HomeMy WebLinkAbout18081 (19) �� CTTY OF DIAMOND BAR ��
t DEPARTMENT OF COrMdUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860.3195 Fax{909)861-3117 PRESS
��'��� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION ��PERMIT ��p/C
o ADDRESS I Zy I�� �'1�C�� C�2EST J�.1.�E DATE Y�� NUMBER / ii
� ISSUE Q�TYPE OCC
APN LOT $ TRACT DATE Z� CONST. GRQUP
p OWNER �C OC_�RVS.1-� �►J�1EiTMf/vT C�ROvP
p ADDRESS �S�S MC.Q`TLfRR�tJ AVE ZONING SETBACKS
gcmrMo►.rrFR�.� ZIP g11sY TEL.3Z31Z(Le1�1 FRONT RW ❑
APPLICANT TEL.,.{,LC OLISCB REAR �
� SIDFJSIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS
� CITY ZIP TEL. PROPOSED USE
o ARCH/ENG/ ,
z� DESIGNER NO.DWEL. NO. NO.
N ADDRESS UNITS STORIES BEDAOOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SO.FT. FACTOFI PSF ADJ.AREANALUATION
O !i OWNER-BUILDER DECLAFiATION SFFVAOD/REM
p I NEREBY AFFIPoA UNOER VENALTY OF PEfW1iY 111A7 I AM E%EMPT iROM THE CONTRACTORS U• G0f290/CBfpOfl
lL CENSEUWFORTHEfOLLOWIN6REA50N(SEC.70.71,SBUSWESSANOCPOFESSIONSCODE:ANYqTYOR (n
U COUNTYWF11CHpE0UIHESAPERMITTOCONSTRUCT.ALTERMPROVEDEMOL15H2ORREPNFANVSTRUC• W P81f0/DBd(
� TURE,VRIOR TO RS ISSUANCE,AL50 0.EOUIRES THE APPIICANT FOH SUCH DERMIT TO FlLE A SIGNED W
STA7EIAENT THAT HE OR SHE IS UCENSED PURSUANT TO THE DR7NSIONS OF THE CONTRAttORS LI-
� CENSE UW(C/NPTEfl Y(COAl1AENCWd WITH SECTqN 7000)OF DIVISION�OF THE BUSINE55 AND PRO- � POOVSP3
FESSIONSCADE)ORTMATHEORSHEISEXEMPTiHEREFROMFNDTHEBASISFORTMEALLEGEDEXEMP•
V TION.7VlYVIOLATqNOFSECTiON7oT.58YANVAPPIICANTFOHAPERM�TSUBIEGTSMEMPIiCANTTO Z Re•Raof
A LML VENALTY OF NOT MORE T11AN FNE NUNDRED DOLURS(isCol r
� OAASOWNEROFTHEPHOPER7Y,OHMYEMPIOVEESWITHWAGESASTHEIRSOLECOMPEN$ATqN, � COTrt18fCi21
WILL DO TME WORN.ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEG 7W�.BUSI• J
� NE55 M1�VROFESSIONS COOE:TNE CONTRACTORS UCENSE UW DOES NOTAD7LY TO AN OWNEq OF ?
