HomeMy WebLinkAbout12937 �
1�� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
(909)86a3195 Fax(909)861-3117 PRESS
'�*' � BUII.DING PERMIT APPLICATION FIRMLY
Q AD RI SS�oT� S - p«'+'�o�(A 'I�¢j� a� APPLICATION ' Z ` PERMfT P/C
p DATE � NUMBER � � #
' � ISSUE TYPE OCC
APN LOT TRACT7 DATE CONST. GROUP
p OWNER �-+�ITCC-�, TQ w,p l e't-��l' _ -
o ADDRESS Z'Po �'f �J !/✓l O�{T�S. (/P�-�� � ZONING SETBACKS
Z CITY G� G/a-Z}��''( !�. TEL. _ FRONT RW ❑
g APPLICANT .13 • ►�t.vinn 11s�AI 4 TEL. ° REAR ❑
� �— SIDE/SIDE STREET RW ❑
CONTRACTOR • �• �L-�/o✓1 %�Lfo SIDE ❑
Q ADDRESS O O L.y�4 S�o..ff �
o CITY�a!—��S ZIP "��3 TELS92 0 5f87
PROPOSED USE
wo ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� . OWNER-BUILDER DECLARATION SFR/ADD/REM
O
0
I HEREBY AFFlRM UNDER PENALTY OF VERIUPV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Garege/Cerport
W COISEUWFORTHEFOILOWPIOREA90N�5EC.7ro1.68U3WESSANOPROFE5510N3CODE:MIVGTYOR (n
U COUHTYNR/K7/qEpUIRE3AVERMRTOCONSTAUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRMIYS7AUC w �
W TURE.PRIOR TO ITS pSUANCE,PLSO REW IRES 7HE MPLICANT FOR SUpi PERMIT 70 FlLE A SIONED w P8�{0/D6CK
� STA7EMEHf THAT HE OR SHE IS LICENSED PURSUAM TO hiE PROVISIONS OF 7HE CONTRACTORS LJ- �
� CENSE UW(QUPTER Y(COMMENGNO WITH SECTION 7000)OF DIVISION 3 OF THE WSINESS AND PRO- PaaUSpe
FES9qN3COD�ORTMATMEOR3HE13EXEMPT7HEREFROMAN07HE8ASISFOH7HEALLE�EDE%EMP- �
TIOH.ANYVIOLATIOHOFSECfION7oJ1.6BYAHYMPLICANTFORAPERMI75UBIECTS7HEMPLICANiTO Z RaRoot
� ACML VENALTY OF NOT MORE hiAN FNE HUNDRED DOLLARS(i600).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESAShIEIRSOLECOMPEN5AT10N, � CommBfCiel . �
WILL DO THE WOfiK,AND TME 9TRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.70M.BU51- J
N NE33 M1D PROFESSIONS CODE hIE CAHTRACTORS LICENSE UW DOES NO7 APPLV 70 AN OWNER OF � ,
PROPEAfY W110 BULD9 OR IMPROVESTHEREON,M1D WHO DOES SUCH WORK HIMSELFOR HERSELF OR �
� 7HROUGH 18S OR HER OWk EMPLOYEEB,PROVIDED THAT SUq1 IMPROVEMENTS ARE NOT INTENDED OR LO �
�1 OFFERED PDR SALE IF,FqWEVER TME BUILDINO OR IMPROVEMINT IS SOID WITHIN ONE VEAR OF COMPLE-
Z �TION,THE OWNER�UILDEH WILL HAVE THE BURDEN OF PROVINO hIAT HE OR 6HE DtD NOT BUILD OR
� W PROVE FOR THE PURPOSE OF S/�L.E�
� ❑I,ASOVMEROFhIEPROVEHfV,M1IXClUSNELVCONTMCTINONrtTHLICENSEDCOPfTMC70RS
TO CONSTRUCT THE PRO,IECT(SEC.7041,BUSINESS ANO PROFESSIONS CODE:7HE CON7MCTORS LI- Velufitbll ADJ.AREA
CENSE UW DOE9 NOT MPLY TO MI ON7iER OF A PfiOPERTY NM1iO BULLDS OR IMPROVES TIEREON,AtJD
� NM1fOCOHTMCTSFORSUCHGR0.1EC7SWlhlACONTRAC70R(S)LICENSEDPURSUMlTTOTHECON7RAG • QUqNTITy DESCRIPTION , - FEE
� TORS 110ENbE UW.). �
.��
� ❑I AA1 E%EMPT UNDEA SEC. 8.a P.C.f-0R THIS REASON � �
3 c'
� s :Z- 2�•�
DATE OWNER F-'
� UCENSED CONTRACTORS DECLARATION � �' w�S
� W ( O,IL- S��c,
I HEREBY AFFIRM UNDER PENALTY OF PERNfiY THAT 1 AM UCENSED UNDER PROVISIONS OF CHAPTER
� Y(COAIMENCWO WITH SECTION 7000)OF DMSION 30F iME BUSINESS AND PROFESSIONS CODE,AND Z "�57�(.l'CQ Q-� S�/�(,{� � �
X W LICENSE IS IN FULL FOHCE ANU EFFECT. m
LLI � .r /
� ucENSE CUSS "� _ LIC.No. !"�Q�"���� — � �L�LP-A-To�
„ . (~j DATE 2-2.. CONTRACTOR „� � i`Ltiovt�ob.c'j a i �'�"'� � v '�l
