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HomeMy WebLinkAbout17221 (42) �,` CITY OF DIAMOND BAR � � DEPARTMENT OF COIvIIv1UNITY&DEVELOPMENT SERVICES ,��` 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS ���� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE e ^ APPL�CATION PERMIT /C T o ADDRESS��'D +�• -1.JI�d1i1Df R�R+R ��.�LO DATE ��NUMBER I vI � APN LOT TRAC ISSUE TYPE OCC � p OWNER �� p� , DATE_�n-� !7-E�� CONST.��- GROUP o ADDRESS O EK.�+ p ZONING SETBACKS FRONT O CITY 1R117� ZIP�� TEL.� 3 RW ❑ o APPLICANT TE�, REAR � �d-. SIDE/SIDESTREET RW ❑ � CONTRACTOR_ p�C SIDE p ADDR SSLI(�1� (4!�]1? � C�TY ZIP��Z`TEL4 • PROPOSED USE w ARC NG/ � y�'(',31 -p / z DESIGNER �k� ^ NO.DWEL. NO. N ADDFiESS UNITS NO. � CITY ZIP TEL. STORIES BEDROOMS � OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER OCCLARATION p SFRlADDlREM I NEHEBY AFFIRM UNDER PENALTV OF PERIURY iYUi I AM EXEMPT FROM TN[LONiMCTOqS tl• CdR60/C3�0lI W CENSEUWFORTHEFq10WINGREA50N(SEG7o]7.5BVSINESSAN�7ROFESSIONSCOOE:ANYCITYOR (n V LOUHi1'YMIp1RE0UIFESAPERMITTOCANSTPUCT,ALTER���ROVE.DEMOLISH,ORHEF�IRANVSTRUC• p81i0/DBCI( W NRE,PRIOR TO RS ISSUANC[.ALSO REOUIRES THE APVLILANi FOR SUCH PER4IT TO FILE A SIGNED w � STATEMENT TUT HE OR SH[IS UCENSEO FURSUMlT TO THE PROVI510NS OF TNE CONTRACTORS Li. � LENSE LAW(tlUOTER i(COAIIAENCING WITN SECTION 7000)OF D�VISqN 7 OL THE BUSINESS AND PRO� � POOUSpB 0 iE55iONSCODE)OIITH�7HEOHSN[ISE%EMa7TMEaEfaOUMIDTNEBA5�5FORTN[AIIECEDEXEMr• (� V TION.NJVVIOLATqNOFSECT10N70]t.58YANYAPPLICANTFORIIPERMITSVBJECT9THEMPLICANTTO Z Re•Roof A pYIL VENALTY OF NOT MORE TXAN FNE NUNORED DOLUAS(f500)r 0 04/S��EROFTMEPROPEHT',ORNYEMVLpYEESNnTHWAGE5A5hIEIH50LELOM7EN5ATqN, ❑ Z 1MLL DO THE WORK,AnD 7i+E STRUCTURE IS NOT INTENDED OR OFFEFED fOR SALE(SEC.70�1.BUSI• J COmm0rCi01 N NESSANOVROFESSIONSCWE:TMECOfiTMCTORSUCENSEUWWESNOTAVPLYiOANOWNEROF ? VNOPERTY MIIIO BU0.D5 OR IYPiqVES THEREON,AhD WHO OOES Sud1 WOqN HI45CLF OF MERSELi pq � THROUGHHISORHEHOWYEYPLOYEES,CROVIOEDTMATSUCHMOROVEMENTSARENOTMENDEDOR m Q OFFEREDFOqSN.EtF,HOVJEVEi�TNEBULDINOORIIAPROVEMCN'ISSOLDWIT}pNq:EVEAROFCOMP�E• Z T10N.iNE OWNER�BUI�DEH N^.LL HAYE THE BUi1D[N OF PROVINQ TMAT HE OR SHE OMJ NOT BVILD OR = IAIPROVE FOR TME PURP0.5E OF SALE). w OlA50WNEflOFTNEYROCERiY.AME%CLUSIVELIGONTMCTWGWfiHLICENSEDCONTMCTORS [[ TO GONSTRUCT T11E PRQlECT(SEC.701�,BUSINE55 AND PROFESSIDNS CODE:TME CONTMCTOR$LI- V81Ua�i0f1 ADJ.AREA W CENSEUWDOESNOTAPP�YTOANOWNEHOFAPROPERTYWFqBURDSORIMPRDYESTXEREON.AND � MMOCONTMGTSFORSUCHPRO.IECTSWITNALONTMCTOiyS)tICENSEDDUR5UAN7iOTHECDNTMG QUANTITY DESCRIPTION Y ror�succNSEuw�. FEE � OIAME%EMPTUNDERSEC. B,aP.GFORTMI5REA50N Q � 2 � U Z u" DATE OwrvER ~ (.'