HomeMy WebLinkAbout17793 �` C1TY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
,��w 21825 E.Copley Drive i
(909)860.3195 Fax(909)861-3117 PRESS
''-�� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSRE /� APPUCATION �I -} PERMIT �''�''J� P!C
o ADDRESS���� ZS /�L�Cl� .hJC" DATE ✓ �d �L NUMBERJ_�tt
� APN LOT TRACT DATE � ZU v�CONST. GROUP
¢ OWNER /��-d��� - -�
0
ADDRESS ZONING SETBACKS
z CITY TEL FRONT RW ❑
g APPUCANT TEL. REAR ❑
� SIDEJSIDE STREET RW �
CONTAACTOR � I .O S�""�/l� "7L' SIDE ❑
� ADDRES � PROPOSED USE " �1L,�
o CITy�•}f� ZIP '9'EL. 'f�' //h,�f�' TIL.�' �_! .��
wo ARCN/ENG/
� DESIGNER NO.DWEL NO. . NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
N OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
N
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNOER PENAL7Y OF VEfiR/RV TMAT 1 MI E%EIAPT FROM THE CONTMCTORS U- G8f8QB/CefyOfl
W CENSEUWFOFiHEFOLLOWINOREA50f1(SEC.7Wf.6BU51NE5SANDGROfE5510N5CODEANYCITYOR (n
U COIMTTNTtICHREWIRESAVERM�TTOCONSTRUCT,ALTER�MGNO`/E.DEA10L15H2ORREPNRANVSTRUC• W Pet10/DOCk
S TURE,PRqR TO RS ISSUANCE AL50 REOU�RES 7ME A�PLIGN�FOR SUp1 VERMIi TO FILE A SIGNED
.� STATEMENT 7HAT HE OR 6HE IS UCENSEO PURSUANT TO THE FROVISiONS OF TXE CONTMCiORS LI-
� CENSE UW(dUVTER 0(COMAIENGIN�WITH SECiION 700D1�DIVISION�OF THE BUSMESS ANO PRO• � POOUSpa
^ FESSqNSCOOE)ORiH�THEORSHEISEXEMPTMEREFROAIANDTXE8�1515FORiHEALLEGEDE%EMP•
� TION.ANVVIOlAT1ONOFSECTION7W1.6BYANYAPPLIGNTFOR�OERUITSUB.lECT5TIEAP�LKANTTO Z pe•Roof
� ACMLCENALT/OFNDTMORETHANFNEHUNDREDDOIIAFS(S5o07.):
� 04�0'NNEROFTHEPROVERTl,ORMVEMPLOYEESN7THWACESASTHEIqSOLECOMPENSATION, 0 COmmBfCl81
Z WILL DO T/1E WOR1(,AND TME STRUCTURE IS NOT INTENDED OR OFFENEO FOR SALE ISEC.70��,BUSI- J
NESS NA7 VROFESSIONS QDDE:THE CONTRACTORS LICENSE UW DOES NOTAPPLV TO AN OWNER OF
� PROPERTYINIOBUILDSORII.IPROVESTHEREON,ANDNMOOOESSUCHYIORKNIMSELFORHERSEIFOR =
� THROUGHWSORHEHOWNEMPIOVEES.PRONDEDTHATSUCHMPROVEMENTSMENOTINTENOEDOR m
QOfFEREDWRSALEIF.110NiEVERTMEBUILDINUORIMPROVEMEMIS50lDWITHiNONEYEAROfCOMPIE
Z TION,TNE OWNER�BNLDER WILL HAVE TME BURDEN OF VRONNO THAT HE OR SHE DID NOT BUILO OR
= IMPROVEFORTHEPURPOSEOFSALE).
