HomeMy WebLinkAbout18181 (17) .----- __ .
J� CITY OF DIAMOND BAR
� i DEPARTMENT OF COMMUNTTY 8c DEVELOPMENT SERVICES
��y 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
'��� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE APPLICAT N
ADDRESS �OK L/ DATE NUMBER ��/ 1t/C
� ISSUE TyPE p�C
APN LOT T A T DATE CONST. GROUP
O OWNER
p ADDRE.S..S� �,,�, ZONING SETBACKS
g APPLICA�(VT���- ZIP� TEL. � � FRONT Ryy �
REAR
� TEL. SIDE/SIDE STREEf RW ❑
� CONTRAC � SIDE �
Q A�DRESS -�-��-.� �
o CITY • ' ZI TEL��tfi'�Qj/ P�P�SEP US
w ARCH/ENG! � � `l��`�
z DESIGNER ��i's-
a ADDRESS NO.UWEL - NO. -
� C� ZIP TEL. UNITS STORIES BEDROOMS
� DESCRIPTION S4.Ft FACTOR PSF ADJ.AREANALUATION
¢ ONMEH-6UILDER DECLARAT�ON
O SFR/ApDrAEM
Q I NEREBY AFFIRM UNDER PENALTY OF PERIUHY THAi I AM EXEMP7 FRpM T11E COHTMCTOAS L4 Garage/Carport
� COUNT7WHFCH EOUIRE9APEFMR OCONSTqUCT�AL ER�PROVE.DEMOU,OqS�D RMlYSTRU6 �
NRE FRqR TO ITS ISSUANCE.QSO REW�RES THE MPLM.IWT FOR SUp1 VERMIT TO FlLE A SIGNED W Pd1iO/D9Ck
� STATEUENT THAT NE OR SME LS UCENSEO PURSUANT TO iHE PHOVISIONS OF TME CONTRACTORS L4
� CENSE UW(CNAPTER o(COAIAIENCW4 WITISECTiON 7oo0)Of DMSqN�OF THE BUS�NE55 AMJ GH0. � PooUSpa
8 FESSIONSCOOE)ORTIA7HEOIiSHEtSE%EAIPTTHEREFNOMANOTHE&ISISFORTHEAILEGEDF%EMP• C7
710N.ANYV�OUiIONOF5ECT10N7Wt.5BVANYAPPUCANTFORAPEAM175U8JECTSTHEAPPLiCA7JTT0 z Re-qoat
F, A GVIL FENAL7YOF NOT MORE THAN FIYE HUNDRED DOlURS(S5o0).�: � �
� OtA50NMENOFTHEPROPERTY,OHMVEMPLOYEE5IMTMWAGESASTNEIR3pLECOMFENSATION, O COT1fIB�C1d1
Z WILL DO ME WORK,M!�THE STRUCfURE IS NOT INTEN�ED ON OFFEFlE�FOR SALE�SEC.7o��,BUSi• „J �
� NESS AND PROFESSION$COpE:THE CONTFUCTORS UGENSE UW DOES NOTl1CPLY TO AN OWNEROF �
VqOVERTV 1N1p BUI�p50R IMPROVES THEREON,AND WNO DOES SUCl1 WORN HIMSELF Oq HERSEIF OR
Q TMibUCHHI50RHEROwNEUPIDVEES,VROVIOEDTHATSUpIMVROVElAEN75�RENOTPl7ENOEDOq m
p OFFEREDFOqSALE1F,HOWEVERTNEBUILDINGORnAPqOVEUENTI550lDVATHiNdiEYEAROFCOMPLE•
= iqN,7NE OWNER-BUttDER Wttt HAVE THE BURDEN OF PqONNO THAT NE OR SHE O�D NOT BUfID Oq
MOROVE FORTHE PURVOSE OF S/�LE).
