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HomeMy WebLinkAbout17975 (19) CITY OF DIAMOND BAR / J� DEPARTMENT�F COMMUNTIY&DEVELOPMENT SERVICES -r 21825 E.Copley Drive (909)860-3195 Fax(909)86l•3117 PRESS "%.� BUILDING PERMIT APPLICATION FI R M LY � J08SITE � DATE CATION � NUMB R� N/C S o ADDRESS � 22 �� �W � � � OZ-� c� i ISSUE TYPE OCC .- APN LOT ACT DATE � � � CONST. GROUP p OWNER '�" "" ADDRES ZONING SETBACKS Z CITY ZIP ' TEL. FRONT RW ❑ � PLICA T i TEL. REAR D o SIDE/SIDE STREET RW ❑ � ' h SIDE ❑ � ADORESS ' PROPOSED USE � � CITY ZIP TE o ARCH/ENG/ • � z� DESIGNER ���'� NO.DWEL. NO. NO. a, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � - �j N DESCRIPTION SO. . 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O 1.AS OWNER OF h1E PROPERTY,AA1 EXCLUSNELY CONTMCTINO YAiH UCENSEO CONTRACTORS Q TO CONSTRUCT THE VR0.IECT(SEC.70ar,BUSINE55 M1D PROFESSIONS CODE:THE GONTRACTORS U• V311121iOf1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONMEROFAPPOPERT/W110BUtt.D50NMPROYESTHEFEON.�NO Z� W/qCONTMCTSFOR3UCHFPOJECT4WITHACONTMCTOR(5)L�CENSEDPUfi5U11NTTOTHECONTMG �UANTITY DESCRIPTION FEE � TORSUCENSELAW). ', � ❑I AM IXEMPT UNOER SEG B.t P.C.FOR TN�S REASDN U � ¢ u" DATE ONMEN V Z �yy � '� LICENSED CONTRACTORS DECLARATION W � IHERfBVAFFU7MUNDERPENALTVOFPEiWRVTMAT1�ulICENSE�UNDERDRON510N50FCHADTEH �r d Y[COMMENpHO WITH SECTpN 7000)OF DMSION�OF TNE BUSINESS AND PROFESSiONS CAOE,ANO Z X AfYLICEN5E45l1FULLFORCEANDEFFECT. tL m � LICENSE CU55 �� � ���.No. � a 3 3 S lo � . J V DATE ��_�j �O 1� CONT{3ACTOR�R , •rP u. W r � !WORKERS'COMPENSATION DECLARATION ¢ � I U � IHEFEBYAFFIRMUNDERPEWLLriOFGERNRYONEOFTHEFOIIOMIiNGDECLARAT10N5: fA Z ___ -. . . _'_ ___.. . � Q 0 _IHAVEANDWILLMAINTAMACERTIFlCATEOFCONSEMTOSELFaNSUREFORWORKERS' S � COMOENSATqN.ASDqOVIOEDBYSECTION]7000F7HEU�ORCODE,FORTMEPEHFORMANGE U Q OFTHEWOFKFORWHIp1TH13GERMITIS155UED. � � � W _IHAVEANDWILLMNNTAMWORKERS'COMPENSA710NINSUMNCE,ASPEOIAREDBYSECTqN f� O 77oaOFTHEUeORCOOE,FORTHEPFRFORAIMCEOFTHEN'ORKiORW1nCH7N15PERMITlS LSSUEO.MYWORKERS'COMPENSAiqNINSURANCECARRIERANDPOLICYNUMBERME: CONSTRUCTION � V j �pq�Eq PLAN REV�EW � POLICYNUMBER ELECTRIC O• � 0 (iFiSSECf10NtEmH0T8ECLe.stETmOFTfPERMT6Poii0NEHR�OREDOq1113SR+0U)ORLESSI PLUMBING i z . 1 CERTIiY THAT W iHE PEPFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED,1 MECHANICAL (,�} SHALL NOT EMPLOYANV PERSON W ANY MNi�ER 50115 TO BECOME SUBJECT TO T11E f-":7 /� �T � I�l-1 „�y.�,.