HomeMy WebLinkAbout16815 (37) _� CITY OF DIAMOND BAR r_
� DEPARTMENT OF COIvIIvIUNITY&DEVELOPMENT SERVICES
��` 21825 E.Copley Drive
(909)860-3I95 Fax(909)861•3l 17 PRESS
�'��� BUILDING PERMIT APPLICATION FIRMLY
'� JO�SITE �(
o ADDRESS .2 I�OU �-2U��Pr- (G n P C�. DATE CATION � �NUMBER l�V� �/C
� APN LOT TRACT ISSUE TyPE p�C
DATE CONST. GROUP
p OWNER r�'1����� 1 � �� Wi / 2
o ADDFESS 'D erlano C�f, ZONING SETBACKS
g ��N �ZIP 9�Te�.90 a 453-(�I FRONT RW ❑
APPLICANT TEL. REAR p
� SIDE/SIDE STREET RW p
� CONTRACTOR • SIDE p
� ADDRESS � mon .
o S PROPOSED USE �� � OS �
ctrv_ An1z, c+ ziP O�TEL 7/y-'15�l- �0 c
o ARCH/ENG/ '-
z DESIGNER
� ADDRESS NO.DWEL NO. NO.
cn UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUII�ER DECLARATION SFWADDlREM
O
1 HfFlEBY AFFlRIA UNOER PENALTY OF PE0.NRY THAT 1 AM EXEMPT FRqA iHE CONTMCTORS ll� G820B/CBfPOR
W CENSEUWFOqTHEFOILOWINOREA50N�5EC.To]I.SBUSINESSANOGROFESSIONSCOOE:ANICITYOR (n
V COUNTYYN71G1REWIRE511PERlAITTOCONSTRUCT,/�LTER.0.IPROYE,DEMOLISH,ORREPAIqANYSTRUC• w
W NRE,GHqq TO I75 ISSUANCE.ALSO RCOUIR[5 THE APPIIGWT iOR SUCH PEN.�iT TO FILE A SIGNED W PdtiOIDBLk
r2 S7A7EA/ENT THAT M[OR SHE IS 110ENSED PURSUANT TO THE VROVIS�W:S OF TME CONTMCTORS ll�
� CENSE UW(CHAPTER 0(COIAMCNC:NG WIiH SECTION 7000)OF DIVI510N J OF TME BUSiNE55 AN�GRO- V' PooVSpa
fE5510N5CO0E)ORTIATHEOHSHEISE%E4PT7HEREFROMANDTNEBASiSFORh1EALLEGEDExEMP- �
V TqN.ANYVIOIATqNOFSECT10N7031.68VANYAPP�ICANTFORACERMITSV&IECTSTN[MPLICANTTO Z Re-Roof � 5 'y
ACML PENALTY OF NOT MOqE THAN FIVE HUNDRED DOlURS(fSOt).�:
� 04ASOWNEROFiHEPROPERTY,ORMVEMPLOYEESWITNWAGE5A5TNEIRSOIECOMVENSA'qN, Q
Z WILlDO TME WOqK,AND THE STRUCTURE IS NOT INTENDED OH OFFER"e0 FOR SALE�SEC.)01�,BUSI� J COmmO�Ci�I
� NESS ANO VROFE5510NS COOE:iHE CONTMCiORS LICENSE lAW DOES NOiAPPLYTO AN OWN[ROF
PROPERTYVA108UILDSORMPROVES7HENEON.ANDVAIODOESSUCNVJORKHIMSfLFORHERSEIGOR �
Q ?HROUGHNISORMERONMEIA7LOYEES.VROVIDEDiMAT5Up/1YPROVEYLMSARENOTINTENDEDOR m
Q OFFEREOiOR5AlE1F,HOWEVERTMEBU1L01NCORM7pOVEMENTISSOLDVATMINONEVEARpF�pMP�E.
