HomeMy WebLinkAbout18369 CTTY OF DIAMOND BAR EXP I R E D
J� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
I
21825 E.Copley Drive 0 C T 0 9 2002
(909)860.3195 Fax(909)861-3117 PRESS
`%:M' BUILDING PERMIT APPLICATION FIRMLY
r JOBSITE �u� O� p��r� D R , APPLICATION ����1�PUMB R � D�� P!C
o ADDRESS b DATE 1 "r1W u
� ISSUE TYPE OCC
� APN LOT TRACT DATE CONST. GAOUP
p OWNER L O
" ADDRESS 2�{ 3 0 2 �L - � ZONING SETBACKS
Z CITY �rLONQ �..�TEL.IC�/-396�� S� FRONT RW ❑
g APPLICANT TEL. REAR p
� SIDE/SIDESTREET RW O
� CONTRACTOR L�4 P A"SSO C SIDE ❑
� ADDRES �722-R f/�►fL�l/r4- y� PROPOSEDUSE
� CITY - l'lo ZIP �II G�5 TEj�(�-5re7/2-s��
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLAFATION SFR/ADDiAEM
O
p 1 HEREBY AFFlHAI UNDER PENALTY OF PERIURY TW�T I AM EXEMPT FROM THE COMMCTORS L4 Garage/Carport
W CENSEUWFORiMEFOLLOWWGRE115ON(SEG7071.6BUSINESSANDGROFESSIONSWOE:M7YCIT70R ((�
GJ COUNiVNMIpIREWIRES�PERAIRTOCONSTRUCT,ALTEH,0.IPROVE,DEMOlJSH,OHREPAIRANY57RUG W PetIO/DBCk
� TURE VRqR TO rtS ISSUANCE ALSO REWIRES THE A7PLICANT FOR SUCH PERMIT TO FILE A SiGNEO W
STATEYEM T7uT HE OR SME IS LICENSE�PURSUANT TO iHE PROVISIONS OF THE CONTMCTORS L4
� CENSE UW(CNAPTER 0(COAINENCPJ(i WITH SECTqN f0o0)OF OMSION�OF 7HE Bl1SINESSAND PRU � PooVSpa
fE55qN5CODE�OHTHATHEOR5HEISE%EMPTTHEREFHOMANDTIEBASISFORTHEALLEOEOE%EM7• (�
VTION./JJYVIOUTqNOFSECTION7Wt.6BVANVAPPIICANTFORAPEWAITSU&IECTSTIIEAPVLICANTTO Z qe-Root
A CMl FENALT'OF NO?MORE T/AN FME fNNDRED DOLURS�f Sa0).j:
O LI150NNEflOFiHE PROPERTY.ORMYEMPLOYEES WITH WAGESAS THEIR SOLE COMPENSpT10N,
Z � Commercial -
N'ILL DO iHE riORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFEpED FOR SALE(SEG 7a�,BU51• J
� NESS AND PIiOFESS�ONS CODE:THE CONTRACTORS LICENSE UW DOES NOi APPLY TO AN OWNER OF �
PROFENiY WMO BUILDS OR IMPROVES TMEREON,AND NMO DOES SUpi WORN HIMSELF OR HERSELF OR
Q THROUGHHISORHERO'MIEYPLOYEES.VNOVIDEOTHATSUCHIMPqOVEA1ENT5ARENOTMENOEDOH m
� OFFEREDFORSDLEIF,NOWEVE0.TME9WDINGORIMPROVEMENTISSOlDK7THINONEVEAROFCAMRE•
Z 71ON,ME OWNER�BUILDER WILL HAVE iHE BUROEN OF VFOVIN6 TMAT HE OR SHE 01�NOT OUILD OR
= pAPROVEFOHiNEPURPOSEOFSALE} _
�y,� 04�30WNEROFMEGROPERTY.AME%CLUSIVELYCOMRACTWOWITHLICENSEDCONTRALTORS
� TOODNSTRUCT THE PRQIECT(SEC.7W�,BUSME55 M!D PFiOFE5510N5 CADE:1HE GONTRACTOFlS LI� V0IU0fiOf1 AQl.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROGEfiTVYR108URD50HIMPPOYE3THEREON,MlD
� WHOCONTMCTSfORSVq/VROJECTSWIiHACONTMC70R(S)LICENSEDPURSU�NTTOTMEGONTMG QUANTITY DESCRIPTION FEE
Y 70RSUCENSEIAW.).
