HomeMy WebLinkAbout17928 �� CITY OF DIAMOND BAR
� DEPARTMENT OF COIv�IUNITY&DEVELOPMENT SERVICES
�.Y` 21825 E.Copley Drive
(909)8b0.3195 Fax(909)86I-3117 PRESS
'`��' BUILDINGPERMITAPPLICATION FIRMLY,�.,
JOBSITE �/ '' �� ,r� APPLICATION �PERMIT �P!�
o ADDRESS T ������h �� � DATE NUMBER #
� ISSUE TYPE OCC
APN—�y�LOT TRACF DATE �CONST. GROUP
p OWNER /"�lf`/EJ�, Lt/a b
�'` AODRESS �'/��� ' ZONING SEiBACKS
z CITY .0• � ' ZIP / STEL � FRONT RW ❑
� g APPLICANT TEL. R�'p �
� SIDE/SIDE STREET RW p
� CONTRACTOR L� ,G 51DE ❑
� ADDRESS + � ��
� CITY t1+� ZIP�.�'TEL ? PROPOSED USE
� ARCH/ENG/ ,
DESIGNER NO.DWEL. NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BU�LDEH OECLARATION SFR/ADD/REM
O
p 1 HEREBY AFFlFUI UNDER FEN/LTY OF PEiWRY TNAT I AM E%EMCT FROM THE CONTMCiORS U- Ga19oB/C��pOR
W CENSEUWFOqTHEFOLLOWIN6REASON(SEC.70.11.6BUSWESSANDOPOFESSIONSCOOE:ANYCfTYOR (n
U COUHTYWMCMREWIRESAiE��TTOCONSTfiUCT,IY.TE0.�PNOVE,OEMOUSM.OPNEPNRANYSTRUG W Pet10/DBCk
b TURE.PILOR TO RS ISSVANCE.�WSO REWIRES THE AVVLICANT FOH SUCH VENMIT TO f1E A S16NED W
STAiEUEM TW�i HE OR SHE IS UCENSEO Vl1R5UANT i0 THE PflOVIS10NS OF TME CONTfUCTOR$L4
� CENSELAW(p1AFTER�(COUIMENCR1CiW1iN5ECTqN7000)OFDMSION�OFTHEBUSMESSANDPfW � PaoUSpa
FESSqNS CODE)OA iHAT HE OR SNE IS E%EIAPT THENEfROM AND ME BASIS iOR THE ALLEGED E%EA1D•
� TION.AN1'VIOL11t10NOF5ECTpN7o71.SBVANYAPPIICANTFORAPERMIT3UBJEGTSiHEMPLIGWTiO Z Re-Aoat
A CML PENAITY OF NOT AqRE THAN FlVE NUN�RED DOLURS(t5o�.1:
� Ol��'NEROFTHEPROPERTY.OHMYEMVLOYEESWIiNWACEShSTF1EIRSOLECOMFENSATION. O �mmereial -
z WILL 00 THE WORK.AND TME STRUCTURE IS NOT INiENDEO OA OiFEREO FOR 61iLE(SEC,7W�.BU51- J
� NESS 11ND PROFESSIONS OODE TME CONTMCTORS LICENSE UW DOES NO7 AVCLYTO AN OWNER OF �
PHOPERtt WFfO BURDS OR W VROVES TMEREON.M10 WMO DOES SUCM YYqRK NIMSELF OR HERSELF OR
(L TMROINiHHI50RNEHOWNEMPLOVEES,PROV10E0iHAiSUp11MPROVEMENTS�RENOTINTENDEDOR m
QOFFENEDFORSALEIF,IqMEVE0.7ME8UlDINCORM1�PROVEUENTB50LOWITMINONEVEAROFCOIAPLF•
� TION,TNE OY/NER•BUIIDER WILL NAVE THE BURDEN OF iROViNG THAT HE OR SHE OID NOT BUILD OH
� MPROVELORTNEVURPOSEOGSALE). ����
w O4��WNEROFTMEPROPEfi7Y,AMEX0.U5NELYCOMMCTINOYrtTHLICENSEDCONiMGTORS
� TO CONSTRUCT THE PROJECT(SEC.70N,BUSINESS M10 PROFESSIONS COOE:h1E COMRACNRS U- V21U8fi0f1 A0.1.AREA
CENSE UW OOES NOTAOVLY TO AN OYMEFI OF A GROPEfiTY WIIO BIlRDS OR 7APf10VE3 TMEREON.AN�
� W1qfANTMCT5fOR5UCMGRQIECTSWiTHACOMMCTOR(S�LiCEN5E07UR5UANTTOTHECONTMG OUAN7ITY DESCRIPTION FEE
� TOflSl10EN5EUW.). .
