HomeMy WebLinkAbout17648 (30) �� CITY OF DIAMOND BAR �^�
DEPARTMEN'T OF COMMUNtfY&DEVELOPMEM SERVICES
21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRESS
�����` BUILDING PERMITAPPLICATION FI MLY
o DDRIESS-0`./(��� 1�.7Cif�a:CO`Xi1!/(� DATE CATION �I I�J O,(� NUMBER I� �/C
� ISSUE TYPE OCC
APN LOT TRAC7 DATE �'I ��CONST. GROUP
p OWNER
ADDRESS ZONING SETBACKS
gCITY ZIP TEL. REAR RW ❑❑
APPLICANT TEL. SIDE/SIDE STREET RW O
� CONTRACTO SIDE p
O ADOR PROPOSED USE � "a � �NI '
CITY ZIP -
o ARCH/ENG/
z� DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBY AFFIPoA UNOER PENALT/OF PERIUPY TMAT I AM E%EMPT FROM TME CPYTMCTORS l4 Garage/Carpart
W CENSEUWiOFTHEFOLLOWIN6qEASON(SEC.7a7L68U5iNE55�NDVROFE55lON5C0DE:ANYCITVOP (f�
U CqJN7yWH�p�REWIRESAPEqMITTOCONSTRUCT.AITEi�0.7PflOVE.DEMOlISN.ORREPAIR�NVSiRUG W patio/Deck
� NRE,VRpfl TO I75155UN10E,ILL50 REWIRES TME APPLICAN7 FOH SUQ1 VERMIT TO FIIE A SIGNED W '
SiATE4EM THAT HE OF SNE IS UCENSED CURSUANT TO THE PROVISIONS OF THE CONiRACTORS lb
� CENSEUW�CHMTERY(COMMENCINaWITHSECTpN7000)OFDIVISIONJOFTMEBUSMESSMJDPRP �'1' POOVSQ2
� FESSIONS COOE)ON THAT HE OR SME IS E%EMPT iHEREFRpA iVlD TNE BA515 FOR 7XE 1LLlE0ED E%EMP•
TION.ANVNOUTIONOFSECTION7071.68YANVAPPLICANTFOFA7ERMITSUBJECTSTHEAGPLICAN770 � F�B-ROOf •
ACML PENALTY OF NOT MORE T1AN FNE HUNOREO DOLURS(i50D�J:
� OI�SOWNEROFTHEVROPERTY.ORMYEMPLOYEESWIiHWACE5A5iME1flSOLELOM7EN5A7pN, � �mmerclal
Z 1MlL DO THE WORN,ANO TNE STRUCTURE IS NOT�NTENDED OR OFFERED FOR SALE(SEG 7o�L BUSI•
N NESS I�ND PROFESSIONS COOE:TME CONTMCTORS UCENSE Uw OOES NOT AiPLV TO AN OWNER OF �
PpOPERTY NTiO BUILDS OR OAVpOVES iHEREON,ANU YAIO DOES SU[:FI WDPK HIMSELF Ofl HERSEIF OR
(L TMROUCHHISORHER015NEMPLOYEES,VPAVIOE�TNATSUp/1MPROVEIAENTSARENOTPlTENDFOOR m
W OFFEREDFORSALEIF,FIOWEYERTMEBU0.DINGOqIMPROVEMEHTLS50lD1'ATHINONEYEAROFCOM7LE�
� TION,iNE OWNEN•B111L�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
Z iMPROVEF01iTHEWRFOSEOFSALE}
W OlA50WNEROFTHEPROVERTI',A/AE%CLUSIVELYCONTMCTW6VnTHlICENSEDCONTRAL70N5
[[ TDCONSTRUCYTMEPR0.IECT(SEC.7M�.8USINE55AN�GROFESSIONSCODE:7HECONTRACTORSLI� Velu0ti011 ADJ.AREA
111 CENSEUWDOESNOTAPPLVTOANOVRIEROFAPROPERTYWIK18UItD50RMPROVESTHEREON,MID
� YAIOCONTRACTSFORSUpIVROAECiSWITHIIWNTIUCTOR(SJIICENSEDPUfiSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
� TORS LICENSE I.AW).