� ❑�ASOWNFROFiNEPROPERTY,AME%CLUSIyELYCONTRACtINOWRNIICENSEDCONTMCTORS
TO CONSTPUCT THE PRQIECT(SEQ ION,BUSINE55 M10 iROFE5510N5 CODE:TNE CONTMCTOR9ll• V21U3tiOq ADJ.AREA
� CENSEUWDOESNOTMPLVTOANOWNEROFAPFlOPEHiVWnOeURD50RIMPROYESTMEREON,AN�
1MMOLONTMCTSFORSUCHVRO.IECTSWIINACONTMCT0fy5)LiCENSE�VURSU/WrTOTHECONTMP OUANTITY DESCRIPTIOM FEE
Y TORSLICENSEIAW).
0 O 1AM E%EMPTUN�ER SEC B.�PG fOR TMIS NEASdJ J
� U
�=' DATE OWNER H
U
� UCENSEO CONTRACTORS DECLARATION w
� INEAEBYAiFIRAIUNDERGENALTYOFVE0.1URYiHA71AMLICFNSEDUNDFRPAOV7SION50iCHAPTER �
O„ •(COMMfNCW4 NTTH SECTION 1ooD)OF DMSiON 7 OFhIE BUSINESS 4J0 GROFESSIONS CO�E,ANO Z
X MY UCENSE IS N FULL FOI7CE AND FF T. /
NiR m
� UCENSE CU S LIC.NO.����'V �
--►---t
V MTE � '� COMRACTOR pJ,
W .
� WOfiKERS'COMPENSATION DECLARATION a
� IHEREBY/IFFIRMUNOERPEWLLiYOFPEiLM11RYpVEOFTNEFOtIONf.NGDEQAMTIONS: V
C/7 Z
� _IMAVEANDYNLLLLUNTAWACER71FIGiEOFCONSEMTOSELiaNSUREFORWORI(EAS' a
COMPENSATqN,A$PpOy�pED BV SECTION 77000F ME LA80A COOE,FOR TNE DERFORMANCE U
OF THE WORK FOR VlHlpi THIS iERMiT IS ISSUED, W
� �
� __IHAVEANDN^.LLMAINTAINWORKERS'COMPENSA7qNIN5URANCE.ASREWIqEDBY5EC7qN
� 770o OF THE LAeOR COOE,FOR TNE VERFOAMANCE OF THE WORK FOR WHlpl THIS PEAMlT15 /� �
ISSVEO.MYWORI(ENS'COMPENSATIONINSU CAqpIERANDVOUCYMJ4BEqARE: CONSTRUCTION
j ��ER PLAN REVIEW
� iOLICYNUMBER �7•I l���
ELECTRIC
� (MSSECIKNNEmNDTBEOd.GtEfEDOFhEPERMTISiY7qpNEF4l�OREDOq1/JLSR�00)aRILSS? PLUMBING
w
Z 1 CERTIFY TMAT IN THE PERFORMANCE OF THE WORK FORMn1iCH THIS PERUIT IS 55UED,1 MECHANICAI
C7 SHILLLNOTEMPLOYNt'tPER50NWAN'lMANNERSOASTOBECOM[SUBIECTTOTHE
Vj WOPo(ERS'COA/PENSATqN UWS OF�IFORNIA,AND AGREE THAT IF I SHOUID BECOME tNSPECTION FEE
S SUBJECTTOTNEWORKERS'COMPENSA7qNPPOV1510N50FSECTqN37000FTMEU80R
CODf,l SNAII CORTA4ITH COMpLY N7TH i1q5E is s. ISSUANCE .
O ^ �
W OATE Y APPLICAN7: SMIP ��`✓ -'� - . .
�.1.
� WARNIN6:FALURETOSECUREWORKEHSCOMPENSATIONCOYERAGEI NUWFUL,ANDSHALLBE ENERGYP/C ,� � � � � _%�->
SUBJEClANEMPLDYERTOCfl1AlINALPENALTIESANDLMLFWESUPTO NEHUNDREO7NDUSAND ENERGYPE MI7
]�,,, DOlUR5�f10o,0oo�,M1A001710NTOTMECOSTOFCOMPENSATpN,DAMACESASPNOVIpEDfORIN ��
_l SECTqN37cDOFTMELABORCOOE,INTEREST,ANOATTOqNEY'SiEES. -' � '.,��1 ���
aC RETENTION�FEE:
OCONSTFUCTION LENDWG AGENCY PRE-ALT F�1E':-•��.
� IMEREBYAFFIRIIUNOEROENALTYOFCEfiNqYTHATTHERE15ACONSTPUCTIONLENDIN6AGENCY ��-- •
FORTNEPERFORIA4NCEOFTMEWORKFORN7iItl1THISGERMITISI55UED�$EC.�007,CIV.C.). .,,. , _..^__
z
w
� LENDER5NAIAE
� LENOER'SADORE55�
w �CERTIFVTHATIHAVEREADTHISADPIICATIONAN057ATETHAi7HEABOVEINiORA1ATpNISCOHRECT. TOTAL FEES /' 3a
� IAGREETOCOMPLVVYITMAILCT'ANOCOIMTYOR0INANCESANDSTATEUWSNELATiN6TOBUILDING
� CONSiFUCT10N,M'OHEqEBVAUTHORQEREPRESENTATIVESOFiHISCOUNTYTOEHTERVPON7Hf
Z IIBOVE�MEMqNEDiROPERNFORINSPECTIONPURPOSES. COMMENTS
0 L
�
m PEFM�T�EEN v
Q �
�
y SIGNATUREOFPERMITI E ATE
� RECPL N0. PAID BY VALIDATION
WHITE—Depanment Copy,YELLOW—Finance Capy,PINK—Assessor Copy,GOLDENROD--file Copy,GREEN—ApplicanYs Copy
— -- _ _... ._ ._ , -.._,__. , . �-
. . . , , .�. ,. .,
�Ca i�' OF DlAfU9(3fSQ E3�R
If����C�'i0i�+ F�ECOi��
_._�__.___�_.. __.�....._..� ._._._.. .__�..:_ :; :...^..___,....�. { � _...
'1►�l•'9:�I�E�'�CI�►''I o�:.�:�[". ,f►`Ey���', r'�;l:ti I�E-�.a_�c _�(eliri. �r��F=: ;Ii�F-���c .�cl� i
--------_-------------____. .-.._ .:-- ------ , _____ _...._ . _._.._.____..__�__..._ ..___.____._ .___.__�___..__..._______��� - - �
SET BACK � � FLOOR JOIST � j
FTGS/FORM5ISTEEL � � � ' -} FHA REQMTS '
ELECTRIC GflOUND y j � UPJDER FLOOR DUCT � �
GROUND PLUMBING I I UNDER FLOOR CU�IDUIT
SLAB GRADE I � FIREPLF,CE FOUNDATI�N
TEMP POWER i I FIREPLACE BO"JD BEAM
WATER SERVICE � '� MID HT. BOND BEAP�1
AOOF,SMEATHING ���;—_�� L 8 FL BO"JD BEAbA _
FRAMINGNENTILIATION��� � I `i �FINAL BOND BEAh1
ROOF COVER �,'7�l— ��., PRE-GRADING I
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLU�JiBING � FINISH GRADING
SHOWER�fUB TEST j POOL ELECTRIC
EXT.LATH/SIDING j ; POOL FE��dCI�.G
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IP�1PS.
DRYWALL NAILING DEDICATIOfdS
SEWER FIPJAL ENG.
SEPTIC TANK LEINDSCAPEIIRRIG.
SEEP PIT/L.L. � ON SITE IMPS.
GAS AIR TEST FINAL ZONIWG
FINAL CONST. ����� ��� `�IRE DEPT. FINA!
FINAL HEATING �� � HEALTH DcPT. FIfJAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ENERGY I
� �
�'i�i� F �''I''����(t .��.
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
i w� ""'""1
1 ,
�Jf�
��,