(�(��S � CQ��T �()NG�O'A4D �¢ LICENSED CONTRACTORS DECLARATION W CC IHEREBVAFFIRIAUNOERPErUITYOFPEiWRYTMATIAMLICENSEDUNOERPROV15:ONSOFCHAPTER � � ^ � 0(OM.�MENCNaVrtTY15EC710N70oo)OFDMSION]pFTH[BUSINESSANDPROFE5510NSCOOE,AND Z I �I.�. 'u �� YYLILENSEISWFl1lLFORCEANDEFfECT. � � LICENSECUSS��� LIC.NO.��� � V OATE �^��-^�� CONTRACT0f1�'�_, . ._ d � �,'�'DR �] 7U�ERS'COMPENSATION DECLARATION Q I✓� NIHEREBYAFFIRMUNDERiENALTYOFGE0.AIRYONEOFiHEFOLLAW.NGDECLAMT10N5. Z � _IHAVEANDNnLIMAINTAINACER7IFICATEOFCONSENTTOSELHNSUH[FOFWORKERS' ¢ Q CONPENSATqN,ASGROViDE08YSELTION�7000F7MEUBORCOOE,FOFl7MEFERFpRMANCE U Q Of iHE WOfU(FOR WHICH hltS VERMIT I5155UED. � W IHAVEANDWILLIAAINTAINWORKERS'CW�PENSATIONMSUiUNCE.A5RE0UIRE00V5ECTIOH ^� / � i7o00FTHEL�BORCODE.FORTHEPERiORMANCEOFTMEWORKFORMMICMTHISPERMITIS �,�� �\�.Y� J ISSUCD.MYWORKERS'COMPENS�TIONINSURANLEWRAIEFANDPOLICYNUAI�ERME: CONSTRUCTION .� 0 j CARqIEH r �»fl PLAN REVIEVJ 0 POIICYNUMBEH��p�I��' � �� ELECTFIC • I Z Q _�,�_,._�_. - ' 1 � (fHtSSECrONNCEDNOiB[CC�i'LEfEDCFTEPERMft6fpqOnEMIRqiED�Ol1A0.5�iiaCl�lE351 PLUMBING __ � `u� l� Z I CERTIFV THA7INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERA�iT I5lS5UE�,1 MECHANICAL I f '��� � U' SWLLlNO7EMPLOYANY0ER50NMl/WYIAANNERSO�ST08ECO�c'SU&1CCTTOTHE � WORKERS'fA4VEN5AT10N4W50FCALIFORNI�AND�GREETHATIF15H0ULDBECOME INSPECTIONFEE � � S SVBJECTTO7MEWORKEHS'COAIPENSATIqJPROVISiONSOF5ECT10N7�000FTHEUBOR � LOOE.ISHALLFONTFIWITHCOMPLYYATHTHO P SqNS. ISSUANCE � p DATE: �Z'�� APPLICANL _ . SMIP I � � WA{WINO:FA�IU(YETOSECUREWOANERS'COA�PENSATqNCOVERACEISUNI,hWFUL.ANDSHALLBE ENERGYPlC I�� r' - LL SVOJECTANEMP�OYERTOLR:M:NALVENALTIESANDCMLFWE9UPTOONEMUN�REDTMWSiWO ENERGYPERMIT ' � �� � DOlLARS(S1o0,000),IN ADDITION TO THE COST OF COIdPENSATqN,DAMACES/5 PROV'OEO FOq IN SECTqN710eOFTHEU00qCOOE,INiER[ST,IINOAT70RNEY'SFEES. RETENTIONFEE: OCONSTRUCTIONLENDINGAGENCY PR[-ALTFEE: 1� � � IHEHCBYAFFIRMUNDERPENi1LTYOFVERJURYTMATTMER[ISACONSTRUCTIONLENOINCAGENCY d' FORTMEFERFOqMANGEOFTNEWORKFOfiWMICHTMi57ERMITISIS5UE0(SEC.70W,CIV.C.). � W 1J l�r F LENDEftSNM�E 5 � LENOER'S1�OR[SS q � ICERTIFYTNATIHAYEREADTMISAPVLICATqN�NDSTATETHATTMEA80VENFORMATpNISfARRECT. TOTAL FEES ��O1 —I 1 � li1' � w IAGR[ETOCOMPLYWITHhLICRYAN�COUNTYOFDINANCESAN�STATEUWSRELATWGTOBUIIDING w�• d V. CONSTRUCTION.AND MEREOY MIf1iORIZE flEPRESENTATIVES OF TH;S fAUNTY TO EN7EH UPON THE �j 1�J Z ABOVE�uENTqNE'JVROPERTYFORINSPECTqN�URVO5E5. `l 1 � COMMENTS �._r� � � U�� m -:11�- 4 PE ITT�E E RIN N �' �-(z Ql (n biGNATUHLOFVERMITTEE OATE � RECPL k0. � PAID DY VALIDATION WNITE—Depanmenl Copy.YELLOW—F�nance Copy,PINK—Assassor Copy.GOL�ENROD—Fila Copy,GREEN—Apphcant's Copy � . . - . . . � .. .. - , - . .. -., . - - - - � .: - _ _. . -- . .. :,.