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HomeMy WebLinkAbout18061 (17) �� CITY OF DIAMOND BAR � !i DEPARTIv1ENT OF COMMUNTTY&DEVELOPMENT SERVICES .�,; 21825 E.Copley Drive (909)860-3195 Fax(909)661-3117 PRESS `'%� BUILDING PERMiT APPLICATION , FIRMLY JOBSITE g APPLICATION.�{ PERMIT G P/C o ADDRESS J � DATE J a� �2- NUMBER/6�G� S c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER � O " ADDRESS ZONINCa SETBACKS gCITY ZIP TEL REAR Rw ❑ APPLICANT TEL. SIDEJSIOE STREEf RW ❑ � CONTRACTO / SIDE p � ADDRESS PROPO E USE o CITY • ZIP TEL =��e• � � ARCH/ENG/ v DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDAOOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION � Q ' OWNER-BUItDER DECLARATION SFR/ADDlREM O p I HEREBY AFFlRM UNDER PENILLTY OF FERNRY TI/�T 1 AM E%EMPT FROA1 TME COt�RMCTORS lF Garege/Carport W C£NSEUWFORTHEFOILOWMOREA50N(SEC.T0.7t.5BU51NE55ANOPROFE5510N5CO0E:ANYC(T1'OR (n U COUNTYWHid/REOl11HE5AGERMITTOCONSTRUCT./�LTE0.IAIPROVE.DEMOLISN,OflREGA1RANVSTRUG W PafiO/DOCk �LTUqE,CRION TO ITS ISSUANCE,IL50 REWIRES THE AP�IICANT LOR SUCH�ERMIT 70 FIIE A SIGNED W � S7ATEA�ENT THAT HE OR SHE IS 110EN5ED PU135UANT TO THE PROVISiONS OF THE CONTRACTORS L4 � CENSE UW(CHAPTER a(COMMENCIN�VATISECTION 7000)OF OIVISION]OF TNE BUSINESS AN7 VR0- LL' POOUSp3 FESSIONS COOE)Ofi THAT NE OR SHE IS EXEMPT THEREFROM AND TME BASIS FOR TiE ALLEGED E%EMP- � TION.ANYVqUTIDNOFSECTION70�1.SBYANYAiPLIGURFORAiENAiTSUBJECTSTIEAPPLICAN7T0 Z qe•Rool � AGVIL FENALTV OF NOT MORE THAN FNE HUNDREO DOLUAS(f50D�.): 0 O1A501YNEROFTHEPROPERTV,ORMVEMVLOyEESWITHWAGESASTHEIq50LECOMPENSATION, O CpmmerClel - Z 1MLL 00 THE WORK,AND THE STRUCfURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70t/,BU51- J � NESS AND DROFESSIdJS COOE:THE CONTRACTORS UCENSE lAW DOES NOi A7VLY TO AN OWNER OF ? PROPEHfV�N1O BUILDS OR IMPROVES tHEREON,AND NMO OOES SUdi WORK HIMSEIF OR HERSELF OR � TMROUCHNISOi1HERONTlEAIPLOYEES,PROVIDEOTHATSUd10APPOVEAlENTSMENOTIVTENDEDOR m QOFFEREDFORSKEIF,HOWEVERTNEBUILDINQORIMPROVEMENTISSOIDWITHINONEYEAROFCOMP�E- Z TqN,TNE OWNER�BUIIDER WILL HAYE ME BURDEN OF iPOVW6 TMAT ME OR SHE D�D NO7 BUILp OR = MPpOVE FORTIE PURPOSE OF SALE). O L�OMMER OF iHE PROPEHTY,AM E%CLUSIVEIYCONTMCTINO WfTM UCENSEO CONTMCTORS � TO CONSTRUCT TME FPOJECT(SEC.70ar,BUSINE55 AND PROFESSIONS CODE TME CONTMC70R5 L4 V01118 I ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPi107ERTVWMOBUILD50RIA1PROYESTHEHEON.AND � 4.M1qCONTRACTSFORSUCHVR61ECT5WRHACONTMCTOR(SJLICENSEDGURSUMRTOTHECONTMG QUANTITY OESCRIPTION FEE Y TORS UCENSE UW.). . � O IAM E%EMGT UNDER SEG B.i P.C.fOR THIS REASdJ � � LL � DATE ONMEH V Z W � UCENSED COPlTRACTORS DECLAHATION �j � IHEREBYhFFIRMUNDERPEW�ITYOFDE0.IURYTHATIAMUCENSEDUNDERPRON5qN50FCHAPTER V. a Y(ODMMENCPIO N7fM SECTION 700o)OF DM510N 7 0F THE BUSMESS AND PROFESSqNS CODE,AND Z X MY LICENSE IS IN FULL FOR E AND EiFEGT. 11J �i m � UCENSE CLASS ' UC.NO.��' / � F- V DATE,,�5� �� G..