HomeMy WebLinkAbout16552 �� CITY OF DIAMOND BAR �—�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�y 21825 E.Copley Drivo '
(909)860-3195 Fax(909)861•3117 PRESS
`'%•M` BUILDINGP�RMITAPPLICATION FIRMLY
JOBSITE APPLICATION PERMIT
o AODRESS � ✓� Y ' DATE � ZZ � NUMBER �r�� M
� APN LOT TRACT �I D TEE � / TYPE OCC
p OWNER U ' f �- �L�d1�' CONST. GROUP
u" ADDRES � � ZONING S ACK
Z CITY IV ZIP TEL. '�' -D� .S . FRONT RW ❑
g APPLICANT TEL. REAR ❑
� SIDFJSIDE STREET FiW O
CONTRACTOR ' I L � �/r�G9C/� SIDE ❑
Q ADDRESS --
� CITY ZIP TE ,_ c� PROPOSED USE
o ARCH/ENG/
� ADDRESS NO.DWEL+-�- t� NO. NO.
� CITY ZIP TEL. UNITS /•P�` STORIES BEDROOMS
c�i� DESCRIP7ION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLAHATION SFR/ADD/REM
O
p 1 HEREBY AFFlRM UN�ER PENALTY OF PE�1RY THAi I AFA EXEMPT FROM iHE COMMGTORS LI• Gaf8991C0fpOR
W CENSEUWFORTHEFOILOWWORE�ISON�5EG7a71.68USWESSNJDGROFfSS10NSCODEANYCITYOR (n
U CWNTYWHIp1RE0UIRE5APERMITTOCONSTfiUCf.ALTE0.MPROVE.OEMOUSM.OfiREPAIRANYSTRUG W Pgt10/DBCk
� TUHE,PRIOR TO ITS ISSUANCE,ALSO REWIHES THE APPLIC�NT FOR SIKM PEFUIT TO FILE A SICNED w
STATEMENT TMAT ME OR SME IS 110EN5ED PURSUANT TO THE PROVi510N3 OF iHE CONTMG'�ORS Lti
� CENSE UW�CFUPTER 9(C01.7MENdNO WITH SECTqN 7000)OF ONISqN�OF ME BUSINESS AND PRO- � POOUS�
FESSI�NS LOOE�OH THA7 NE ON SHE IS EXEMPi TNEREiROM AND TNE BA515 F011 iHE ALLEGED E%EMP•
� TIDN.ANVVIOLATqNOFSECTiON7a71.60VANYAPPLIGWTFORAPERMiTSUBJECTSTHEMPLICANiTO z RaRoof
A CML VENALTY OF NOT MORE THAN FNE HUNDRE�DOLURS(f500).1:
� OI���EROFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASTHEIRSpIECAMPENSATqN, O CORIR10ft181 '
WILL 00 THE WO{iK.ANO THE STRUC7URE IS NOT INTENOEO OF OiFERED FOq SALE lSEC.70u.BUSI.
N NESS AND GilOFE5510N3 COOE:THE CONTFlACTORS UCENSE UW DOES NOT AVPLY TO AN OWNEH OF ?
PROCEqTY K510 BURDS OR IMPqOVES TIEREON.M1O NM1IO DOES Sl1CH VJOHK NI11SElF OH MEHSELF Oq
S THROt,Y]HHISORHEROYMEMVLOYEES,PRONiOEDTH�tSUdiWPROVEMENTSARENOTNTENDEDON m
0 OFFEREDFORSALE.G,110WEVER7HEBULDiNGORwPROVEAIEMI550LDWrtHNONEYEAqOFCOA1PlE�
Z TqN,TME OWNER-BUM1DEH MnLL HAVE TFIE BURDEN OF PROVINa THAT ME OR SHE OiD NOT BU�ID OR
= MPROYE FOR THE VURP0.5E OF SALE}
w OI�OWNEROFiHEPHOPERTY.AME%GLUSIYEIYCONTMCTN6WITHUCENSEDCONTMCTORS
Q TO CONSTRUC'T THE PRQIECT(SEG TON,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS L�• V01U0UD� ADJ.AREA
L11 GENSEUWDOESNOTAPPLYTOANpWNEROFAiROPERTYWhqBUItDSORIMVROVESTMEREON.AND
F W11000MMCTSFORSUCHGROIEMSWI7HAWNTRACTOR(S)LICENSmPURSUANTTO7HECONTRAG QUANTITY DESCRIPTION FEE
� TORS LIGENSE UW.).
� OIAAIE%EMPTUNDERSEG B.BP.GFORiH15REA50N U
u" DATE OWNER �
Z W
F¢ LICENSED CONTRACTORS DECLARATION W
CC IMERE9VAFFIRAIUNDEHPENALTYOFPEWURY7HATIAMLICENSEDUN�ERPROVISIONSOFCHAPTER V.
p� •(COMMENdNO WITH SECT�ON 7000)OF DMSION 70FTHE BUSMESS ANO PROFESSIONS CODE,AND Z
X MYLICENSE IS N NLL FORLEAND FFFECT.
