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HomeMy WebLinkAbout17170 (37) � CITY OF DIAMOND BAR v � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 2I825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��%�� BUILDING PERMIT APPLICATION FIRMLY JOBSITE �' 1 —�` APPLICATION (��, U PERMIT �I P/C o ADDRESS� � �u'� � DATE � Zv NUMBER l U � � APN LOT TRACT �SSUE ,6 /�, TYPE OCC DATE Z � �� CONST. GROUP p OWNER '•r `�tP � �' " *� " ADDR SS ` ' ��p�� ZONING SETE�ACKS z CITY�,y},;M � �• ZIP 1� TEL. F�1a,�UZ.�Y, qEART RW ❑❑ g APPLICANT TEL. SIDEISIDE STREET RW ❑ � CONTRACT t"' ,.. . � SIDE ❑ � ADD SS � CITY��n4ty,_ ZIP��1�}TEL. r� �1� PROPOSED USE � � - V' �� �, o ARCH/ENG/ t� _f— • W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS N CITY ZIP_�� TEL. cn DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION � ONMER•6UILDER DECLARATION SFR/AODlHEM O 1 HEREBY AFFIRM UNOER VENhLTY OF VERRIRY TNAT�AM E%EMPT FROM THE fANTMCTORS ll� G2!9 Je1C21pOR W CENSEUWFORiHEFOLlO`MNGREASON�SEC.70If.5BUSINE55�NOPROFE5510N5CODE:ANYGTYOH (n U COUNTYWHICHpEWIRESAPERMITTOCANSTHUCT.ILLTEF.MVROY[.DEMOLISH.ORREFAIR/�MISiRUC• W PatblDeck � TURE.PRIOR TO RS LSSUANCE.A150 0.EOUIRES 7HE APPIICANT FOR SUCH PERMIT i0 FIIE A SIGNC� w STATEMENT i//AT HE OR SHE IS LICENSEO pURSUANT TO THE PROVISiONS OF THE CONTRACTMS U� � CENSEUW�CHAPTERC�COIAMENCINOMATHSECTION7000)OFDINSIGN70FTMEBUSMESSAY'JPRO- LL" PooUSpa FESSIONSCODE)ORTFIATHEORSHEISE%EMPTTN[REFROMMIDTHEBASISFORTMEAlLE6EDE%EMP• (� VTpN.ANYVIOLATIONOFSECTqN7071.5BYANYAPPLICANTFORAGEHMiTSV&lECTSiMEAPPLIGMlTTO Z Re•Rocl A CML VENALiY OF NOi MOHE TMAN FIVE HUNCflEO 00LUR5(f 500))' � OI,ASOWNEROFTHEPH07ERTY,OHMVEMo�0YEE5WITMWAGESA51HElOSOLECOAIFENSATION, ❑ COR1rti0rCi�l � WILL DO THE WOfiK.�NO THE SiRUCTURG IS NOT INTEAGED ON OfFERED FOR SALE ISEC.70u.BU56 J � NE55 AND VROFESSIONS COOE:TN[CON7NACT0�5 LICENSE LAW DOCS NOTAP7LV TO A4 ONTIEF OF ? VROPERTY NA108URDS OR IIAPROVESTNERCON,M1D YM0 DOES SUCH WORNHIMSCLFOR XERSE:F OR � THROUCHHISORHEflOWHEMPLOVEES,PROVIDEDTHAiSUCMWPROVEMCNTSARFNOTMENDE00R m � OFFEREOiOR3ALEIF,IWVdEYERTME&ALCINGORMPROYEIAENTISSOlD1MTHiNONEYEAROFCOMP�E� Z TqN,THE OWNER�BUI�pER Will HAVE TME BUNDEN OF PROVWG TkUT ME OR SHE DID NOT BUILD OR MVROYE FOfl iME VURP05E OF S/�LE4 W ❑I�OWNEROFTHEPROPERTY.MdE%CLUSIVEIYCON7RACTWGWRMLICENSEDLONTiUCTOHS Q TO CONSTRUCT 1HE GNWECT 15EC.70��.BUSINE55 AND VROFESSIqJS LODE:TME LONTMCTORS LI� Veluati0n��� ADJ.AREA W CENSEUWDOESNOT�PPLYTOANOWNEROFAPROPERTYW1109UILOSORIMPROVESTIIEREON.AND � YJ'WCONTMCTSFORSUp/DR0.1ECT5WiTHACONTRACTOR(S�UCENSED7VRSUANTTOiNECONTRAG QUANTITY DESCRIPTION FEE Y TORSLICENSEUIw.