p O IAM E%E�PTUNDEH SEC. B.i V.C.FORTMIS HL�SON Q
� �
� a
OATE ONMER U
F UCENSED CONTFlACTORS DECLARAT�ON w
� 1 HEREBY�FFIRM UYDER PENALTY OF PEiL1URY THA7IAM LICENSED UNDER PROVISIONS OF CHAPiER Ur
�., 9(COiAMENCINOMATHSECT�ON7000lOF01VISqN�OFTMEBUSINE55ANOPROiE5510N5CODE,AND Z
W LICENSE IS N FULL FORCE�ND EFFECL m
� LICENSE CUSS �O LIC.N0. ��� �/ � -
� J
V DATE CONTMCTOR 0.
. .. W . ._ ... . . _ . .
� WORKERS'COMPENSATION DECLARATION Q
� INEREBVAFFIpMUNDERPENALTYOfPER1URYONEOF7HEFOLWWiNODEClARA7qN5: U
CfJ Q
� _�IHAVEANDMALLMA�NTAINACERTIFICATEOFCONSENTTOS[LF-INSUREFORV/ORKERS' _
COMPENSATION,ASVNOVIOEDBVSECTIONJ7000FTMELA90RCODE.FORTMEPERFORMMICE `U
OFh1E WORK FOR WHIp1 TMIS PERMIT IS ISSUED. .�
G
W �_IHAVEANON9LLI.WMAINWORKERS'COMPENSATIONINSURANCE,ASREWIREOBYSECTION
O37000FiMELABORCOOE,FOHiHEVERFONMANCEOFiHEWORKFORWHICHiMISFEfYM171S
� ISSUED.MYMqRK 5' OMP NSAT��'��ER AND OOLI�E: CONSTAUCTION
� CARRIEF � /� �� PLAN REVIEW
� Pd.ICYM1�AeER�_2�- �O/ ELECTRIC �
0 (n�ssEcroNNEmrarBEop.RETEDOF71FFEaMisr�iia�ErA+LX�E�oa1�R+1t+0010(iLFSsI PLUMBING
Z ICfRTIFYTIIATWTNEOERFORMANCEOFTHEYJORKFORWHICHTNI5GER1AiTI5lS511E0,1 MECNANICAL
('} SMALLNOTEMPLOYMlYVERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE
� WORNERS'COMPENSATIONU1NSaFCALIFORN�0.N'1D11GflEETHAiIFISNOVLOBECOME INSPECTIONFEE
S SUBJECTTO7HEWOAKERS'COAICENSATqNGRONSqN ION71000FTNElABOR
GOOE,IS ALLFORMWIT caa�vw�— rNo vAo s. • ISSUANCE � .
� SMIP
'p OATE� � 11PPLI
� WARNiNG:FAILURETOSECUREWORKERS' PE nT10NCOVERAGEISUNUwFUL,ANDSHALIBE ENERGYP/C
SU&IECTANEMPLOYEflTOCRIMWAL7EN/LLTIESANOCMLFMESUFTOONEMUNDREDTNOUSAND ENERGYPERMIT
DOlURS(SI00,000),W MDITION i0 THE COST OF fAIAPEN5AT10N.0AMAGES AS DROVIOED FOR IN
J SEG1bN 770!OF 7XE LABOR CODE,NTEREST,ANDATTORNEYS FEES. qETEN710N FEE• �
� �
a CONSTFUCTION LEN�ING AGENCY pRE-ALT FEE:
O
� INEREBYAFFlRMUNOER7ENKTYOFPE�YM1IRYTHATTMEREISACONSTRUCTIONLfNDINCACENCY
nZ- FONTHECERFORMANCEOF7HEN'OWCFORNM1IICMh115VERA11715155UED�5EC.7091,CN.C).
