HomeMy WebLinkAbout16793 (42) �. CITY OF DIAMOND BAR . �
� DEPARTNtENT OF COMMUNITY c@ DEVELOPMENT SERVICES
21825 E.Copley Drive
_ (909)860-3I95 Fax(909)861-31 l7 PRESS
'%�� BUILDING PERMIT APPLICATION FIRMLY
� JOBSRE ,APPLICATION �c7 PERMIT �J� P!C
o AODRESS l• DATE t/ NUMOER � #
� ISSUE TYPE OCC
APN LOT TR t DATE CONSL GROUP
p OWNER
" ADDRESS � ZONING SETBACKS
z CITY ZI L. ' �� FRONT RW ❑
� APPL Id EL.-�����' //� REAR ❑
� SIOE/SIDESTREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRES
p Cm, � E PROPOSED USE
o ARC G C�l
� DESIGNER NO.DWEL. NO. NO.
= CDDRESS ZIP TEL UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLAFiATION SFWADDlHEM
O
W CI MEREBY 11iFIRM�1NDER VENALT/OF VERAIRY THAT 1 AM EXEMPT FflOM ME CONfMCTORS lb G2f2gB/CB�pOR
ENSEUWFORTHEFOILOW:NGREA50N(SEC.70]1.SBUS�NESSIWOPROFESSqNSCDDE:ANVCT'OR (n
CJ COUMYNTIIpiREOUIRESA�ERMrtTOCONSTRUCT.ILLTERIIAvqpVE,DEMOLISH.ORREPAIRANYSTRUC• W PatiO/DOCk
� 7I1RE,CRIOR TO ITS 6SUANCE.AL50 REIX11R[5 THE AVPLICANT FOR SUCH PERAIIT TO illE A SIGNED W
ST�TE�EHT THAT HE OR SHE IS LICENSEO DURSUA�T TO TME PROVISIOHS OF THE CONTMCTORS Lb
� CENSE UW(CHAPTER D(COIAMENCINC WITH SECTiON 7o0oj OF DINSqN 7 OF THE BUSMESS AND GR0. �- PooVSpa
FESSIONSCOD[)ORTFIATHEORSHEISE%EMPTTMCREiROMANDiHEBA515fORTHEALLE6EDE%EMP• (�
TION.ANYVIOLATIONOFSEGTION70�I.SBYANYAPVULANTiORACERMITSU&1EGTSTMEAPPI�GANTiO Z Re-Roof
A CML PENALT/OF NOT MOf1E TMAN FIVE NUN�REO OOLUHS(f 500�.�:
� OI,ASOMMEROFTHEPROPERTY,ORIAYEMPLOYEESWITMW�GESASTMEIqSOLECOM7EN5ATION, ❑ COmmOrtlal �
YALL DO TME WORK ANO THE STRUC7URE IS NOT INTENOEJ OR OFFEREO FOR SALE ISEG 70u.BUSi� J
N N[SS AND CROFESSIONS CODE:TH[CON7PACTORS UCCNSC UW DOES NOT�V7LY 70/JJ OWNER OG ?
PROPERTY WNO BURDS OR VAPRpyES TNERCON.AND WHO DOES SUCH W01iK HIMSCLF OR MERSELi OR
CL TNROUCHHISORHEROM?�EMPLOVEES.PRONDEDTHA75UCHIMPROVEMCMSARENOTINTENDEOOR m
� OFFENEDFOR9ALEIF,NOW[VERTMEBU0.DINGORIMPROVEMEMISSOIDWRHINONEVEAROFCOMP�E•
Z TqN.TME OWNER-BU1lDER NnLL MAVE TME BUFDEN OF PROVING iMAT ME OR SN[OiD NOT BUI�p OR
� MPROVEFORIHEVVRPOSEOFSALE�.
w ❑I,ASOWNEROFTMEDROPERTV,AAIEXCLUSNELYCONTRACTWOWITNUCCNSEDCONiRACTORS
Q TO CONSiRUCT THE 7R0.1ECT(SEC.70��.BUSI�E55 AAD VROFESSIONS COOE:TMC CONTMCTORS LI� V31u21im ADJ.AREA
� CENSELAWDOESNOTMPLYTOANOWNEROFAVROPERTVYR108UR�SORIIAPROVCSiHERCON,AND
WHOCOMRACTSFORSUCHiRQlECTSWITHACOHTRACTOR(5)I�CENSEDVURSUANTTO7NECONTMG QUANTITY DESCRIPTION FEE
Y TORS UCENSE LAW�.