z TqN,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINC TMAT ME OR SHE DID NOT BNLD Oft
� MPROVE fOR THE PURPOSE OF SALEL
�yJ ❑4�40WNEROFTHEVROPERTY,AME%LlUSIVEIYCONTMCTWGW!TNLICENSEDCONTfUCTORS
[L TO CONSTRUCTTME GR0.IECT(SEC.70M BUSINESSANO CROFESSIONS CDD[:THE WNTRACTORS U- Vd11181i0f1 ADJ.AREA
W CENSEUwDOESNOTAPPLY70ANOWNEROFAPROVERTVWHOBUILD50fiIMPROVESTHEREON,AND
� WNOCONTMCTSFOqSUCHVROJECTSWITHALONTRACTORIS)LICENSEDVUqSUANi7DTMECON7qAU QUANTITY DESCRIPTION
Y TORS UCENSE LAW). FEE
� ❑Ilu1 E%EA�PT UNDfR SEC. B.8 P.C.FOR THiS HEASON ¢
� U
� �
DATE OwNER F-
Z U
� LICENSEO CONTFiACTORS D[CLARATION W
� INEREBVAFFiRUUNDERiENALTVOFPE0.IURYT1uT1A1ALICEN5E0UNDEAPROVI5iON50FCNMTER �
p_ 0(COMMENCIN6WITHSECT10N7000)OFDMSqN70F7HEBU51NE55ANDVROFE55lON5COCE,/WD Z
!< W LICENSE IS IN FULL FORCE AND EFFECT.
o u��,sE�us5 !t—?�ry ���.Na. 7 7�(��O �
V DA7E �- � G- o f coHrAacTon`�p�y1� �'� r a
w
� WOFiKERS'COMPENSATION DECLARATION a
� INEREBVAFflIUIUNDERVENALTVOF�ER7UMONEOFTHEfOLIOWiNGDECURATqNS. z
� IHAVEANDWRLMAPliAINALERTFICATEOFpONSENTTOSELFdNSUREFORNppNERS' ¢
� �OMPENSATqN,ASPfiOVIDEDBYSELTION�7o00FiT1EUBOqCOOE.FORTNEGERFOqMANCE U
Q �OFTMEWORKFOHNRiICMTMISVERMIiISI55UED. �
� V IHAVEANOW'LLAAAVJTNNWORNERS'CWPENSATqNINSURANCE,ASREOl1iR[DBYSECTqN �/
J7000FTHElAF30RLODE.FORTHEPERFOflMANCEOFTHEWORKiORWMIp1TNI5iERMITIS /DA ///'�
J ISSUED.MY WORKERS'COMPENSATIO��N�R�O POLICY NUMBERARE: CONSTRUCTION ! / ""V
j WqqiER `1 Un� PLANREVIEW
=R
� P0.ICYNUMBEF �a ELECTRIC
Q
� (IHISSECiIONr�[mNoiBE00r.s�EimOFMVEa1.ti6Wnd+E�tlhDnEDOatAiC',(t�m10R�E551 PLUMBING
Z ICENTIFYTHATINTHEPERFOR/AANCEOFTHEWORKFOi3YMICHTN15PFRMITI5155UED.l MECHANICAL
C7 SHALLHOTEMPLOYMlYGERSONNIWYMMlNERSOAST09ELOMESUBIECTTOTHE
(j� WORKERS'COMVENSATIONUWSOFCALIFORNIA�'D�CREETHATIFISHOULOBECOME INSPECTIONFEE
SUOJCCT TO THE WORKERS'COMPENSATiDN PROVIS�ONS OF SECTqN 7�00 OF TME UBOR -
s CODE,IS/UILFORT/WITNCOMPLYW1IHTlqSE Je�a,o,vi�sar�+s.� �J ISSUANCE r7
pDATE: � �OI APPLICANT. '�➢LJCiCiu1 � • L=1PAU(/� SMIP �7�\�� �. . ..•. • •� /
� WARNINC:FAIWRETOSECURLW017KERS'COMPENSATIONCOVERAGEISUNUWFUL.ANDSHAL�BE ENERGYP/C
LL SU6JECTANEMVLOYERTOCflIMIN�LPENALTIESANDCMLFIh'ESU7TOON[FNNOREDiHOVSAND ENERGYPERMI � ��I��I •
DOlUR4(f l00.000�,IN ADDI7qN TO TME COST OF COMGENSATqN.O�M�GES AS 7HOViDED FOR IN
� SECTIDN770eDFTH[LAWRCOOE,INTEREST,�Y�AiTORNE75fEE5. RETENTIONFE /� • �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �__I�� �
� IHEREBYAFFiRMUNDERGENALTYOFPEfUUflYTHATTMEfiE15�CON5TRUC710NLENDING�GENCY �l�— – - �
fOR TME iEflFORM�HGE OF TME WORK iOR WMCH TXIS PEHMIT IS ISSUED(SEC.7ovi,CIV.C.).
Z
w
� lENOER"5 NAME
F– LENOER'SA:IDRE55
� TOTAL FEES � 3��"�
¢ ICERTIFYTMATIIUVEREI4�TNI511PPLICATqNANOSTATEil/�77HEABOVEWFORMATqNISCONRECT.
