HomeMy WebLinkAbout17961 (26) ' C1TY OF DIAMOND BAR ���` S �� "
_ �p'�/ � v T
�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �-�nr�� �
21825 E.Copley Drtve �i "—� --�
'" (909)860-3195 Fax(909)861-3117 � ) PRESS
`'�'� BUILDING PERMIT APPLICATION j FIRMLY
oN JOBSITE APPUCATION y�= RMIT r'� _�j� P!C
ADDRESS DATE NUMBER_� � �✓� #
� ISSUE p� TYPE OCC
APN LOT TRACT DATE v CONST. GROUP
p OWNER Vf�_��'� •
"" ADDRESS ZONING SETBACKS
gCITY t���t�r0 � IP TEL t ^ FRONT RW ❑
APPLICANT � TEL SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
o C�RESS P TEL. ' PROPOSED USE `� �
� DESIGNER {1I�I�'N1Ij� G� `1I ID : 0 �S, • �
� ADDRESS NO.DWEL NO. NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS�
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNEFi-BUILDER DECLARATION SFR/ADD/REM
O
p I MEREBY AFFlPoA UNDER PENALiY OF VE0.NRY THAT I AM EXEIAPT FROM ME COMMCTORS ll• Gdf890/C81p0�t
W CENSEUWFORTHEFOILOWINGREA50N{SEC.7071.58USINESSANDVROFESSIONSCOOE:ANVqTYOR (n
U COUNTYWHICHREONRESAPERMIiTOCONSTRUCT,ALTER,IMPROVE,DEM0U5H2ORREPAIRANYSTRUC• W PetlO/DeGk
� NRE.PRIOR TO RS ISSUANCE.JLLSO REOUIRES THE APPLICANT FOfl SUCH FERMR TO FllE A SICNEO W
STATE4ENT TUT HE OR SHE IS LICENSED PURSl1ANT 10 7HE PRONSIONS OF TME CONTMCTORS ll•
� CENSE UW(CNAPTER Y(COMIAENCW4 NATH SECTION)000)OF DIVISION 7 OF THE BUSINESS AND 7RD• LL' PooVSpa
FESSIONS CO�E)OR TMAT HE OR SHE IS E%EMVT TMEREFR04�NO TNE BASIS FOR TME ALLEGED E%EIAP•
VTION.AM'VqLAT10NOF5ECTION10.t1.6BYANVAPPLICMITFORAPERMITSUBJECTSTMEMPLiCANTTO Z Re-Roaf �
A CINL GEN�LTY OF NOT MORE THAN FIVE HUNDREO OOLURS(f Soo).):
Z ❑4�SOWNEROFTHEPROVERTY,ORMVEMPLOYEESWIiMWAGE5A5TMEIRSOLECOM7EN5AT10N, O �mm0fC18I '
YALL DO THE WORK,AND THE STRUCTURE IS NOT IN7EN�ED OR OFFERED FOR SALE(SEC.7011,BUSI• J
y NE55 AND PROFESS�ONS CODE:THE CONTRALTORS UCENSE UW DOES NOT APPIV TO AN OWNEH OF �
PROPERTY WT1D BUILDS OR IMPFOVES THEREON,M!D W110 DOES SU(71 WDHK H�MSELF OR HEHSELF OR
� THROUGHHISORHERONMEMVLOYEES.PROVIDEDTHATSUq11A1VROVEAIENTSARENOTWTENDEDOR m
QOFFERE�FORS/lE6,NOWEVE0.IMEBUdDSJGORIMORDVEAAEMI550tDWITHIYONEYEAFOFCO/APLE•
Z TION,THE OwNER-BUILDER WILL HAVE TME BUROEN OF pROVIN�THAT HE OR SHE OiD NOT BURA OR
= MPROVEFORTHEPURP0.5EOFSALE�
W 04���EROFTHEGROVERTY.AME%CLUSNELYCONTRACTWOWIiHLICENSEOCOr7TMCTORS
¢ TO CONSTRUCT TME FROJECT(SEC.)ON,BUSINE53 AND FROFESSIONS LODE:THE CONTMCTORS LI• V3I118IIOf1 AQI.AREA
W CENSEUWDOESNOTMPLYTOANOWNEROFAiROPERTYWHOBUILD50RIMPROVE57HEREON.AN�
� VY/qCONTMLT5FOR5ULMPRQIECTSWITHACONTMCTOR(5)UCENSEDPURSUNRTOTHECOMRIIG QUANTITY DESCRIPTION FEE
� TOHSUCENSELAW). -
� OIIJAIXEMPTUNDERSEC. B.6P.C.FORTHISREASON U
� �
� OATE OWNER F"'
Z W
�Q LICENSED CONTRACTORS OECLARATION W
CC IMEREBY AFFIRM UNDER PENALTYOF FERNqY TMAT I AM ULENSEO UNDER VRONSIONS OF CHAPTER �
p„ 9(COMM[NCINO WfiH SECTION 1000)OF DMSION 70F THE BUSINE55 ANO PROFESSIpNS CO�E,AND Z
�X GYLICENSE IS W FULLFORCEMID EFFECT.
