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HomeMy WebLinkAbout17613 _ _--- -� - - - .. - ----- - - - -- _ - —_._---------- -- ___ _ __ _. .. __ —- _ _ . _ � CITY OF DIAMOND BAR DEPARTMENT OF COIvIIvIUNiTY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS "%:'�' BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE a �LCD/V !'3[.1/C'�N APPLICATION/ 3 t �j� NUMBER I [�! Jf lC ADDRESS �� � DATE c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDRESS_2� �/ ��LCrYV �StJ ZONING SETBACKS Z CITY ZIP TEL. FRONT RW O g APPLICANT ��, REAR ❑ SIDE/SIDE STREET RW O � CONTAACTOR GD G�_ SIDE ❑ ADDRESS PROPOSED USE +�C S' � CITY ZIP TEL � � � ARCH/ENG/ � c iz DESIGNER NO.DWEL. O. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER•BUILDER DECLARATION SFR/ADD/REM O . p I HEREBY AFFlRM UNDER PENALTY OF PERIURY THAT I AM E%EMPT FNOM THE GONTMCTORS ll• Gef2g6/CelpOrt W CENSEUWF�RTHEFOLLOWW�NEASON(SEC.70.71.68USINESSANDGROFESSIONSCOOE:ANYCITYOR (n C) COUNTYWNIdIREOlI1RE5APERA11iTOCDNSTRULT,AITER.IMPROVE.DEAIOLISH,ORREPAIRIWYSTHUC- W P2110/DBCk L TUHE,VRqR TO ITS ISSUANCE,�LSO REWIRES THE ADPLIGWi FOR SUCJI PERMIT TO FILE A S�G4ED � STA7EIAENT THAT HE OR SHE IS L10EN5ED PURSUANT TO THE PROVISIONS OF THE CONTMCTOR3 ll- w .� CENSE LAW(CHAPTER Y�CO�IMENCIN6 WRH SECTqN 7000�OF OIVISqN�OF THE BUSINESSANO PRO- u' PooVSpa FESSIONSCOOE)ORTNATHEORSHEISEXEMPTTHEREFROMANDTHEBASISiORTHEKLEG[DEXEMP- (� VTION.ANYVKKATqNOFSECTION70.71.6BYANVA7PlICANTFORAPERMITSUBJECTSIHEAPPLICANTTO Z Re-Rool C A qVR PENALTY OF NOT MORE THAN FIVE MUNDRED DOlURS(fSoo�J' Z ❑I,ASGWNEROFTHEPFlOPER7Y.ORMYEMPLOVEESVnTHWAGE5A5TNEIR50LECOM7EN5A710N, � COmm0fCi21 WILL DO THE WORK.AN�THE STRUCTURE IS NOT IMEN�ED OR OFFERED FOR SALE(SEC.70rI,BU51• J NESS ANO PROFESSIONS CODE:TME CONTRACTORS IiCENSE UW DOES NOT APPLY TO AN OWNER Of � VROPER7YNn108UILDSORIAIFRDVE57HEREON.ANDMM1/ODOE55UCMWORKVEMSEIFORNERSELfOR = � THi10UGHHISOiiHEROWNEYPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTMENDEDOR m w OFFEREDFORSALEIF,HOYlEVER11/EBUIDINGORIMPROVEAlEM1550LDWfTMNONEVEAROFCOMPIE- � TION,THE OWNER�BUILDER WILL HAVE TME BUROEN OF PROVINQ TN�T HE OR SHE DID NOT BUIID OR Z MPROVEfORTHEPURPOSEOF3ALE? 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'`�� � DATE��s� �O� OYMER - V Z ' W �Q LICENSED CONTRACTORS DECLARATION W [L 1 HEFEBYAFFIpM LNDER PENALTYOF PERtt1RV THAT I AM LiCENSE�UNDER GRONSIONS OF CHJIDTER � p„ •(C0IAMENpNO WITH SECTION 7000�OF ONiSiON�OF TME BUSINESS AND PROFESSIONS CODE,ANO Z X MYLICENSE IS W FULLFOHCEMIO EFiECT. m ll! � UCENSE CIASS IC.N0. `� J V DA7E � ���O`"�f� ' CONTMCTOR a- W � WORKERS'COMPENSATION DECLARATION � � IHEFEBVAFFIRMUNDERGENALTYOFPERIUMONEOFTHEF011O'MNGOECLARATIONS: V N ¢ � �IH�YEANOWILLMNNTAINACERTIFICA7EOFfANSENTiOSELFdNSUREFORNfORKERS' 2 COMPENSATION.AS