-. , . . . ... . , . �. - . . .. .. .. .. . �I i'�' :JF �I��,P�,rC3f�'r� F��,•.; 1��1��s'=��'o"?���' �3�CG,=:e� .. _. ._.___------_—.----.__.__-- �-�----------------- _ _...._....._...------- - �- -----� •-------_._ _ �._^ . � 1�:K;1_t�•.:._. c r�_:t'-•~ IiF:I.. c:'_C)a.- (���.i:a:'C: Glc ► )_t�C� .. _ I►I�i. ..._..I"C 1►�i , ,� - � •��_ r - • - ��E ': .. li`F.`i_:!:¢`''�C�:� ' -•----...:-- --....---. ._.._..__. _ _. .. ._ . . . ., . . _ .. . . . _.._... - --.. . ..... ----------...-- - SET BAC�: ' ' FLCG;JJ':ST I I � � � � , , ._. .----•---�------ --�-• - --- -----..._ ..— - --- ----- -- FTGG�FORi�15'STEEL I -- .--- --- - .: l FF!;"�REQP:;TS -I---- --� _ _ —..— � .... -_•-•---• --�—--- ELECTRiC GROU�•l� � � '' Uh:DER FLOOF? DUCl� � � I----...---.—...;---_--- , ---1--------- ---- GROUND PLU�:"31�JG � ; Ut1��F. FLCOR CU?•ID'JIT � -�---- — �-------- — ------- SLA�GRl'�DE �-------- � _ ------__�_� � FIR�PLAGF FUiJ`lDE�TIO��. � --- TED.4P POVJER I _ ___ i I FIREPL.ACF_iiO��D 6�Ai,1 _ _I ___ i WATER SERVICE I I �I I �•�^ID HT. �O�JD F3EA�" ' I ROOF SHEATHI�JG - ---- ------i � f3 F=L 6�'•:D ErF�,�,; --- � ----- - FRAtJiIPdGlVENTILIATION� ��___ __ ! FIP.AL EJfv'D£cAF.1 __:. _ _ i _ _ ROOF COVER I I � � FR_-GR�'+DIh:G I � ROUGH HEl,TING j � B��•:Gf-'I�J�� i � ROUGH ELECTFaIC � I � E F�UUGI 1 GR!`.Dli�!G � ----1------- -- --' — ROUGH PLUh�"BIfJa I__ I . _ I i FI?;15Fi i;�Rr^,Di�d�i I __� SHOb'VER,rfUB TEST I __I_I �'GUL ELECTHIC � � EXT,lJ',TH,•`SIDIPJG �-1 ____. _I_i_►�oo���r�cir��=____ I�,I __._ VJALL INSULATIO�J I I I �'COL Fi�lAL � � CEILING INSULATION � ' _ �j O�F SITE I��PS;__ ;_ � DRYNJ�,LL NAILING � _�_ ; DEDICATIO'dS � _ _ SE�"JER � � _—�,i FIh�AL E�•iG. 1 -- SEPTIC TANK I I I LF,PJDSCF,PJIRRIG. � S[EP PIT/L.L. � � �ON SITE R.1i'S. ; _ GAS AIR TEST L � _ _ �� FINAL IO�dif•1G I � _ FINAL CONST. � (J 'j : j.f �IR� Q�P'T. FI"JA'_ � l— L�-- I I FINAL HEATING � �_� HEAL7H DEPT. FIN.AL , FINF:L ELECTRIC � I' /,�,,,� � � GFV. FErS PA!D � FINAL PLUR181NG �����L.. v i_^�tG' � I I EN�RGY - _ � -- I � � � - -----� ---- -_T�....�-r-...-.._. .,.._�, .,�- : i�;� � _ ... . ., . , -----�--------I-----�—----- - •: •" _.. .. --•--- � --- COMMENTS „ – SEPTIC TANK SIZE SEEP PIT/U 51ZE -- ---- — ',I ._.______, --.-- -- v�r� — ` , , — :� .