� LICENSE GU55� UC.NO. ��fi/��f- j
� .+' � l-
V OATE RACTOR a - - " -
W
� WORKERS'COMPENSATION DEC R TION a
� U
� IHEREBVAFFIiWUNOERDENALTYOFPE0.tt1RVONEOFTHEfOLLOWINGDEGiARATpNS: Z
Q
G _I/UVEMlDWILLMAIMNNACERTIFICATEOF�pNSENTT050.F�IN5UR[FORWORNERS' _
� COMPENSATION,ASPNOVIOEOBVSECTIONJ70oOFTMEUBORCOOE,fORTHEPERFORMANCE W
OF TME WORK FOR WHiCH TMiS fERMiT IS ISSUED. �
�
�IFUVEANOWILILURlTAINWORKERS'C0IAPENSATqNINSURANCE,ASNEWiREDBVSECTqN �O�` ` ' /
O J7000FTHELA90RCODE,FORTHEPENFORMANCEOFTHEWORKFORNM1iIp/THtSPERAlIT15 �`�'��
155UED.MYWOHKEfiS'COMVENSATIONINSURANC�E/sMRIERANOPOLICYNUAIBERARE: CONSTRUCTION 1 V
jGARIER��� �• _ PLAN REVIEW
2 va�crNurneER_�"L� � ' � ELECTRIC
¢
0 �sEcme�ru�mwreEoor.aFrEoocnEVEw.�rsFonor+e�a.en�omuuisaim�oa�ssl PLUMBIN�
Z ICERTIFYTHATNiHEPERFORMANCEOFTMEWONKFORWHId1THtSPERMITl5155UED,1 MECHANICAL
(,'J SMALLNOTEMPLOYANYfER50NIN�NYMANNEHSOASTOBE�ESU&IECTTOTHE
� WORKER5COMPENSATIONUWSOFGALIFOHNIA,MlDJ1GREE7HATIFISMOULOBECOME INSPECTIONFEE �_
S SUBJECT TO THE YJORKERS COMPENSATION PROVISIONS OF SECTqN�7000F7HE U80R
COOE,I HAILFOR71Nn7HCOMPLVWITHTMOSEPROV1510N5. ISSUANCE � /�
� ' SMIP
p DATE: �P�IICANT:
W ENERGY P!C
WMNIN(i:F�l TOSECUREWORKERS'COA�PENSAT H EI UNUWFUI.ANDSHALLBE
�y SUB,IECTANE PLOYERTOCRMWALFENALTIESMlOCIVIL WESUPTOONEHUNOREDTHOUSM7� ENERGYPERMIT
OOIURS(f I .000).W AOOITIDN 70 THE CAST OF COMPENSATION.DM7AGES AS PROVIDED FOR IN
J SECTION170aOFiNELA80RCODE.INtEREST,ANDATTORNEY'SFEES. RETENT�ONFEE: �
� —
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHEREBYAFFIRMUN�ERiENALTYOFPEFWRVTHATTHEREISACONSTRUCTIONIENOWGACENCY
FOH 7HE CEHFORMANCE OF THE WOHK FOR WNICH MIS PERMIT IS ISSUEO(SEC.7097,CIV.C.).
