HomeMy WebLinkAbout18290 (19) �,` CTtY OF DIAMOND BAR
� DEPARTMENT OF COMMUNTTY&DEVELOPMEM SERVICES ,['
21825 E.Copley Drive /
(909)860.3195 Fax(909)861-3117 PRESS
��%�� BUILDINGPERMITAPPLICATION F RMLY
y�, JOBSITE /�! � APPUCATION • A fS'� PERMIT� / 1 P/C
o ADDRESS � T bs �;r/a�r ce �r DATE � "� NUMBER� x
� issuE TYPE occ
APN ' LOT TRACT DATE �� CONST. GROUP
p OWNER �j�+ �,� _
"�' ADDRESS ���� �, �i� ZONING SETBACKS �
gCIN ZIP TEL.�_���� R�RT. RW OO
APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS o , y
p ,� PROPOSED USE e��� e � ,[�
CIN ZIP�/� TEL.
o ARCH/ENG/ .
z DESIGNER
w NO.DWEL. NO. NO.
N ADDFESS UNITS STORIES �l� BEDROOMS
� CITY ZIP TEL.
N
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BU�LDEFi DECLARATION SFR/ADDlREM
O
p 1 HEREBY AFflRM UNOER PENALTY OF VERNRY M�T 1 AM ExEMaT FROM TME CONTMCTOHS L6 G2fHgB/CB�pOft
W CENSEUWFORTHEFOILOWIN6REA50N(SEC.7071.68USPiE55AN07ROFE55lON5CO0E:ANYCIiYOR (n
U COUNTyY,rICHREOUIRESAPEN.nTTOCONSTRUCT,ILLTER,IMPROYE,DEMOl15H2ORHE7AIRANYSifiUC- W Pdti01D6Ck
Z TURE.VRIDR TO RS ISSUANCE/�150 RE�UIRES THE APPLICM7T FOR SUCH PENMIT TO iILE A SIGNED
W STATEUEM THAT HE OR SHE IS UCENSE�VURSUANT TO TNE PROVISIONS OF TME CONTRAC70RS U• W
� CENSE UW(qUOTEq 0(COMAI[NCINO N7ri15Ett10N 70oa)OF DIVIS�ON f OF TNE BUSINfSS AND PRO- � PooVSpa
FESSIONSCODE)ORTFUTHEORSMEISE7(EAIPi1T1EREFNOMANOTHEBASISFORTMEAIIEGEDE%EIAP- C7
TION.ANYV1OLAi1DNOF5ECTiON7071.5BYANYAPPUCANTFORAiERMIT5U8JECT5THEAPPLIGWTTO Z Re•Root
A qVIL PENALTY OF NOT MORE TMAN FIVE HUNDRED DOlURS(f SOD).j:
0 04ASON'NEROFTHEPf10PERiY,OHMYEM7LOYEESWITMWAGESFSTMEIR50lECOM7EN5ATION, 0 �mmercial �
Z WILL DO THE WORK,AND THE STRUCTURE i5 NOT INTENDE�OR OFFERED FOR SALE(SEC.701/,BU51- J
� NESS AND GROFESSIONS OOOE:7HE COI.TRACTORS LIGENSE UW DOES NOi APPIY TO AN OWNER OF =
VROCENTY WNO BU0.D5OR IYPROVES THEREON,AND WNO DOES SUCH WORK HIAISELF OR HERSELF OR
Q THROUGHHISORHEROWNEAIDLOVEES.DROVIOE07HATSUCHWGROVE�AEN75�RENOTW7ENDEDOR m
� OFFEREDFORS.LLEIF,/IOK'EVERTMEBUiL01NCORIMPROVEMENTI550LDVATHINONEYEAROFCOMPLE-
Z TION,THE OwNER-BUI:DER WILL HAVE THE BURDEN OF PpOVINO TNAT NE OR SME DiD NO7 BUtLD OR
� MPROVEFORTHEWRPOSEOFSALE�
01,AS ONMER OF 717E PROPEHT'I,AM E%0.USIVELY CONTRACTMO WIiH LICENSED CON7RAC�ORS
