HomeMy WebLinkAbout16632 CTTY OF DIAMOND BAR EXP I R ED
-�'� DEPARTMENT OF COMMUNII'Y R DEVELOPMENT SERVICES
r � 21825 E.Copley Drive ,JUN 17 2002
(909)860-3195 Fax(909)861-3117 PRESS
�`%:�' BUILDING PER117[T APPLICATION FIRMLY
� JOBSITE � n �/ APPLICATION - PERMIT 1 2�'/C
o ADDRESS�3�� �I.�N �D�L�'" DATE NUMBER I ��ln J/k"
c� ISSUE TYPE OCC
APN LOT • TRACT DATE CONST. GROUP
p OWNER
LL ADDRESS � ZONING SETBACKS
oCITY 6 ZIP(f�� TEL. b � 7 ^ FRONT RW ❑
APPLIC NT TEL. REAR ❑
� SIDFJSIDESTREEf RW ❑
� CONTRACTOR��MQ� � SIDE ❑
� CITY ES � ZIP �� TEL � PROPOSED USE � � � L � ��
o ARC NG �
z� DESIGNER NO.DWEL • NO. NO.
n., ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OOWNER-BUILDER DECIARATION SFR/A�O/REM
p I HEREBV AfFIRAI UNOER PENALTY OF PERIURY TNAT I AM E%EMPT FROM THE CCNTRACTORS U� Gef098/CBfpOR
W CENSEUWFOR7HEFOlLOWIN�REASONISEG70.71.58U51NES5ANDPROFE5510N5CO0E:ANVCIiYOR (n
U CpUNTYWNICHRE�UIPESAPERMITTOCONSTRUCf,l�1TER�P��E.DE1.10lISH.ORREVAIRANVSTAUC• W patia/Deck /
TURE,�RIpR TO RS ISSUANCE,AL50 REOUIRES iNE APPLICANT FOR SUCM PERMIT TO FILE A SIGNFD
w STATEMENT TMAT NE OR SHE IS LICENSED iUHSUMR TO THE PROVISIONS OF THE CONTRACTORS l/� w �
� GENSE UW�d1APTER Y(COMMENCW 0 WITH SECTION 1000)OF DIVISION�Of THE BUSMESS AN�PRO• V" POOVSP3
� FESSIONSCDDE)ORTIIATMEORSHEISEXEMPTTIIEREFROMM'OTNEBASiSFORTH[ALLEGEDEXEMP•
� TqN.ANVVIOLATIONOFSECT�ON70�1.6BY/WYAPVLICANTFORAVERMIT5U8JEC757HEAPPLICJINTTO Z Re•Roof
A CML 7EN�1TY OF NOT MORE THAN FNE HUN�RED DOLURS(3500�.):
� ❑IASOWNEROFTHEPROFERTY.ORMVEMPLOYEESVIITHWAGE5A5THEIRSOIECOMPENSATION, 0 -
WILL 00 THE WORN,�ND THE STRIJCNRE IS NOT INTEN�E�OR OFFERED FOR SALE(SEC.70�1,BU51• J Commarcial
z NE55 AND GFOFESSIpJS CODE:THE CONTRACTORS UCENSE LAW OOES NOT APFLV TO AN OWNER OF
N PROPFRTVNM1IOBUM1DSORIMPROVFSiNERE0µM1DNM1lODOE55UCHWORKNIAISELFORNERSELFOR �
CC TNiiOl1GHHISOqHERONMEMPIOYEES,PROVIOEDTMATSUCHIMPROKMENTSARENOTIMENDE�OR m
W OFFENEDFORS/�LEIF,NOWEVERTMEBU0.DINOOPIMPROYEMEMISSOIDwITHiNONEYEAROFCOMPLE-
0 TION.TME OWNER�BUtIDEfl MALL MAVE TME BUFDEN OF PNOV W�iMAT HE OR SHE DID NOT BUILO OR
Z IMPFOVEFORTHEPURPOSEOFSALE).
