HomeMy WebLinkAbout16899 (44) �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
��` 21825 E.Copley Drive
(909)860-3195 Fex(909)861-3117 p(3E$S
"'����� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSITE 1
o ADDRESS�D (� ��• ��i�lCaO►-, �I�G�. DATECATION � (q O' NUMBER_ ` �1 �/��
g ISSUE �I TYPE OCC
APN LO� TRACT DATE CONST. GROUP
p OWNER
LL ADOR SS � ZONING SETBACKS
gCITY � • ZIP TEL.���;�� A�RT RW ❑
� APPLICANT T SIDE/SIDESTREET RW O
� CONTRACTOR SIDE ❑
� ADDRE S .
� CITY ZIP TE t � � PROPOSED USE
o ARCH/ENG! �+. ' �-"
� DESIGNER_ �+r/ti8
ADDRESS NO.DWEL. NO. NO.
� CITY Z�p TEL UNITS STORIES BEDROOMS
�
�n DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER OECLARATION SFWADD/REM �
O
I HEREBV AFFlPoA UNDER PENALN OF PEMIHY THAT 1 AM EXEMGT Fii�M THE CONTMCTORS LF Garage/Carport
W CENSEUWFORTHEFOLLOWWUREASON�SEG70.71.6BUSWESSANDGROFESSIONSCODE:ANYCI7YON (�
U COUNTYWHIpIREWIRESAPEPMITTOCON57RUCT,ALTER.PAPROVE,DElAOL15//,ONNEPAIRANVSTRUG W patio/Deck
� TURE,VRpq TO ITS ISSUANCE.�L50 REOUIRES THE MttICANT FOR SUCH PERMITTO FILE A SICNED W
STATE�AENT THAT HE OR SHE 45 LICENSED VURSU�NT TO TXE FPOVISIONS OF TME CONTMCTORS L4
� CENSE UW(GMAPTER Y(COMMENqHO WITM SECTqN 70D0)OF DIVISqN�pF THE BVSINESS AND PP6 � PooVSpa
FESSqNSCO0E10RTMAiHEORSMEISEXEMPTTHEREFHOMAN�THEBA515FORTHEALLEGEDE%EMP•
iION.Af1VVqLATqNOFbECTION70]1.68VANVMPLICANTFORAPERMITSUBJECTSTHEAPPLICANTiO Z Re•Roaf
A CMl YENN.iY OF Npi MOliE THAN FIVE MUN�REO DOLURS(SSoo13
0 ❑I,ASOWNEROFiHEDPOPERTV,ORMVEIAPLOVEESWITNWA0E5ASTHEIH50lFCOMVENSATqN, 0 Cpmmercial . -
Z YALL DO THE WORK,AND TNE STfiUCTURE IS NOT INTENDED OF OFFERED FOR SAIE(SEC.7oN,BUSb J �
� NE55 AND GFOFESSIONS OOOE:TME CONTqACTORS LICENSE UW DOES NOi 11PPLY TO AN OWNER OF j .
PROPERTY WHO BVILDS OR MAPROVES TNEREON.AND W110 DOES SUp/WORK FIiMSEIFOR HERSELF OR
� 7MROUCH HIS OR XER OYM EM7LOYEES.7HOVIDED TMA75Up/MPqOVEMEN75ARE NOT MEI�DED OR m
Q OFFEAEDFORSALEIF,HOWEVE0.IMEBUIDiNGOR�MPROVEIAENTI550lDWfTH�NONEYEAROFCOMPIE-
Z TION,THE OWNEF-BU�LDEN WILL HAYE 1HE BUqDEN OF PRONN6 THAT HE OR 511E DID NOT BUILD Ofl
= 0.1VROVEFOR7NEOURPOSEOfSALEJ.
W 04�ONTlEROFTIEPHOPEHiY,AME%CLUSIVE�YCONTMCTINOWfTFIIICENSEDCONTRACTORS
� TO WNSTRUGT TME PROJEC7(5EC.70N.6USINE55 ANO VROFESSIONS CODE:THE CONTRACTORS LI� V21UetI0f1 ADJ.AREA
W CENSEUWDOESNOTAVPLVTOANONMEROFAPROPFRTYMnqBUttD50FIMPROVfSTHEREON,AND
?- MTIOCAMMCTSFORSUCMiROAECTSWIiHACONTMCTOR(S�LICENSEDVURSUANTTOTNECONTMG• QUANTITY DESCRIPTION �E �
� TORS 110ENSE UW).
