HomeMy WebLinkAbout10883 - _ a_._.. __..__ _ . _ _..._ . �
_.x--�-,��-
-- "- CITY OF DIAMOND BAR _:.,;. ; �np'RE�
��� COMMUNITY DEVELOPMENT DEP.4tt'PMENT
� 21660 E.Copley Drive Suite 190 �+
(909)860-3195 Fax(909)861-3117 Q(,,� �3 ��fl� PRE`S`S
� "9N" BUILDING PERMIT APPLICATION FIRMLY
,, _
, r'`�'�'� ;�.s- s; � APPLICATI N PERMIT �'�S� .�/C .
. .,, ,,�
JOBSITE . /� ��(
o ADDRESS ���� � �✓ PA� ���.EyG �"' DATE � NUMBER _
°D APN LOT TRACT ISSUE TYPE OCC ,
DATE CONST. GROUP
p OWNER S A^�G-H A 'V� �
o ADDRESS �'�'�� i � � f/��^' ��-' � �- � , ZONING SETBACKS
Z CITY �7 h M c +✓� ('S A�'�5-- TEL. FRONT RW ❑
o APPLICANT CKiFfL.L�;%S 4R-iS�"TTEL. Z� �7� SDE/SIDESTREET RW �
z
Q CONTRACTOR I��- Jy��HiO-^�I ����-- C� SIDE �
o ADDRESS `2.S E> SANT�. �-4-J4ft�5���
o CITY �C�--�i A ZIP��AGy�'EL.J Z�7 PROPOSED USE
w ARCH/ENG/
z DESIGNER
W NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
cn
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BCILDER DECLARATION
� _ SFR/ADD/REM
� I HEREOY AFFIRM UNOER PENAIiY OF PEF.NRY THAT I AM EXETAPT FROM THE CANTRACTORS Lf- � Garage/Carport
W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.5BUSINESSANOPROFESSIONSCOOE:ANYq7YpR
U COUNTYWHICHREQUIRESAPERMITTOCONSTRUCTALTER,IMPROVE.DEMOLISH.ORREPAIRANVS7RUC- W Pdt10/DBCk I
Z iLRE,PRIOR TO ITg ISSl1ANC=,ALSO qEOl11RES THF APPI.ICANT FOR Sl1CH PERMIT TO FILE A SIGNED �
w STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PqOVISIONS OF THE CONTRACTOR5�I- W
� CENSELAW�CHAPTER9(COMMENCINGWITHSECTION70oojOFDIVISION30FTHEBUSINESSANDPRO- LL' PooUSpa �� -
0 FESSIONSCO�E)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHE�ASISFORTHEALIEdEDEXEMP� (�
U TION.ANYVIOLATIOfvOFSECTION7031.5BYANYAPPL��CANTFOFAPERMiTSUB�ECTSTHEAPPLICANTTO z Re-Roof �
� ACIVILPENALTVOFNOTMORETHANFIVEHUIJDREDDOLLAFS'�55oa)J: ' �-"'- - '�-' -
� ❑I,ASOWNEROFTHEPROPERTY,OFMVEMPLDYEESWITHWAG=SASTHEIRSOLECOMPENSAiION, � COfI'1II10fCi81
z WILL.�O THE VJOqK,AND TNE SiRUCTUHE IS NOT IN7EN�ED OR OFFERED FOFI SALE(SEC.7a44,9U51- J
� NESS AND PROFE55'.ONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ,
PROPERTVWHOBUILDSORIMPROVESTHEREON,ANOWHODOESSUCHWORKHIMSELFORHEFSELFOR �
p[ THROUGHHISORHEROWN'eMPLOVEES,PROVIDE�THATSUCHIPAPRDVEMENTSAREiJOTINTENDEDOR m
� OFFEREDFOaSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTI550l.DVlITHINONEVEAROFCOMF�E �
Z TION,THE OWNEFi-BUILOER WILL HAVE TNE BUflDEN OF PROVING THAT HE OR SHE DID NOT BVILD OR
� IMPROVEFORTHEPURPOSEOFSALE). �
w ❑I,ASOVJNEROFTHE?ROPEftTY.AME%CLUSNE�YCONTRACTINGWITHIJCENSEDCONTRACTORS
('� TO CONSTRUCT THE PROJECT(SEC.704d,B1151NE55 ANC PFOFESSIONS CODE:THE CONTRACTORS LI- VellJd21011 AOJ.AREA �
W CENSELAWDOESNOTAPPLYTOANOWVEfiOFA?ROPERTYWHOBUILDSORIMPFOVESTHEREON,AND .
� �WHOCONTRACTSFORSUCHPROJECTSWI7HACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITV DESCRIPTION FEE
Y TORSLICENSELAW.).
� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON J
� a
'-�.S U .. . , .._
� �
DATE OWNER �
Z W
� LICENSED CONTRACTORS DECLAFATION ' � � W
¢
� IHFRERYAFFIRNUNDERPENALTYOFPEPJUFVTHATIAMLICENSEDUNDEFPROVISIONSOFCHAPTER �.
p_, 9(COMMENqNG WITH SECTION 700�)OF�NISION 30FTI-E BVSINESS AND PROFESSIONS CODE,AN� Z
X MY LICENSE IS IN FULL FORCEAN�DjEFFECT.
� LICENSE CLApSS ��s� �"`� LIC.NO. � �+ �6��J �
U �ATE 1 � 7C CONTRACTOR�_M�6'"J�,�'1✓/ ° J
W
� WORKERS'COMPENSATION DECLARATION Q � �,P J�"' �CJ q �p
V 7
� IHEREBVAFFIRMUNDERPENALTYOFPERJUFYONEOFTHEFOLLOW'.NGDECLARATIONS: Z 1 �� � ���„�f ^) � /�
( G�
� _IH0.VEC.NDWILLMAINTAINACERTIFICATEOFCONSENTiOSELP�INSUREFORWORKERS' � 2 J - ^
¢ COMPENSATION,ASPROVIDEOBVSECT'�.ON37o00FTHEL4BORCODE,FORTHEPERFORIAANCE CJ •�' ���� +� �Z''�.-L� B�V
Q OFTHE WORK FOR WHICH THIS PERNIT IS ISSUED. _ _ �
w -,}��/� IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIRE�BYSECTION
Q j�\ 3700 OF THE LA6OR CO�E,FOR iHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSlJEO.1,1V WORKERS'COMPENSATION INSUPA.�NGCE CARRIER AND PIX.ICY NUMBERARE:� CONSTRUCTION
� CARRIER C��-IZ�/� /�"�kC�r�.� �,a�� PLANFEVIEW
Z POLICVNU!ABER �� �niTi�/�r__/A G ELECTAIC � �
v�
Q
� -- (i}iISSECTpNNEmNO7BE0.Y�APLEfmOFhiEPERMffISFORIXJEHUNDREDDd.LARS(510J10RLES5!. PLUMBING
W
Z I CEP.TIFV THAT IN THE PERFORMANCE OFTHE VJORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL �O
C3 SHALL40TEM?LOYANYPERSONINANYMANNERSOAS OBECOMESUBJECTTOTNE
(n WORKERS'COMPENSATION LAWS OF CALIFO IA,AND REE THAT IF I SHOULD BECOME INSPECTION FEE -
� SUBJECTTOTHEWORKERS'COMPEYSATI P O'✓I51 SCFSEGTION37DOOFTHEtA90F
COD I SHALL F THWITH COMPLY WIT'� HOS P ISIONS. ISSUANCE __.� ' O10
0 �J�
p DATE:"' 7^�r APPLICANT: SMIP
J WARNIIJ :FAIIJRETOSECURE WORKERS' MP �ATION COVERAG s uN�nwFu�,wo sna��e` ENERGY PJC
� SUBJECTANEMP�OYEaTOCRIMINALPENAL ANDCNILFWESU? OONEHUNDaEOTHOUSAND ENERGYPERMIT
�OLLARS(5100,000),INADOITION TOTHE C OF COMPENSA710N AMAGES AS PPOVIDED FOR IN
J SEC710N3]Oe OFhiE LABOR CADE,INTEA T.ANDATTORNEV'S E5. RETENTION FEE: � � - -- � � ��-��� � � � -� --�
�
aCONSTRUCTION LENDING AGENCY , PRE-ALT FEE: ' "-��� �'�
� IHERE6VAFFIFMUNOERPENALTYOFPERJURYTHATTHEREISACANSTRUCTIONLEN�INGAGENCY � �� - � � - �
�-- FOR THEPERFORMANCE OFTHE WORK�OF WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z .. . . . . . ,. .
W —
� LENDER'S NAME � � - - .
F— LENDER'SA�DRE55 � � ��- �� � ��� '-� ' ' '
� TOTAL FEES "' "/`d, ��
� ICERTIFYTFiATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORREC7. �'�
W I AGREf TO COUPI V'JJITH ALL CITV AN�COIiNTY ORDINAN(:ES AND STATE LAWS iiELATING TO BUILDING ' '
� CONSTRUCTION,ANDHEREBYAUTHORIZEFEPRESENTATIJESOFTHISCOUNTVTOENTERUPONTHE �- �
�. � .:+ �.,.�»�.�,
Z ABOVE�MENTIGNED PROPERTY FOfl INSPECTION PURPOSES. ... COMMENTS �F'"'�' y�"`�� 1°��'; .
� G� ��-r s'a�' 1��l�'.�-� __ _ _ , .
�_ ��.,� ,,. � ,�'i,���.;.
�
x 3
� PEftMITTEE E(P ) �Q �� . .... ., . . . . . i . S�;. I {' tlli v'.e.��
¢ �p
— _ ...'_"..__. , i� '�.9 k
� SIGNAT REO PE DATE � r � _
= RECPT.N0. � � PAID BY VALI�ATII�N �.`
~ WHITE-De artmentCo YELLOW-FinanceCo F'INK-AssessorCo GOLDENROD-FIeCo GREEN-A IicanPs�Co - - '"����� ,
P PY, PY� PY, PY, PP PY:.. . .�-.
,.a.i�rdl'v�'''}I��`�% '_ _.,...;:�- .'�Ht`ti:�a�wY c'..�.:.": . �.:�:�:':.:c" .. , �p:ik+' �` . '"..,. _d"8 f(# C .� , ` .. ;#a��.. .�;;&` � ,...
„ ... .. . �r.:., .. .� .
. . ...•..:e r.:u�. .�-«. . . R
.� ,4 s. �';<' ,n� .`'..�8':
.... t t:`:4i �,..+,. . ,
. ."'4..�r. ,�.s
;.. � e ' . ' � �r�� tTT'��AM���,B�R
, , ��i' -,�INSPECTICIN`��CA�L� .
■ � � y � � w � � � � • � r
s��r sAc�c ' ' • ` ' t` ��oo�.�as� !
F1"G5tFC1FiMStSTEEL �'NA REQMI'S
ELECTR]C�Rt}I�NC� UND�Ft FLOUR DUCT �
GftC?UND PLUII�BlN� t1NaE �l.00R CC?�lDUIT ._ ,
SL�B(�RAbE FIFf�PLAC�Ft�UNDATiON
'TEMP POWER FIREPLACE Bt?ND BEAM
WAT�Ft SE�iVICE MID.Fi,T.BO1VC}BEAM
Rt7t3�SI-6EAl'NING 8 FT.BC}ND BEAM
FRAMINtal1/ENTILIAT1C71V FINAL 80N�BEAM
RCIOF Ct)VER PRE-GRADING
FiOUGH HEATIN.t`'� BENCHlNG
Rt)U{a!� ELECTFiiG RfJUGH GRAdlNG
R�°JU(aH F�l3MSING F�NISH GRADING
SHt3WERTCUB T�ST POUL�LECTRIC
EX3'.LATHISiC?1tUG PC?CJ�FENCING
WALL INSIllA71ON POC7L FINA�
GEIL�NG INS�lLAT1�N OFF SiTE IMPS.
i�RYWALL NAI�ING DEDICATIONS
SEW�R FINAL ENG. i
SEPI"IC iAS�K LANC?SCAPEJlR�i1G.
BEEP PITtL.L. C}N S1TE ItVIPS: .
GAS A{R TEST F`IN�I..�C}lUIN(a
FlNAL CQNST. �IF�E D��'`f. FiIVAt
_
FINAL E-IEAT!NG HEAI�TH DEPT. FINA�
FIhIAt EL�CTFtIC C7EV. �EES PAID
F1f�1AL P�.UMBlNta E1VER(aY r
j .
' � i
..,. . ,r�,,\ . � .. � , .. , .�,�_. � . . _ -. . . � . . . —
CE�NEIlt1EI�ITS
� , , _
"'� . . ,
�., - _ . .
. ;.��'' _
s�P-ric rArvK s.i��
sE�����r�u s�z�-�`��-�'�..-.��,._
> `.1