= 04�OMMEROFTHEFROPERTV,AMEXCLUSNELYCONTMCTWGWITHUCENSEOCONTRACTORS
W
[[ TO CONSTRUCT THE PRQIECT ISEC.70N,BUSINE55 AND PROiE55lON5 CODE:THE CONTMCTORS LI• V01UatICA ADJ.AREA
W CENSEUWDOESNOTMPLYTOANOWNEROFAPROPERTYWHOBUILOSORIMPROVE57NEREON.�ND
� NM1qCONTRACTSiORSUCHPRQ1ECfSWITHACANTMCTOR(5)LICENSEDGUHSUANTTOiHECONTRAG QUANT�TY DESCRIPTION FEE
Y TORSLICENSELAW).
� ❑I AM EXEMM UNOER SEC. B.t P.C.fORTH�S REASON U
�
�
LL' OATE OwNER F"
Z W
� LICENSED CONTRACTORS DECLARATION W
� IHEREBYAFFIRMUNDERVENAL7YOFDERIURYTHATIAMLICCNSEDUNDERPROVISIONSOFCHAPTEH �
p. 0(COMM[NCWOWITHSECTqN7000�OFDM510N70FTHE8V5:NES5ANDPHOFESSIONSCODE,ANO Z
X AIY IIGENSE IS N FULL FORCE AnND EFFECT. A J
� UCENSE CIASS�,J LIC.NO.�,��b/ � ,�"_r j
� onrE��� cor�rcancro�_ty�,/}�(n�fi—�— a
w
� WORKERS'COMPENSATION DECLARATION ¢
� 1 MEREBV I1FiIRM UNDER GENA:TY OF iERJURV ONE OFTHE FOLLOWINQ DECURATIONS U
`—" a
� _IHAVEANOWILLMAINTAINACEH7IFICATEOFCONSENTTOSELF-INSUREFORWORKEIiS' 2
COAI7ENSATION,ASPROVIDEDBVSECTON77000FTNELABORCODE.FORTHEPERFORMANCE U
� OFTHEWORI(FONVA/1CHTHISPERMITISISSUED. �
W �'
_IHAVEANDWILLMAINTAINWORNERS'COMVEN5A7qNIN5URANCE.�SREWIRED8Y5ECTqN I�I.I �
Q 37ooOFTHEUtiORCOOE.FORTHEPERFORMANCEOFTHEWORKFORKM1IICHTHI5VER1A1T15 �
LSSl1ED.lAYW+ORKERS'CdA7ENSATqNINSURANCECARPIEFANDPOLICYNlJ1ABERARE: CONSTRUCTION V
j uRRIEP � � PLAN REVIEW
—i �
� POLICV NUMBER ���j/ ELECTRIC '
Q /O
� (IFCSSECIICHNEmNOT8E07MREfEDOi7HEPEFiA4T6F0(tONEMd�f�EDDOLLAitSR�W)OfiLE55} PLUMBING
Z I CEPTIFY T1UT IN iNE PEkFORUANCE OF THE WORK FOR WNlp/THiS DERAIIT lS ISSUED,I MECHANICAL � �
('} SMALLNOT EMPLOV ANV PERSON W 11HY MM1NfR SOAS TO BECOME SUBJECT TO T/E •
� riORKERS'COMPENSATIONLIWSOFCAL60(iNiAANOACREEiHATIFISHOULDBECOIAE INSPECTIONFEE
S SUBJECTTOTMEWORKERS'COMPENSATIONPROVISiONSOFSECTIDN37o00FTHEU80R QO
�JP 1 SHALL FORTMWITH COMPLV WITH TM�SE PROVISIONS. ISSUANCE
� (, � �� ' SMIP �
p DA7E: �/�. 1 i(7V j_ APPLICANT. ��.T�_� _.._.._.. _.- —
� � � ENERGY P/C
WARNINO: URETOSECUREWORKERS'COMPENSATIONCOVERACEISUNUWFUL,ANDSHALLBE
� SUBJECTANEMPLOYERTOCRIMWALPENALTIESANDCMLFINESUPTOONEHUNDREOTHWSAN� ENERGYPERMIT
DOlUqS(S10o.000).W IDOITION TOTME COST OF GOMPENSATqN.OAMAGE9 A3 PROVIDEO FOR IN • -
¢ SECTION770lOFTHEUBORLOOE,INTEREST.ANDATTORNEY'SFEES. ��l- ��
AETENTION FEE: _�.a�
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� �MEREBVAFflRMUNDERVENNTYOFPERJURVTHATTHEREISACONSTRUC7lONLEN0INCACENCV
d FOf1TMEiERFOfiMANGEOFTHEWOFKFOFWHICHTHISGERMIT15155UED(SEC.709�,CIVC.).