VROVIDED BYSEGTiON 7700 OFTHE L�BOR CODE,i0R THE PERFORMANCE W OFTHE WORK iOR WHlpl THIS PERAAIT IS ISSUED. � � �I MAVE AND WILL MAIMAIN WORKERS'COMPENSATpN INSURANCE.AS REOUIRED BY SECTION ^ Q 77000FiMEU90RCO0E,FORiHEPERFOflMANCEOFTNEWORKFORVYMICMTHISPERM1T15 �-/v' �1 J ISSUEO.MY WORKER5 COMPENSATION INSUFIANCE LARRIER MIO VOLICY NUMBERAAE CONSTRUCTION �� � �iEq PLAN REVIEW � POLICV Nl1M6ER ELECTRIC � (fW55ECIK1NNEmNOTBE�.TLETmOFhEiEPo.iTISFORONFMU�DAIDDOl1AMRiaO)ORL�aS1 PLUMBING - - -------- - - - ... Z I CERTIFY THAT W TME iERFORMMlCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL I� 1'y�:�=� -����� ����� "� ��" '" � (.�} SHALLNOTEIA7LOVANYDERSONWANYIAMINERSOASTOBECOMESU&IECTTOiHE �-' '� � �� •�- � ��� N WORKERS'COAIPENSATION UWS OF CALIFpRNIA AND ACREE iNAT IF I SHOULD BECOME INSPECTION FEE �� SUBJECTTOTHEWORKERS'C0IAPENSATIONPRONSIONSOFSECTION77000FTNELABOR ISSUANCE ( COOE,ISHALLFORTl1WITNCOMPLYWITHTHO PH SqNS. pDATE:�=�APRICANL� � � SMIP O � WARNiNO:FAILURETOSECUREwORKERS'CWAOENSATIONCAVEHAGEI5l1NLAWFUL,ANOSHALLBE ENERGYPlC '-�-��..,- J 6U&IECTANEMPLOVERTOCRIMIHALPENALTIESANDGMLFWESUPTOONEMUNDREDTHOUSAND I1--�-�. . LL pOLURS�f1oo.0001.INFDDITIONTOTHECOSTOFCOMPENSATqN,DAMAGESASVROVIDEDFORIN ENERGYPEHMIT `- --- � SELTIDN370lOFTMEUBORCOOE,MTEREST,ANOATTORNEY'SFEES. RETENTIONFEE: !•^ a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � IHEREBVAFFWIAUNOERPENILLTVOFOERJURYTHATTHEREISACONSTRUCTIONLENOINGA6ENCV d FORTHEVERFORMANCEOFIHEWORKFORWNICHTHISDERAIITISISSUED�SEG�ou�,CNC.). Z W � LENDER'SNAIAE � LEN�EHSADDRE55 � ICERTIFYTMATIHAVEREADTHISAPPLICATIONANDSTATETNATTHE�BOVEWiOR1AATIDNISCORRECL TOTAL FEES 1 y7. �JO d IAGREETOCOAIPLYWITNALICITYANOCOUN7YOR01NANCE5AND5TATEUWSPEUTINOTOBUIL01N6 / � CONSTRUCTION,AN�HEREBVAUf110RREREPRESENTATNE50FTHISCWNTYTOENTERUPONTHE Z ABOVE�MENTqNEOFROPENTViORINSPECTiONPVNPOSES. COMMENTS � �/� ' � �O A�i��s-� , ��-1'�L/�' m PERMITTEENAME(Vql TR) � _>� �.- �P'C- /--�D -T 3- 9 . � SIGNA EOFPE TfEE DATE /� pAIDBY VAUDATION � RECPT.N0. WHITE—Department Copy.YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—Fle Gopy,GREEN—Applicanl's Copy - . . .. • . . r . .:r . .... . , , .�, . , . . , . . „ .. , . ,. . . .� . �,.., . 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LATH/SIDING I PO�L FENCINu WALL INSUlATION POOL FINAL CEILING IN�ULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIO�JS SEWER FINAL EfJG. SEPTIC TANK Lt,NDSCAPE/IRRIG. � SEEP PIT/L.L � Of�SITE 1�,1PS. GAS AIR TEST FINAL ZONING FINAt�CONST. �Q� —� � . FlRE DEPT. FIPJA! FINAL HEATING � HEALTH DEPT. FINAL FINAL ELECTAIC DEV. FEES PAID FINAL PLUMBING � ENERGY � 1 .�:f�s��� Wb=i:�:�� AL___-- . , ::.;.. . .---- � — --- ..... _ .... .__.�..._....__ COMI'v1ENTS V SEPTIC TANK SIZE SEEP PIT/U SIZE �6 ._.__..��..� y�y�p - e ' ..__.. _�_-'�---- ..._ __.