HomeMy WebLinkAbout16602 (20) �` CITY OF DIAMOND BAR
� DEPARTMENT OF COIvL1�fUNITY&DEVELOPMENT SERVICf:S �•
E. ��` 21825 E.Copley Drive �—
(909)860-3195 Fax(909)861-31 l7 PRESS
"`%:� BUILDING PER11lIT APPLICATION FIRMLY
o ADDRESS ����1 r���l�-r�� (,(J�� APPLICATION rn ,�j �( NUMBER� P!C
DATE l!/ v v j_
c� ISSUE TYPE OCC
APN L T TRACT DA7E��� _CONST. GROUP
p OWNER ( Crl 1.�
� ADDRESS (�'r ZONING SETBACKS
z CIN ZIP TEL. Ld FRONT RW ❑
� APPLICANT TEL. ' REAR ❑
� ���' SIDE/SIDE STREEf RW ❑
� CONTRACTO � � SIDE ❑
� ADDRESS —�- L� tT � l u !�-�
� CITY ZIP TEL PROPOSED USE s
o ARCH/ENG/ �7�t
�z DESIGNER NO.DWEL. PlO. NO.
n. ADDRESS UNITS :�TORIES BEDROOMS
� CIN ZIP TEL
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADDlREM
O
p I NEi7EBV AFFIRM UNDEF OENALTY OF DEiWRV THAT 1 AM E%EMPT FROM THE CONTRACTORS L4 Garage/Carport
W CENSEUWf00.THEFOILOwINGREILSON(SEC.7mt.SBUS�NESSANDPROCE55lON500DE:/NVCITYOR (n
U �qJNTYWHIq7RE0UIRES�PERA�RTOCCNSTRUCT.AITER,PAPf10VE.DC40L15H2OFREPAiRANVSTHUG W .PaI10/OBCI( -
� NR[.PRqR TO RS ISSUANCE.AL50 R'cOU1RE5 THE APPLiCANT FOH SL'p1 PERMIT TO flLE A SICNEO ' W ' - -
� STATEMENT TMAT ME OH SHE IS LICENSEO PURSUANT TO iME PHOVISIONS OF THE CONTMLTORS LI�
� CENSE UW�CNAPTER 9(LOMMENCTIC WITM SECT�ON 7000)OF OIV1510N]OF TNE BUSINESS AN'J VRP u- PooUSpa
FESSIONS CODEI OR TNAT HE OR SHE IS E%EMPT THCREFROM AND 7HE BAS�S FOR THE ALLEGED E%EMP•
V710N.ANYVIOLATIONOFSECTION7071.58YANVA7PLILAMFORAPERMITSU0.ICCTSTHEAVPLICAMTO Z Re-Roo1
F A GNLOENALTV OF NOT IAORE 7MAN FNE HUNORED DOLUAS(f500)��
0 OI,ASOVMEROFTHEPROPERTV,OR1AVE�AttOYECSWRHWAGESASTH[iR50LECOlAPENSATION, 0 COmmBfCIBI '
Z WILL DO iNE WORK,AND THE STRUCRJqE IS NOT IMENDED OF OFFERED FOfl SPLE(SEG 70N,BUSI� �J
� NE55/ND GROFESSIONS COOE:THE COHTMCTORS LICCNSE UW DOES NOT APPLY TO IW OV/NER OF ?
VROPERTY Y/MO BUILDS OR IMPROYES TMEREON,AND WMO DOES SUp/WORM HiMSEIF OR MERSELF OR
Q THROUCHHISOHHEROWNEMPLOYEES.PROVIDEDTHATSUp11MPROVEMENTSARENO7MEN0E00R m
� OFFEREDFORS/�LEIF,HOWEVERTMEBUILD'�NCOfliA1PROVEMENTI550lDN7THINONEYEMOFCAMPLE•
Z 710N,THE OWNER�BUI:DER WILL HAVE iHE BUROEN OF GFONNG THAT HE OR SNE DID NOT Bl11LD OR
= UADROVEFORTHEPl1RPOSEOFSALE).
