HomeMy WebLinkAbout17112 (37) �` CTTY OF DIAMOND BAR
DEPAR'IMENT OF COMMUNITY&DEVELOPMENT SERVICES ��
.��� 21825 E.Copley Drive
������� (909)860-3195 Fax(909)861-3117 PRESS
.A BUILDING PERMIT APPLICATION FIRMLY
o AOD R�ESS d� d � S DATE CATION � , �1 NUMB R I_ � I 1 �11�
� APN LOT � TRACT �SSUE TYPE OCC
DATE CONST. GROUP
p OWNER _/�A. 1•I�
� ADDRESS CC Pn ZONING SETBACKS
z CITY J�/'j, %�!/a� C3P�• ZIP 717Ci TEL. - Y-^C�-S l FRONT RW O
g APPLICANT f;A Z r � !t-�✓"►C,_ TEL.9.c�-'i(.3-'�ncr� REAR ❑
� SIDE/SICESTREET RW ❑
� CONTRACTOR • � G N SIDE ❑
� ADDRESS � ' VF
� CfTY � .�r r ZIP a� ' TEL.�-�-S�� PROPOSED USE
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. N0.
a ADDRESS UNITS STORIES DEDROOMS
� CITY ZIP TEL.
cn
u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAflATION SFR/AD�lREM
O
I H[REBY ALFWY UNDER PENALTY OF PERIURY THAT 1 AA1 E%E1APT FROY T1E LONTRALTORS LI. Ga�ygq/�af�On
W CENSEUWFORTHEFOILOW:NGREA50N(SEC.7071.SBVSINE55111:DPROFESSqNSCODE:ANYC�7YOR (n
U �p{JNTYWI{�p1pEWIHESAPEqMITTOCONSTRUCT,ALiERIMPROYE,DEMOLISH,pqpEPAIRANYSTRUC• W P9Ii0ID0G1(
w NRE.PRIOR TO RS ISSUMKE.ALSO REWIRES iHE APPLICMIT FOR SUCH DERIJIT TO�4E A SIGNED W
STATEMENT 7FUT M[OF SYIE IS UCENSED%1RSUANf TO T+E PROYISIONS OF TME C�NTMCTORS U�
� CENSE UW�CHAFTER Y(CAYMENCM�NATH SECTION Im0)OF DIVISION 70F TME BUSINE55 AND PRO� � POOVSpd
FESSIONSCOOE�ORTHA7HEORSHE�SEXEMPTTNEREFROMIl4DTHEBA515FORTHE/LLLEGCDEXEMP. (�
V TION.AM/VIOLATqNOFSECTION1071.6BYANV�PPLIGIVJTfOFADERMITSUBJECTSTHEAPPLICANTTO Z Re-Rool
A CML OENALTY OF HOT►bHE TNAN FNE NUNONfD DOLLARS(f SOD)):
D I,AS OVMER OF THE GROVEFTY.OR MY EMPLOYEES V.9TH Wn6E5AS THEiP SOLE COMPENSATiON,
� O Cammertial
WILL DO THE WORK,IL4D THE STRl1CTURE IS NOT INTENDED OR OFFEREO FOR S�LE fSEC.70�{,BU51• J
NL55 AND PROFESSIONS COOE:TME CONTMCTOAS UCENSE Uw pOES NOT APPLV TO AN OWNCR OF
� 7NOPEHTYIMIOBUMSORIMVROVESTN[REON,ANDYMODOESSUp7WOFNMIMSEIFORMERSELFOR � �^�'J R r � '1 i
wTHROUCHHISORMEROWNEI,P�OYEES,VROVIOEDTNATSUCMMPROVE�ENTSANENOTWTENDE'JOR m ♦" /���
� OFFEREDFORSALE.IF,FqW'VERTMEOULD11vOOAIMPROVEMENT1550tDYrtTHINONEYEAROFCAM�'LE� yJ1/bAd' '! A/C.� c.i{,��j
Z TION.THE OWNER-BUILDER N'ILL HAVE TME BURDEN OF PROY�NG iHAT HE OR SHE�I'J NOT BNLD OR
= W PRDVE FOR iNC PURP0.SE OF SALE).
w 04ASOVJNEROFTHEPROPERTY,AME%QUSNELYLONTMCTWOY/ffHUCENSEDCONTMCTORS
Q TO GONSTRUCT THE VR6IECT(SEG foal BIJSIN[SS M!D PfiOfES510N5 COOE.1ME CONTMCTORS L4 V0�118110R � � ADJ.AREA
W CENSEUWDOESNOTMPLYTOANOWNEROFAPROPEflTYWMOBURD50RIA1PROVESTMEREON.AND
� W/qCONTMC75FOR5UCMVRQIEGTSMnTHl1CONTMCTOR�S�UCENSEDPUFSU/�NTTO7MELONTMG OUANTITY DESCRIPTION FEE
Y TORSUCENSEUw.).