W UGREE TO COMPLY WTTH/�1L CiT7 AND COUNTV ORD:NANCES AND S1ATE UWS HELATWO TO BUdD�NG
� CONSTRUCi10N,/U:DHEREBYAUTVIORREPfPHESENTATNE50FTN15COUNNTOEHTERUPONiHE
Z /�[iOVE�MENTIONEDDRODERTYFORINSPECTIONPURPO5E5.
� COMUENTS
� `�eh�ecu l�• �erb�er
m GFRMI E NM1E(7RiNTj
4 �,�ti 7-lq-o�
�
(n S�GNATUflEO�VERMITTEE DATE
� RECPT.NO. . � _PAID 6Y VALIDATION
WHITE—DeDartment Copy.YELLOW�inence Copy.PINK—Assessor Copy.GOLDENROD—File Capy.GREEN—Applicant's Copy
. . . _....'�� .. , �..�.....�`.....:�T" .."t:. �.. .. ♦ .i '�-_" �-e . .�. .v �':i., .ry.. - .-'�_ __. - ... ..��"_ . ...'� __"." � .- �-.. .,..... _.
�C!t':" C!F i�1,��i':,�}f�':.: r=�i'�fz �
II�S�'f��:: i'iU�� F-�f.:�'��:�
�.� �-._--����... '` '-""_""_,_..-.'^�_-_f_'.G."�-_'___""""._".'_'
li`E-'i.'=':�;I'If'li'l �t_:� , IGf=7' ' . f1�: I��1-=ir'';t^.-�..t�1t�� ----------ej?tr= � I���:t.!:.:����ccl:l
. ...._._.:. ._ . . .._.. ..-- -.. _ .. _. .. . .. .. .. . ..... . . ....... . . ..._.. ... . .._._.-----�-- --
5�BACf: ; . � � ; FLOOR JOIST.; j
� -- � �-•—�---- . � --- i -----;----- ----
FTGS.FORti1S;5TEEL � - --- -• ------- -�'-----� � f Ii��REQ":1T� �,
ELECTRIC GROUND � i Ut•JD�F.FLO�Fi DUCT � � '
-� ------------------ -
GRD'JND �'LUiA31t�G � � � ! Ui•;D:R FLOOR CU"��DUIT �
.. - ----� ` -------• --�- ----=---------------
SLAB GRADE � � i FIFi--F'u^�vc FJIi�dDl�TION ' i i
---�--- - ------ -- --
TE��P PO4"JER I ____ � __ __ I I r�IRcPLAGE GO�JD E3Ei,"�1 I _ I •
VJATER SERVICE � � I l tAiD FiT E�O"�D BEi1t: I,__ I __
ROOF SHEF;THI��1G�!'o���' _L I a F7. 60tJ7 E�A'.� -------; --�
�-----•- - --I �
FRA�JINul1,�ENTILIATION I I � ; FI?d:1L E30P.D 6FF�","
ROOF COVER � ___I __� PRE-GRAD;tJG �_ I
ROUGH H�ATIP�G I � BFP!CH!PdG �
ROU.a � - - � }--- ---Dli•.G --- --
''H ELECTRIC RCUGH GRl: � ;
ROUGH PLU"."E31�JG � � ___'.� � Fi�:ISH uR!',D�id� ` � _
SfiOb^JERlTU�TEST j j POOL ELECTRIC � �
� �---�-- i �
EXT. UITH;SIDING � � i i POOL FEI�:�IPJG
�"JALL INSULATION �� � F'OOL FIidAL ; �
CEILIPJG If•��ULATION � OFF SITE IP1PS. ! I
DRYtiti�ALL PJAILItJG � � DEDIC/1TIO�dS �
SEVJER _ � � FIiJAL Ef�G. i _�
SEPTIC TA�dK ti • � � V'iPJDSCAPE/IRRIG. I � _
SEEP PITlL.L. � � ' ' ON SITE It.1r S_ I I
GAS AIR TEST I I I FINP�L ZO�JI�d3 �
FINAL CONST. . �_i �!R�DE�•T. FIPJAL
'1 L'i-�.� - I I
FINAL HEATING � � I HE/',LTH DEPT. FINAL _
FINAL ELECTRiC I I I DEV. FEES PA!D I I
FIh�AL PLUP."�31NG i I I EN�RGY i
--- --- , ---
� � .
• ---- .--------------_.-__ �.'� •,.-?'� - - -----_---'---- I ---------
CUMME�JTS
SEPTIC TAPJK SIZE
SEEP PIT/U SIZE ----- --
—_•_•-----'�f-- — ---- —
��i� –
` , . — . —
-