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HomeMy WebLinkAbout17284 (17) �\ CITY OF DIAMOND BAR / DEPARTMENT OF COIWv1UNITY&DEVELOPMENT SERVICES E ,��y 21825 E.Copley Drive � / . (909)860.3195 Fax(909)661-3117 �.i PRESS `'%.�` BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATION n � PERMIT �''j��,L P/C d AD�RESS�Z3� Ol Aw�v�n✓� 1L J"�Z I�L.I�� • DATE�v Z b �I NUMBER 1 f L[J � � APN LOT TRACT ISSUE � b TYPE OCC DATE CONST. GROUP p OWNER � `'��'�C.�• o ADDR S � A ZONING SEfBACKS z CITY �Pl. ZIP TEL• - FRONT RW ❑ g APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW O oCONTRACTO �A�k� �`• SIDE p ADDRESS ��l �u �, CITY G{7t2DV1r4 IP TEL " �I ' PROPOSED USE i i o ARCHlENG/ W DESIGNER NO.OWEL. NO. NO. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� ONRJER-BUILDER DECIARATION SFR/ADDlREM O p I HEREBY AFFIRM UNDER PENALTV OF PEfLA1RY THAi I AM E%EMPT FROM THE CONTqACTORS LI• G8f8QB/C8fp011 W CENSEUWFORTHEFOLLONANOREASON(SEC.)0.71.SBUSWESSANOPROFESSIONSCOOE:MIVCfTYOR (n U �p�7yW�11p/REDUIRESACERMITTOCONSTRUCT,ALTE0.��R��.OEMOUSH,OAHEPAIRANYSTRUC. W Palio/Deck � 7URE.VRIOq TO rtS ISSUANCE,ALSO RECUIRES THE APPUCANT FOR SUCH PERMIT TO flLE A SiGNE� w STATEIAENT THAT HE OR SME IS LICENSED VUf35UANT TO THE PROVISiONS OF THE CONifiACiORS LF � CENSE UW(CHAPTEH i(COMAIENCWQ WITM SECTION 7000�OF DIVISION 7 OF THE BUSiNE55 AND PRO� u- PaoVSpa iEuiONS COOE)OR TINT HE OR SHE IS EXEMPY iMEREFflpA AN0 TME BA515 FOq THE ALLECEO E%EMP• � 710N.IiNVV10lATIDNOFSECTION70.71.SBY/NVA7PlILAMFORAPERMITSU&IEGTSTHEAPPLICANTTO Z Re•Roof A CML PENALTY OF NOT MORE THAN FNE/NN�RED OOIURS(SSoO).�: � OLI150NNEROFTFIEGROPERTY.ORMYEMPLOYEESYfiTHWAGE5A5THEIR50LECOMPENSATqN, � �pmmercial �� z WILL 00 TNE WORK,ANO TME STRUCTURE IS NOi IMENDE�OR OFFEREO FOR SMLE(SEG 7ou,BUSi• J � NESS AND GROFESSIONS COOE:THE CONTiUC10R5 LICENSE UW DOES NOT APPIY i0 M!OWNER OF ? FPOVEHTY NR10 BUILDS OR AAPROVES THEREON,M1D MMOOOES SUCM WOftK NIMSELF OR HERSELF OP � THROUGH HIS OR NER OWN fA17LOVEES,GROYIDED THATSUCN LLIPROVEMEMSARE NOT WTENDEDOF L� w OFFEREDf01iSALEIF,1/OWEVER7ME8UILDINODRIMPROVEMEMISSOIDWITHINONEYEAROfOOMPLE• 0 TION.TME ON'NER�BUILDER WILL HAVE TME BURDEN OF PROVWO THAT ME OR SNE DID NOT BU4D OFl 'z IUPROVE FOF THE PURP0.SE