GROPERTY1N108UIIASORIIAPROVESiHEREON,ANDNMODOE55UdiWORKHIMSELFOqHEHSELFOR
Q THROUCHHISORHEROWNEIAPLOVEES.PROVIOEDhIATSUGIp.APppyEAAENTSARENOTWTFNDE00R m
0 OFFEREDFORSKEIF,FIOWEVERTMEBUiLOwGORIMPROVEMENTI550lDWITHINONEYEAROFCOMVIE•
Z TION,TME OWNER�BUILDER WILL HAYE THE BUR�EN OF iROVIN6 THAT HE OR SHE DiD NO7 BUItD OR
= p.1V1iOVEFOqTHEPURPOSEOFSALE}
W OI.ASOWNEROFTHEGROVEHTV,AMEXQUSIVELVCON7MCTM�WI7MlICENSEOCONTRACTOfiS
� TO CONSTRUCT THE PRO,IECT(SEG 70u.BUSINESS IwD iA0FE55pNS WDE:THE COItTMCTORS U• ValUation ADJ.AREA
W CENSEUWDOESNOTAPPLYTO/WOVMEROFAVROPERTYW/qBUILDSOflIMPROVESTHEREON.AND
� WIqCOMRACiSFORSUCHVRO.IECTSVATHACOHTMCTOR(S�LICENSEDPUFSU/MTOTHECONTM6 QUANTIN DESCRIPTION FEE
Y TORSLICENSEUW.�. �
� O I MI E%EMPT UNDER SEC. &6�.C.fOR THIS REASCN Q EQ'rS�FT.�S��
� U
LL �
DATE OWNER U
Z W
¢ LICENSED CONTRACTORS DECLAFiATION W
2 1 HEREBYAFFIRM UNDER PENALTY OF PERNRv THAT I AM lKENSED UNDER PROVISiONS OF CHAPTER �
d, Y(COMMENqNO WITFISECTION 7000)OF DMSiON 70F THE BUSINE35 ANO CROFESSiONS COOE,AND Z
�l� MY UCENSE R IN FULL FORGE AND EFFECT, m
� LiCENSE qJ15S C�Z"U LIC.NO. S�O�I� �
�
v on� 5.-Z3-O Z COMRACTOR STF f�f-T a
w
� WOFiKERS'COMPENSATIONDECLARATION a �STFR..S Z3
� IHEREBYAFflPMUNDERPENALNOfVE0.NRY0NEOFiHEFOLIANANGOECIARAT10N5: Z ( �S Sd '��
a
G _IHFVEANDNALLMAINTAINACERitFlCATEOFCANSEMTOSEIF-INSUREFORWORKERS' S S
-7d- COMPENSA710N,115 iflOV10ED Bv SECTtON 7�ooOf TME UBOR COOE,FOR TME PERFORMANCE W
OF N'OFiKFORWHICHTHISPEHMITI5155UED. �
O i
W �IHAVEANDNILL4AINTAINWORNERS'COMPENSATIONINSURANCE,ASREOUIHEDBYSECTION
Q J7000FTHEUBORCOOE,FORTHEPERFORMANCEOFTHEN'ORKWRWHIq17HISPERMITIS
ISSUEQMYVlORI(ERS'C01.�PENSATqNiNSUR+WCELARR:ER�NDPOIICYNUMBEflME: CONSTHUC7ION
J
j aqaEq PLAN REVIEW
� POLICYNU4BER ELECTRIC
0 (IFiSSfCiIOfJNEmNOTB[OOMFtEIIDOFTEPEPMT6FOR0�`�EIMaRmD]U1�Itt0010RLE55? PLUMBING
Z 1 CERTIFYTHIIT IN h1E PERFORMANCE OF THE WORK FORYMICN THIS VERMIT IS ISSUED.I MECHANICAL `
C7 SHALL NOT EIAPLOY ANY VERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COuvENSATqNUW50FCALIFORNIA.ANDAGREETHATIFISHOUIOBECOME INSPECTIONFEE
S SUBlECTTOTHEWORKERS'LOMPENSAT�ONDHONSIONSOFSECTION77000FTHELABOR �•
CODE,I SIULL FO(iT/Ml11M CAMPLV WITH 71105E GHONSIONS. ISSUANCE
� SMIP
p DATE: APRICANT.
� ENERGY P/C
WARNINO:FAILURE TO SECURE MIORKERS'COMPENSATION GOVERAGE IS UNLAWM,AND SHALL BE
LL SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCMLfWE5U0i00NEHUNDREDTMOUSAN� ENERGYPERMIT •���
OOLUfU�f 700,000),IN ADD(T70N TO TME COST OF COMPENSATqN,DAMAGES AS PHOVIDED FOR IN �
J SECTION�70lOFiMEIABORCODE,NTEREST,ANDATfORNEY'SFEES. RETENTIONFEE:
Q
a ' CONSTfiUCT10N LENOING AGENCY PRE-ALT FEE:
O
¢ IHEREBVAFFIRMUNDER7ENALTYOFFERIURVTHAiTNEREISACONSTRUCTIONLENDW6ACENCV
� FOR THE CERFORMANCE OFTHE WORN FOR WHlp/THIS OERMIT IS ISSUED�SEC.7091,CIV.C.).