� WORKERS'COMPENSATUNUWSOFCALIFORNIA,ANDACREETNATIFISHOUIDBECOME INSPECTIONFEE ' ` S SU&IECTTOTHENORKERS'WMPENSATIONPROVISqN50F$EGTqN77000FTHEUBOR J�-- cooE,i sw�u FoanrMn�coMc�r vnn�nase vao�sia+s. ISSUANCE � SMIP � p DATE: APPLICANF - J ENEHGY P/C WARNINQ FA4URE TO SECURE WORKERS'COMPENSATIDN LOVERAGE IS UNUWFUL.AND SHALL BE �y SUBJECTANEMVLOYERTOCRIMINALFENALTIESIU.DCMLFWESUPIOONEMUNDftEDTNOUSAND ENERGYPERMIT OOILARS(StOo.aoO).IN 11�DITION TO THE COST OF COMPENSATqN.DAMAGES Il5 VROVIOED iOR�N `-� � SECTION 770!OF 7HE U1BON CODE,NTEREST,ANO ATTORNEY5 FEES. RETENTION FEE: u '' - a I CONSTRUCTION LENDING AGENCY PRE-AL7 FEE: QC IMEREBVAFFIRAIUNDERGEN.LL7YOFPE0.NtiYTHATTHEREISACONSTRUCTIONIENDINa�GENCY � nZ- fOF THE GEflFORNANCE OFTNE MfORK FOR WHICN THIS PfRMIT IS ISSUED(SEC.9097,CIV.C.�. W I � LENDEq'S NM�E I � LENDEH'SADDRE55 �� 1 � ICERTIFYTMATIMAVEREAOMISMPLICATIONANDSTATETHATTHEABOVEMFORMATpNISCORFECT. TOTAL FEES w IAGFEETOCdAGLYNATM�LLC�TVµ�C��NNORDINANCE5M1D51ATEUWSREUTINOTOBUIL�ING � CANSTRUGTION,AN�MEREBYAUT/IORRE REPRESENTATNES OF THIS COUMTY TO ENTEH UPONTNE �/'�J �� • Z ►BOVE�IAENTIONEODROPERiYFORINSPECfIONGURVO5E5. COMMENTS � `��~���—.p � C � � 1� — S, m GE TTEEN (PN� u��, G._.. 1 ,Q s--- Jr—g—��— .p� - y sia E OF P Mirt � o�tE 7 PA1D BYC VAUDATION � �� RECPT.�0._./� ' . WFIITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Capy,GREEN—ApplicanCs Copy • . , . ... „ . -v , ., .il��., �H ,. . - ..'• . � ,.� .. � . . . � . . .... � - � . � , . . . . L.�f'a{ ��' �..F��—i�4ri Q�1��' C�i��.� 1P'�9��'i.�a EClT�1 ���C3E:E7 'I►w�.'i,a�c;:cCe)►� r.1_::'- -_.. l�'�=i.a:sc:,:���:1��_�_...._._...._...(�°E-`i,?=!c;,t�[c1►��...__....._.�...-�`tr�;i�� ��I��F:�j::i�c�p'c7�� i _ .. .. _ _ ,.. _____. __ . ---------.-. . � _ .. .__.. ___._, _...__.._..... .__._ ._..._�.--- -_.. ...._.__..----_._._.___..___._.______�_________.._ SEi'BACY. ! . i __ � FLOOR JOiST � � .�-� -- � /r"'�------ FTGS!FORMS/STEEL �HA REa"�1TS . �y�_3,.���y1�`�_�e'._......—.-.�..,.—.. '_—_ ELECTRIC GROUfJD i �;' � UtdDER FIQOR DUCT � GROUND PLUP�1BIi�G _ I__ I_ _ _ _�UiJDER FLODR CU?�I�UIT_ � SLAB GRADE ! i _ __ _j FIREPLACE FOUNDATION � TEMP PO'NER � I� j FIREFLP.GE BOND EEA�v1 WATER SERVICE I _�_1_PlIiD HT. E30;JD BEAF.1 __ ROOF SHEATHING ,/ �/,Z' I 8�. BQ�JD�E3EAP;1 I 4J_ _— —r:-. ._ � � FRAD.IINGNEIVTILIATION� �(/Z��� _ I ' FINAL E30ND BEAK'f i ROOF COVER I� � I ; PRE-GRADING' � ROUGH HEATING —� I BENCHING . ROUGH ELECTRIC ���j pL � I��RQUGH GRADI`JG __ ROUGH PLUMBING � I � I i FINISH uRADlNG � SH�VJER/TUB TEST / II j_; PO�L ELECTRIG EXT. LATH/SIOICJG _/� - I �. POOL FENCING I WALL IfJSULATION � , �� POOL FINAL CEILING INSULATION �� _ j OFF SITE IPJIPS. i DRYWALL NAILING � /( �'Z ! I DEDICATI�JNS •,, SEVJER r � FINAL ENG. • SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/LL. � OCJ SITE Itt4PS. GAS AIR TEST ; FINAL ZONING FWAL CONST. J �_ ! '• FIRE DEPT. FINA'� FINAL HEATING /� � � 1 HEALTH DEPT. FINAL FINAL ELECTRIC J`Z DEV. FEES PAID FINAL PLUMBING �__ � ENERGY I �s�s�2 �/��_.�� � _ � � A..�.�. �...�..._.�._.- . _`��''. "'`'`���_"� __.,.____.___ I COP��IMENTS � ---- - -- —- - - ---- -- - - --.___� ..__ ._. -- � SEPTIC TANfC SIZE SEEP PIT/U SIZE _.,..�p1 I . y`��, .�: __ . - , � '�y .