HomeMy WebLinkAbout16814 (42) �� C1TY OF DIAMOND BAR �—
� DEPARTMENT OF COIvIIviUNfTY&DEVELOPMENT SERVICES
c 21825 E.Copley Drive
(909)860.3195 Fax(909)861-3117 PRESS
� BUILDING PERMIT AFPLICATION FI R M LY
a DDRIESS ���O S N ea�,1 P1��Q/1 P C� • APPLICATION ���q��� NUMB R �t7�I�T' �!C
o DATE �
c� ISSUE TYPE OCC
APN LOT TjACT DATE CONST. GROUP
p OWNER _� � q �?
ADDRE O 1" , ZONING SETBACKS
z CITY nrZIP �TEL. FRONT RW ❑
g APPLICANT TEL. REAR O
SIDE/SIDE STREET RW ❑
� CONTRACTOR O SIDE ❑
O CDDRESS Z�P � TEL.7/y-7��I'�I� PROPOSED USE �0� � 4 /
w ARCH/ENG/
�z DESIGNER NO.DWEL NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER OECLAFATION SFR/ADDlREM
O
I XEREBV AFFIRM UNDER PENALTV OF PE0.RIRY T1MT I NJ E%EMPT FROIA TME CONTMCTORS LI- Gefd98/COfpOR
W CENSEUWFORTMEfOLLOWINGREA50N�5EL.70.71.5BU5INE55AN�PHOfE5510N5CODE:ANYCITYOR (n
U �OUNTyWHICHREOUIRESAGERIAITTOCAN51fII1Ci.l1lTER,IMFROVE,DEMOL15H.ORRE7�:RANY5TRl1C. W Patio/Deck
Z NRE,PFUOR TO RS ISSUANLE.ALSO REOUIRES THE APPIICANT FOR SUCH VERMIT 70 FILE A SICNED W
57ATF1AENT THAT NE OR SME IS LICENSED VUNSUAM TO 7ME VROVi510N5 OF THE CONTflALTORS LI�
�s CENSE UW�CHAPTEN i ICOMIAGNC�NO WIiH SCCiqN 7000)O�DIVISON]OF THE BUSINESS AND Vqb LL PooUSpa
T. fE55�ON5CO0EJOfiTMATM[ORSMEISE%EMPTTI7EREFROMANOTHEBASISFOR7HEALLEGEDEXEMP•
V TqN.ANYVqLAT10NOF5ECTION7071.59YANVA7VLICANTiORAOERMITSUBIECiSTHEAPPLIGNTTO Z Re-Roof � � �
� ACN�LVENALTVOFNOiGORETW�FIVEFNNOREDDOLURS(tSDD�.):
0 ❑4ASOWNEROFiHEPR07ERTY.ORMYEMP�OYEESM�TMWAGESASiNEIqSOLECOMPENSATbN, ❑ COTRIO�CIdI
Z 1NLL 00 THE WORK,AND TNF STRUCTURE IS NOT INTfN'JLD OR OFiEAED LOR S�LE�SEC.7M�.BUSL J
� NE55 AND PROFESSIONS CDDE:TNE CONTMLTORS LICENSE UW OOES NOT APPLV TO AN OWNCR OF =
ipOPERTY MA10 9UL�5 OR IAIPROVES THER[ON.AND WHO DOES SUCH V�ORK HIMSRF OR MEftSELF Ofl
� TNROUCIiH150RHERONMElA7LOVEES.PROVIDEDTHAT5�1CMMORpVEMEMSAFENOTMTENDFDOR m
w OFFEREDFORSILEIF,/101VEVER7NEBUlDINGOR147qOVEMENT15501DW�TM.NONEYEMOFCOMi�E�
� TIDN,THE OWNER-BNLOER YnLL NAVE THE BURDEN OF PROVINC THAT NE OH SM[�IO NO7 Bl11LU ON
Z p1PROVE fOR THE VURPD'uE OF SALE}
_ ❑IASOWNEROFTMEPROPEilT1:AMEXQUSNEL'/CANTMCTINCWITXLICENSEDCONTMCTORS
� TO CONSiRtKT THE PROJECT�SEG 70��,BUSINE55 M1D 7NOFESS:ONS CODE:iHE CONTq�CTORS U• ValU0Ii0l1 �' ADJ.AREA
W CENSEUWDOESNOTI1PPlYTOANGWNEROFAPROPERNWMOBUIID50RIMVROVESTiEREON,�ND
� NAIOODNTRACTSFORSUCHYRQIECTSWITHACANTRACTOR�S)LICENSEDYUHSUANTiOiMECONRiAG QUANTITY DESCi71PTI0N FEE
Y TONSUCENSEUw.�.