� TO CONSTRUCT TME PiiOJECT(SEC.70��,BUSINESS IWD PROFESSIONS CODE:iHE CONTMCTORS LI• V0108ti00 �'� ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAVROVENTVWMOBUiIDSORIMPROVESTHEREON.AN�
� ri710fAMiUC75FOR5UtlIDR61ECTSN17HACONTMCTOR(S�IICENSEDPURSUAHTTOTHECANiMG QUANTITY OESCRIPT�ON FEE
Y TORSLICENSELAw.�. '�,
� O I IM EXEMPT UNDER SEC. B.a P.Q FOR TilS REASON Q �
'�S V
� �DATE OWnER
Z W
� LICENSED CONTRACTORS DECLARATION W
� IHEREBVAFFIRIAVNOERPENALTYOFPERAIRYTHATIMALILENSEDUNOERPROVISIONSOFCHAPTER V,
p. Y�COMMENCWaWITHSECT10N7000)OFDIVISION]OFTHEBUSINESSANOPROFESSIONSCODE,AND Z
`X MY UGENSE IS N FULL FOfiCE AND EFFECT. �
� 0 LICENSE CUSS IIC.N0.�O �� �
_ ._ V DATE o3-- CONTMCTOfI a -
W
� ��WORKERS'COMPENSATION DECIARATION �
� N IHEREBYAFF6iMUN0ERVENALTYOFGERlURYONEOFTHEFOLLOV11NG0ECLAMTI0N5: Z
� _IHAVEANDWILlMA1NTNNACERTIFICATEOFCONSENTTOSELF-INSUREFORVJORKERS' _
COMPENSATqN,ASPROVIDED8Y5ECTON77000FTMELABORCODE,FORiHEPERFORMANCE U
� OF THE WORK FOR WHICH 7W5 VENMIT IS ISSUEO. �
O
W _I HAVE AND WILL MAMTA�N WORKERS COA/vENS�TION�NSURANCE.AS REOUIREO BY SECTION
Q �70o OFTHE LAOOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS `�I •�O
¢ ISSUED.IAYYVORKERS'(pMP��TI0NIN5URANGEG/iRRtERANDPOLICYNUMBENARE: CONSTRUCTION
� awRIER J Tu �Q PLAN REVIEW
� roucrr+uMeeR �3 3 ELECTRIC
� (fF4S5ECilONNEmNOT8E00MREImOFhEPERMTBiORONEM1rOqED0011l�1iSRt0o10RLE5S} PLUMBING
Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHlpl THiS PERMIT IS ISSUED.I MECHANICAL
C7 SHALL N0T EMPIOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO TME
� WORKERS'GOAIPENSATIONUWSOFCALIFORNItiM1DACREETHATIFISHOUIUBEC0IAE INSPECTIONFEE
S SUBJECTTO THE N+ORNERS'C04vENSA7iON DROVIS�ONS OF SECTION]700 OF THE UBOR
CO�E,I SHALL FORTHWI7HCO�APLY WtTNT1qSE VROVISiONS. ISSUANCE - '�7/)
� %�b'/����. � A7RICANT. _v��rT/i C!— SMIP ��1 V
p DATE:_/7 �
� ENERGY P/C
WARNIN@GAiLUR TOSECUREVlORKERS'COM7ENSATqNCOVERAGEISUNUWFUL.ANDSHALLBE
J SUBJECTANEIAPLOYERTOCFIMINALPEN�LIIESANOCMLFWESUPTOONEMUNOREDT/IOUSANO
� DOIURS(f100,000),W ADOITIONTO THE COSTOF CONPENSATION,OAMACE5115 PROVIDED FOR IH ENERGY PERMIT
� SECTION�70eOFTHEIABORCODE,INTEREST,ANDATTORNEY5FEE5. RETENTIONFEE:
d ! CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IHEREBYAFFlRMUNOERFENALTVOFPEfVURViHATTHEREISACONSTRUCTIONLENDIN6ACENCY
� FOR THE GERFORMANCE OF THE WORK LOR WHICH THIS PERMIT IS ISSUED�SEC.�091,qV.C.).