� OIAAIE%EAIPTUNOERSEC. B.lO.GFORTHISpEASON U �
u" DATE OWNEH �
Z _ _ —____. .__ '_�.—_' ___ ___'_" .. _ _ ..
� UCENSED CONTRACTORS DECLARATION w
� IHEREBYAFi1RAlUNDERPENALTYOFCEfiNRVTHATIMIL�CENSEDUNDERVROVISiONSOCCHAPTER
p� Y(COMMENCINOVATHSELTqN7000)OFONISION70FTHEBUSINESSANOPROFESSIONSCODE,AND Z �L� C1
X ►IY UCENSE IS N FULL FORCEAND EFFECT. m V �Q�
L1J %
� IICENSE CUISS �.1 LIC.NO. • j
V DATE���I� V�_CONTPACTOq -� d
W
� WORKERS'COMPENSA7ION DECLARATION ¢ �
� IHERE9YAFfIRM11N0EN0ENALTYOFVERRIRVONEOFTHEFOLLDWINGDECLARATIONS: Z
� _IHAVEAND'MLL►1AINTAINACERTIFIGTEOFCONSENTTOSELF�NSUPEFORWOILCE0.$' _
COYPENSATIDN,ASGROYIDEOBYSECTION�7000FTHEUBORCODE.FORTHEGERFORMANCE w
Q OF TME WORI(iOR VAIICH THIS VERIAITLS I55UED. �
w �IHAVEANDYAlLMA1NiAtNWORKERS'GOMPENSATIONINSUMNCE,ASPEW�REOBVSEMqN
¢ ]7000FTHEUBORCODE FORTMEPERFORM�NCEOF7FIEWORKFORWHiCHT1115GERM1715
0 ISSUED.M'/y`yg Kf S CO PENSAT INSURA'CE CARRIER AND POLICV MIAIBEF ME: CONSTRUCTION �
j CARRIER N�II � �1'�� PLANREVIEW
�—
� POLICY NUMBER 4 ti �' ELECTRIC �
� (fFP55ECf10NF€mNOTBEOpA'IETmCFTVEPEFMfBPoRONEMI�ORm0011ARS6�00)ORLES51 PLUMBIN�
Z ICERTiFYTHATINTHEFERFORMANCEOFTHEWORKFORM/MIpITM15PEfl1A1T45155UED.l MECHANICAL
C'} SMALLNOT EMPLOV N!V PERSON W MIY AIMlNER 50 AS TO BECOME SUBJEM TO THE
(fj WORKERS'fAMGENSATiONUW50F�IPofiNU,ANDAGREETHATIFISMOULDDECOME INSPECTIONFEE
S Sl18JECiTOTMEWORKENS'COMPENSATIONVfiOV15lONSOFSECTION77000FTNEUBON
COOE,ISH/11.FORTHVATHCOMPLVWITHTFIOSEPR ior�s � ISSUANCE
O �� ��5�� SMIP I (�.�'� .���_. �,
DATE; APPLICAM: �I
� WARNIHG:F/JLURETOSEWHEWU�iKERS'COMVENSATIONCOVERAGEISUNLAWFUL.ANOSHALLBE
ENERGY P!C � �
9
�y SUBIECTANEMPLOYENTOCNIMINALPENALTIESANOCMLFWESUPTOONEMUJDREDiNO115M1D ENERGYPERMIT
DOLLMS(f t0o.000).N ADOITION TO THE COST OF COMPENSATION.DAMACES AS VROVIDEO FOR IN
� SECTqN�70EOFTHEUl80RCODE.NTEFESLN1�ATfORNEY'SFEES. RETENTIDNFEE: �
a CONSTRUCTION LENDING AGENCY pREALT FEE: �[j- � �
� IHEREBVAFFlRMUNDERPENAITYOFPERN{IY7MATTHEREISACONSTRUCTIONIFNOWOAGENCY —�—_ '
a- FOR THE PERFOi3A�MlCE OF TME WDRN FOR NMICH THIS DEiiM1T IS�SSUEO(SEC.1oG7,CIV.C.�. � --_ _,.__
Z '_'__—�„
W
S IENDER'S NAYE .