� ❑I/AIE%EMPTUNDFRSEC. B.IP.C.FOATMISREASON U «i• '�`'iR� .�
�
ll.. �
pATE OWNER V
Z W
FQ LICENSED CONTRACTORS DECLARATION W
LL IHEREBYAFFIRMUNDERPEW�LTYOFVERIURYTHATIAMLICENSEDUNDERVROViSiON50iCMA7TER Vr
p� o(COM1A[NCWaVATNSECTqN7000�OFDmSiON�OFTNEBV5iNE55ANDVROFE55iON5CODE,AMD Z
M1/IILCNSE IS IN FULL FORCE 11ND EFFECT.
ysa� rS �
� LICENSE C �s� NJ G �IC.NO. j
v onre /J�,�C�I OZ[j f�I__ CONTRALTOA �
w
� WORKERS'COMPENSATION DECLARATION Q
N IHEREBYAFFIRMUNDERPEN�LTYOFPE0.NRYONEOFTHEfOLLAN^NCDECLAMTIONS: U
(/) Q
O ��HAYEANDWILLMAINTAINACERTIflCATEOFCONSENTTOSELF-INSUREFORN"DRKERS' _
� COMPENSATION,ASVPOVIOEOBVSECTION77000FTMELA90HCOOL.FORTMEYERFORMANCE W
OF THE WORIC FON WHiCH 1Hi5 PEFAl1T�S ISSUED. �
�
�IHAVEANDWILLiM:MA1NWORKERS'COMPENSATqNINSUMNCE.A5FE0UIREDBV6ECilON ,,-"�` �
0 77ooOFTHELA00RCODE,FORTHECERFORMANCEOFiMEWOHKFOHWMICHTH15PEi1MiT15
' ISSUED.MYWORNEPS'COM7ENSATIONINSUMNCECARRIERANDPOL�CYNNA9ERARL: CONSTRUCTION 1�v
7 CARRIER J�T� /SM P //VS. FZI N D PLAN REVIEW
� PO�ICYNUMBER F�
¢ �/�.C�._�Q�-- ELECTRIC V��
��• i —
� (iTi55ECfI0NH�NOTBE00MRFfIDOFTfFEFAtTbfDROnSMJKX1ED00LLAR5Ri0c10R1E554 PLUMOING
Z ILERTIiYTHATN7T7EPERFOAMANCEOFTM[WORNFORWH1CHiH15GENAITI5I55UED.l M.ECHANICAL
(�} SNALL NOT E�PLOY ANY CfR50N N�NY NANNER SOAS TO BECOME 5 JECT ]iHE
(n WORKERS'COMGENSATIONUWSOFCALIFORN1IA 7�GR[E7/UiIF .HO JBECOME INSPECTIONFEE � 1 �- •'�� /\\ � � � '�„ U.Q
S SU&IELTTOTHEWVRKCRS'CO�APEN "1NPHOV.iONSOFSECT J] TM[UBOR �'"�
�ucaarNvnn�coM�rwi � se oviswNs. , ISSUANCE
O ^, . '
p DATE: � � � APPLICANT: SMIP , � , _
� ENERGY P1C �
WAANINO:FAILVRETOSELUREWONCERS'COM NSA N �ERACEISUN Wi L,ANDSNIyLEE
� SU&IECT/WEMP�O7ERTOCR:MINN.PENALTIE AND :LF ESUPTOONE '� �ACDTMWSMID ENERGYPERM.IT I
DOLLANS(f 100.000�.IN ADDITION i0 TNE COST 'C01.1 N fqN.DAMACES PRO`�:DED FOF IN
J SECT�OP17�oBOFTMELABOnCODE,w7ERE5T, ]A : EY5FEE5. RETENTIONFEE: � �—� � --- ---
2
nw. CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
Q IHEREBYAFFIRMUNOERPENALiYOFVERIURYTHATiMERE15ACON5TRUCTqNLENDWGAGENCV
d fORTMEPENFORMANGEOFTMCWOAKFORWHIGMT„ISpERMiTI5155uED�5EC.]os1.CIV.C.�,
Z
W
� LENDER'S NNAE
� IENDER'Sll'IDRE55
W 1 GERTFY TMAT I H�VE READ iM15 APVLICATqN ANO STATE THAT TNE ABO�E INFOR4ATqN IS CARAECT. TOTAL FEES a �
� IAGREET0001.�PLVWITNALLCITYAN�COUNTYORDINANCESANOSTATEUNSRELAiNGiOBULOiNG
� CONSTRVC'TION.IWOHEREBVAUTHORREREGRESENTATNESOFTMISCWNTYTOFIRFRU70NTNE
Z /IBOVE�MEMIONEDPHO�ERTTFO�iINSPEGTqNPVNPO5E5. COMMENTS
o � _r ,N� oL�..
