HomeMy WebLinkAbout16664 (35) CTCY OF DIAMOND BAR ��'
��� 1 DEPARTMENT OF COMMUNI'IY&DEVELOPMEM SERVICES
I
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 RESS
`�•� BUILDING PERMIT APPLICATION FIRMLY
Q A�0 RIESS �I DD .J. A�Q[Y1Q/L���C� {J�U i� APPLICATION il PERMIT f I n /C
o DATE V NUMBER� p
� APN�1� LOT� TRACT I�� DA EE 1 ONST. GRO P
p OWNER ^ �
"' ADDRESS C� � In ZONING SETBACKS .
w �. � FRONT _�"�C 15� RW O
z CIN ZIP��. TEL. R
REAR ❑
g APPLICANT ` «• '�T TEL. �� "�3I'�r!'�� SIDE/SIDESTREET RW p
� CONTRACTOR �� M.^ SIDE p
� ADDRESS � ` ` ;�' �, � pROPOSED USE T �
� CITY I 21P '20� TE c.
w ARCH/ENG/
z DESIGNER , ' ~�'� NO.DWEL NO. NO.
nW. ADDR�SS . �� UNITS � STORIES .�_BEDROOMS�A
� CITY U ti d ' ZIP '�'>r TEL, y J���3 - ,L )
� DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION
� OWNEH-BUILDER DECLARATION SFR/ADDlREM
O
p I NEREBY AFFlRM UNDER PENALTY OF PERIURY iHAT I M1 E%EMVT FHOM 7HE CONTMC70R5 LI• G3f2g0/CflfpOA
W CENSEUWFORTHEFOILOVlP16REASON(SEC.7071.SBUSINESS�V7�PROFESSIONYCOCE:ANYCITVOR (n
(� Ct7UNTYWHICNREOt11RESA7ERA/IT7000NSTFiUCT,ALTERIMPROVE.O[MOUSH.ORREPAIRMIYSTRUG W Pdti01O0Ck
Z TURE.�RION TO ITS ISSUANCE,ALSO REW IRES THE A7PlICANT FOR SJd/7ERIIIT TO FILE A SIGNE�
�L� STATENENT THAT HE OR SNE IS LICENSED PVliSUANT TO THE PROYi5lON5 OF 7HE CONTfUCTOHS LI� W
� CENSE U'N(CHAFTER Y(COMM[NCINC WI7H SECTION 7000)OF DIViSqN�OF THE BUSINESS AND PRO- � PooVSpa
FESSIONS COOE)OR iMA7 ME OH SHE IS EXEMPT TMEREFHOM AND TNE BA515 fOR TNE ALLECED E%EMP•
V TION.ANYVpUTqNOFSEGTION7071.SBYANYA�PIICANTFORAFERMITSUB:ELiSTHE�PP�ICANTTO Z Re-Fioof
A GVIL FENAITV OF NOT GORE THAN FIYE HUNDRED�OLUNS�f5oo)):
0 OlASOWNEROFiMEPR07EHTY.ORMYEIAPLOYEESNnTMWAGESASTHCIRSOLECOMPENSATqN, O COmmercial ,
Z WILL DO THE WORK,M10 TNE STRUCTl1RE IS NOT INfENDEO OR OFGEREO FOR SA:E(SEC.70�<.BUSI- J
NESS AND DROFESSIONS CODE:TNE COhTMCTORS LICENSE LAW DOES NOT APPLY 10 AN OWNER OF
� PROPERTVMA108U0.DSORIIdPROVESTHEREON.ANDWHODOESSUCHN'OiiKMt4ISELFORHERSEIFOR �
Q THROUCNHISORHEFOWNEUPLOYEES,FROVAEDIHATSUCHUAPROVFMEN'SARENOTINTENDEDDR m
� OFFEREDFORS.LLEIF,FqWEYERTMEBU:DINdORIMPPOVEMENTI550LOWiTIwNOhEYEAROFCOMPLE-
Z TqN,TME OwNER-BUILDER Y/iLL HAVE THE BURDEN OF PROviNO TMA7 HE OH SHE DIO NOT BUILD OR
� MPqOVEFOqTHEVURPO5EOf5ALE}
O l�ONMER OF THE PROPERi1;AM EXCLUSNEIV CONTMCTINC WRH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRO.IECT(SEC.)M�.BUSiNESS ANO PPOFESSiONS CODE.THE CONTRACTORS L4 Valu0ti0�1 ADJ.AREA
W CENSELAWDOESNOTAP7LYTOANONTlEROFAPROPERTYWHOBl11LD50RIM7RJVESTHEREON,/WD
� VAqCAMRACiSFORSUd10R0.1ECTSVIITHACONTMCTOR(S�UCENSEOVURSIIAVTTOTMECONTiUC- QUANTITY DESCRIPTION FEE
Y TOiiS UCENSE Uw.�.