Z
W
� LENOERS NAME
F- LENDER'SAODRE55 � /
w ICERTIFYTHATIHAVEREADTHISAPVLICATIONAND5IATETHA7THEABOVENFORMATqNISCORRECT. TOTAL FEES � ��/' • /n�
� IAGREEiOCOMPL�N7TM/�LICRYAN�COUNTYORDINANCE5AND5iATEL�WSREI/�TINCTOBUIDINC �/// V
� CONS7RUCTION,ANOMEREBVAUTMORIZEREVPESENTATNESOFTNISGOUNTYTOENTERUPON7HE r
Z ABOVE-MEMIONED PROPEHTY FOHINSPECT�DN 7URPOSES. COMMENTS
� 5,.�.;� 1-t,c.�c F y
_
aPERMIT7 E(PRIHn
N ' ..�—Z���
� S�CNA REOF PE ITfE DATE
� , RECPL N2 PAID BY VALIDATION
, WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy.GREEN—ApplicanPs Copy
__ _ i _. . � . ...,�,.... . T ...__... ._ . .. .. • i � . _ . . � ... � � r q � , "i �. . " . . .
. .. . .. ._ � ♦.. • � . ' . ' . , � ' . � . , ' . ♦ r. . '� .i . _ ..._ ' �1 . .�. r .. . �
Cii':' C�f= �I�►fsllt�t'�f� �f�,E�
ItdS�=EC y It3�� T�CUF�&�
�1►�-�1:a-1��."1EC�+,1►yl _._.._ e�:.�,t= T.li'�-'�Ga.E�!'.�,IRI� � � .li��-`i�-1�.".�["Cs;)��� o't�d'C= ^il►��-'�.daE�'�'�����
__ .� . . . . � _ _
-----.__------- -__ __..__ -- � --- _...-- -.. . . ... ..___ ....___..___ -�----� _-�----- -.___. ---__.._._.._--------- ---___.__�_
SET 6ACK � _ `, ; I I FLODR JDIST ; •_ �
FTGS!FORMS/STEEL � �� FHA REQP�ITS _I
� ELECTRIC GROUND __ I __ i i UNDER FLOOR DUCT �
GROUND PLUPJIBING i U��dDER FLOOR CUt�IDtJIT �
SLAB GRADE I FIREPLACE FOU^1DATION i �
TEMP POWER I I FIREPL�CE BOND BEAM �
WATER SERVICE _j __I_� P_11� NT. �OND BEF��,4 _
ROOF SHEATHIfJG I I 8 FT• BON� BEF�P,�
FRAMINGNENTILIATION I � FINAL F30ND EEA".�1 �—
ROOF COVER � i PRE-GRADING I---�
ROUGH HEATING l BEtJCHI�IG I
ROUGH ELECTRIC � ROUGH GRADING �
ROUGH PLUPr1BING I l FINISH GRF,DING
SHOWER,rTUB TEST _ � l POOL ELECTRIC
� !-------
EXT. LATH/SIDING � � ! POOL FENCING �
4'VALL INSULATION �— � POOL FINAL i
CEILING IN�ULATION OFF 51TE IPAPS. � �
DRYWALL NAILING � DEDICATIOPJS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRRIG. �
SEEP PIT/L.L. O�J SITE ID.1PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. ��Z� �� ^ �IRE DEPT. FINA!
FINAL HEATING L� HEALTH DEPT. FINAI.
FINAL ELECTAIC DEV. FEES PAID
FINAL PLUMDING ENERGY
.,,,�.�'.-„-...-„�--
-- -�!-'t.. c,reti. .
CUMMENTS � ' '
SEPTIC TANK SIZE
SEEP PIT/U SIZE
;i��
,,`��� �, .
�,