� OIAMDfEMPTUNDERSEC. B.lP.0.FOqTHISREASON U
u' DATE ON'NER �
� W
�Q LICENSED CONTRACTORS DECLARATION W
[Z IHEREBYAFFINMUN�EHVENALTVOF RYTIATIAMLICENSEOUNDEROROV15iONSOFCHAPTER Ur /I�.T� T� /f
p. 9(COMMENCINO WfTM SECTqN 7000 f ONiSION 70F TME BUSINE55 ANO iROFE5510N5 COOE,ANO Z ��� �`
`X MYUCENSESINM1JCp�EAyO fFECT. .��� �`�
/ - � m
�
� UCENSE CLASS �� �� IIC.NO. � J �
~ DATE CONTMCTOR ��� �� a
U
W
� WO ERS'COMPENSATtON�ECLAFlATION Q
� I HEREBV AFflRAI UNDER PENALTV OF PE0.IURV ONE OFTNE iOLLOWiN6 DECLARATIONS: V
N a
� �INAVEANDMALLMiVNTAWACERTIFIGAtEOFCONSENTTOSELf�NSUREFOflWORKER3' S
COMPENSATION,ASPRCYIDEDBYSECTION�7ooOFTHElAF10ACO0E.FORiHEPERWN>�MICE W
OF FONWNICHTMISPEHMITISISSUEO. � �
�
_I MAVE AND WILL MAINTAIN WOFiKERS'COMFENSATqN WSUMNCE,AS REOUIRED 6Y SECTION
Q 77opOF7FIEtABOROODE,FOHTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
ISSUE�.MYWON(ER�P�NS�iJQ4.WSUMNCECMRIERMlOPOLICYNUMBEqARE: GONSTRUCTION
j CARiUER f=� PLAN REVIEYJ
� POLICYMIIABER ELECTRIC
O
(I}i55ECIfON1�EmNOTBE�EfE➢CFiFEPEFAyT6fORONE 1s+oma+tessi PLUMBING � —
Z I CERTIFYTMAT INTf1E RFORMANCE OF 7HE WORK FOR W i iM15 D T ISSUED,� MECHANICAL
� SNALLNOTEAI7LOV VERSONNANYMANNENSOA570 OTHE �
� WORKER5 PENS 10NUW90FCALIFORNI ATIF -COIAE WSPECTIONFEE
SUBJECTTO E MERS'W�PENSATIOND SION F ��]) GTNEUBON ISSUANCE
O CODE, 5 F wm�canv�r vnrn na PRO `
f� �
p DATE: C' pLICANT: SMIP
W ENERGY P/C
LLWAFWINQ:F.VL TOS CUREWORKERS'COMPENSATIONCAVERAGEISUNUwFULANDSHALLBE
9UBJECfANEMPLAYE OCHMWAI.PENALTIESA1NqVILFWESUPTOONEHUNOREDiH0U5M1� ENERGYPERMIT
OOl1AHS(510D.000).IN OITION TO THE COSTOF COMPENSATqN.OAMACES AS PROY�AEO FOq N
� SECTIDN77oeOFTNEUBORCODE.MITEREST,ANDAlTORNEYSFEEA qETENTIONFEE: j
W CONSTRUCTION LENDING AGENCY PRE-ALT fEE:
�
� INEREBYAFFlRMUNDERVENALTYOFiEM1RYTMATTHEflEISACONSTRUCT10NtENDINOAGENCY
dZ FOR THE PERFORAIANCE OF iHE WORK iOH W WCH TN�S PERMIT IS ISSUE�(SEC.9097,CIV.C.�.