� OIAME%EAIPTUNDERSEG. B.BFQFORTHISREASON U
�
LL ¢
DATE Ow4ER V
Z W
� UCENSED CONTRACTORS DECLARATION � W
� IHEFEBY�FFIRMUNOERPENALTYOFPERRIRYTHATIAMLICENSEDUNDERPROVISIONSOFCMMTER V.
d Y�COMMENCINOWITHSECilON7000)OFDIV�SION�OF7HEBVSINESSMDPROFESSIONSCODE,AND Z
MY�ICENSE IS M FULL FOFCE AND EFFECT. m
q G�
� LICENSECLASS, O LIC.NO.�CiJ �'� �
V DATE � �_ CONTFUCTOR�����A�C� � G a
W
� WORKERS'COMPENSATION�ECLARATION , U Vq� ("(� �JG.�^ WDrLC
N IHEREBYAFFIRMUNDER7EN/�LTYOFGERJURYONEOFTNEFOLLOWINCDECURAiIONS. Z ( 2 ,�
�
Q
� �IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ /1
'T,�- COIAPENSATION.AS PROVIOED BY SECTION Y/Oo OF TME LABOR COOE,FOR THE VERFORMANCE 'U ��
OF THE WORN i0R WMICH THIS PERMIT IS ISSUED � +n �
�
W _IMAVEMIDYALLMAINTAINVJORKERS'COV7ENSATIONINSURANCE,�SRCOUIREOBVSECTION
Q 9TOOOF TME UBOR CODE,FORTHE PERFORMANCE OFTFIE WORN FOFl WNICHTHIS PERIAR IS
ISSUED.MYWORKERS'COMPENSATqNINSUR CECARR�ERAnDPOLICYNI:MOERARE: CONSTF�UCTION
J
j CARRIER � � �'„ '�^���n• PLANREVIEW
Z va�cvNur.+oEA ��- ELECTRIC
¢ �ssEcrionr�mwreFoor.a�Erman[ccn.rrsw�or.E�uwa�oaiiuu6,ro)rn�ss) PLUMBING
�
Z I CERTIFY THAT W THE PERFOPMANCE OF THE WORK FOR WMICN 1Hi5 PEf,MIT IS ISSUE�.t MECHANICAL
(} SMALLNOTEAIFLOVANYVERSONPIMNMANNCRSOASTOBECOMESUBJECTtOTHE
N WORKERS'COIdPENSATI0NUW50FCALIFORNIA,AN�AGRFETHATIFISMDUIOBECOME INSPECTIONFEE
S SUBJECTTOTHEWORNERS'CWaCFNSATqNPRON510NSOF5ECT101137000LTHELABOR
CWE,I ALLJf ORTIMIITNCO�.�PLYWITH7HD5�PRONSKKJS. � / ISSUANCE
� DATE: `�' /DI APPLICANT. `�•�'✓IJ� -. �NC�iuli� SMIP
0
� ENERGY P/C
WARNINC:FAILURE TO SECURE WORI(fR5'COMOENSATION COVERACE�S UNUW FVL,/�ND SHALL BE
� SUOJECT/WEMPLOYERTOCRIMINAIPENALTIESIW�CNILFWESUPTOONENUNOREDTMOUSAND ENERGYPERMIT
OOLURS(S 100.0001.W b�ITION TO THE COST OF�pM GENSATION.DAMAG[5 AS GPOVIDED FOR IN
J SECTION770BOFTHEUBORCODE.INTEREST,MlDATfORNEYSFEE4. ' RETENTIONFEE:
�
pW, CONSTRUCTION LENDING AGENCY PRE•ALT FEE: -
O
� IHEREBYAFiIHAIUNDERPENALTYOFPEKIURYTHATTHEREISACONSTRUCTIONIENDINGAGENCY
�- FORTMEPERFORMMJCEOFTHEWORKfORWHICHiH157EFMITISISS�'ED�SEC.�o9�.CIV.C.).
Z
W
� LENOER'S NAA1E
S
F- IEN�ER'S ADDNE55
� TOTAL FEES
� IGERTIFYM�TIHAYEREADTHISAPPUCATIONANDSTATETHATTMEABOVENFOFMATqNISCORRECT. � �
W I�GREETOCOAIPLYWITHALLCITYANOCOUNTYOR�INANCESANOST�TEUwSREUTINGTOBVILDING �
� CANSTRUCTION,ANDNEREBVAUTFIORIZEREPRESENTATrvE50F7HI5COUNttTOEN7ERUPONTnE
Z ABOVE�MENTIONED PROPERTY FOR INSPECTION VURPOSES. COMMENTS
� �,ODlS � ��"�
J
�
m vEar.anE wE lvanrt�
¢ �� ��, ,
N ,
N Si NA F3 CF PERMITTEE 0 E
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, LDENROD—File Copy,GREEN—Appiicanfs Copy
^� if` ' E^;' �^ ".^. � �':
t.J' � . . �_':.�.:jiu.. itl. k�_!�-�,, .
