/�DDRE55 /�
W ICERTIFViMATIHAVEREADTHISAPDLICATIONAN�STA7ETNATTHEABOVEWFORMATIONISCONREGL TOTAL FEES /��/(�l• (�, �)
� I AGREE TO COMPLV WITH ALL CITV ANO CAUNTY OROINANCES 1WD STATE UwS NEUTIN6 TO BUILOINO � �J�+� 1�/
� CONSTRUCTION,ANDNEREBYAUT110RIZEPEPRESENTATNESOFTWSCOUNTYTOENTERUPONTHE
Z �BOVE�NENTIONEDGROPERTVFORINSPECTIONDURPOSES. COMMENTS
� ca( 2A�OGL/�F
m PE EENAME(PRINn
¢ ��_ S D ��
�
(n 5� NATUREOF RMITIEE D�TE
� RECPT.N0. PAID BY VALIDATION
WH�TE—Department Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appicant's Copy
� .. � , , .. . . . . „ .. . . ... . . . , .. .. �.r, .,i.,. .�.r ...l' . , ..r.v�,r. -� �i'... . ' v' • ,... �J. .. . . . _ ,_ ., . i.�.. . � �. , . �. . .,,.��.._
^ir�� ��_ �s�,r�ror.r� �r��
� it�s�Ec�iora r�cor�o
__�._�....___.._.._____ ._� ,__..___..�s...__..._,____._
_.._.__ _T______ _ ____ ___________
i►r��.�=t`�.:E'��m)►r! €��},.�:- il►y��.}`"C.��`�JR,� (���i:�,_�Lc '�Ce�i►'� �y�'ar': I►rf-'7:�wc �d�:�
__��..___.�...�.---.---____._.. . . . __ _.__...__ .. _.__._.._....__. ..__ .._.__.... _ . .____ __.._._�_ ----.__ __.�-------_.:_._..�_
SET BACK � � � I i FLO�R J015T " �. �
FTGS!FORP�IS/STEEL I � _ _ ! FHA REQP�iTS _ I �
ELECTRIC GROUND � � � Ui•JDER FLGOR DUCT �
-�--
GROUND PLUMBWG I � _ ____ ' UNDER FLOOR CU�!DUIT i _
SLAB GRADE I I i FIREPLACE FOUNDATIOfd I
TEMP POWER �_I FIREPLACE BOND BEAM
WATER SEAVICE I PAID HT. �OND BEAP,1 I
ROOF SHEATNING �ZfUZ _�' I.I 6 FT. BO`JD BEAM _ ---'i _—
FRAP�IINGNENTILIF�TION � � FINAL EiOND BEAt�1
R��F COVER ��_p2i I PRE-GRADING
/ BENCHiflG
ROUGH HEATIP•!G �_
ROUGH ELECTRIC j � ROUuH GRADING
ROUGH PLUMBING I FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LF,TH/51DING I I PaOL FENCING ;
WALL INSULATION �--�_�-POOL FINAL '
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL NAILING � QEDICATIONS
SEWER FINAL EPJG.
SEPTIC TANK � LANDSCAPE/IRRIG.
SEEP PIT/L.L. � OfJ SITE Ih1PS.
GAS AIR TEST FIt�AL ZONIP�G
FINAL CONST. � � �IRE DEPT. FINA!_
FINAL HEATING I � HEALTH DEPT. FINAL
FINAL ELECTRIC I � DEV. FEES PAID
FINAL PLUMBING � � E��JERGY
;�-t�,�� �:�=;�Ir..�
.:s:._.___..______._�.__.__._�____._.r
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
....... ��� ----- ,
�,�� _
�
.__....._..____._:=?_----__..__._.. �
