Loading...
HomeMy WebLinkAbout11-1679 CITY OF DIANIOND BAR � .. . I �� � ii vEPARTI�LENT OF COIbIMUN11'1'&DEYELOPA'IENT SERVICES ����,�� 21825 Copley Dri��e,Diamond Bar,CA 9176� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(9U9)839-7027 PRESS '-"<��'� BUILDING PERMIT APPLICATION r- FIR�AflLY � JOBSITE APPLICATIQ PERMIT P/C 4 ADDRESS I fI�SFS .D�AM�+nd `�Al1_ DATE �ZI/�/// NUMBER,� � o �SSUE �- TYPE ` OCC r' APN LOT TRACT DATE I����I CONST.� GROUP �� p OWNER C•-l-` �A••� p ADDRESS IQ�.F S D�►s��.�d lRA�- ZONING SEfBACKS oC�7y l�'..,�.o,✓.( ZIP TEL. FRONT RW ❑ APPLICANT TELQ'��l'�(-fi414 REAA � o SIDFJSIDE STREET AW ❑ � CONTRACTOR r � SIDE O Q ADDRESS '�` fD L o V ��-Q— �`u n PROPOSED USE � CITY 1L ZIP��� TEL�23^ 4�S w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZiP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER•BUILDER DECLARATION SFiUADD/REM O [� I HEREBY AFFIRM UNDER PENALTV OF PEWJRV TFIAi I AM EXEMPT FROIA THE CAMWICTORS L4 GdId9B/CBIpOA W CENSEUWFORTHEFUILOWINGRE450N�5EC.70.7t.5BU5WE5SANDPROFES510N5CADE:lWYCITYOR (n U ��'(YM:CHREOUIRESAPERMITTOCA`15TRUCT,RLiERU•IGROVc.DEMGLISH,ORRE7N.�ANYSTRUG W patio/Deck � Z TURE,GFIOR TO 1T5 ISSUA\CE.AL.50 REOUIRES THE APPUCANT FOR SUp/PEAMIT TO FlLE A SIGNED W w STATEMEM THAT HE OF SHE LS IJCEN5E0 PURSUPNT TO THE PRONSIONS OF THE COMRACTORS U� � GEr�SE LAW(CHAPTER 9 1�1AIdENCwG vATH SECTqN�ooD)OF DIVISfON a OF TFIE BUSwE55 AND PR6 � PDoUSpe � FESSIONSCODE70R1TIATHEORSHEISE%EMPTTHEREFRO�AANpTHE9A515FORTHEALLEGEDFJ(EIAP• V TION.A�4YVIOlAT10NOF5ECTI0.Y70]�.58YANYAPPIICAl:TFORAPE0.MIT5U9.fECTSTNcAPPLIWlTTO Z R2-ROOI � A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOWRS�S50o).): � OI.ASOYMEROFTHEPROPEr7TV.O.iAIYEMPLOYEES�'l17H1�AGESASTNEI.i50LECOMP�NSATION. � COTT0fCl81 Z WlLL DO 7HE WO?%.J.nD TrIE STRUCTURE IS 1:OT iNTEN�EO OR OFFEA�iOR SALE�SEG 1oa4,BUSb J NE55 AND PAOFESSIONS CADE TME CONTRACTORS LICENSE LAW DOES NOi A7PLV TO AH OWNER OF S� s{ � PRO?ERTYWH08U1LDSOPIMPROVESTHEREON.ANDWHOOOESSUCNIVOPKHIIASELFORHERSEIFOR � J '� L[ iHpOUGH HIS OR HER OWN EMPLO�EES,CROVIDED THAT SUCH UAPROVEMENfS ARE NOT IMENDED OR m w OFFEAEDFaRS.LLEIF.F101YE�ERTMEBURD�N(iORIIAPROVEMENTI550lDVmHwONEYEAROFCOMPIE- � TION.THE OWNEA�BUILDER Wlli HAVE THE BURDEN OF 7ROVING THAT HE OR SHE�ID NOT OU�ID OR Z IMPROVE FOR 7NE PVRGOSE OF SALE). = O1�50WNEROFTiEPROPERn:AAIE%ClUS�VELYCOI�fiRACTINGWITHLICENSEDCOMRACTORS W W ENSExIqWDOESN07APPLY7oANOwNEROGAPROPERTrWHOeUILDSORDUA AOVESTMHE�.AENl.AND Valuatlon �] OO. �y ADJ.AREA � YAiOCAMRACTSFORSUCNPqOJECTSWITHACONTMCTOR(9)UCENSE�PUNSUANTTOTHE00?RR4G QUANTITY DESCRIPTION FEE Y TORS UCENSE lAW�. � � � O i AM EXEld7T UN�EF SEC. 9.A P.0 FOR tW5 REASON U � Q � OA7E OYlNER U W � LICENSED CONTRACTORS DECLARATION w � I HEFEBY AFFIRM UNDER PENALTY OF 7ERJURY TMAT I.VA LICENSED t1N0ER PROVIS{ONS OF CMAPTER .0 � B�CAMMENCW6 YlITH SECTION 7000)OF DIVISION]OF THE Bl15ME55 AND P.iDFE55�ON5 CADE.M'D Z X 1JY LICENSE IS IN FUIL FORCE AND EFFEGT. m LLI ` � LICENSE CLASS ��J ���.ko. �90 y 9� j ~ I� 1 J V DATE I.C'1�' I I CONiRACTOR�� KU�ri� a W � � WORKERS'COMPENSATION DECLARATION -� Q � 1 HEAEHY AFFIRM VNDER PENALTV OF VER/V�iY ONE OF TNE FOLLOYlING DECL+�RATIDNS: � C/� Z Q � I MAVE AND YlILL R1AI11tA1N A CERiIFICATE OF fANSEM TO SELFdNSVAE FOR WORKERS' _ COMPENSATIpN,AS PROVIDED BY SECTION])00 OF TNE IFBOR LOOE FOR 711E PERf-0pA1ANCE U Q OF THE WOPK FOA VhiICM THIS 7ERlAI7I5 ISSUED. � � W IYiAVE.WDIY1LLIdAINTAWYlORKERS'GO!.7PENSATIONINSURANCE.ASREOUIREDBYSECTON Q �»Oa OF iME IAEOR CAD'c.FOR TH'c PERFO�MANCE OF THE YlOR1(FOa YMICN T115 PEN.UT IS ?D�S� ISSUED.�dV WO.iKERS'CA1dPENSATqN INSUaNJCE CARFIER A11D Pq.ICY NUM9ERME CONSTRUCTION j WRAIER 1Nf C� ��� PLAN REVIEW f�, � POI.ICY NUTABER ►,uSA S'O O ��I 8'L a� � ELECTRIC `^ Z Q Q Rti+�ssEcria+n_�rnra=_m.RE7IDo'n-EGEw•7(4SFoaar_Fut�Lxi-_`oD7lAaR5li�mloaLEssl PLUMBING W z I CERTIFY TYAT U�THE 7EAFORIIANCE O:TH's YlORK FOp 1YHICH THLS PERAIIT IS ISSUED,� MECHANICAL (�} �SMALL�O7 EtA?LO'I ANY PEfl50N IN AM'I.I.Wy'cR SOAS TO BECONE SUBJECT TO THc � V10RKER5'COM7ENSATION LAV15 0F CALIFOP1�fl.,VJD AGREE TMAT IF I SMOUL�BECAlAE INSPECTION FEE S SU7JECTTOTHEL'lOalcERS'CAAIPENSATWNP.iO`/i510N5OfSECiION]]OOOFTNEU20.i CAOE,l SHALL F�RTHVATH CON.PLY M THOSE PROVI510N5. �SSUANCE � p DATE: � APGLICANT: '1 l SMIP w J� ENERGY P/C --� YlAHNING:FAIL4.iETOSECURE�'JORICERSCAR�PENSATIOt1CAVERAGE�SUNLAWFU DSHALLBE � SU�uIECT.�lIEM?L�YEAT000.UAP1AiPENA!TIESM'OQNLFVtE5l1PTOOt1EMUNDR£OTHWSAND ENERGYPEAMIT DOLLARS�S10D.G�0),iN ALiDIiION TO TNE COST OF COMPETISATIaI.D0.hfA�ES AS PqOV1DED FOR IN J SEGTION 17oD OF THE LA80R CODE�N7EAE57 AtlD ATTORt7EY5 FEES. RETENTION FEE: �O Q O CONSTRUCTION LENDING AGENCY PRE{►LT„FEE� �./J-r s C�C7 � t MEREBV AFFIR/A U�IOER PcNAITY OF PcRJURY T7iAT TMcRE IS A COHSTRUCTIOY LENDW6 ACENCY `j 7J 7 _ � FOR TiE OE.iF00..lANCE OF THE YlORI(FOR YMICH TNIS PE�IT IS ISSUED ISEC.]097,pV.CJ. . Z W � IENOER'S NN.Ie !_- LENDER'SAODRE55 � ICER7IFYTHATIHAVERe1D7'WSAPPLICATIONN:DS7A7ETHATT11EA90VEINFORMA7KKJ15COARECT. TOTAL FEES S w 1 AGREE TO CAIdPLV YATH A�L CITY 1WD LOLINTV ORDWANCES AND STATE UWS RElANdO TO BIIRDING � CANSTRUCTION.ANDHEREBYWTIKIRIZER3RESENTATNESOFT!-0SCOUNTVTOENTEFUPONTHE zq90VE�1AENT10NE�PilOPEA7'YFOAiNSPECilON7Ui7PO5E5. CO�rIMENTS � �c]ru'� J l�-P, .�Q1 � � m PERMITTEE N (Pq1NT) � i�� 15�11 Uj SIGNANFiE DATE = RECPT.NO. PA1D BY VAUOATION ~ WHITE—DepaAment Copy.YELLOW�Inance Capy,PINK—Assessa Copy,60LDENROD—Flle Copy,GREEN—Applfcant's Copy �. . - . CI�'�' 0�' D��,9U9�3�� ��R ' I�iSPE����3iV ��C�RD � � � � � � . � s . a - SET 6FlCK FLOOR JOIST FTGS/FGPMS/STEEL FNA RE(�MTS ELECTRIC GROUf�ID � IJPdQER FLOflR DUC7 GROUIVD PLUMBI(�!G �Ut�1QER FLOOR GVNDt��1T SLAB GRADE FlREPLACE FOUI`�DAT!ON TEM? POWER �F!REPLACE BOND BEt�t�ll WATER SERVICE �M1D�Ir. BOhJD f3EA�A ROOF SHtATHlNG 8�T. 13GiVG BEANt � FRAMIPIGNEt�1TlL�.710A! I FiN�L ht;3Pd1� B�atv1 ��— P�C�F i,:pVE�� ---- I Pi�c-t;RADIl�J a �^ ROUGH 1�EAl'IiVG ��BENCyIN��: i �_ -- ROUGN ELEGTRIC ;HJUGH�aR;�Qii��c �ipJGH PLUNiBIVG FIhJI�H GRADI?�1G � � �S—HC—�'dV—ER;TI�a TE�T FC70L cLEG�RIC � EI Y.T. LF��f-I/S!D!NG �— _ j P(1G�FENCING —;— �--WALI_ItJSUL,�TIOP; � P � ' FIP�1• L — --- � CO� � . GEILING iP�SUL��lON Q��SITE IN1PS. DRYd'+1A.LL NAILItJG DEQICATIONS I SEVVER FINAL ENG. I SEP'fIC TANlC LAfVDSC,4PEiIRRIG. SEEP PIT/L.L. --- I ON SITE IMPS. GAS RIR TEST r�FIN�L ZOfJIf�;G FINAL COi�JST. FIRE DEPT. FIPJA.� � FiNAL HEATI�JG ^ i __ ___ ____ HEAI_TI-I GEPT. FIPdAL �IiVAL EL�C7RIG---- -- DE�/__FEFS PAID � --- FiNAL PLUMBING --- ENERGY' — ----- — — I ----- ---� — -- -- —_---------- ----{-------Y � � I -----�--- I ---------------�----- ---- ---- �---- �:�������s ---------�--------------------------- -- ----- ----- � SEPTIC TANK SIZE ----------------------- ------------- -- -- --- SEEP FIT/lJ SIZE -- , , .� — --------------------- ------- — . . . . ,�,; ;:� . --___-------------------------------