� ❑I AM E%E4PT UwOER SEG. B.i i.G.fORTn15 REASON Q
� U
LL �
D�TE OwNER U
Z W
FQ LICENSED CONTRACTORS DECLARATION W
K IFIEREBVAFFIMIUNDERPENPL7VOFPERIURYTMAT�AMLICENSEDUNDERVRONS�ONSOFCMnGiER �
d Y(COMMENQNGWITXSECf10N7000�OFO�VISION70FiHEBUSINESSANDDRO�ESSiONSGODE,AN� Z
X MYLICENSEISNFULLFORCEANOEFfECT.
� UCENSE CLA� LIC.NO.��� �'1�/� j
-- U DATE CONTRAC70 a
W
� ORKE S'COMPENSATION CLA ATION ` '�
� a
NIHER vAFiIR1AUNDERPENALTYO�PERIURYONEOFTNE�OLLOw'NGOC RATIONS� Z
� �IIUVEIINDYALLMAINTAINAGERTIFILATEOFCONSEMTOSELF-INSUflEFORWOHKERS' _
COMPENSATqN,ASDROV:DE08YSECT10N77000FTMEU00RCODE,FORTHEPERFpRMANCE W
OFTNE WORK FON WNICH THIS OERAIIT IS ISSUEO.
� 2
�I FUVE AND WILL MAINTA:N WORKERS'COMPENS�TION INSUMNCE,AS REO IAEO BY SECTION
Q 9700 DF THE U�BOR OOOE,FOR TME PEFFOflMMlCE OF iHE WORK fOR W;yyyM THIS VERMIT IS
i55UE0.►IY WOFU(ERS'COMV NSATI N I UFW CAP ' R AND POLIC yUTABER 11rtC: CONSTRUCTION
� GRRIER \ / PLAN REVIEW
Z poucrNuueEa _ EIECTRIC �
¢
� (nu5Ecf10NHCmNOie OOrdPLEi OFhErE 6PonOnE/Al�f1CD0alAfiSR+a�ORlEss} PLUMDING
W
Z ICERTIFYTNATINTHEOERFORAI�NCEOFTHEWORK�ORYJHIGHTHISPEN��TISi55lJED,I MECHANICAL �
(J SM/LLL NOT EMP�OV MIY PERSON W ANV MMlNER SO AS TO BECW�E SUBJECT TO THE ---
N WOiL(ERS'CAYPENSATqNUw50FCAtIfpRNiA,ANDACRCETHATIF15HOUlDBEOOAIE INSPECTIONFEE "�� � 1 �� ���'��
SU&IECTTOTNEINORKERS'COUPENSATIONPROYISIONSOFSECTqN910oOFTMELAflOR . ._ ./%. �� � -� ��..-
s woE.isw�ucorm+win+coMrtrvnn�tnosEVRo�sans. ISSUANCE
O
p DATE: ACP�ICANT: SMIP I I=_'J�_=���
D
J WMNING:FA0.UNETOSEWREWORKERS'LOA�PENSATIONCOVERAGEISUNUWNI.ANDSWLLLBE ENERGYP/C
� SIAJECTANEMFLOYERTOCRIMINl4.PEN/LLTIESANDCNILFINESUPTOONEMUNDREDTHOU5M10 ENERGYPERMIT
DOLURS(f100.000�,WADDITIONTOTH[COSTOFCOM7ENSATION,DMIAGESASPROVIDEOFORIN { ` . �
� SECTIONl70eOF7HELABORCODE.PITERLSLAYD�iTOR4EY'SiEES. RETENTIONFEE: .`�-�. ..._..--�
[Wi.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IMEqEBYAFFIRAIUNOERCENALTVOFPERIL'RYTNATTXEREISACONSTpUCTIONLENOwG�G[NCY
fOR iHE FEHFORM0.YLE OF TME WORK FOR YlH�CH 1NIS VERMiT IS�SSUED(SEC.7097,CIV.C.�.
Z
W
� IENDER'S NAME �
F- LENOERSADORE55
¢ ICERTIFYTHATIMAVEREA�iH15�PPLICATIONANDSTATETNATTVIEAOOVEINFONMAiIONISCORFECT. TOTAL FEES 1 � DO
W IAGRCE TO Cd.A?LY WIT11 ALLCITV AND COIMTV OPDINANCES ANJ STATE UWS REUTING TO BUILDING �
� CONSTPIK dJ,ANDMER[BVAUTHORIZEPEPR[SENTATNESOFTN:SCOUNTYTOEHTERUPONTHE
ZABOVE�M IONED 7ROPEftTY FONINSPE r�aao. COMMENTS
�
J
�
m P MIT7EE N �NIN
4
cl� �..-i � �'1
icn�ruHE .crnr�rre — r
� RECPT.NO. _PAID BY ' �VALIDATION
WHITE—Departmenl Copq.'YELLOW—Finence Copy.PINK—Assessw Copy.GOLDENROD—File Copy.GREEN—ApplicanTs Copy
..._...,_. . . __ .,.. ,.,._..,.. ._,.,.r........�,.,.. ......
._ . .. . . .,.... ---,-_...__. �.... ......... ...a _, , ... _ . .. � _.. ,-.... . _ .. . .
�I i:' Oi �1/=.i.�G�T��(� �i-.f?
' �~ li�'�:=��,"�EC►i•7 ti�C(�rif�
_�—__�_.___----- ------�-- -._ ..--�-----.._. _.. ---.._._.__..__...-----._ ---- --._._�---------- -- -------____ ----- —_
._ .. _
- — -- .... . _. .
1►�E=�R!=f."I'1�1►�: 'i_S:?"= I►'F-`f:�-�,r^rr.l�: ���I�_i��=.E: :It l�'!. [y�'�E'_ I��E-'7;,I�c',`I'e).'t
...._......_. ..:.. ._. . _ .. . ..__ •. ..._... --- - ....- - --�•-----�-----
..... _.. ... . ..... .. .
SET BACK ..._...._I, j � ! FLOO�;,��,J7 � �. . ;
,
-- �---- --•�----------------._....—• ---------.._.- — �— -----
FTGS,'FORP�IS;STEEL � -- � -- — � I FH�, REG�,"."TS — i ---- � —
ELECTRIC GR�UfJD � � i UPJD�P. F�C�R D'JCT � � _
GROUPJD PLUi11�ING � _ __ ___i_� Ut1D�R FLOOR CUi�uUIT~'-I _T�=� _ _
--�----�--------- -- --- -
SLAB GRF�DE ' _ _I j FIR�PLAGr �C�U�JDATIO�J _i_ __ �I -
TEP.9P FOVVER I I I FIR=FLACE 60PJD E�AtY� � �—
- -I=; _-..._ --
�^lATER SER��ICE ( � _ I I t:".i�t-iT. EO�d� BEAF:1 _ j� ;
ROOF SHEATHI�dG _j _� I II Fr. 60"dD f3EA".' —�' '_� � . . — --
FRAD.IINGNEfJT—ILIATION—1� �_ ____ i� I FIPJ.AL E?OtJD Ei��"." ___� � _
ROOF COVER I I I ; FRE-GRADI�JG _ j
ROUGH HEATIf•1G �_� � � B�i•JCHIiJG f
* �.�ROUGH ELECTRIC �__�_ 1 ; F�OUGH Gf;t,Dlf•J� __
ROUGH PLU'•:'EItdG � � _ __I l Fli•JiSH GR/',DIf�G I �
SHOti^JER:rfUB TEST I I _ _ �_I_�'OOL ELE.CTRIC �— I _
EXT. LF,TH'SIDINa I I F'OOL FEi:CIP.G �
�"JALL INSUU',TION —� � POOL FINAL
CEILINu IiJ�ULATION � � OFF 51TE 11�1PS.
DRY�"JI',LL PJAILIPJG � ; DEDICATIO�JS
SE1"JER � FI"JAL EPJG. � _
SEPTICTAh�K � I LAPJDSCAPE/IRRIG. I I
J- ------
SEEP PIT/L.L. i � � } CN SITE IL�°S. �
GAS AIR TEST � �y� FI��AL ZOtdl�•1G �
FINAL CONST. � i I ! F!RE DEPT. FI��P,L �
FICvF;L HEATING � � � � HEr",LTFI DEPT. FINi�L_�
FINAL ELECTRIC �� �� O� _ � ! DEV. FEES PA!D � }
FINAL PLU'�iSING � I I I E��=���" I _I __
I � � _ ._. ._ ---,-�-------__ .._ _.
- � -- ----�--�-� '� ='�-..''- - - - ---- - ----� �
COMMENTS
SEPTIC TAP�f: SIZE
SEEP PIT/U 51ZE — — ---- —
---____��i_�..._..,_...__... ------
h�r�
�, . �
.� .