OF SALE�. w Ot�O�'�NEROFiMEPNOPERTY.AAIEX0.U3IYE�YCANiAACTW6NniHUCENSEDCOflTMCTOR9 �[ TO CONSTRUCT THE PRQIECT(SEG 7ou,6�SINE55 ANO PHOFESSIONS CODE:THE CONTMCTORS LI� V01t18Si0� AQI.AREA W CENSELAWOOESNOTAPPLYTOANOwNEROFAPqOPERTVWHOBUKDSORUAPpOVESTHEREON,AND � N7qCONTRACT5FOR5UCHPRO,IEGTSWITHACANTRACTOR(S�UCENSEOPURSU�NTTOTHECONTMG ouaNmv DESCRIPTION FEE � TOFS UCENSE UW�. � OIAME%EMPTUNOERSEG B.BP.C.FORTHISREASON U � � u" DATE OY/NER f' Z W � LICENSED CONTRACTORS DECLARATION �j � IHEREBYAFFIRMUNOERPENAITYOFPERJURVT/UTIMIUCENSEDUND[qVROV1510NSOFCHAPTER � � 9(COMMENCWO VATH SECTION 7000)OF DMSION]OF THE BUSINESS ANO VROFESS�ONS COOE,AND Z ��� MY IICENSE IS M FULL FORCE AND EFFECL m � IICENSE CU55 � �+ V LtC.NO. � ��� J F— �V DA?E Z CONTMCTOR __ � a W � WORKERS'COMPENSATION DECLAFiATION U � N INEREBYAFFlNMUNDERPENALTYOFPERNRYON[OFTHEFOLLOWINGDECLAMTIONS: ' �n z Z � 11Un �1 � � _I MAYE AND WILL MAINTAINACER7IFICA7E OF GONSENT TO SELfdNSURE FOR WDRKER3' 2 ■��L 'r � � CdAPENSATqN.AS PROViDED BV SECTION 770o OF TNE UBOH CODE,FORTNE VERFORAIANCE w ��� �� F 1HE WORK FOR WNICH TNIS PERMIT IS ISSUED. � O 1 HAYE AND MALL MAINT�IN WORKERS'LOM7ENSATION INSURANCE,AS REIXI�RED BV SECTqN Q i7o00F TME UBOR COOE,FOfi 7HE DERFORA1ANCE OF THE WORK FOq wNItl/7HIS PERMlT15 ISSUED.MY,��yo,RKERS COMPENSAT'AN INSURANCE CARHIER AND POIIC`/NUMBER ME: CONSTRUCTION jCMRtER=CS/� � � �� PLAN REVIEW � POIICY NU/ABER�� ELECTRIC Q p (nussEcriw�mNoree�IDCFn+�vvr.�tswr�a��onmoa�R,onoa�ss� PLUMBING �'� MECHANICAL � Z I CERTIFY TIUT NTHE PERFORMANCE OF THE WONK FOR WHICHTNIS PER�ITIS ISSUEO,I — (�} SWLLLN�TEMPLOVANY�ER50NWMlYMANNERSOASTOBECOMESUBJECTTOiME vj WORKERS'C041PENSATIONIAWSOfCALIFORNItiANDAGREEIMRTIF15110UlDBECOME INSPEC?IONFEE SUBJECT TO THE�RKERS'COMVENSATqN PNOVi5iON3OF SECTI N]7Do OF iME 1A90R ��� OCODE.�SHALL FORT�NA7M COMPLV VATH TI JSE PROVI' N. ISSUANCE p pATE: � ` , APPLICANT: _ � SMIP ' J ENERGY P!C WMNIN@FAIIURETO5EW0.EWORKERS' NSAiIONCOVEMGE�SUNUWFUL.ANDSHILLBE � SUBJECT/UIEMPLOVERTOCRIMINAL7ENALTIE NDCIVILFWESUDTOONEHUNOREDT110US�ND ENERGYPERMIT OOLURS(5100.Ooo).IN PDDITION TO TME CASTOF COMGENSATION,OAMACES AS VflOVIDED FOR IN J SECT1oN 170e OF h1E UBOR COOE,INTEREST,AND�TTORNEYS FEES. RETENTION FEE: � 2 pW. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFINMUNOERVEN/LLTYOFPERNRYTHATTHEREISACONSTRUCTIONLENDIN011GENCY fOR TME PERfOPAWJCE OF THE W0�7N FON WMiCi/TNIS PERA/IT IS ISSUED(SEC.�oC7.CIV.G). � � LENDERSNAME � lEN0ER5ADDRE55 �f WICERTIFYTUTIHAVERE�DTMISAPPUCATIONANDSTATETM�TTIEABOVEINFORMATqNISCORRECT. TOTAL FEES �"�'�5� � 1 ACREE TO CAMv�Y N7TH ALL CffV AND COUNTV OROINANCES AND STAiE UV✓5 RELATIN6 TO BU0.01N0 � CONSTRUCTION.AND HEREBYAUTipHIZE PEPRESENTATIYES OF TNIS LOUNTYTO ENTER UPON hIE Z ABOVE�MENtIDNED7R07ERTYFORINSPECTIONFUFPO5E5. COMMENTS 0 � � m DEA�i EEN�WE Q � � �� � PE E � �tE qECPL NO. PA�DBY VALIDATION � � WHITE—Department Copy,YELLOW--Finance Capy,PINK—Assessa Copy,GOLDENROD—file Copy,GREEN—Applicant's Copy �� 1 t� �� �1�;`Lii l��.t �1��� �A�:.�7["��✓ 0�6��'� 1�`i{��ild.`�'{i.� I►rF-`�:�=�.CI�,a►�! � zr;,��;� .._. ii��-`7.i�c` C:�'�.1.�yi`}-'i;�.;f` G+tg"�'ti� ..._.__�. �l�k�= 'I���-'�;�=±1��'a1r� i ____.___ ._�_.____..__.:_ __�__�. _ . _._..___. .___ _ _.. _ .-----� --�----- - . ..__ :.__ _-_._---_. __.___..�.�.________ � 5ET BAGK � � � FLO�R J�tST i-� _ ___-- -, — - �--- FTGS/FORMS/STEEL � FHlI REQP�TS � � ELECTRIC GAOUND ' � UNDER FLOOR QUCT � I GRDUND PLUPr181NG i U�dDER FLCOR CUf�IDUIT . � SLAB GRADE �� FIREPL'A'CE FOUNDATION ' TEMP POb'VER I FIREPLAC�E30ND BEAM �_i WATER SERVICE � MID HT. �OND BEA�JI I ROOF SHEATHING ' � .3 FT. BOi'JD BEAPJI I • FRAMINGNENTILIATION FINAL E30ND QEAM I ROOF COVER —�-- PRE-GRAD�NG � ROUGH HEATING BENCHING ROUGH ELECTRfC _i ROUGH URADING � ROUGH PLU1v1BING I FINISH uRADIPJG SH�`NERlfUB TEST �1 POOL ELECTRIC ' EXT.tATH/SIDING � POOL FFNCING �,NALL INSULATION POOL FWAL � CEIUNG INSULATION OFF Sll E Ih-1PS. � DRYWALL NAiLING �EDICATIOPJS � � SEVJER FWAL ENG. SEPTIC TANK t1',NDSCF,PE/iRRIC,. � SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST � FINAL ZONING - FINAL CO�JST. � �� �1RE DEPT. FItJAL FINAL HEATING � � � � '�ALTH DEPT. FINAL FRJAL ELECTRIC _ ( � DEV. FEES PAID FINAL PLU".�BING � j ; ENERGY _..__,.._ � • , I r� r�is : , rtr •-� COMMENTS�ifS� Z ui�1�5 ���sw� �"�1l_-zl���.��� . nou�,i�o��Lw�,r.�.N f'Ru�;{lu�-�_i�. •?•��.,�,z , . SEPTICTANK SIZE SEEP PIT/U SIZE ��N_.._._...�___.___, ,���� � .: , � ; � , , ,. . , . —.__---.__.__=`.a...____._..____l. : : '