HomeMy WebLinkAbout17521 �� CITY OF DIAMOND BAR
I i DEPARTMENT OF COIvQvfUNiTY&DEVELOPIv1ENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRESS
���� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSITE � ��, APPLICATION PERMIT I�1;�� P/C
� o ADDRESS � DATE La��UU"D l NUMBER�� O 1 a
� issue TYPE occ
APN LOT TRACT DATE CONST. GROUP
p OWNER _Q
o ADDRESS . ZONING SEfBACKS
gCITY_Bt�.ISF�'.��_ ZIP��y TEL ._ FRONT RW O
APPUCAN�� ` TEL. REAR p
zd SI�E/SIDE STREET qy�l ❑
� CONTRACTOR G. SI�E p
� ADDRE S '
� C�IY 21PQ� TE . PROPOSEDUSE
o ARCH/ENG/ 1
� ADDR SS � f - NO.DWEL. NO. NO.
� ��TM � TEL UNITS STORIES BEDROOMS
�
� DESCRIPTION S�.FT. FACTOR PSF AOJ.AREANALUATION
� ONRJER-BU�LDER DECLARATION SFR/ADD/REM
O
p 1 MEREBY AFFIRM UNDER iENALTY OF PEFLAIRY TNAT 1 AA1 E%EMPT iROM 1HE CONTMCTORS LI• Gef898/CefpOR
W CENSEUWFORTHEFOLlO`MNaREASON(SEC.70.71.SBUSINESS/�NDPROFESSIONSCODE:ANYCIiVOH (n
V COUNTYNT/ICHREOUIRESAPERMRTOCONSTRUCT,ALTERIMVROVE.DEMOLISH,ONNEPAIRANYSTRUC• P8Ii0ID8Ck
W TURE.VRIOR TO RS ISSUANCE,AL50 PEOl1IRE5 THE AVPLIGNT FOR SIKH PERIAIT TO FILF A SICNED W
� STATEUEM THAT NE OH SHE IS LICENSED VURSUANT TO THE VROVIS�ONS OF TME CONTMCiORS LI-
� CENSE UW�CHAOTER Y(COMIAENCINO N'I7H SECTION 7000)OF DIVISION�OF THE BUSINESS AND 7q0- u" POOUSpO
fE55lON5CODE�ORTFIATHEORSHEISEXEAIPTTHER[FROMANDTHEBASISFORiHEALLEGEDEXEMP- (�
V TION.ANVVKKATqNOFSECTION70�1.6BYANYA7PLICAMFORAPERMITSUBJECTSTHEAPPLICANTTO Z pe-Roa1
� A GYIL PEN�LTYOF NOT MORE THAN FIVE HUNORED DOLUHS(SSoo).�:
� 04�OWNEROFiF1EVROPER7V,ORMYEMFIDYEESWITHWAGESASTHEIRSOLECOAIPENSATION, � COTmOfClal
Z W�LL 00 THE WORK,MlU THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�1.BU54 J �
N NESS ANO PROFESSIONS CODE:ME CONTMCTORS IICENSE UW DOES NOT APVLY TO AN OWNEF OF
VROPERiYVAIOBUILD50RIMPROVESTHEREDN.ANDWHODOE55lId/N'ORKMIMSELFORHERSELFOR �
K THROUGHHISORHEROwNEUCLOVEES,VROVIDEOTHATSUCHWPqOVE1�AENTSAPENOTINTENDEDOR CO
O OFGEREU�ORSALEIF,HOWEVERTMEBUIdNCDRIMPFOVEA1fNTISSOLDWRMNONEYEAROFCOMPLE•
Z TION.TME OwNERBUtDER WILL HAVE THE BUROEY Of PROVINO THAT HE OR SNE DID NO7 BVILD OR
� WVROVEFORTMECURPOSEOFSAIEG
(y� 04�OWNEROFTMEFROPERTY,M/EXCLUSIVELYCOMMCTINOWRHLICENSEDCONfMCTORS
Q TO CONSTRUCT THE FR0.IECT(SEG TWI,BUSME55 M10 PROFESSIONS CODE:THE CONTMGTORS LI• V8It1dIIOf1 ADJ.AREA
W CENSEUwDOE5NO7MPLYTOANOWNEROFAPHOPERTYWXOBUILDSORIMPROVESTMEREON,AND
� NM1�OCONTRACTSFORSUCHVR0.)ECTSWITHACONTMCTOR(SILICENSEDPURSUAMT07HECONTMG OUANTITY DESCRIPTION FEE
� TORSLICENSEUW.� .