�
m PEauiTTEE [lP 7�
¢ 3� n/
�
� SIGNnTUHEOfP R E DA .
� RECPT.N0. PAI�BY ,VALIDATION
WHITE—Department CoDK YELLOW—Finance Copy,PINK—Assessa Copy,GOLDENROD—File Copy.GREEN—AppliCani's Copy
/
. . .. . ...... ... ... ..... . . . . . -- -- -- � , -.
6.r1 �,�'r �i ��.''-�w�:ILJ{`tS3 �'l��.iT
�r,���=:_�:�s-iu�, r��c;;n
:1►`�-''l�l�f'����;��1I --^- �/G�,�1 ---.._.1►'F�C�='c•"_�.1:."_-_.___. .l,��`:'= r�'.�1�_�►r,____._.._�--�:f.�,3�-._._.._���ti'i:.!�c��E'o'��� __.
. ..----------.:._..::..._...__._.._...__. _ .-. _ .. ..._.� ...:..... . ... . . _. _ . _......__ .. .. .... __ ...... ...-=-._.--•-,..----
... _ .... LC�On JC�'S1 , : ' 1
SET BACK I �-----I,, ^ , .. . . � _
-- --►---- --- - - - - ---
FTGS/FORP.�5J5TEEL � ; I ! FH�;REQ'.1"fS i — -� ,_
ELECTRIC GqOUfJD � 1 I I—� _.
I , , UIJD�� FLOOR DUCT I
GROUND PLU�,ABI�JG � I ^ I � UIlD�R FLOOR CU�•�DU1�1 ; •
-�-----� --- -----
SLAB GRADE i I i }� FIR�PLACE FOU:IDATIOiJ ; i '
TE��1P PO�VER I � �I I FIR�PLF,CE F��PJD BEAP.1 � _ �
. i ------
V�JATER SERVICE I j �-- -- � � �"ID HT. C�OP�D f3EAt" I
ROOF SHEATHING _ I __ I I F �• 6�hD i3�_/;'.1__ �_ ' � _
FRF,P,�ING,NENTILIATIOfJ! I _I_I_FIPJAL EOhJD BE��:" �
ROOF COVER I' I _ ^_ I �'��-GRF,DItJG__�� j
ROUGH HEATIfdG ��� I BE�•dCF+IiJG _ � �
ROUGH ELECTRIC ; ' i RJUGH GRADIF.0 �
ROUGH PLU��rBING 1-- —�-�-- —; � FIi.ISH uRA.DI��G --- �--� --
SHOI,"JER/TU�TEST � _� �_j POJL ELECTRIC
EXT. L!',TH!SIDIyG � I I PO�L FE�JCIf.G �
VdALL IPJSULATION I rJ POO�FINA� � __ _
CEILING INSULATIO^! � �_ � � OFF SITE It:^,PS_ 1 _
DRY�^JALL fJFJLIfJG � � . � .(.�F.D�DIC;ITI:�idS --}---- � -
SE1"JER � ! . • l,)•FIPJAL ENG. �—�_ _
SEPTIC Tl1NY. . } � , 1 � � LANDSCAPEiIRRIG. I �
SEEP PIT/L.L. I —' T i r O"J SITE i�.�r S. I I
GAS AIR TEST �_ � � FINFL IO�JIN�3 I _
FINAL CONST. � �-2C�•O� j ���� � ,_. IR� Dc�T. FIPJA,. f i
FINAL HEATING � � � I f I�ALTf1 DEPT. FIP�IAL I I __
FIiJF,L ELECTRIC �__� _ �,I D�V. FE�S PAID , �
FINAL PLU!���91�JG � I � ENERG`r �
� � '_�.;� �:,_ . �'�___..�___.._�� --� -
�r �, �
CUPJIMENTS _�o.�t E VEti�=��0 � Ec,Q.�S_`�_O.cL ' _
( .- - — –
SEPTIC TAPJK SIZE
SEEP PIT/U SIZE — ---` --�
��y�.._.._�_�_. --- ---
ti�T� -
�
� , ---
_; . , .,