� ❑I M1 E%EAIPTUNDER SEC. B.6 P.C.FOR THIS REASON �
�
LL �
DA7E OWNER U
Z W
� UCENSED CONTRACTORS OECLARATION �
� INEREBYAFFIIiNUNDERPENALTYOFPEfiIURYTHATIAMLICENSEDUNDERPiiON5qN50FLMAPTER Vr w'� KLY}� .�CNi
p� Y(COMMENpN6VY17HSELTION7000)OFDNISION70FTHEBUSINESSIWOPROFESSIONSCODE,ANO Z
MV IICENSE IS M ML FORCEAND EFFECT.
o C-3 6 �7 �4vs m
UCENSE CU55 LIC.NO. j
V DATE 7���S'�n Z CONTMCTOR� �SS� d
W
� WORKERS'COMPENSATION DECLARATION ¢
= U
N IHE0.EBYAFFIRMUNDENVEN.LLTYOFPERIURYONEOFTHEFOLLOWIN(3UEClANAT10N5:
C� Q
C _IHAVEANDYALLMAINTAINACERT�FICATEOFGONSENiTOSELHNSUREFORWOitKERS =
� COMVENSQION,AS FROVIOED BY SECTiON lToo OF TME LABOR CODE,FORTME PERFORMANCE U
�Q OF THE WORK FOH WHICH THIS PEFMITIS ISSUEO. �
�
�I HAVE AND WILL I.W MAIN WOiL(ERS'COMOENSATION INSURANCE,AS REOUIRE�BY SECTION
Q i7000FTHElABOFC00E,FORTHEPEHFORMANCEOFTHEWORKFOFWMICHiHISPERMITIS
ISSUEO.MYrnWO_R1S�ER.S' 0 NSATIONWSUvpy��L,/.�fi�R1ERANDiOLICVNUMBERARE: CONSTRUCTION
jCARRIER /"���� �""'--� PLANREVIEW
� va��cr Nun�eEtilN CZ�4 �.���l� ELECTRIC
� �nassEcra+r�rooreeo�ErmoFnEv�rtsroaon��a�voa�uisR,ao�a��ss7 PLUMBIN� �S�
Z I CERTIFY THAT IN TME PERFORM�NCE OF TME WORK FOR WHICH THIS PERMR IS ISSUED,1 MECHANICAL
('} SHALLNOTEMPLOYANYVERSONINANYMANNERSOASTOBECOMESUBJECTTOTME
� WORNERS'COMVENSATqNUWSOFCALIFORNiAANO�GREETNATIFISHOVLDBECOME INSPECTIONFEE
S SUB.IECTTOTNEWORKEH5COMPENSA710NPROVISIONSOFSEC710N]7000FTMElA90R
COOE.I SHAIl FORTIWITH COMPLY WITHTHOSE PROVISIONS. ISSUANCE •�
� SMIP
p DATE: APPLICANT:
� ENERGY PIC
WARNINfi:FIULUPE TO SEWRE WORI(ERS'COMPENSATION COVERAGE IS UNUWFUL,M!D SHAIL BE
�j 6UBJECfANEMPLOYEFTOCRIMINALPENALTIESANOCNILFWESUPTOONEHUNOREDiHOUSAN� ENERGYPERMIT
DOLURS{Stm.00D),IN/�OITION i0 7HE COST OF COMPENSATION.DAh�AGES AS PROVIOED FOR�N
� SECTION77080FTHEU�BORCOOE,MTEREST,ANOATTORNEYSFEES. R�ENTIONFEE: '` � -
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREBVAFFIRAIUNDERPENALTYOFFEiL1URYTWVTHERE15ALON5TRUC710NLENDINGAGENCY
Z FON THE VERFORM�VlCE OF iHE WORK FOR WHlpi iHIS VERMIT IS ISSUED(SEG]067,qV.C.�.