� OIAMEIfEMPTUN0ER5EC. B.iP.C.FORiHI5REA50N ¢ �.r�G�T � 'O�►
U
LL' DATE OWNER F- �� ,� � ��
a. r. n
FQ UCENSED CONTRACTORS DECLAAATION w ' y S OO BT1'�. O
LL IHEREBVAFflRI1UN0ERVENAITYOFPERJURYTHAT�AMLICENSEDUNDEHOROVISION50FCHAPTER � ^� O
p. 0(COMMENCIN6K'17HSECTION7000)OFOMSION]OFTHEBUSINESSANDPROFESSqNSCODE,AND Z L /1
�X W UCENSE IS H R1LL FORCEAND EFFECf. J1,� m • SO
� UCENSE CLA55-� ' �V UC.NO.� �✓V � '
�
�,~j DATE CONTRACTOR �` d
W
� WORKERS'COMPENSATION DECUTAATION �
� IHEREBVAFFIRAIUNDERPENALTYOFPf0.NFVONEOFTHEFOLIOWINCDECLAMT10N5: Z
� _IMAVEANDWILLMIUNTAMACERTIFICATEOFCONSEMTOSELF•INSUREFORWD(iKERS' _
COMPENSATqN,AS PROVIDED BYSEGTION 7700 OFTHE UBOR CO�E,FORTHE PERFORMANCE U
Q � OFTHE WORK FOR WHIpITHIS VER411T IS ISSUED. �
� �IHAYEANDWILLMAINTAINWORKERS'COfAPEN5AT10NIN5URANCE,115REWIRED8Y5EGT10N
� J7ooOFTMELABORCOOE,FORTHEPEHFORMANCEOFTHEWORKFORWHICHTHISPERMRIS
ISSVED.MYINORKERS'COMGENSATqNINCS�URAN�CEC'ARFIERANDPOLICYNUMBERARE: CONSTRUCTION
jGRRIER � � v I PUW REVIEW
POLICY NUMBER
4 ��� � ELECTRIC e
� (n+s5ecnor+r�mraTeEo�.r�rmoci�PEwatswnor�Mrnr�[opou,u�s�sla)oqtFss} PLUMBING
Z ICERTIFYTHATINiHEPERFORMANCEOFTHEWORKFORWHId1TH15PEfU/ITISISSUED.1 MECHANICAI
C7 SW1lLNOTEMPLOVANYPEN50NWANYMANNER50itSTOBECOMESUeJECTTOTHE
� WORKERS'CdADENSATIDNUW50FCALIGORN11AN0AGREETMATIFISHOULDBEfAME INSPECTIONFEE
S SUBJECTTOTNEWORNERS'COMDENSATqNVROYISqNSOF5EC710N�70oOFtMEU80R ,r �+`
CODE,1 SHALL FORTVIYATH COAIPLV WITM THOSE PPAVISIONS. ISSUANCE 1
0 /i'�"�.\ � 1 �': �
p DATE: APRICANT: SMIP � ����
� ENERGY P/C
WARNINO:FARURE TO SECIIRE WORKERS'COMPENSATION COVEPAGE i5 UNUWFUL,AND SHILL BE
� SU&IECTANEIAPLOVERTOCRI�AWALPENALTIESANDCMLFINESUPTOONENUNDREOTl10USAN0 ENERGYPERMIT "'
' OOLUiYSlfloo.000),NAD01T10NTOTHECOSTOFCOMPENSATqN,DAMAGE5A5PROViDEDFORIN
� SECTqN]70lOF7HEUBORCODE,MlTEREST.ANDAT,TONNEY'SFEES. RETEMIONFEE:
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ��•
� IHEREBVAFFIRAIUNDERPENALTYOFPERJURVTNATTHEREISACONSTRUCTIdJLENDIN6AGENCV �� � �
iOR TNE FERWRMANCE OFTNE WOi7K FOR N'Nlp/THIS PERMIT IS ISSVED�SEF 1oY7,CIV.C.�.
� �
� IENDER'S NAME
� LENDER'SADORE53 /�
W ICERTIFYTHATIHAVEREADTHISAPMICATqNANOSTATEhUTTMEABOVEP1FOfWATIONISCORRECT. TOTALFEES �—/��gO
� IAGHEETOCOIAPLYMATHALLCRYANDCOUNTVORDNANCESMlDSTATEUwSREUTW670BVILDIN6 � 1
� CONST�CTION,ANONEREBVAUTMORIZEREPPESENTATNESOF ISCOUNTVTOEMERUPONTHE
QABO��1 pNF.D PROPER FORI PE wn vuAooses. COMMENTS
J
� _��
m C �� NUAE(vRINT) .
4 �z 3�-o r
N
(n 5 E OATE
� . RECPT.NO. PAID BY VAUDATION
WHITE—Department Copy.YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
_ , . .. .. - .... .. , _ .. .. , � , , .
� �a�4' C'� D!f-�MC�i�k7 E+f'�k'�
If�S��C,;"`s�IQ�� �;E�(���J
1 1 ---=--_-__.� y,... r _._._._.., (�` �.._� �..��.._._._,_--___.� �__.__--
'� !►�'��Iy�Lt!l�J�� �J� .I' I��-`�� ''� t �J'�! � �`i:.� c�t'lc;'1►�d r,) �.�� '1►'������'"R"Q1�# '
l .
_..___.___�__�----__ .-----. .._. __ _.._. __. .
___ _.__ _.__. __�__.___ � - —_._�_
SEi BACK , ! . I.�-FLOOR JOl�T`'��
FTGS/FORMSISTEEL ---- � ----- '— ' � FHA REQh1TS-- --- - — �-- -
ELECTRIC GAOUfdD � ' � UNDER FLO�R DUCT �
GROUND PLUMBING � I Uf�lDER FLOOR CUM1!DUIT , � '
SLAB GRADE V � ^ FIREPLF�CE FOUNDF�.TION I �
-- - - -- _�----
7EMP POWER � I _I FIREPLACE E30i�U BEAh1
WATER SERVICE I _ _ _�1 P.41D HT. �OND EEAPJ!
HOOF SHEATHING ! I I_8 f7.BOND 6EAFA �
FRAh^INGNENTILIATION I I FINAL E30i�D BEAR�
ROOF COVER I PRE-GRADING
ROUGH HEATING BENCHiNG '
ROUGH ELECTRIC ROUGH GFiADING
ROUGH PLUMBING I FINISH GRADING �
I SHOWER/TUB 7EST POOL E.LECTRIC �
; �XT.LATH/SIDING j POOL FFPJGING _
, WALL I�dSlJLATION POOL FIf�AL i
CEILING Ii�jULATION OFF SITE IP�6PS.
DRYWALL NAILING � � } DEDICATIONS L
�
SEV'JEA , FINAL ENG. � �
SEPTIG T�NK _ I LANDSCF,PE/IRRIG. (
SEEP PIT/L.L. � ON SITE li�'PS. �
GAS AIR TEST � FIN.AL�ONING
FINAL COiJST. - ' ' '-�' G!RE D�'PT. FINA!
� FI�IAL HEF+TING � HcACTH DEPT. FINAL
FINAL ELECTRIC , p'�. � � �" � FEES PAID
FINAL PLUPABING i , ; - — - - �I EP�ERuY --
. �-
I � -- ,---- ---_--- ��� ' .'_' ' � '°. .��.� �. ,.—� � — .
�:
� CONIMENTS j�2'�•�'i, r�^KP f'�►� G���a-r r}�`(/=t��
,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
..._ Fv i�... �
,,f�}�
�I .,_
,=h li . . , . . ,