Z
W
� LENOERS NAME
� LENDEFYSADDRESS �''
W ICERTIFYTrUTIHAVEREADiMISMPLICATIONANDSTATETHATTHEABOVEWFOR1AATqNISCARRECT. TOTAL FEES �J/ )
� 1 AGREE TO CAMv�Y WITI ILLLCffY AND COUNTY ORD�NANCES AND STATE Uw5 REUTINC TO BUILDIN6 LJ
CONSTRUCTION.AND NEREBY�UTMORRE REGRESENTATIYES OF THIS COl1NTV TO ENTER UPON THE
ZABOVE�MENTICNEOVROPERTYFORINSPECTIONPURPOSES. COMMENTS
� ����� ���
_
m PERMITTEE NAIAE IPRINT7
Q
l/� ,/
� S�CNATUREO ERMITTEE �—� �ATE '
� RECPT.�O. _PAID BY VALIOAT�ON
�. WHITE—Departmant Copy.VELLOW—Finance Copy,PINK—Assessor Copy.GOLDEN OD—File Copy.GREEN—ApplicanCs Copy
.,,, ,. _ - _ . . . . T..-..,. ,�> � .... _.,.., -,- ., >.� . _ _ �
. .�,r,. . - „ „ . 4 ...� v..,.. . . ,, . , � . , . . , , .
�i r��r c�� ���,�,�ar��r� �r��
�r������aic+�� r���a�a�
_ `�',J' :) ��;:_.._._.�+� �_..� �;� `,._,..-�..��. i _..:� ,c;_;_._...._. f�-;:=�.�- ��l�
� �I�F-�:a�c 9'Ia 4�� � F � � ►F�� -� a. ��`i,. _�. '.[I(��1►�� �el'�t'��=,. ���� `� ! c �'�o� I
�� __._._- .... ., ._ _.___u ___.. f ; . .___ .--- ._�_. ______�- _ _
.. _ ___. _ ___._._. _. ._ _�_ �_.__�.____....---____.._�______�__.
SET BACK __�; � ; - � � FLOOR JOIST ; I
4----
FTGS/FORMS'STEEL ( ' �_ `�__ I FHA REQMTS _� _
ELECTRIC GROUND i ' � UNDER FLOOR DUCT �
GROUND PLUPI1BING i I UNDER FLOOR CU���DUIT ;
SLAB GRADE FIREPLAGE FOUi�JDATION
TEMP POWER l i FIREPLACE BOND E3EAM
WATER SERVICE i � tv11D HT. BOND BEAM
ROOF SHEATHING �f����Z .�— I 8 Fi'. BOND BEAh� I
FRAMINGNENTILIATION � � I FINAL BOND BEAM �
ROOF COVER 7��/��_�i� _ PRE-GRADING
ROUGH HEATING � BENCHIfJG
ROUGH ELECTRIC i � ROUGH GRADING
ROUGH PLUPJIBING I I-� FINISH GRADING
SHOWER/TUB i EST POOL ELECTRIC
EXT.LATHlSIDING � ; POOL FENCING �
VVALL INSULATION POOL FI�lA,L �
CEILING IN�ULATION OFF 51TE IPAPS.
DRYWALL NAILING DEDICATIOrdS �
SEWER FINAL EPJG.
SEPTIC TANK LANDSCAPElIRRIG.
SEEP PIT/L.l. �N SITE I��APS_
GAS AIR TEST FI�JAL ZOPJING
FINAL CONST. � FIRE DFPL FWA!
FINAL HEATING HEALTH I7EPT. FIfJAL
FINAL ELECTRIC ' DEV. FEES PAID
FINAL PLUMBING ` ENERGY
' ------------- µ � � _�'....� __.... � _.
: �� � ;�� �t :a
CUPJIMENTS _1-(o'�L ��07���
SEPTIC TAPJK SIZE
SEEP PIT/U SIZE —
--' ,��I
y��� i� .
�
