HomeMy WebLinkAbout16823 (39) �� CITY OF DIAMOND BAR ,
� ; DEPARTMENT OF COIvIIvtUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive �
(909)860-3195 Fax(909)861-3117 PRESS
BUILDiNG PERMIT APPLICATION FIR Y
� JOBSITE � �� �Q r��,,..� � ��
>- APPLICATION PERMIT P/C
o ADDRESS a5o . -�,�r DATE NUMBER p
� ISSUE TYPE OCC
APN _ LO TRACT DATE � CONST. GROUP
p OWNER p-�� �
o ADDRESS v . T� ZONING SETBACKS
w FRONT' RW ❑
zg CITY ZIP TEL.��{y��3(D REAR ❑
APPLICANT TEL. �� SIDElSIDE STREET RW O
¢ CONTRACT ��d.SE4 SIDE p
� ADDRESS �_�i
� CITY ZIP��� TEL. PROPOSED 11SE
o ARCH/ENG/
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES � �EDROOMS
� CIN ZIP TEL.
�
�n DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I MEREBV AFFIRM UNDER VENPLT/OF GEiWRV THAT I AM EXEMPT FROM THE CONTMCTOfiS L4 Garage/Carpart
W CENSEUWFORTHEFOlLOY7:NGREASON�5EL.7071.S8U51NE55AN'JVROFESSIONSCODE:MrvC1TVOR (n
C1 COUNTYNMICHREOVIRESA7ERMITTOCONSTRUCT,IILTER�!PROVE,DEMOLISM,OfiREPA�RANYSTRUC• W
W TURE.VHqR TO ITS ISSUANCE.AL50 REWIRES TME AF7LIGWT FOq SUCH VERMIT TO RLE A SiGNED W PatiO/DOCk
STATEMENT 1HAT HE OR SHE l5 IICENSE�Vl10.SUA4T TO TME VROVISIDtiS OF THE CONTHACTORS U�
� CENSE UW(CMA7TER Y�COAAMENCINO WITN SECTICN 7000�OF DIVISION f OF THE BUSINESS M10 PRD- u" POOVSpe
FESS�ONSCODE)ORTHA7MEORSHEISEXEMP77HERElRqAANDTHEBASISfORTMEA:IEGEDE%EMP- C7
V TION.ANYNOlATK1NOF5[CTION7071.SBYANY�PP�ICANTFORA�EAMITSUBJECTSiHEACGUCMITTO Z RB-Rpp}
� ACML PENALTY OF NOT MOfi[TIAN i1VE MINDRED DOlURS(5500��:
Z ❑4ASOWNEHOiiHEPR07ERTV,ORYYEMP�OYEESWITHWAGESASiHEIR50lECAMPENSATION, Q COTTBfCi�I
WILL DO TME WORK M70 iHE SiRIKiURE IS NO71N7ENOED OR OFfERED FOR SALE(SEC.70u.BU56 J
N NE55 AND PROFESSIONS CODE:TNE CONTRACTO(35 LICENSE LAW DOES NOT APVLY TO AN OwNER OF ?
FROGEHN W110 BU0.L5 OR IMPiiOVES THEREON.ANO NMO DOES SUCH WOrtK NIAISELF OR NE0.5ELc OR
Q 7MROUCHMISOHNEROWNf1IVLOvfES.PRONDEDTHATSUCHYAVROVElAEN75ARENO71NTEl.'DEDOR m
w OFFEREDFORSALE.IF,F70WEVER7F�EBUILdNGO�i1MPROVEMCNTIS50lDWITHINONEVEAROFLOMP�E-
� TION,TME OVINER-BUIIDER WILL HAVE THE BURDEN OF PROVING MAT ME OR SHE DID NOT BUIID OR
Z IMPROYE FOR TnE PUi1P0.5E OF SALE).
_ ❑�ASOWNEROFTHEVROPEHTY,AME%0.USNElYCONTMCTINGWITHLICEN5E000NTMCTORS
W
� TO CONSTHUCT TiE iRQ1ECT(SEC.70u,BUSINE55 AKJ PROFESSIONS LOOE:TNE CONTMCTORS LI- VdlUeliarf AQI.AREA
� CENSEUWDOESNOTAiPLYTOANOWNEROFADROPEHTYWNOBURO50RIA1PpOVESTHEREON.AND
W11000NTMCTSFORSUCHCPQIECTSYATHACONiMCTOR(S)IICENSEDPUR5UA4TTOTHECONTRAC• QUANTITV DESCFlIPTION FEE
Y TORS LJCENSE U1w).
� O I AM EXEMPT UNOER SEC. B.t G.C.FOR TMIS REASON Q
� U
t� ¢
� DATE O�fA U O(� O
F¢ LICENSED CONTRACTORS DECLAAATION W
CL IMEREBVAFFIRMUNDERPENALT/OFPERIURVTHA71MIl�CENSEDUI:DERGROV1510NSOFCHAFTER
� Y(CpAMENCNG WITN SEGTION 7000)OF DiV1510N i OF iME BUSINESSAN�PROFESSiONS CODE,�.V'J Z OG OO
O MV LICENSE IS N FULL FORC N/0 EFfECT. ��� ?
`c
LICENSE S LIC.NO. �p J
V OATE `� CONTMCTOR f.J�-,(J��_ d
W
� WORKERS'COMPENSATION DECLARATION -�
¢
� IHER[BYAFGIRMUNDERPENALTYOFVERNRYONEOFTHEFOLLONfNGDECLARAT10N5: Z �
� �IHAVEANDYALLMAINTA:NACERTIFlCATEOFCONSENTTOSELFaNSUHEFORWORKEflS' _ '
COMPENSATqN,ASVROVWE00YSECTION77ooOFTMEL�00RCODE,FORTMEPENFORMANCE W
OFTHE WORN fOR WHiCH THIS FERMIT IS ISSUED. �
W
�HAVE AND VALL MAINTAN WORKERS'COMPENSATION INSUMNCE.AS REOUIRED BY SECTION //�� ^
Q 9700 OF TNE UBOH CO�E.FOfl 7HE PERFORMAKCE OF THE W K iOR WHICN TMIS PERMIT IS � ,�I�� //
ISSUED.UYK�DRNEPS' PEN"TIDNINSUfUN ECAHR:EP NDPOLICYMlL18[R11R[: CONSTRUCTION l/
� GRRIER� PLANREVIEW
Z VOL�CYhLMBER-�6�+-�1� ELECTRIC
¢ /
� (MSSECIIONNCmNO7BE00MRFfEDOFTEPERM'6PoiiU:EMIiNiEDOQ1AFL5(f�oo�IX1LES5} PLUMBING
Z ICERTIFVTNATINTNE7ERFORIAANCEOFTMEN'OHKFORK'HICNTHISPERIdITISISSUED.1 MECMANICAL
(,�J SHALLNOTEAIPLOYlWVOERSONRlANY4ANNER50A5TOBECdA[SUaIECTTOTME
(n WORKERS' OMVENSATqNUW50FCALIFORNIhA 7AGREETMATIFISNOULDBECOME INSPECTIONFEE
SV0.IECT OTME HKERS'fAMPENSATIONPROV �ONSOF CTION]10o .�EIA80
�j � n+toMv�rwin�reas +o�sa ISSUANCE
�� SMIP
p DATE: _ APPLICANT. . --
� WARNING. AYU iOSECVREWOANERS'COA/PENSATIONCOVERACEISUNUVhUL.ANDSHKLBE ENERGYP/C I ~�,/`�\ I' I I ��
� SUBJELTANEMPIOYERTOCRIM:NAIPENALTIESANDCMLFII:E4UPTOON[iNNDREDTHOUSAND ENEiiGVPERMIT
DOLUfiS(i10a.00a),IN 11D�iTqN 70 TME COST OF COM�ENSAiION.D/�dAGES AS PROVIDED FOR IN �
¢ SECTION]7000F7NEUBORCOOE.WTEREST,AND�TTORNEY'SFEES. RC-TENTIONFEE: �
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� IHEREBYAFFIRMUPIDERPENALTYOFPE 1RYTHnTTXEREISACONSTRUCT�ONLEND'�NG�GENC`! �T`�T, I
� FOR THE VERFORMANCE OF THE�F i �CH THIS GERMIT IS ISSUEO(SEC.]097,CIV.C.�.
w '__r...__-I
i IENDER'SNA/A[�
WLENDERSAfiDRE55 I��,�
� TOTAL FEES
¢ ICERT�FYTHATINRVEREADTHISAPPLICATIONANDSTATE7HA7THEAl30VE11:FORMATqNISCORRECT.
� IAGREETOCCMPLVWITH�LLCITYANDCOUNTYO�iDINANCESMlDSTATEUWSREUTWGTOBUI�DiNO �
� Cd+STRUCTION,ANDNCREBVAUiWRIZEREPRESENTATNESOFTNISCOUNTYTOEMERUPONTNE
Z ABOVEII[NTIONEOPROPERTYFORINSPFCTIONGUAPOSES. COMMC'NTS
� S"C � T
m v¢wemee (va�rn� I-' r 1�'����
� (/'�1 %f/J (�/
� S�GNAf "' F .�EE D , �
� R[CPT.N'�. _PAID 6Y _VALIDATION
WHITE-0eDanment Copy.YELLOW—Finance Copy.PINK—Assossor Copy.GOLDENRO ile CODV.GREEN—Applicanfs opy
.. ....... . ....,..... .. . .. . _ , , , v ._� . .. _. . . . , .
,..
.., , . . , . �,,. . , ._,..v�..,. .. , �.,. .. . , . . . .� . . .
�E�,9 �i" �If:�ll:'�iiti�' �1t'',�
3'��.L�L�VY+'V�� ^1�41V��Y�J
� ___.��- ...�.__._._... . .�����.�..- .._ ...._� _'_..�.__�_..�..� .._� � _.�"�_�������._._.��� .-. .�. � _...��.....�.�� �Y.� .
.. �... _ . ..
.. .._
I���`i..i=rt:!'Ccl►'E �/:.`'E'=.. I�F-1:�= F�... ,�f=C�= .-�"(.Je. 1�E – �`E-`� _ c)�f
:t:: _i-, i �� �.�' '� � 'T' I :�I�e:��
_.. .. .
._.- -----�- --...------ -------._ . ... .. .. . . .. . ...... . . . . . . .. .. .. ._.. . . ... ..._ - - -- - - --- �----------.._._.._
SET BF.CY. ; l I FLOO'�JOIST • � � 1 � �• �
- - - ----- ... — --
---- - ---
FTGS/rOR"�1S;5TEEL --- -- - ; - ------- i ; FF1F, F�E�".1TS ---------- i -----i--
ELECTRIC Gq�UfJD ; -----j----- -- -- _.�_; UhlDER FLO�R DUC i --;----- �
GROU�JD PW�:61NG � --- --�------- -- j UIJD'cR FLOCR•CU?•��UIT � —`'-------- -------
SLAB GRADE I I __ _� �_FIR=PL/��G_FOU�vD�1Tl0�•1_�_ �_ _ _
TEi.4P POVVER � I � FIF��PLACE'B�PJD ��At�1 I I _
�^JATER SEFVIC� � n —�--- - I I t.!ID HT. E30?vD [3Er"��1,--_--�---�.
ROOr SH�ATHING � S�_-d�t � I ; � FT. BON�.f3E/�":'�- --- --- _ .
FRAh,11NG,NENTILI/ITION � � � F�INAL E3�PJD E3El,�"
ROOF COVER g-��o� I � i ��t-GfiF,�INu -
ROUGH HEATING ; I I BF�•:�HIhJa �
ROUGH ELECTRIC I __� � ROUGH GRF.DIf�.0 __ '
ROUGH PLUP�IBI�JG � � ! Flf'dISH uFii:DII'J� � �
SI�O�:'ERlTUB TEST � � F'O�L ELEC�fRIC �
�.
EXT. LE1TH!51DING � ` POOL FcP;C�NG �
L'Jr1LL IPJSULATIOiJ � i POOL Fli•JAL I I __
CEILIPdG INSULATION I i OFF SITE IR1?S_ l_ � _
DRY�^JALL PJl�,Iur�G � � DEDICATIO��S �
SE4"JER � } l FR�AL EPJG. --- �-- k--
SEPTIC TANK i • ' { Ll�PJDSCF�PE/IRRIG. i I
SEEP PIT/LL. � � � OiJ S�TE R.1P5. I I
CAS AIR TEST � � � FI�JAL ZO±JRJu _
FINAL CONST. ejlL--O�,_i-� , ,=';�D�FT. FI"dA� f
FIi�AL HEATIP,IG � I I I F{EF�Li H C�PL FI�JF;L �
FIi�AL ELECTRIC � � j DL'V. FEES Pr"�ID �
FItvAL PLU^AE31iJG � ; EPJERGY I
� �- ---- -- � --
,
I _r-•-�•_-,...�__ .__�,__.---
� � ._ _;... ..
� • , � -
.
. , ,. . ...
--- -- �----------�-- -------- . ,_ .. .. . -----..._. .,.. ._. _._ . ........_ --
cor,��,�Er�-rs
SEPTIC TAPJK 51ZE
SEEP PIT/U SIZE -- — —
_��.M i__ - – --- –
��r� - — – - ---
� '
�, .