Z
W
� IENDER'SNAME
� IENDER'SADDRESS
W ICERTIFYTHATIHAVEHEADTHISAPFL�GTIONANDSTATET/UTTHEIIBOVEPJiQHM�TIONISCORRECT. TOTAL FEES /l/�
� IAGREETOCAMPLYVATHKICT'ANDCOUN7VORDMANCESANOSTATEUWSREUTINGTOBUIIDING � �W•
fANSTRUCTqN,AND NEREBY AUT/IORRE REPRESENTA71VE5 OF?HIS COUNTY TO ENTEfl UGON TNE
ZABOVE�MEMIONEDVROPERTYFORINSPECTIONVURPOSE COMMENTS
� �
J
�
m CERIAITTEENAME(PPJ J
Q .
N
Uj SIGNATUNEOFiERMITTEE DATE
� RECPT.NO. PAID BY ' VALIDATION
ITE—Depaamenl Copy,YELLOW—Finance Copy,PINK—Assessa Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
. . . , �.� � .. ..�..� J It i . � � . . ..�l.'T .l ... � w . " _ .-.�. , . ...�t'. �.��. ' - .�: . . . - , .i�.. r.. ... � il ... . V�•t. . \ . •.i
���:� or= ni��,.��nsn �e�a�
�r�s���.�€�rti ?��ac�a
^ I�'�`�.a�:�';1rlc;�►�� r}��'�= 'I►�l—`9;a��v.?,,�.�;j^.1-..__._____�;i�'ir�=i�.!["ioi�� _.�.�}���'= � ����F•�:��e�'�c�'� ,..
�
' ---.___.-----._:.._�__.�.__ _�. _.. ___.__..._. _. ...._.. _�_._......_ __...__..___w.._._.._r._..__.__.. ._ . �._.�.___�__.______.___.. -- - -._.__--
5ET BACK . - I _ ' � '� I ( FLOOR JD15T , �.� i .
-�--- !
FfGS/FdRMS/STEEL � � �` �I , ! FHA REQMTS I
ELECTRIC GROUND � � � � ' I UtJDER FLOOR DUCT � I
GROUND PLUt�iBING � ; _ ; UfJDER FI,OJR CG�IDUIT � ; _
SLAB GRADE I �__ I I FIREPLF�CE �OU�IDATION � I
TEMP POWER I i FIREPLACE BOND BEAti1
WATER SERVICE _!� MID HL E30ND BEAM '
ROOF SHEATHING 3 <'� —�y i 8 FL BO�JD BEAP�1 � —
FRAMINGNENTILIATION � � _� FINAL�OND BEAM i
ROOF COVER �/�Z �PRE-GRADING
ROUGH HEATING BENCH(NG
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUMBING i ' FINISf-I�HADlPJG
SH�WERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
VVALL INSULATION POOL FINAL
CEILIPJG IN�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATI�P�S '
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. � " OP�SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. ! • �IRE DEPT. FINA!
�
FINAL HEATIPJG HEALTH DEPT. FIfJAL
FIt�IAL ELECTRIC I I � DEV. FEES PAID
FINAL PLUMBING � ENERGY
,•r
��—.�,.�,V�-.._,,,f,�ti;_.._..._._�_. — �
,
� .....e'.. __...�_.._l._'r.'.!.'_..'._ �_..__..."'
' - .___�..—..-�.--. . �-� _._i.;" ' '_ '
��
CUMMENTS
, �
.-; - - _,---.. �— —-
SEPTIC TANK SIZE
SEEP PIT/U 51ZE
��! �
��l� � � _
�. ; ,--
�.. ..___�.__�-�_ ....____.�_._! 1 �� .