W OI,ASOWNEROFiHE7ROPEHTY,AME%CLUSNELYCOMRAGTRlCV71THLICENSEDCONTRACT0�7S
� TO CONSTRUCT iME Pi10JECT(SEG 7ota,BUSINE55 AND PROFESSIONS fADE:THE LONTMLTORS LI� V8IU01iOf1 _ _ � ADJ.AREA
W CENSEUWDOESN07APPlYTOANOWNEROFAPROPERTYWnOBUILO50i1RAPFOVESTNEREON.AND
� WHOCONTMGTSFOflSUGHVR0.IECTSWITHAGONTMLTOR(S�UCENSE�PURSUANiTOTHECONTHAG OUANTITY D[SCRIPTIOr� FEE
Y TORS IICENSE UW).
¢ O IAM E%EMPTUNDER SEC. 8.l P.C.FOR iM15 REASON U �
� _.._ .....� �• � .
LL �
DATE OWNER V
Z W
� . LICENSED CONTRACTORS DECLARATION W
IHER[BVAFFIRMUNDERPENALTVOFOf0.JURYTHA71M1UCEN5EDUI:DER7ROVI5bNSOFCIUPTER V,
d i(COMMCNCINC W17H SECTION 7000)OF DiNSqN 70F THE BUSINE55 AND PROFESSIONS CODE.AYD Z
X MY LICENSE IS IN NLL FORLEAND EFFECi. m
LLl
0 LICENSE CLA I ��IC.NO.����� J
V DATE I��CONTRACTOfI _�<<r a
W �
� WORKERS'COMPENSATION DECLARATION Q
= U
N IHEREOYAFFIRMl1NDERGENALTYOFpE0.RIRYONEOFTHEiOLLOYfNGDELIARATIONS:._ '�-"
._. . N ... . . . . ¢
� �IHAVEANDMALlG1AINTAINACEFiTIFICATEOFCONSEMTOSELF�INSUREFOHWORNERS' _
� CqAPENS�TION,ASVROVIDEDBv5ECT10N77000FTMElABORLODE,FORiHEiERfORMANCE �U
OF 1HE WORK FOR WHiCH 7HIS 7EM9T IS ISSUED. �
�
W _IHAVEANDWIuIAAINTAINWORNCRS'COA!PENSATqNINSURANCE,A5RE0UIREDBVSECTiON [� !�
Q J7DOOFTME LABOR GOOE.FOR TME PERFORMPNCE OF THE WORK FOR WNICH THIS PERMIT 15 • / v
J U^SUED.MYN'ORI(ERS'CAMyPENS1ITIONINS'UMNCECARANiEg ANOPOliC7NVM�ERARE: CONSTRUCTION 1 ��
j �- � CARRiER -��-� -, l�l� r'u/�� � PLAN REVIEW
� POLICV NUM6ER_��_�� 2 (`� — ELECTRIC
o �nass[crr�r+n[mr+ore��oanevea.nsra�or,e�¢ooaUras�s+oc�on�ss�. PLUMBING .
Z I CERTIiV TNAT pl iHE PERFOiUAAYCE OF TNE Y�'ORK F011 WHICH THIS VERMIT IS ISSUED.1 MECHANICAL -� ���
(} SHALLNOfEMPLOYANYVERSONINANYMaNNENSOASTOB[COUESU&1ECTTOTHE
� WORNERS'CdA�ENSATIONUWSOFCAUFORNIA,AND�CREETHATIFISFKKILDBCCOAI[ INS?ECTIONFEE
S SU&IECiTOTHEWORKERS'COMPENSATqNOROV1510NSOFSECTION]7o00FTHElABOR I C
cooe,�s�uu oRrM+nn�ca.��rwirnrMoseaarnnsior+s. ISSUANCE _at
a �/
O DATE:� �_ APPLICAFfT:��!�� SMIP
�
W ENERGY P/C
J WARNIN6:FNIURE T SECURE VJORKERS'COMFENSATION fAVE �GE IS UNUWFUL.AND SHN18E
� SUQIECTANEMPLOYERTOCRIMPIALPENAL77ESANOCNILFWESU7TOONEHUNDR[DTFI0USMID ENERGYPERM.IT -
DOLLARS(f100.0001,IN AODITION i0 iHE COST OF LOMPENSA7qN,D/�F1AGL5 AS PHOMCEO FOR IN �
� SEC71ON77DBOFTHELAflORCOOE,INTEREST.AN�ATTORNEY'SFEES. RETEFIfIONFEE:
d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
CC I HEREBV�iFIRM UNDER PENALTY OF�ERNRY iH�T TNERE IS ACANSTRUCTION IEND�Na�GENCY
4- FOR 7HE PERFORM�NCE OF THE WORK FOR WHiCH THiS VERMIT IS ISSUEO(SEC.7097,CIV.C.).