O I.A30MMEP OF 7HE VROPERTY,AM EXCLUSNELY CONTMC7ING WITH LICENSED CONTR�CTORS
Q TO GONSTRUCT TF1E PflO.IEGT(SEG 70N,BUSINESS AND PROFESSIONS CODE:TNE CONTMCTORS U� Valtla2l0f1 ADJ.AREA
W CENSEUWOOESNOTAPPL�TOIWOVINEROFAPROVERTYW1108URD50HIMPiqVE3THEREON.NIO
� MAIOCOMRACTSFORSUGHPROJECfSWITHAGON�MCfOR(S�UCENSEOPURSUANTiOTHECONiMG QUANTITY DESCRIPTION FEE
Y TORSLICENSEUW).
¢ O I MI E%EMPT UNDER SEG B.t V.G FOR THIS REASON � U
�
LL" DATE OWNER �
Z W
F UCENSED CONTRACTORS DECLAFUTION �j
� IHEREBVAFRRMUNOERVENAL7YOfVEiWRYTHATIAYIICENSEDUNDERiROVIS�ONSOFCHAVTEp �yr .
d a(COAIMENCpMWI7HSECTqN70oo�OFOMSION�OFTNEBU51HE55AN0VROFE55qN5CODE,AN� Z
MY LICENSE IS IN FULL FORCE AND EFFECT.
O r� � 7'�Z� �
� UCENSECLASS LIC.NO.� � �
V DATE `�--�����CONTFACTOR � �t� a
W
� WORKERS'COMPENSATION DECLAFATION a
� U
� IHEHEBYIIFFIPMUN�ERVENALTYOFiE0.R1RYONEOFTHEFOLLOWW6DECLAMT10N4:
y Z
Q
� _IHAVEANDVnLL4AINTAINACERTIFICATEOFCONSEMTOSELF•INSUREFORWORKERS' 2
CpAPENSATqN,AS OROVIDED BV SECTION 370o OFTNE UBOR COOE,FORTHE PfRFORMMICE U
Q OF 7ME WORK FOR WNICHTHIS FEHuti IS ISSUED. �
0
_I HAVE 11ND WILL MAINTAM WORKERS'COMPENSATION INSURANCE,AS NEOUIRED BY SECTION �o^ ,� �
dQ J7oo OF THE tABOR COOE,FOR THE PERFORMANCE OF THE WORI(FOH WH�dI T1115 VERAIR IS '�1
ISSUE0.4AYWORKER3'COMPENSATIONINSUHANCEC�RiUERANDPOLICVNUMBERME: CONSTRUCTION 1
jur+aiEa � /� PLAN REVIEW
� POLICYNUMBER 7�� ELECTRIC
� (iFISSECTqNtEmFqTBEooe,p�E7FDOcnEpEaMts�OnauElU�d+E�0atulsRtaqORtESS} PLUMBING
w MECHANICAL
Z 1GERTIFYT/MTNTHEPERFORMANCEOFTHEWORKFORYMICHTHISPERMITlSISSUED,1
(J SMILLLNOTEMPLOYIWYiER50NINANYMANNER50A5TOBECOMESVOJECTTOTME
� WORKEfiS'COM7ENSATIDN UWS DF GLLIFOfiNIA QPEE iMAT IF I SHa1LD BECOME INSPECTION FEE
S SUBJECTTOTHEVqRKEfiS'COMDENSATIONPPA W� iON17WOFTHEUBOR ISSUANCE /—•
WDE,ISHALLFORTNWITMCdAPlVW17NTl1O5 SqNS. �
� r SMIP •�
W OATE:��_��PLICANT. - �
� WARNINO:FAILUHETOSEWREWORNEHS'COMPENSATION EMCEISUNUNFULANDSMALLBE ENERGYP/C
�y SUBlECiINEUPLOVERTOCRiMINALVENALTIESANDCM WESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT
OOIURS�ftoo.aoo),INADDITIONTOTHECQSTOFCOMP SATtlN.OAMAGE515PROVIDEDFORIN
� SEGTqN]TolOF7HELABORCODE,INTEIfEST,ANDA aeersvecs. RETENTIONFEE:
a CONSTRUCTION LENDING AGENCY pRE•ALT FEE:
Q IHEREBVAFFIRMUNDERPENAITYOFPERJURVTHATTHEHEISACONSTHUCTIONIEN�M�AGENCY
n- fOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PER1AiTI5155UE0(SEC.3a97.CtV.G�.