Z
w `- . "
� LENDEfY3NM1E
� LENDER'SADDRESS
/
W ICER7IFYTHATIHAVEREAbTHISAPPLIGATION�NOSTATET11ATiM[ABOVEPIFOWAATIONISCOHRECT. TOTAL FEES
� IAGREETOCOMPLYWI7MALLCITYANOCOUNTYOFOINANCESANDSTATEUWSRELATINGTOBVILDINC I ���
� CONSTRUCTION.AN�MEREBYAUTTIOAIZEREPRESENTATNESOFTNISCOUNTYTOENTERUPONTHE
Z 1180VE�IAENTqNEDVROPERTYFOFINSPECTION7URPO5E5. COMMENTS
�
� ��
°° venraineENw.+e(vAi '
¢ �
�
Uj S�GNATUREOF D E
� RECPL NO. � PAID BY �VALIDATION__ _
WHITE—Departrnent Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fde Capy,GREEN—Apd�caM'S Copy
i�.. v. . .i. �'F'.i ?.7'4 .„:��<: ' . " '�! �'�'f \':; r,16" �i:!` . ,v .n }:i. .�`�.y�i:�iJ�'�i.:-J�f'. ..j�� _y aN� .� .r"� Y ' i . .� ,,. .i
, . . , . � . � ...� .1.'1'. ',l;....
CITI' OF DI�,f�Jl�t�'D BAf�
1���PEC310f� rECOf�C�
il►`�-'�:��c�iCf�1►i0 i�k.1:F'= li�k-'i.act�;'r���4 � �IL�E=i.l=i�`,�r(�)►�l �)_'9:G?: I►�k-�1.:1�c�`iCm)�1. i
---------- --_____--- ----.._ ._.._-------_.�_.------�.__.__.._._....---------___.__-------------_...�.�__�_-------_=._.��-----
SET BACK � FLOOR JOIST � _
FTGS/FORM5/STEEL FHA REQM1/ITS �
ELECTRIC GROUND UNDER FLOOR DUCT �
GR�UND PLUMBING I Ut•1DER FLOOR CUf�IDUIT •
SLAB GRADE FIREP�ACE FOUNDATION
TEMP POWER I FIREPLACE BOND BEAM
WATER SERVICE ~ MID HT. EiOND BEAM �
ROOF SHEATHING � � i 8 �T. BOND BEAP�1 �
FRAMINGNENTILIATION � FINAL BOND BEAM '
ROOF COVER PRE-GRADING
ROUGH HEATING BEfJCHIPJG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�1'UB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FEPdCING
WALL INSULATION ' � POOL FINAL I
CEILING IN�ULATION OFF SITE IDAPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.L. ' OPJ SITE IMPS.
GAS AIR TEST FINAL Z�NING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC • DEV. FEES PAID
FINAL PLUMBING ENERGY
rp��.�-,,, �j; �y�-�� _.._....__— �
COMMENTS
SEPTIC TANK SIZE ,
SEEP PIT/U SIZE
�►�_�
�r�r/ :
��
� _ -� ' '