1�r� -� . - ._ . R_.�_,v �'f-�
...�. Ls . 1i..:a,' �..t'.'���'ti+ ��_Y
.�'—_—_-- -- - _ . . _ _.. . . ._.— ,--�._ ._._. ._. ...-•- - --------.
-- --
. 1 4 _._.__� ...... .. ....� �.._�. __ .._-.._._�.'
���}.i,at� ���c iRY� f i;`.. ` I��',C�c ° ... ��'�=9.�..� ;•l� ��� [r..'�'r . I��l:,c!��.c, "e'1.�
SET BACf: � ' � � FLJ��n J.��ST , � -� ---
i i i � ,�� �, �
-- - , --- -- - •=----� �--------
FTGS'FOFi��1S'STEEL ----"--- -------.-------�----- -- —
� ---- -- , � rF��, �������s
ELECTRIC GROUf:p ; -----,-------- —� � U'J�ER FLO�R D��C�" 1-- -----;
— - ------ -- - — ---- ---•-' - --------- ----- -
GR�UPJD FLUi.1GIiJG � � U;:Q;:!-i FLOJ=CU°�:iUli !
SLAB GRF,D� �----i--- ------ - �_� Fli� P-��GF_FOU';��,TI.�' ---------*---- --------
TE�"P FOtiNER � --- � - --- -- - : ' FIRcr=LhC.-i= E�C:,:'_D ��!=Ai,1` -- �Y__----� ----
--•-- �----- - ---- -
1n1ATFR SERVICE I I i � �;11D HT. :'O'.1D E Ff,":, I
-- -- ------- - - - -- -- • �------- �
ROOF SHEl�THIi!G I � � � �' f-f. E:��°�,D E[=F,;- - - - ----� _ ----
FRA�,^Ii�G'VE�JTILIATIOiJ � 1 1 '� FIiIAL EiO';D L'-Er�;,i I I
---�— -------- ------•-------�— ---�-----
ROOF C0�'ER � � - -----i ; PR�-UF;i',��'I��:u '
— -- —=-------� - ------- .
I
flOUGH H�i�TiiJG •�%� � .•-- I '. . _ � .Ri�Dlid',� —
��t/---1=r----•-'.__ ._ �')Gf �' -- -- --
.. � E�i�1�f;liJ''-- �
ROUGH ELECTRiC I� �-.-�'- ------� i�_�-- ��--------- � -------
ROUGH FLU",1�I��lu � i r_�r����H �:,;,qp';�C i I
SHOI,"JEP.�'TU�TEST ------- --- ---; i i'O.`�.L EL�i;I F�1�- --�-- i- --------
EY,T. LF,TH!SIDI�JG- ----�-- -- --� i F'O�L F��fJ�i^;G- -- �-------�---- --
VJF�LLIfJSULATIOPJ---� ---i- --- -- i i f'OOLFIi!F�,L -- - � �--- --- -
CEILIfJu IIJSULF�i ION
----�--- I OFF SITE 1�.1PS.
--- ---- --_-------- -- � ---- I------�-
DRYt'JALLfJAILIfJG � _� _ _ � DEDICf�,710�dS _ I __I _
SEI�JER � � F"IidAL ENG.
SEPTICT/',���'rC I� 1� LA��DSC�+P�/IRRI�i. I } --- --
SEEP PIT/LL I '', I CfJ SITE I�^?S. �
GF�S�IR TEST l -��---- �� �FIi�AL ZO�dI'JG _ _. -
FI".�F,�CONSi. ,,%✓ ' �, ' � FIRE DCFT. FI"JF:L-
1____t.� i ,�____: .__ :-
FI'JF,L HEF,TIfdG ,;' / ;; ;` �-"`" j I Hcf,LTH DEPT. FRfAL �
� , �A ..----_�_, •— ----- - - I
FI�Jl�L ELECTRIC ;' :J j;�- - � : �J�\'. �=EES FF;ID
,-�- --- ---
Flf�t',L P�U�r151��G / r------- � ; �tJER,;'r
� _---�_� .-_ - �- - -.-�_ I - ---
� - ---�----�--------------I� - :. '_ ' - - - I -- -
CUi��P,�1E�JTS
SEPTIC TF,N:� SIZE
SEEP PIT/U SIZE — - —
�;p --- -
1�ti�' �
-- --- i---
��a ' �