�
� LENDER'S NAME
� LENDER'SADORESS
w ICERiIFYTHATINAVEREADTHISAPPLICATIONANOSTATETMATTNE�BOVENiOR/AATIONISCORRECT. TOTAL FEES � ?j�p� � O
� IAGREETOCOMPLYVATHALLCfiYM1000VMYOR�INANCESMlOSTATEUNSREUTINCTOBUILOW6
CONSTRUCiION,AND MEREBYAUTHOR2E REPRESENTATIVE$OF THIS COVNT7 TO ENTER UPON THE
ZABOVE•MEMIONEDVFIOPERTYFORINSPECTqNFURPO5E5. . COMMENTS
�
J
_
m 7ERMITTEENAME
Q
� �..
Uj TUPEOFPE E DATE '
� RECPt N9. _PAID BY VALIDATION
WHITE—Uepartment Copy,YELLOW—Finance Copy,VINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Applicant's Copy
� • � ., .. . . '� . . ..:.s.� .�<� , . .. . „ ,.:«,� �.r..�..�. . -�� � �i.. .. .� . J_, . .i��.. . .. , -�+•�:°,. .. .i�..r':•�:r+.. ...5 �. �� -.-u. .. . .. .... _ „ .. ,
CITY C�� DI�'�MOND BAR
' IT�SF�C�iQiV RECt3f�D
�i.l��'�����?.K��J _�;���w� I���.�l��.ga������� �I��'��___.k._. .����!`� � �►��:����'
SET BACK . . � ;_____� , �� �;FLOOR JOIST �4 - - -
FTGS/�ORMS/STEEL , _ I ` __ ' FHA REQMTS '
ELECTRIC GROUND � —i . ' �
� i UNDER FLOOR DUCT ,
GROUND PLUMBING ! U���DER FLOOR CUt�IDUIT
SLAB GRADE i FIREPLACE FOUN�ATI�N •
TEMP POWEA � �_ I_ FIREFLACE BOND E3EAM
WATER SERVICE I � i � MID HT. BOND BEAP�1
ROOF SHEATHING �Z,l`GZ ' _ i g Fi', BOND BEAM
FRAMINGNENTILIATION I � � ; FINAL BOND BEAM
ROOF COVER �3�L��i"L �� i�PAE-GRADING �
ROUGH NEATING �f BENCHING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING ! FINISH GRADING �
SHOWER/TUB TEST j � i POOL ELECTRIC �
EXT. LATH/SIDING ! j i ; POOL FENCING
WALL INSULATION � � j i POOL FINAL
CEILING INSULATION I i ' OFF SITE IMPS.
DRYWALL NAILING ! i DEDICATIONS
SEb'VER ; j FINAL ENG.
SEPTIC TANK _ � , LANDSCAPE/IRRIG.
SEEP PIT/L.L � '� ON SITE IMPS.
GAS AIR TEST � FINAL ZQNING �
FINAL CONST. � FlRE DEPT.FINA� !
FINAL HEATING ; HEALTH DEPT. FINAL �
FINAL ELECTRIC I : � DEV. FEES PAID �
FINAL PLUMBING � ; j ENERGY
� I �ic ����;c��'?�o�c�c'�; � � ,
. ___ _ _`_— _ _. . --------. _____.
__ ___._ - --
COMMENTS �
f.. .
SEPTIC TANK SIZE
SEEP PIT%U 51ZE
_ ��-�' ��
: . �
����,�... !�;
-- N
°;
_, .� - � _ . .
� . . :� , . � .'�--.
.�._,..��,......,.�___..W._...._._.:.a �