HomeMy WebLinkAbout16597 (17) �� CITY OF DIAMOND BAR ,
i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES EXPI R ED
21825 E.Copley Drive
"� (909)860.3195Fax(9U9)861-3117 JUN 1� 1002 PRESS
���� BUILDING PERMIT APPLICATION FI R M LY
� JOBSITE � /� b/ APPLICATION PERMIT P!C
o ADDRESS � ^��` DATE � O NUMBER� 8
� APN LOT TRACT DATE � �� TMPE �C
CONST. GROUP
p OWNER
o ADDRESS L ` ZONING SETHACKS
z CITY ZIP TEL. • FRONT qyy ❑
g APPLICANT TEL. REAR p
�d SIOFJSIDE STREET RW ❑
� CONTRACTOR SIDE p
O CfDTDYRESS Z�P TEL. PROPOSED USE�P 10 P...��D[� �(`rJ -I c.LJ '�7Y�.P
o ARCWENGI �c�-
z� DESIGNER NO.DWEL. NO. N0.
= CnDRESS Z�P TEL. UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF AOJ.AREANALUA710N
p� ONRJER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBV AFFIRAI UNDER iENALTY OF PERAIRV THAT 1 AM E%EMP7 FFqAI THE CANTMCTORS LI• G2f2g8/CB�OIS
W CENSEUWFOiiTNEFOLLOWINGREA50N(SEC.70.71.SBUSiNE55pNOVROFES5iON5C00E:ANYCI7YOR (n
U WUNTYWMICHqEOUIRESAPEqMITTOCONSTRUCi,ALTER�PA�E.DEMOUSH,ORREVAIRANYSTRUC• W patiolDeck
� 7URE.PRIOR TO RS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SIKH PERMIT TO i1LE A SIGNED W
� STATEAIENT THAT HE OR SHE IS LICENSED VURSUANT TO THE FROVISIONS OF TNE CONTqACTORS L4 �
CENSE UW(CHAPTER Y(COA/1AENLWQ N7TH SECTION 70D0)OF OIVISION]OF TME BUSINESS MID PRO- POOVSpB
� iES5qN5CO0E�ORTHATNEORSHEISE%Er.IPTTMEFEFROA/ANOTHEBASISFORiMEALIECEDEXEMP. (�
TION.AN'IVKKATIONOFSECTION7071.68VMlYAPP�ICANTFOHAPERMITSUBJECTSTHEAPPLICANiTO Z Re-Roo1
A CML PENALTV OF NOT MORE T/4W(NE HUHURED DOLURS(f 500).�:
� ❑4��N�EROFTHEPROPERTY,ORMYEMv�0YEE5MAiMWAGE5A5THEIR50lECOMPEN5AT10N, � COmm8fCL71
Z VnLLOD TME WORK,/VJD THE STRUGTURE IS NOT IMENDED OR OFFERED FOR S�V.E(SEC.70l1,eU56 J
� NESS ANO PROFESSIONS CODE:THE CONTRACTORS UCENSE UW OOES NOT AVPLYTO AN OWNER OF ?
VROPEiRY WF10 BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIA/SELF OR HERSELF OR
Q TMROUGHHISORNERONMEMPLOYEES,GHOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEUON LO
O OFFEREDFORSALEIF,HOWEVE0.THEBUILDINODRIMPROVEMEMISSOL�WITMNONEVEAROFCdAVLE•
Z TION.THE OWNER.9UILOER WILL HAVE TNE BUtiDEN OF PFOVWd THAT NE Oq SME DID NOT BNID OF
� WVI70VEFORTHEDURP0.SEOFSALE�. .
W OI,ASOWNEqOFiNEPROPERTY,AA1f%CLUSNEIVCONTMCTp1GWRHLICENSEDCONTMCTORS
� TO CONSTRUCT iHE PRQIECT(5EG 70M.8U51NE55/WD PROFE5510NS CODE:THE CONTMCTORS L1• VBIUalI0f1 ADJ.AREA �
W CENSEUWDOESNOTMGLVTOMlOWNEROFAPR07EHTYWNOBUILDSORIMGROVESTMEREON.A�D
� VhIOCONTMCTSFORSUCHiROJECTSWITHACANTMCTOR(5)LICENSEDPURSUANTTOiMECONTRAG QUANTITY DESCRIP710N �E
Y TORSLICENSEUW� /
� ❑IAMEJ(EMMUNDERSEC. B. . i0 ISREASON Q 1 r� O � �
� ' U
ZDATE OWNER U �
O W
� UCENSED CON TORS DECLAFiATION W
� IMEREHYAFFIRMUNDERPENALTYOFPERNNYTMATIAMIICENSE�UNDERPROVISqN50FCHAPTEH Vr
O., ifCOMMENCINUWIMSECT10N700a)OFONi5iON70F7HE8U51NE55ANDGROFE5510N5CODE,AND Z
� MV UCENSE IS N!Fl1LL FORCEAND EFFECL m
� L�CENSE CU55 UC.NO. �
V DATE GONiRACTOR d
W
� WORKERS'COMPENSATION DECLAAATION a
� IHEitEBVAFFIRAIUNDERPENALTYOFPERNRVONEOFTHEFOLLOWINGDECLARATqNS: Z
� �IHAVEANDN'ILLMAINTNNACEHTIFlGTEOFCANSENTMSEIF•INSUREFOFtWORKERS' _
Q COMPENSATION,ASVflOV10ED8Y5ECTIONT1000FTMEUBORLODE.FORTNEPERFORMMICE W
Q OFTHEWORKFORWHIpITMISPERAIITISI55UE0. �
� �IHAVEANOWILLI.WMNNWORNERS'COMPENSATpNINSURANCE,ASREWIREDBYSECTION
Q97000F THE LAeOR COOE,FOR THE PEflFORMANCE OF THE WORK FOR WHICH THI9 GERMI71$ �
� ISSUED.MYWORKERS'COIdPENSATqNINSURANCECARflIERANOPOIICYNUMBERARE: CONSTRUCTION
� CAHRIER PLAfV REVIEW
� POLICYNUMBER
ELECTRIC �D
� (IHSSECTIDNNEmNOTBE00Ad;E�EDOFhEPERMT6FOROtrEFtIDqEDDOLLAFIS(StOo)OfiLE55} PLUMBING �
Z ICERTIFYTMATWTNEPERFORMANCEOFTHEWOHKFORWMIp1THI5pERMIT6I55UED,l MECHANICAL J
(7 SHAILNOTEMPIOVANYPER50NINANYMPNNER50�STOBECOMESUBJECTTOTHE
(q WORKER5COMPENSATIONUWSOFCAIFOHN10.ANDACREETHAT�FISHOULDBECOME INSPECTIONFEE
SUBJECT TO THE WORKERS COMPENSATION PqOVI510N5 OF SECTION]70o OF TNE UBOR
s CODE,ISMALLFORTMWITHCOMPLVWIT7THOSEVRONSqNS. ISSUANCE �OO
� SMIP
p DATE: APPIICANT.