� O IA1A EXEMPT UNDfR SEC. B.l PG FOR THIS REASON U
�
LL ¢
DA7E OWrvEq V
� W
� LICENSED CONTRACTORS DECLARATION w
� INEREBYAFFIRIJUNDERDENALTYOFVE0.NRYhIAilA1AlICENSEDLN�[flPROVISIONSOFLNAPTER V.
d y(CpAMCNCPlOYATHSECT10N7000�OFDMSiON70FTH[BUS.NESS�NDPROFESSIONSCOOE,AW Z
X MY LICENSE IS M FULL FOACE FND E�FECT.
� UCENSECUSS c -�y LIC.NO. �OL(LV D �
V D�TE • GONTRAGTOR e �IC ��,( 4J.
W
� WORKEFS'COMPENSATION DECLARATION �
= U
� IHEflEBY11FFIRMUNDERPENALTYOFFEiWMONEOFTHEFOLLOW:NCDECUMTiONS:
N Z
a
G �IHAVEANDVALLMNN7AINACERTIFICAiEOFCONSENTTOSELF-MSUREfORWWIKERS' _
� COIAPENSATqN,ASVROViOEDBVSECTiONri]oOFTHELAffOHCOOE,fORiHEPERFORMANCE 'U
OF TNE WORK FOR WMICH 7MI5 iEPMIT�S ISSUED. �
�
w IHAVEANDVALLMAINiAINWORKERS'COMPENSATIONINSUfUNC[,ASHEOV�RED8Y5[CTION
Q f7000FTMEl/�BORCOOE.FORiHEPERFOquANCEOFiH[WOIU(FORWHICHTiISPERM1T15
ISSUED.MYWORNERS'COMPE SA7 INSVNANCECARR�[R NDPOLICYNVMOERAR[: CONSTRUCTION •��
� �,Ra�Ea 'S�-a�e �u n� PLAN REVIEW
� POLIGYNUMBER D ' �Z ELECTRIC
Q
0 �nassEcmrN[mwTe[m.��rcooFncv[�sra�a+���oaiuis�s�oe7aa�¢ssa PLUMBiNG
Z I CERTIFY TiAT P!THE PER�OMIMlCE OF TNE WOPK FOR WMiCH iHIS VERMiT IS I55UED,l MECHANICAL
(7 SWLLLNOTEMPLOVANYVENSONIN/�YYAIANNERSOA5T09ECOYESUBJFCTTOTHE
� WOqKERS'COM7ENSATqNNw50FCAUiORNIA,AN�AGREETMATIF15//IX1LD8[COME INSPECTIONFEE �^' -��_
S SU[i1ECTTO7MEVJORNERS'CdAPENSAiIONDRON5iON50FSECTIDN77000FTHEUFIOR -��" •/��
CODEJ ULL ORTHWRHGOMPLYWRHTNOSE ONSqNS. ISSUANCE ��� '�I '1 _ �S lr=
���,�,` �D��. $NIP +I�^
� � �� � APPLICANT: ��-�-+�1 f�. r��""
w DATE.
J WARNING:FA0.URETOSECUREMroFLCERS'COMPENSAiIONCAVERACEISU�:UWFVL.ANDSHALLBE ENERGYP/C ,��' � • �
� SIAJECTANEMPLOYEFTOCRIMNALPENkT1ESU�lDCMLFwESUPTOONEMUNDACOTHWSµD ENERGYPERM� J _ 1
pOILARS({100,000�,N ADOITION TO THE CQSTOF COAAPE45ATqN,D+U.�AGES AS PflOVIDED FOR IN
¢ SEGTIDN77000FiMELA80RCODE,INTEREST,ANDATTORNEY5FEE5. RETENYIONFE 1 -I �O
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: `,,��'�� -� _ - ��i f
� IHEREBYAFFIRMUNDERPENALTYOFPERRIRYTHATiHEREISACONSTRUC710NtENDINCACENCY
FOR 7ME PERFORMMICE OF THE WORK FOR N'HiCH 1Hi5 PEP��T 15155UED�SEF Jao7.CIV.C.�.