� LICENSE CLASS �J LIC.NO, ��OO'�`i' . . �
V DATE �22/S�, corirrucroR€�{�j �A C I►-1 C�1 a
w
� WORKERS'COMPENSATION DECLARATION ¢
= U
� IHEREBVAFFIRYUImERVENAL7YOFPERIURYONEOFTMEf-0LLOYHN0DEC1AMiqNS:
� �
� _IHAVEANOWILLIMIMAINACERTIFIGTEOFCONSENTTOSEI.FJNSUREFORWORNERS' _
` fAYPENSATION,ASPROYR7EDBY5ECTON77000FTMEUBORCODE.iORTHEFEHPoPMANCE U
d OFTHE WOHK FOR WHId1THIS VERMIT I5155UED. �
� �IHAVEANOWILLMAINTAWWORNERS'COMPENSATIONINSUMNCE,ASREOUIHEDBYSECTqH
4Q �7000F THE LABOR ODOE,FORTHE PEAFORMANCE OF THE WORK GOR WHICHTHIS PEAMIT 15
ISSUED.MYWORKERS'COMPENSATIONINSURANCECARHIERANOOOLIC/NUMBEqARE CONSTRUCTION
� CARRIER � PLAN REVIEW
� POLICYNUMBEN � — � ELECTRIC
� �nessecnor+�mNoreeoor.at�ooFn�vEaMrswqan��voaunsKim�antEss) PLUMBING
Z 1 CERTIFYTHAT W TME PERfORMANCE OFTr�E WOiiK FOR WHICM iHIS VERMIT IS ISSUED,i MECHANICAL
�} SHALLNOTEMDLOVANYCERSONNANYYANNERSOASTO6ECOMESUBJECTT07XE
Uj WORNERS'COYPENSATqNU�M30FCALIFORfiIA.ANDAOREETHATIi151qULDBECOME INSPECTIONFEE , _7
S SU&IECTTOTHEWORNERS'COMPENSATqNDiqV1510N50FSECTION]7000FTHELABOR lJ
eooe.i sw�u rormn+�'rH wMr�r wirr�n+ase vrrohsia+s. ISSUANCE
p OATE: � O APPLICANF����A SMIP
� ENERGY P/C
WARNINU:FARUHE TO SE WRE WORNEPS'COMPENSAtIDN COVERAGE IS UNLAwFU4 AND 51uLL BE
� SU&IECTANEI.IPLOYERiOCWM�tULPENALTIESANDCIVILFwESUPTOONEMUNOREDTMWSAND ENERGYPEPMIT
OttLAF15(S1uo,000),IH ADD111qJ TO TNE COST OF GOMPENSATqN,DAMACES AS PRONDED FOR IN
� SECTION77aeOFTNEUIBORCODE,INTEflEST,ANDATTOfWEY5FEE5. RETENTIONFEE:
d CONSTRUCT�ON LENDING AGENCY PRE•ALT FEE:
O �
� IHEREBYAFFIRMUNDERFENALTYOFPERNRYTHATTMEREISACONSTRUCTIONLENOWOA6ENCY
FORTME PERFOfiMANCE Oi THE WORK FOR WNIp/TNIS PEPIAIT IS ISSUED(SEC.7097,CIV.G�.
�
� IENDE(1'SNiUAE
� IENDER'SADORESS
¢ ICERTIFYTNATIFUVEREADTMI511PVULATpNANOSUTETNATTMEABOVENFOflMAT10NI5CORRECT. TOTAL FEES
W IA6REETOCOMP�VN7THALLCRYANDCOUNTYORDIN.WCESANDSTATEUN�SRELAT�N6TOBUiLU1N0 �
� CONS7RUC7qN.ANDNEREBYAUTMOPIZEREPFESENTATIVE50FTM15COUMYTOENTERUVONTHE
Z ABOVE�►IENTIONEDPROPEHTYFOitINSVECTqNPURPO5E5. COMMENTS
_ /(Jl��ll GIJ� ��
m PEpMITTEENAME HiNn . (
y \ J 1� V
y SIGNATU F EH iT E DI1TE
� RECPT.NO. PAID 8Y VALIOATION
WHITE—Oepanment Copy,YELLOW—Finence Copy.PINK—Asaessa Copy,GOLOENHOa-File Capy,GREEN—ApplicanYs Capy
. _., „s.r_ -....�,-:. �....�-:� ,.�:,.�..>,. ...,.•,....,— �� . , , . , ... _.___ .. . ..... ._ _
,. , , ....,.,..r^-„ .aK�.t-: ,w,�.n_t�,, ^•-7�,.u-i� ��c:s�.4y-r„-r•;.. ..V��..i.�.-.c�vs.;c.�.-,� .,.r,: _ . , . , . .
CIT'�' OF DIAMOND BA,R
If�SPEC i(Oi� RECOI�D
. .; �.E-�����-G��k . :.:���°�.������.._._�����.�f�'�ai�� �'�(����1�����°�►�� - 'e'�r���..: ; .ur� �' ���.
- - --.- - � - - - .---� �� ^ `�
SET BACY , • � FLOOR JOIST
FTGS/FORMS/STEEL • _ FHA REQMTS
ELECTRIC GAOUND � - UNDER FLdOR DUCT � '
GROUND PLUMBING ( UNDER FLOOR CU�IDUIT.
SLAB GRADE ' I FIREPLACE FOUNDATIOP� I I
TEMP POWER ��� ��� =,� � FIEiEPLACE BON�BEAM --
WATER SERVICE � I I MID HT,BOND BEAM '
ROOF SHEATHING I 8 FL B�hJD.BEAM �
FRAMINGNENTILIATION I FINAL BOND BEAM •
ROOFCaVER •�� PRE-GRADING I i
ROUGH HEATING BENCHING I
ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING
SHOWERITUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING � DEDICATIONS
SEWER FINAL ENG.
' SEPTICTANK LANDSCAPFJIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST i FINAL ZOPJING
FfNAL CONST. - � � FIRE DEPT. FINAL
FINAL HEATING j HEALTH DEPT. FIPJAL �
FINAL ELECTAIC � DEV. FEES PAID �
FINAL PLUMBING I ENERGY
� I
ic�1�.�'s.1���m-�`.� �
COMMENTS
. i, , � ;; ,,. . .
SEPTIC TANK SIZE '
SEEP PIT/U SIZE
_ "�� ��
�
_ _ j
������ `�i:
��- . . , ,