W ENERGY P/C
� WAiWIN6:FAILURETOSECUREWOfIKERSCOMPENSATIONCOVEMGEISUNUWFUL.ANDS1UlLBE " - — ----—
�y„ SU&IECTANEMPLOYERTOCRIMWALPEWLLTIESANDCMLFWESUPTOONENI/N�R[DTHOUSAND ENERGYPERMIT
D�ILAR.4(l100.000),N ADDITON TO TNE COST OF CD4VENSATIDN,DAMACES AS PROVIDEO FOR N
� SECTqN�7aeDiTNEV�BORCOOE,INTEiiEST,ANDATTORNEY'SFEES. RETENTIONFEE:
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFIRM UNDER PENALTV OF PE0.IURV TNAT THERE IS A CONSTRUCTIdJ 1FN01N6 AGENCY
Z FOR THE CERfORMANCE OFTME WORK FOR NMICH 1HIS PERMIT IS ISSUEO(SEC.]aY7,CIV.G�. .
W
� IENDER5 NAME
� IENDERSADORE55
W ICER7IFYTMATIHMEREA�THISAPPLICATIONANDSTAiETNATTHEA80VEWFORMATqNISCORNECT. TOTAL FEES � ` �(O
� IAGREETOCdAPLVWITHALLCITYAN�COl1MVOR0INANCESAN�STATEUWSREUTWGT0811401N0 .J
� CONSTRUCTION,ANOHEREBYAUhqR2EREPRESENTATNESOFTHISCWNTVTOENTERU70NiHE �
Z ABOVE.MENTqNE07ROFfRTYFORINSPfMIONOURPO5E5. COMMENTS
9
�
m OE EE NIIA RI
Q �.,O
N
(n� SIGN�TUREOFPERMITTEE DATE
. � RECPL KO. _PAID 8Y VALIDATION
WHITE—DeDanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GDLDENROD--File Copy.GFEEN—Applicant's Copy
�-. •_1•...'1� -..�w..':..m'�c..n -.-rl.:�.,r�f��a�.�.....:�.ni �..�.�.�.. ,.�.._..i• _..__.�• h'-4 r � .. '�f!.. , -. � Y r . . , . . . .
. . . . . . ti� - .�
. CI i 3' t�F �'►1�afJi�FF;D �l'ai�
ife!SF=�C�fOT�� R€�CQ;C�
_ ,_.__ _.�._..__.._�__i ...._ ..�_ .�-- -
,. _ _ . _, . . _
��►�1+''l:��E;ql�)►�i: Q)'�'�'_ !1►F-`i.1 a� '�`+��:v �it..'i�� +�;�C{�'�'1►�! �y�`���= :I��k-����c;;'1^"c�;�
------------ ---------____ _ __.
_.__...._ ___ . �_ .__.._____.. _:___ _..__.__._ ..____. _- --'-___----------=------
5ET BACK ' C , � FLODR J015T.,
FfGS/FORMS/STEEL `� � i ! �, ' FHA REQMTS �
ELECTRIC GROUP�D --� '-' UNDER FLOOR DUCT
GROUND PLUMBING UPIDER FLOOR COf�IDUIT � �
SLAB GRADE FIREPLACE FOUNDATION I
TEMP POVVER FIREPLACE 60ND BEAM
WATER SERVICE MID HT. �OND BEA�A
ROOF SHEATHING I II FT'. BOND BEAM �
FRAMINGNENTILIATION � FINAL E30ND BEAM I
ROOF COVER I PRE-GfiADING �
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUPJIBING � FINISH GRADING
SHOWER/TUB TEST PDOL ELECTRIC
EKT. LATHlSIDING PDOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANt< LANDSCAPE/IRRIG. �
SEEP PIT/L.L. I ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FIPJAL
FINAL HEATING � NEALTH DEPT. F1NAL
FINAL ELECTRIC DEV. FEES PAID
FINF,L PLUMBING � � ENERGY �
�
r�—:t' eic �:1�.r.
_.,.!'_.___.__.--_.__L.._._._____,.___.__�
cor,nnnENTs
SEPTIC TANK SIZE
SEEP PIT/U SIZE
/��
r��� s
�� � I .