Z
W
� LENDER'S NAME
F= IENDEHSIIDOHE55 O
WICERTIFYTNA7IFUVER[�DTMISAPPLICAiIONANO5TA7E'�7T1E�90YEWiOW.��TqN15CQniiECi TOTAL FEES � Z
� IAGREETOCOMPLVVATNALLCIT/MIDCOUNTYORDINANCESANOSTATELAWSREl/1TWGTD8U4DIHG
CONSTRUC710N.AND MEREDY AUTHORRE REVPESCNTATNES OF THI$CWH7Y 70 ENTER UPON TNE
ZABOVE�MEMIONEDVROPERTYFORINSPECTIONPVHPOSES. COMI.7ENTS
� �ebeccu A.�Fr �1pr
m FEAMIr7EE �[(PRIHT)
a �. L '� 4 a�
� �
(/� SI(�+NATUREOFVERMITTEE DATE
� RECPT.�.'O. . PPJD OY VALIDATION
WHITE—DeDanment Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy.GFiEEN—ApDlicanfs Copy
—-- -... . .. ... - - , - - �..--� -- -- . _. , -
....
. .•��....:..,,. :'.'�1 ,":��..�..':. �:� . . � ... .- . . - . ......:-�:1;�..1. , i ... .... . .. .._.. . .. • �. . . ..... � .. �.... ..,... ,- ...
Cii',` �F �31��:i',�C!i�� r=al'{[�
If�'S:=t=f:.:Et7�� i=��CCf�;�:►
1.y -. . _
__.�__..__.._.._.� _._.
�l�f�,li��C.�fr��L�1 i��1iC= �l�E�:.�:.`C'F'C��. (1'E��:���.i:'..-r���l�� C/'�:T� (���`1��:.�"rC'�:�
......_.. .._.._........._...._ _.._.._._ . .. . . .......... .. . .. .. . _ . . .. .._.._.... ........._. ------'--__ __.__
5ET EAC{; j ! � j ; FLU0;1 J�IGI� j
— -- ------.. .-- ---...._ ....•---�--•-:---- -- - --�- - -
FTGS.'FORh1S/STEEL I � � , f-HA REC]'"TS i I
ELECTRIC G�iOUND -�-----� -------! � Uh1DER FLO�R DUCT - _—�--- - � ---
GROU�•Jb PLU��IBRJG-- � ----__� -- ____� I U'1DrR PLOOR CUi•�D•JIT-- ��_----` ----- _ --
SLAB GRADE I i � ; rl:�=f'Lf,C� FGUidDl:TIO^! I
TEPAP PO4"JER I � -----:_i FIREPL.ACE BO�JD BEF,"�t —�--- j --
UJATER SERVICE I � 1 i:"ID HT. GOPJ� �EF.'•.1 �-------�--
RQOF SH�ATHIidG � I �-�/� --- ----�-�'8 fT. 60."•J��E=��",i ---- -----�.- .--.---� ----
� -•-..-`-^ �-+-------------- - ---
FRAMING.NENTILIATIO^J � � I Fihdnl_f0�•:C 6rA�"__ �__ _ � __
ROOF COVER � ___I�i PR�-GriF,DItJG _ i __
ROUGH HEf,TING I I _ � 6CP1Ctali•dG _ �
ROUGH ELECTRIC I I I I F�OUGH GRADfNG I
ROUGH PLUP.^,BING � I FI'•!ISH GRF,DIPJ� �
SHOI"JER/TUB TEST � � I F'OJL ELFCTHIC I I
EXT. LF,7H/SIDING j � POOL FENCItJ3 I I
l'JALL IPJSULF,TION } j POOL FI��AL i
CEILIPJG IfJ�ULATION � _� i OFF SITE li:^PS. � 1 `
DRY4^✓ALL NAILING � _ � � DEDICF,TIO�JS �
SEL"JER � � FI�JAL EPJG. � -
SEPTIC TF���K � � LAPJDSCAPE/IRRIG. ; I
SEEP PITlL.L. ( I —�_ Ofd SITE I�."PS. � I _
GAS AIR TEST � FINAL ZOPJING
FINAL CONST. � FIRL D�r T. rINl1� -�
�=L?��?�� � �
f�It�AL FiEATI"dG � �_��HE?ILTF� DEr T. FIPJ.AL I I
' FItdF,L ELECTRIC I I I DEV. FE�S P�,�D j�
FINAL PLUFJBIPJG i� � � EN�RGY I �
� � i
I � .__,_..-,r-�_.._---.-----•------ --
-i: -r- ;� � �
I" � i''
. .. .. .�- . .
� - --- - _-'.-'.-'._���.._..._._�"----.'-.-'�--.._ ,
cor�fr,nEr�Ts
SEPTIC TAfdK 51ZE �
SEEP PIT/U SIZE --
—���- ----
t�r�• -
� . � - -
�-