W
� LENOER'9 NAME
� LENDEH'SADDRESS \
WICEHTIFYTMATIMAVEREIDTHISMP�IC�TqNAND3TA7ETHATTHEA80VEINFORM�TqNISCORRECT. TOTAL FEES U
� �AGREETOCOMPLVN7T/ALLCItYANOCAUNTY RDINANCES�IJOSTATEUWSREUTIN�TOBUM1.DING ��
CONSTitUC710N.ANOHE EBYAUTHORIZE SENTAi1V OFTMSCOUNIYTOEN7ERUPONTNE
Z ABOVE-MENTIONEOV FORINSC TION Rros . COMMENTS
� �
�
m PERMITTEE NNAE(P(iINT)
� ! -Z -t�?�
N SK'+NATUREOFVERMITTEE � DA7E
� RECPT.NO. PAID BY VALIDATION
WHITE—Depanment Copy.VELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
. . .�.r. . .n .-a• .ln .�e-:N M'"�'1��ry T .,l;�i'�: �' .�n. . �� "�' ""' . ...... . � `� , . :1�.�. . . . ... �]". " ` .. � .., t�el .' . , . - . -.. . .
CiT`r' C3F DIAf�80tvD BAR
� INSF�EC a iOI�E R�CORD
"���,�:��������.� • ;�,y�'�; "�L���.��F���r#.. . il.��-��.3���.�� _ . .:�'��;��� .. . � ��►���y���.��.��
�....Y_., _ _.__ ...�..._.:.� _.��..._.�..,-:.._.._..w..�._� ..._.......... _........�....._�__.. - .�.�...._._.�.._�...�.. - -
SET BACK � � ' ' FLOORJOIST �`• � _.
FTGSIFORMS15TEEL I � T FHA REQMTS- ` ' `
ELECTRIC GROUND ' � � UNDER FLOOR OUCT
GROUND PLUMBING I � � UNDER FLOOR CUP�IDUIT ;
SLAB GRADE I FIREPLACE'FOUNDATION I
TEMP POWER i I � FIREPLACE BOND BEAM
WATER SERVICE � MID HT. BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM• • ; �
FRAMINGNENTILIATION � FINAL BOND BEAM �
ROOF COVER PRE-GRADING
i ROUGH HEATiNG I I BENCHING -
' ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBING � ' FINISH GRADING
� SHOWER/TUB TEST i POOL ELECTRIC
EXT.LATH/SIDING I I POOL FENCING
-*-+--
WALL INSULATION I i POOL FIPdAL
CEILING INSULATION � � ' OFF SITE IMPS.
DRYWALL NAILING j � DEDICATIONS
SEWER � FINAL ENG.
SEPTIC TANK - � � LANDSCAPE/IRRIG.
SEEP PITlL.L i I ON SITE IMPS_
' GAS AIR TEST ; I � FINAL ZONING
� FINAL CONST. � I �� , �IRE DEPT. FINA! �
' FINAL HEATING i � HEALTH DEPT. FINAL �
� FINAL ELECTRIC ! � DEV. FEES PAID
FINAL PLUMBING �I�� �; i ENERGY
I
ti� � i`�a7f{�c e-.: _ �
COMMENTS � -
SEPTIC TANK SIZE
SEEP PIT/U SIZE
. _ ,��, -�`1
�
3
- ��
���� I-=�i
� `
�.�.��__.... �I � `--ti- ,._