�. � O 1 AM E%EMP7 UN�ER SEC, B.i G G FOATN�S REASON J Q � U U.. � OATE Q OWNEH U . Z W � LICENSED CONTRACTORS DECLARATION W OC IFIERCBYAFFIFWUNOERFENALTVOFPERNRYTMATIAML�CENSEDUI:DEflFPOV1510N50f�HACTEF � d 9(COMMENCINCWITMSECiqN7000�OFDiVi510N]OF7HEBUSINESS/WD7ROFESSIONSCODE.AND Z X MVLICENSEISNMLFOfiCEANDEFfECL m � �'��- .��1'13� � LICENSE CUSS LIC.NO. � J V �ATE CONTRAGTOR �- . W � WORKEFiS'COMPENSATION DECLARATION a NIHEREBVAFiIfUIUNDERPENALTVOF0ERIURVONEOFTHEFOLIOWINGDECLARAT10N5. Z Q 0 _IHAVE/�NDWILLMAMTAMAGERTIFICATEOFCONSENTTOSELFdNSUREFORWORKERS' _ � COMPENSATpN,ASPFOViDEDBVSECTIONl7000FTHEUBWICODE.FORTHEPEpFORMANCE W OFTHE Y✓OpK FOR WHlb/TNIS CERAIIT IS ISSUED. � � w �I HAVE AND WILL MAINTA:N WORI(ERS'COMPENSAT1pN INSURANCE.AS FE WIRED BY SECTION ���''''''/// ^ QJ7000FiHEL/BORCOOE,FORTHEPERFORMANCEOFTM[WOHKFORNMILMIHISPERMITIS ��, / � = RSUEO.YY K.H�COMOE �TIONINS MNCECARRIERANDPOLILYMIM�ERARE: CONSTRUCTION [J �� � uaw[a � � ���1�� PLAN REVIEVf Z VOLICYNUMBER ELECTRIC Q � (i}f55ECIlONNEmNO7BE00�.61ETEDOFitiEPERMTISFORChE1MfiREDDtt1/�fSRiaolOtiLF55} PLUMBiNG Z 1 CERTIFV THAT IN THE PEAFORAIANCE OF THE WORN LON Nh1ICH THIS PERMIT LS 6511ED,1 MECHANICAL (�J SNAL�NOTE6IPLOYlJJVCERSONNMIYIAANNERSOASiOBECOMGSUOJECTTOTME � WORKERS'COMPENSATIONU'MSOFCALIFORNU�A�DAGRFETMATIFISMOULDBECOME INSPECTIONFEE SU0.IELT TO TME WORKERS'COMPENSATqN iROVi5iON5 OF SECTqN 7�Oa OF}H[UBOR S CODE,I SMALLFORTMYITTI COMPLY WIT1 THOSE VROVISqNS. ISSUANCE � � Sh7IP � � p DATE: APPLICANT: � WMNING:FAIURE TO SELURE WORKERS'COMPENSATiON COVERAGE IS VNUWFUL,AhD SNALLBE ENEFGY P/C � SUBJECTANEMPLOYERTOCFIMfNALVENILLTIESANDCIVIIFiKESUPTOON[HUADNEDTMOVSAND ENERGYPERMIT DOLURS({100,OD0),IN ADDITION i0 THE COST OF CDMFENS�iqN.O�/AAGES AS PROVIDED FOR PI � SEC710N 77oe Of ME UBOR CODE.MTERf 5T.AND A7TORNEYS FEES. RETENTION FEE: �O a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O Q IHEREB�AFFINUUNDERPENAL7VOFPE0.NRVTNA7THERE15�CON5TRUCTIONLEND'�NG�GENGY 0- iOR TME iERFORMANC[OF iHE WORK FOR wHICN 7Mi5 YCRMIT IS ISSUCD(SEC.7a97,CIV.C.�. Z W � LEKDER'S NAME F- LENDER'SADDRE55 W ICERTIFVTNATIHAVEREADTMISAPPLICATIONAYDSTATEMATTHEABOVEINFORM�TqNISCORRECL TOTAL FEES 1 ����� � IAGRCE TO Cd.17lV WI7H All GTY A.Y�COUNTV ORDINANCES AND STATE UY75 REUTWG TO BUIIDING � � � CANSTRUCTION,ANDHEREUVAUfWR12fREPRESENTATNESOFTMiStOUNNTOEMERUPONiNE Z ABOVE-MENTIONED 7flOVERTY FO/i INSPfCT10N PURPOSES. COMMENTS � ���` ��' � � 4� ���� l m �EEWW'c(7RIN Q � -����r���� �� � IGNA UHE DEHMI OA� � R[CPT.NO. _PAID 8Y � � VALIDATION WHITE-0eDartment Copy.YELLOW—Finence Copy.PINK—Assessor Copy.GOLDENROD—Fito Copy.GREEN—AppliCenCs Copy .... ,.._.......... ... .. . �.._.._..._._.