W
� �ENDER'SNAIAE
F_- IENDEFYSADORE55
W ICERTIFYTHATINAVEREADTHISMPLIC�TIONANDSTATETMATTHEABOYEWFOW.IATIONISCORRECT. TOTAL FEES O
p., IAGREETOQDMPLYWITHALLCITYhNDCOUMYORDINANCE5AND57A7EUW5REU71NCTOBVLLDINO
CONS7HUCTION.AND HEREBY AUTHOfUZE REPRESENTATNES OF THIS CW NTY i0 ENTER UPON TME
Z ABOVE- TIONE07ROCERTYfORINSPECTqNVURPOSES. COMMENTS
_ �/t'L �A[./1.?'z'/i�.�l '
m PrE^RM/�TT WVAE(PR/iN�T) � A �" �.� ZS�0�
¢ /�� (•�LLY./�
[l�
N SIG 7UREOFPERMIT7EE DRTE
� RECPT.N0. PAID BY VALIDATION
WHITE—DepaRment Copy,YEILOW—Finence Copy,PINK—Assessor Copy,GOLDENAOD—File Copy,GREEN—Applieant s Copy
��. ��,, . . ..,.:'i .. .. . �f .... ..._.... . ,._. ... r . ._._.: -rv^...r.. . .. .__. _"- • "... � . .,... . .rr{ ,�. � � . �.,4 ._... _ . ., . . .' .
CITY OF �i�.r�nor�D 6a�
IP�Si=t�C i 1Qiil RECDE;D
: ,.. � � c � c.� � � _ �► e' r�;a;�t� _� � c` e e -_ _ _ _ _. _ _
I►�E-���.�EC ►� Y.�r ....-1�'�-`,f I��'E-`I'� � ,�s'l��l►�� T �,��� '�I►�f-'�r��c`�'Ql�l; �
_ _ _. .. _ _. . _ �
__._�__--_____.__._.------_ _ ._.._____.._ _.__.._ ._.-. --.- --_ ___, __._---____.------_..�_._----.__. ____ _ ___.__ __..__.____.�W_..._._
SET BACK _ � _ � � ; FLOOR JOIST , � _�
FTGS/FORMS/STEEL FHA REQD.1TS
ELECTRIC GROUN� � ` UNDER FLO�R DUCT ,
GROUND PLUMBING � UNDER FLOOR CU�!DUIT � i
SLAB GRADE I FIREPLACE FOUNDATI�N
TEMP POWER I FI�EPLACE BOND BEAM
WATER SERVICE h1iD HT. BOND BEAM
ROOF SHEATHING 8 FL BONQ BEAM i
FRAP�IINGNENTILIATION I FINAL GOND BEAM I
ROOF COVER ~ PRE-GRF,DING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGFi GRADING
ROUGH PLUMBING I i FINISH GFiADING
SHOU'JERRUB TEST � POOL ELECTRIC
EXT. LATH/SI�ING � I POOL FENCING
WALL INSULATION POOL FINAL
CEILING IN�ULATIOP� OFF SITE IMPS.
DRYWALL NAILIhG DEDICATIO�JS
SEWER FINAL ENG. �
SEPTICTANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FIP4AL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTFIIC DEV. FEES PAID
FINAL PLUMBING ENERGY
�
-_,.._......_
E�fi�r*.t"�_y=�`�'°.�_._�_��_--------
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
;�p ,
I
���� =�
i
�
�
_____._._..��_--------_._..