��_ CONTMCTOR . . _ . W - � WORKERS'COMPENSATION DECLARATION a � U � I NEREBYAFFlRM UNOER FENALTY OF PE0.IURY ONEOF THE FOLLOWING DECUMTIONS: N Z 4 � �IIUVEANOWILLMAMT�INACERTIFICATEOfCONSENTiOSELFdNSUHEFORWCfRKEFtS' _ '��- GOMFENSATION,ASFRONDEDBYSECTION77000FTHELAOORC00[,FORTHEFERFORMANCE w OF 7HE YNDRK FOR NM1/ICH 7MI5 VERMIT IS ISSUED. � � W _IHAVEANDWILLI.UINTAiNWORKERS'COMPENSATIONINSUMNCE.ASREWIREDBYSECTION `' Q J7oDOFTHEUBORCODE.FORTHEPERFORMMICEOFTHEWORNiORNMICHTI15PEPlAIT15 /09 7v ISSUED.MVWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMOERAR[: CONSTRUCTION � � qpaEq PUVJ REVIEW � POIICVNUMBER ELECTRIC � (MSSECf10NNEmNOTBEOd.WLEIIDOFTE�EP/ATBiOROtiEKkDREODOl1ARS6tm�OqLFSS� PLUMBING Z 1 CERTIFY TIMT M THE PERFORMANCE OF TME WORK FORYmICM TNIS PERMii IS ISSUED,1 MECHANICAL �-1=�—'��-�- C7 SNALLNOTFIAPLOYANYiER50NNM1YMANNER50A5TOBEWMESUBJECTTOTHE I J�- ./:�-"'.�� I � N WORKEHS'COMPENSATIONU'NSOFCALIFORN�AMIDAGREETNATIFISiIOUIDBECOME INSPECTIONFEE SUB,IECT T0 THE WORKERS'COIAPENSATION PROVISIONS OF SECTION�7000F iHE UBOR "" O000c.i sww.Foanrvnrn ca.�r�r vnn�n�ose oaohsaNs. ISSUANCE " p DATE: APPLICANT. SMIP � 1 �. ' /1f I% L� � ENERGY P/C WARNIIHI:FAILURE TO SECURE wORKERS'COMPENSATION COVEMGE IS UNUWM.ANO SHALL BE LL SU&lECTIWEMPLOYFRTOCRIUWALPfNALTIESMI�CMLiwESUVTOONEHUNDREDTMOUSAND ENERGYPERMIT 1 ,� OOLLMS�f1Do.000).WADDITtONTO7HECO5TOFCOAIPENSATION,DAMAGESASVROViDEDFORIN .. _ ¢ SECTION 7too OF THE LABOR COOE,INTEREST,AN0 ATTORNEY'S FEES. RETENTION FEE: ' ` � I.� a CONSTRl1CTION LENDING AGENCY PRE-AlT FEE: � � � IHEREBVAFFIRMUNDERPENALTYOFPE0.Ni1VTNATiMERE15ACON5TRt1CT10NLENDWGAGENCY FOR THE GERFORMIVlCE OF iHE WORK FOH WMiCMTMiS VERIAIT IS ISSUED(SEC.fo97,CIY.G�. Z ! W � LENDER'S NAME F- IENDER'SADDRESS ' WICERTIFYIHATIHAVEREA�TNISAPPLICATIONANDSTATETMATTNEABOVEINFOR/AATIONISCOFRECT. TOTAL FEES / 3� /v � IAGREETOCOMGLYWITHALLCRVANDCOUNTYOPD:NANCESANOSTATEUWSREUTWGTOBUILDINO CONSiRUCT1ON,AND MEREBY AUTHORIZE REPRESENTATNES OF THIS CWNT'TO ENTER UPON TNE ZABOVE�MENTqNE�7ROPEH7YFORINSPECTqNVURPO5E4. COMMENTS o ���� � �c. , m PERA/IT7EE NAME(PHINfI! 1" [A !�T-/ � � ���I� � SIGNATURE OF PERM�—��— DAiE pECPT.A'0. � PAID BY �� VAUOATION � WHITE—Depanmenl Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanCs Capy Ci�"1' C�� DlAN':OTr"D ��'�I� liv��'�C a iOft! Ri��t�R�'3 �l�`E'�r�=c;jiC�1►`� _..._. €)..ti.. ^._�1►�F a.� .t�y �e�w.�_ .�..�. ���f7:�� �.,rt�'1�` T.__����.�__--�- ��r �- ���o ,, ► _ F-�. =��� �'��� .__._ _.------.--_.- - -------_ _ _ _ _ .. . ._�__ _ �_ ._ _. _ __ _�__._ _ _ �__ __ ___-_ l - -----_.__� ___ 5ET BACK ' ( ___ I � FLOOR J�15 i " �- -___��-"�— —J _ FTGS/FORMS'STEEL � � FHA REQh4TS � .__;_ � —( ELECTR�C GROUND J�l�_ I i U' N�ER FLOOR DUCT GROUND PLUMBING � __ ,_ I Ut��DEf�F.LQOR CUf�iDUIT , � ' _ SLAB GRADE � l _ FIREP�ACE FOUPIDATION - TEMP POWER I FIREPLACE BOND BEAP�� I WATER SEAVICE � J_ i h"ID HT. BOND E3EAM ROOF SHEATHING � I ��8�• BOND BEA�J' i 2-T ���� �--�- I FRAMINGNENTILI�ITION � �. I I FINAL BOND BEAM ' .�.��T___t%;� ••n�,` i ROOF COVER v��,:�'� � PRE-GRADING ROUGH HEATING `' BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING � FINISH GRADIhJG SHOWER�i'UB TEST 1 _POOL ELECTRIC E�'T. LATH/SIDING � POOL FENCING WALL INSULATION �� POOL FINAL I CEILING W�ULATiON � OFF SITE IP�rPS. DRYVVALL NAILING � DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. OPJ 51TE IP�1P5. GAS AIR TEST FINAL ZONING FINAL CONST. � , �!R[DEPT. FINA!. FINAL HEATING • HEALTH DEPT. FINAL FiNAL ELECTRIC � DEV. FEES P:,ID FINAL PLUDl,61NG j I ENERGY ( � ..,.�.-•ry.�...a-------- .I.,:+.• t.;; �'1,ic. _.._.._---..�,_.... ---•----..__--____�� COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE �+�_...__�_, '�rl�� � i � � . , �k