?
� IENDER'SADORESS �
,� TOTAL FEES���, 5 �,
� ICERTIFYlHAiINAVEREADTHISAPP� ATIONANDSTATETFUTTNEABOVENF011MATqNISCORRECT.
� IAGREETOCOM7�YWITHALLUTYAN OVNTYORDINANCESANOSTATEUWSREUTINOTOBVILDiN6
� STRVMION.MDHERE vAUT/10F �RE�RESENTATNESOFTNiSCOUNTYTOENTERUDONME
Z E#1EMilONEDPROPE YFORIN ecrionvuavoses. COMMENTS
� r � � i P,s -- A DDv01�`P
� .--�-.,�� -�
QPER N rn)
� �� ��V
� SI E OF PERMI EE; DATE
� RECPT.N0. PAID BY VALIDATION
WHITE—DeDartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fila Copy,GREEN—ApplicanPa Copy
�� • . . �• , ., . . �. . . .. . . . ., . . , . . .. . . , � ,'� .;_, , ...a � �.,.�.o. . � , .. . , . , , . ,. . . . .
Ci i�' QF 1f31�>Pf O�tiD (r3l'x6i
1��3S�'�.��IOT;� 9�CCui��7 •
^ __._._T..�.. _
_ _ - -- __
--______
'I�C+ 'N�I.f.`�1C��1��1� ��r,�"[=. I►til.-1�����,�t'.c1C� la Ca:�E`,:P'�e� � '�� � ` _� ��.`}ra�c''i�m��rs. ��
; �� _ '1� � .r�i. �4�C I� b ,i
_SET BACl: �---• ---�--. . --- _ . .._._ _. __._..____......_.._ .._ _.__. .____..�.-----_----..__--_---.-- . .__.--.--�__. ��__ __._..,.._.._____�___
� ' � ; FLOOR J015T � � . � . ' _'
F-fGS.�FORP�S/STEEL ��-y�,p( � FMA REQP.ITS �
�../
ELEGTRIC GROUND _ � UNDER FLOOR DUCT _
GROUND PLUMBING I UNDER FLOOR GU�!DUIT ' � j
SLAB GRADE FIREPLACE FOUI�DATION � �
TEP�iP POWER ( FIREPLAGE BOND BEAM �
WATER SERVICE �_ I MID HT. BOND BEAF.� -
ROOF SHEATHING � � `Jf f}7�l' � _� ' ' 8 F7.BOPJD BEAF�I• � -. . . . . . - _
FRAMINGNEN7.'Dfi��� � �,-�� FINAL BOND BEAM
ROOF COVER t � PR�-G�sADING
ROUGH HEATING �,� J� BENCf�ING
ROUGH ELECTRIC :t _� ; ROUGH GRADING
ROUGH PLUM8ING �,� i FINISH GRADING
SH01h'EFi�fUB TEST POOL ELECTRIC
EXT.LATH/SIDING 1L2 0�_ POOL FENCING
WALL INSULATION ��r POOL FINAL
CEILING INSULATION OFF SITE IMPS. '
DRYWALL NAILING 1�_Z.o� _ DEDICATIONS
SEVVER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/LL. � OtJ SITE I"�1P5.
G,AS AIR TEST . , .FINAL ZONING
FINAL CONST. - JQ ' .� FIRE DEPT. FIFJAL
FIPJRL HEATINu � ' HEALTH DEPT. FINAL
FItJAL ELECTRIC � DFV. FEES PAID
FINAL PLUNBING 'i ENERGY
. . . ��� ,
.;`.,��_�t'_�t:�W��ei�__�__--__�._...!
COMMENTS � - � � �
� � � - ,.�:
. .
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�� �
tdr� :.
`i
� ,
i
� , . .
i "
4 � I - ` _ . , " . ' • ,
� ' .