�t� / t S
� WORKERS'COMPENSATION DECLARATION � � �l O�
� I HEREBY�FFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWPIO OECLARA710N5: Z
� _I HAVE AHD WILL MAINTAfN A CEf{TIFlCATE OF CONSENT TO SELFaNSURE FOR NORKERS' a
S
Q COMPENSATION,AS PROV�ED BV SECTION 97000F THE LABOfi COOE,FOR THE PERFORMANCE U
Q OF hIC WORK FOR NM1llql iHIS PERMIT IS ISSUED. � � -
� � _1 HAVE M1D WILL WUNTAIN WOPo(ER5 COMVENSATION INSURANCE,AS REUUIRED BV SECTKKJ
Q J7000F THE U1BOR CODE,FOR THE PERFORMANCE OF THE WOPo(FOR WHICH THIS PERMIT IS
ISSUED.MY WOR�KE/RS'COMP TION INSURANCE GRRIER NJD POIICV NUMBER ARE: CONSTRUCTION
� CARRIER�_l �•r�f � PLANREVIEW
� POIICYl0.1MBER �}�� C1 {�+� ..IC
� (MssEc�nr+MEIDrarsEmA�tET�ovn�a611.�rsFOaoNE1�l�DA�oa1Af�(i�oo)oaLFss} PLUMBING
Z I CERTIFV THAT W THE PERf-0PMAMCE OF TNE WORK FOR NM1iICN THIS PERMI7 IS ISSUED.I �MECFIA L �I�
�'} SHALL NOi EMPLOV ANV VERSON IN ANY MANNER 50 AS TO BECOME SU&IEC7 70 THE
(/J WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AOREE THAT IF I SIqULD BECOME INSPECTION FEE
SV&IECTTOTHEWORKERS'COMPENSATIONPRGG 1 NSOF CT�[!J)OOOFTHEUBOR -
E,I S FOR7}M1y�TH COMPLV WITH��IyB�'�� ANCE
p f
� p DATE:�(�� APPLICANL�'1 � i SMIP �� .
� WARNINCI:FAILURE TO SECURE WOFiKERS'CAMPENSATION COVEMOE IS UNLAWFUL,M7D SHwL BE EN R�/C
� SU&IECTAN EMPLOYER TO CRIM WAL PENALTIES AND CML FINES UP TO ONE HUNDRED T1/OUSAND ENERGY PERMIT
DOLWiS(f7oo,o00),W ADDI710N 70 THE COS70F COMPENSA7ION,DAMAOES AS PROVIDED FOR IN
� SECTION 370E OF hIE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PAE-ALT FEE:
. � I HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AOENCV -
FOR THE PERFORMANCE OF TiE WORK FOR WHICM THIS PERMIT IS ISSUED(SEC.30D'!,CIV.C.). .
Z
W
� dT LEHDER'S WA1E . �
! �
� LEHDERBADDRESS ;
� I CERTIFV THAT I HAVE READ THIS MPLICATqN AND STATE THAT THE PBOVE INFOfU/AT10N IS CORRECT. TOTAL FEES �� 1'
W I AOREE TO COMPLV VATH ALL CITV M1D COUNTY ORDWANCES M1D STATE UWS REUTINO TO BUILDINf3
� CONS7RUCTION,AND HEREBV AUTliORIZE REPRESENTA7NE5 OF THIS WUNTY TO EMEH UPON THE
Z4BOVE�MENTIOf1ED PROPERTV FOR INSPECTION PURP0.SE5. COMMENTS �
. 9 � �f� (��-(��� C �P
�
m EN i� l\
tn ./GJ��o
� � sqraiu oF EE DATE RECPT.NO. PA1D BY 1 V/WDATION
�' WHITE-0epertment Copy,VELLOW—Finance Copy,PINK—AseessorCopy,QOIDENRO�File Copy,GREEI�Applir,ant's Copy
CITY OF DIAMOND BAR
INSPECTION RECOFiD
' • � + � • � • • � . . � .
SEf BACK � , . '. ` � , FLOOR JOIST
FTGS/FORMS/STEEL � � FHA REQMTS
ELECTRIC GROUND UNDER FLOOR OUCT
GROUND PLUMBING UNDER FLOOR CC7t�DUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM ' ' '
WATER SERVICE MID HT. BOND BEAM
ROOF SFiEATHING S FT. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATtNG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBlNG FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . ' LANDSCAPE/IRRIG.
SEEP PIT/l..L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST! FIRE DEPT. FINAL
r'FINAL HEA�ING ' . HEALTH DEPT. FINAL .
FINAL ELECTFiIC , DEV. FEES PAID
FINAL PLUMBING ENERGY
' i •
. . . ' . ' . • - - .` , . ' • '
COIVrMENTS '� - �
,
; �� , , . . ,
, - ' �
, - . , . ._
SEPTIC TANK SIZE
SEEP PIT/U SIZE ,
il
,
, _ , ; . . .