W
� LFNOER'SNAME
� LENDERSPDDRE55
� TOTAL FEES ��. [J O
w 1 CERTIFY THAT 1 HAVE RE/V�THIS MPIIGT�ON AND STATE TFUT ME ABOVE INFOP1AATqN IS CORRECT.
p_, IA6REETOCOMPLYYATHALLCRYANDLOUNTYORDiN�WCESANDSTATEUWSRELATINOiOBUIlDW6
U, CONSTFUCTION.MIDHEHEBYAUTHORIZEREiHESEN7ATIYE50FTHI5CWNNTOENTERUGONiME
Z /�BOVE-M TIONEDPROPfR�FINSPECTIONCURPOSES. COMMENTS
� "
m VE AME(AINT�
Q
�
(A S�GNAiV OFPERMITTE DATE
� ' RECPT.NO. PAID BY VALIDATION
WHITE—DeDartment Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fite Capy.GREEN—Applicant's Copy
. . . ._ .�) ��� .;.:.:1•'.., .�;•-:•:. 4 ' ^ '�, . .� r,:-,.._x __._ ... . . ._.. .. .-.. . -- . .
. , . � � ..,�.. i. • . . .. . � . _ , .
���vr Qi� �������rl�� C���i
I1�'.�"-��i=Cf�xiUP�! F=c��C3€iDo
_ __T__._ ..___�__�. ,
..._�.___._.__
_ _ ., _ , _. -_ � ..
�1►�l�yR{�c`^I'l�)��f ry��,��� �1►�C'� �c;Q �'cat; .I►�!-'i'����6't�1►'t rk�4�';� ;!►�4.7:��c�`tR'��;�
_.,._�. -----._.__..____.. . ._._:.._.: . _ ,. . .._._. .._..__ _,_ .__, ._._.,____._...-- -..--•..___.___..__._..._,_._.._._---- r--_._._ ,_.._..___r. Y__
SET BACK ; , _ � FLOOR JOIST ' _ I I _
FTGS/FORh1Sr'STEEL � � ' FHA REQDIITS
ELECTRIC.GROUND I y _�_Ui�DER FLOOR DUCT I
GROUND PLUMBING T { U�JDER FLOOR CUNDUIT I
SLAB GRADE ^ I FIREPLACE FOUiJDATION I
TEMP POWER I �I FIREPLACE BOP4D BEAM
WATER SERVICE MID HT. BOND BEAh1 �
ROOF SHEA7HING � 8 FT. BOND BEAM I
FRAMINGNENTILIATIOPJ FINA�BOfJD BEAM
ROOF COVER PRE-GRADINu
ROUGH HEATING BEfdCHI�dG I
ROUGH ELECTFiIC } ROUGH GRADIP�G
ROUGH PLUPJIBING I FINISH GRADIPdG
SHOWERITUB TEST l PQOL ELEC i RIC
EXT.LATHlSIDING � POOL FEfJCING �
WALL INSULATION POOL FIN.4L 'i
CEILING IMSULATION OFF SITE IR4PS.
pRYWALL NAILING DEDICATIOP�S
SEWER FINAL EPJG.
SEPTIC TANK LANDSCAPElIRRIG. �
SEFP PlT1L.L. �N SITE IMPS.
GAS AIR TEST FINAL ZOP�ING �
FINAL CONST. ! , FIRE DEPT. FINAL
FINAL HEATING � HEALTH DEPT. FINAL
FItJAL ELECTRIC 2 ,�Jj_�02 � DEV. F�ES PAID
FINAL PLUPJiBiNG � ENERGY I
� .�.��."a^ ¢�!: f��l�c�r.___-_____._.�_._., �
con��r,nEN-rs
SEPTIC TANK SIZE
SEEP PIT/U SIZE
iR�N I
,��w� -
� -.
�, I ,
__'�__-�-----._:i . ' : '