__...._....,.._........ _.: . ,, .. ,.. .. , .,- -,�•- .. _.._. . . . . . . . . , � , . . . ., ... cs�-�, or= �:i��,w,ar��� er�� 9i�.'.'��'..r'�C�:'i��: F:�GC�E=ti� Ia�F=iC��,c:i[1�1►'! �---`�_�.:�F----�--li`E�3;�=c'�Fc.�--_..._. .------I�;t-'�C?',c -,;��.���i--.._._._�--r�:,•i-�:-----li�l.-`��I:;c'�_�;ej;.� _ .. .... ... .... _ . . _ _ . .. _........ ......_.. ... ._... . _._._....... ----........--- -- ----�..._. ----._._.._...- ..__._....-- --...---- � i � , S�T E3l1CK ' � FLOOR JC;ST • ----� � . • ---- --. ..--�----..__._.__.....----- ---•-;- -.._. _._-- �-- : FTGS'FORP�IS.'STEEL � � ' ! � f H%, FiEQ':1T5 I ----- -------- - I - ` ELECTRIC GROUfJD � ; � ; U�•.�E�, FL07R DUCi � I - ----------•------ --�--- - ' -- GROU�J� PLU;�4BING �_ I_________I : UP.D�R_FLOOR CO3!�UIT_yI_ �. SLAB GRADE � � ! r IR�PL��Cc F7U,3DATIOPJ ' ! TEP.9P POVVER I __ � -- ---_.:_� FIF�EPL�,CF FO�JD dEA�.t- j----- 1 --- �"JATER SERVICE ' t f I i:^.ID HT. �U�JD BL"-F,�.1 • � � I -----� --�----- — - --------- --- ROQF SHEATHRJG I �I � � £i FT. EOfJD E?EF�".' � I __ Io r .a.�/�.�� ---�--— - — FRF,P�11tJG.NENTILIATION � j___ FI�.AL Bb�JD Ei�A�.1 _ � ' _ ROOF COVER � 0_1 0( � � -� i F^n�-GFr,Di�J` � //�- —f '- -- ROUGH HEATING I. j i I 6E�•:CHIP:G i ROUGH ELECTRIC � ! I I F�OUGH GRADIi:u � ROUGH PLUtw�!3RJG � -- --�-� FI'.iSf-{ uRt�Dll'•J�:, --- -_..�— � SHO�^JER/TUr3 TEST -�— i------- -�_`PO�L ELECi RIC � I --- EXT. LATH'SI�Ii�1G � i � POOL F�P�C:iJG � ; �"Ji,LL IPJSULATIO�J -i --- ' ---- � � POOL F1idA! ---- I � - CEILING INSULATIOiJ I I i O�F SITE It�,1?S. � i � DRYI;"JALLNAILifdu � � I j [)EDICP,TIO'dS �___ � SEVJER � i l � FINAL ENG. � SEPTICTANK � ; � ' � I LAFJDSCAPE/IRRIG_ � � SEEP PIT/L.L � � ( � or�SITE IL?P5. j G.AS AIR TEST � � � � FIP:nL"I.OPd1��1G ; FII��P�L CONST. j � ! ' �!:=tE DEr T. f=1�Jr�!. I � FItJAL HEATI"dG � � ; t1E,4LTt-i DEPT, FI1�!}�,t � . I ___" t FINF,L ELECTRIC � �__ I ; DEV• FEES Pr",ID _ _ i � FINP�L PLUti1�iIPJG I I I i Eh:�RGY � � I : -- - - - ' _ _--1��-,...-r.�.�.-.�-:i-".--...�__..._..-.�-..._.., _'_ '� ���:���'' '.:I' �)i - � -----L-------- -------�! : �. .. ' --- CUPJIMENTS SEPTIC TANf:SIZE SEEP PITIU SIZE - - -- ----- --_____.--•--A��..._______----.• - - `+t� , �, � . � -� .