HomeMy WebLinkAbout17371 (17) �� C1TY OF DIAMOND BAR (�
i DEPARTMENT OF COIvIIvIIJMTY&DEVELOPIv�NT SERVICESI i
21825 E.Copley Drive �J
(909)860-3195 Fax(909)861-3117 PRESS
' ��%��' BUILDINGPERMITAPPLICATION FIRMLY
o ADD ESS / �i ��T TE DATECATION )'�� �r NUMBER�73 �f��'4
/
ISSUE TYPE OCC
� APN��2_ LOT TRACT � DATE CONST. GFiOl1P
p OWNER
o ADDRESS - D 20NING SETBACKS
Z CITY � — ZIP �7 lTEL� FRONT RW ❑
g APPLICANT TEL. REAR ❑
� SIDFJSIDE STREET RW ❑
� CONTRACTOREL.��iV �OpGS SI�E ❑
o ADDRESS �T , PROPOSED USE (u�M 1 p A
o CITY � ZIP�/7 TE 4 4
izw ARCH/ENG/��rn�
DESIGNER NO.�WEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
= CITY ZIP TEL.
� DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBV AFFlRM UNDER VENALTY OF PEitAJRY THAT 1 MI E%EMPT FROA1 TNE CONTRACTOfiS LI- GefegBlCeryOf1
W CENSEUWFOR7HEFOLlOWP16HEA50N(SEC.70.71.SBUSWESSMIDVROFESSIONSGODE:ANYCI7YOR (n
U COUMYWHIpIqEOUiRESAPERMR7000N57AUCf,ALTERIMPROVE.0E1.lOLISM,OiiREPAIRANYSTRUC- W P8S10/DBCk
� 7URE,VRbR TO RS ISSUMICE,ALSO REOUIRES THE APCLICIIM FOfl SUCH VEfU11T TO FILE A SICNED W
.� STATEMEM TMAi HE OR SIiE IS LICENSEO VURSUMfT TO THE PROV�SIONS OF 1NE COMRACTOR9 l4 �
� CENSE UW(CNAPTER i(COMMENpNO WI7H SECTqN 7000�OF DIVIS�ON!OF THE BUSiNE55AN�PRb � P�VSpe
fE55UN5C00E)ORiHATHEORSME13ExEMPTTHEPEFROMANDTHEBA5i3FORTMEPLLEOEDE%EMP•
� TqN.ANVVIOUiIONOFSECT10N70�1bBVANNAPPLICANTFORAPEW.�ITSUBIECTSTHEAPPLICANTiO Z FI0-R001
AGNL VENALTY OF NOT LqRE TFLW FIVE MUNDRED DOLUR5lisaa).�:
� Ot�.40VMEROfTHEVi10PERTY.OFMVEMPLOVEESWITMWAGES115THEIRSOLECOMPEN5ATI0N, ❑ COmrtlBftlel -
WILL DDTHE WORK,AND THE SiRUCiURE IS NOi IN7ENOE�OR OFFEHED FOR SALE(SEC.70�L BUSI• J
NE39 AND iROFESSION3 COOE:THE CONTRACTORS LICENSE UW DOES NOYMPLV 10 AN OWNEH OF
N VROPERTYVA/DBU4050RMPROVESiHEPEON,AND1MiODOESSl1LHWORNHIMSELFORXERSELFOR �
� TMROUGMMISORMEROriNEMPLOYEE3,OROV10ED7HATSUCHMPROVEMENTSAFENOTMENDEDOR m
QOFFEREDiORSALE6110WEVER711E8UlDiNUORIMVROVEMEMISSOLDWITMNONEYEAROFCouPIE�
Z T10N,TME OWNER�BUILDER YALL HAVE TME BURDEN OF PROVWd THAT NE OR SHE O�D NOT BU4D q1
= MPNOVE FOR T11E VURPOSE OF 6ALE�
W OlASOWNEROFMEVROPERiY,AME%CLUSIVELYCONTMCTWOYA7MUCENSEDCONTMCTOq3
Q TO CONSTFUCTTHE PROJECT(SEC.7o�I,BUSME55 AND PROFESSIONS COOE:THE COflTMCTORS U• Velu8Uq1 �— ADJ.AREA
W CENSEUWDOESNOTMPLYTOANOVMEROF/1VRpPERTYWHOeU6DSOHI�.�PROVESiHEREON,ANO
� WIqCOM�MCTSFORSUCFIGRQ1ECfSWITHACONTRACTOR(S�IICENSmVURSUANTfOTHECONTMG QUANTIN DESCRIPTION FEE
� TORSLICENSEUWJ. ,.J
� OIAAIE%EAIPTUNDENSEC. 9.8V.GFORTHISHEASON Q
3 �
¢
� DATE OWNER V
Z W
� LICENSED COPlTRACTORS DECLARAT�ON �y
� IHEREBY�FFIRMUNDERPEN/�LTYOFPEILRIRY7NATIAMLICENSEDUNDERPROVISIONSOFCWIPTEN U. Q
p„ 0(COMMENdNO WITH SECTqN 7000)OF DMSqN]OF TME BUSINESS M!O VROFESSIONS GODE.AND z �
�X MYIIGENSEIBNFULLFORCEANO'TEFFECT. ���� � �
� LICENSECLA _SJ LIC.NO. J
. .. V DATE �� CONTRACTOR Q a . -.
W
� WORKERS'COMPENSATION DECLARATION �
� IHEFEBYI1Fi1RMUN0ERPEWLLTYOFPERJURYONEOFTMEFOLLOWIfxiDEp�MTION3 U
�j Z
Q
O ��HAVEANOWILLAWNTAMACERTIFIGTEOFCONSENTTOSELFaN5l1NEFORWORKERS' 2
� CDMPENSA710N.ASPROVIDEOBYSECTION]7ooOF7HELABONCO0E,F011THEPERfORMANCE w
OFTNE N'ORN FOH WHICH TMIS PERMIT IS ISSUED. .�
0
W �_IHAVEAN�WILLMAINTAMWORKERS'LOMPENSATIONINSUfUINCE.ASREWIqEDBYSEGT�ON
� iTa00iT11ELABORCOOE.FORTHEVERFORMANCEOFTHEWORKfOHMMICHTHiSPERMiT15 �I�I p Zd
ISSUED.MV VA/OPo(ERS'COMPENSATION INSU CE CAAA�ER AND P�LICY NU48ER�RE� GONSTRUCTION �
¢ G�RRIER (IP.�II .1.�'� ���'(J� PLANREVIEW �
�
� POLICYN4A10ER�J) ,7._ _ . _ . ELECTRIC
¢
0 RFISSEC11oNr�No78E00hFLE7EDOFirEPEPMiSPotia+EH1�DREDootiM4R+ooIORLFsS} PLUMBING
Z ICE(iTIFYT1U71NTMEPERFORMFNCEOFTHEWORKFORWHICNM15PFRMITI5155UED,l MECHANICAL
(•y SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBfCOA7ESUBJECTTOTHE �
� YYORKEHS'COUVENSATIONUW50FCALIFOfW1AANOAGREEiW�TIFISMOUIDBELOME INSPECTIONFEE
S SUBJECTTO 1HE WORKEHS'COMPENSATqN PROVISIONS Of SECTqN]7ooOFTHE U00R
CODE.I SMN.L fORTHWI7H CO�PLY WITN THOSE VRONSIONS. ISSUANCE �
� SMIP -
p DATE: APPLICAN7.
� ENERGY P/C
WMNINCi:FA0.UHE TO SE WRE MlOHKERS'CO�PENS�TqN COVER�GE IS UNUWFUL.ANO SIULL BE
� SUBJEGT/WEMPLOVERTOGfUMW�1LPENALTIESANOCMLFWESUPTOONEHUNDRE0TNW5Ml0 ENERGYPERMIT
DOlURS(f t0o,0o0),W IDDRION i0 7HE GOST OF GOM7EN511YION.OAMAGES AS PROVIDEO FOR IN
¢ SEGTIONi7oEOFTHElABO(iC�DE,HiERESLANDATTORNEYSiEES pETENTIONFEE:
pw_, CONSTRUCTION LENDING AGENCY ppE-ALT FEE: �
¢ IHEREBVAFFlRAIUNOERPENALTVOFPf0.1URYiHATiMEREISACANSTRUCTIONLFN�WdACENCY
� FOR iHE VERFORMANCE OF TNE WOFK fOR WHICM iHIS PEflMIiIS ISSUED(SEC.l07�,CIV.G�. . �
Z
W
� LENOERSNAME
H LEN�ER'SADORESS ' �
� ICERTIFTiNATIWIVEREADTMISAFVLICAiqNANOSiATETHAT7MEA80VENiOfU1ATqNISCORRECT. TOTAL FEES ��� ���
W IAGREETOCOMPLYNA7HKLCRVANDCOUMVORDINANCESANOSiATEUWSREUTIN�TOBUILDIN(7 ��
n' pON$7qUCT1Of1 ANO NEREBVAU7HDRIZE REGRESENTATIVES OFTMIS GOUIT'70 ENTER UPON THE ^�0= Q/ a�,_1/�T � �i D� /f '
� ABOVE�MENTIONED OROPERTY FOR INSPECTION PURPOSES. COMMENTS S � �"�T���� t1
� f3 I n ��d
Q i � W R� 7 A/ /_/� ( .
tA 6� L/L
N SIG UREO EHM DA7E
� RECPT.�O. � PAID BY � VALIDATION
WHITE—Department Copy,YELLOW—Finanra Copy,PINK—Assessor Copy,GOLDENROD—file Copy,GREEN—ApplicanCs Copy
. /
. �, .._ . , _.. ,�... ,_ .,..ti. . :k..., ,,, . ... .. . . ... . r�.� .v-,��.,r>-F:^til*:K'.y;,:�b,n.r:. .:•m:.. -�� � ..�w.. _.l". ._.F,.� . , . .��„ ..,,. .,._. .. .. . .. .. . ...
` .l.� .
l .
�IT�'�'(�F f,�lAMt3��dD BAR
. IP�Si�EC'a IOiJ RECOi�D
`.�;7�.�����C��.�.�:. o a � ¢ e� �. _,. m
,� _
� - ��T�.�~ ., y���.�.:�'"��i��i;� .. ..__-_: ((a�-���.;��.K �!� �..��`e.�= �I��-����t���
SET BACK _ •... ,.._ �y...._._____. _..�_--.FLOOR;j01ST-` 'c �-� "`- . _� - -- -
FTGS/FORMSlSTEEL �'.,�/^Oj ! FHA REQMTS,• �,- _ - , � � �
� ELECTRIC GAOUND �J7�-D( UNDER FLOOR DUCT ,���- � • �
GROUND PLUMBING �(_Z�-p( UNDER FLOOR Cb�IDUIT : ' � `.
SLAB GRADE , FIREPLA�E FOUNDATION �' � �
TEMP POWER I I FIREPLACE BOND BEAM
WATER SERVICE I ' MID HT. BOND BEAM , �� '
ROOF SHEATHING � � 8 FT'. BOND BEAM� I '`
FRAMINGNENTILIATION � I FINAL BOND BEAM
ROOF COVER PRE-GRADING �
ROUGH HEATING - BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PWiJ�BING � � � FINISH GRADING
SHOWER/TUB TEST ; POOL ELECTRIC
EXT. LATH/SIDING _ POOL FENCING G' _��p���
WALL IPdSULATION POOL FINAL �Zy/�
CEILING INSULATION � i OFF SITE IMPS. �
DRYWALL NAIUNG i ; DEDICATIONS
SEWER � j FIPJAL ENG.
SEPTIC TANK ._ ,. .. LANDSCAPE/IRRIG. �
j SEEP PIT/L.L. � � ' ON SITE IMPS.
� GAS AIR TEST - � � FINAL ZaNING
FINAL-CONST. � � , ` �IRE DEPT. FINA;,
FINAL HEATING � HEALTH DEPT. FINAL • �
FINAL ELECTRIC i I DEV. FEES PAID
FINAL PLUMBING i j j ENERGY �
' �`. . ( �
� ' � � ' ' i P� a �a� v.Q��"�.�`'r _ ; � . - ` .
. . . . � . ' . . . . ' . � .
COMMENTS
. � , :
. ; • -
SEPTIC TANK SIZE �
SEEP PIT/U SIZE
_ �.���
; �
�;r��. . � �i� � . _
' . �i : . -, :
. . , -- . �
..+.� ��__�...__ _� ' � . . . .
�
'