Z
W
� IENDEH'S NAUE '
F_' LENDERSADDRESS �
� ICERTIFYTMATIMAVEREADTHISAPDUGTqN�N�STATETHATTHEABOVEINFORAlATIONISCORRECL TOTAL FEES �
w IACHEETOCOMPLYWRHALLCITVANDCOUNTYOHDINANCESANDSTATEUwSRCLATINGTOBURDING
� CONSTRUCiqN,ANO HEREBY AUTbRRE REPRESENTATNES OF iHiS COUHTY i0 ENTER UPON THE
ZA[lOVE�MENTIONEO GROPERTYFOR INSPECi�ON WRPOSES. COMMC-NTS
O ��
� PERMITTEENAME(P ' � _ < / ��� -
N � _
� SIGNATUREOF�L ... � DATE
� RECPT.NO. � _PAID BY VALIDATION _
WHITE—Depanment Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENRO�FiIo L'opy,GREEN—Applieant's Copy
;�.,�..�.�� .��e�r' •.��..�...5�+�...-�rv.. '\•:•�'1Y• _ �Yli'� •� , �� �� R.1'Y -r ���.__ ' Y
.. . . . ' �. . . . ` v-�..r . . . Y..�'• '�" •.� . ... .� ..,T' ��:l.�.i. •. .�v . ��'.,..:�.{'�1 '.MTr. . � - . � . '• . , . .
' CIT1' OF DIAf�ti�Div[3 BAR
� . INcFEC i IOF�! F�ECORD
._, _ .._ , _. __..-
�li�F-y.���,`Clo ►`I :oy��:E= ;(►�-`��_n��?6'�1:� �!►�E.�i.�=C;:1"[�'J1�1 D�:�i � I � ��e�'��'c���
_.
_ J . _ .. . _ ._, r; I�k-�'._ _ . '
----------_---____.._- -----�--- _.. __. . . ---.__._ _... .----___..---_--_.___.------------._..---..-----------______------._.._ �
SET BACK � � ' ' . ' FLOOR JOISl� .::• �
FTGS/FORMS/STEEL , FHA REO"JITS �
ELECTRIC GROUfJD . - � ' UNDER FLOOR DUCT �
GROUND PLU1�181NG UfJDER FLOOR CUMDUIT �
SLAB GRADE FIREPLACE FOUtJDATION I
TEMP POWER I I FIREPLACE BOND BEah1 �
, . WATER SERVICE MID HT. �OND BEAh1 �
ROOF SHEATHING (�.-c�o� ' a Fr.BoN�eF,��,a
FRAMING,NENTILIATION FINAL BOtJD BEAP��
ROOF COVER �--f�{—¢� _ PRE-GAADING I
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGtI GRADING
ROUGH PLUPJI6ING I FINISH GRADIPJG
SHO�"JER(TUB TEST ' j• •POOL ELECTRIC
EXT. LATH/SIDING ' POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IPJIPS.
DF�YWALL NAILING DEDICATIOPJS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. —�Y�( _ �,_�� FIRE DEPT. FIPJAL
FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID .
FINAL PLUMBING ENERGY
c{_:rr c,];�rfs': � �
��:_.._.z.._.>_.��:_.____--
COMMENTS
� ..,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
��� � . ,
.,��,� r ,
-
� ;. �_; , �
_...._-�__------,------___� ''