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HomeMy WebLinkAbout13582 (11) I ! ' " . . . . t� � � . . �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 W (909)864-3195 Faa(909)861-3117 PRESS �'TM'�� BUII.DING PERMIT PPLICATION FIRMLY } JOBSITE r–�� � � APPLICATION PERMIT ���(�"Z P!C o AODRESS �/ DATE NUMBER,�.>(JO N ISSUE TYPE OCC � APN T TRA T DATE � � CONST. GROUP � OWNER "" ADDflES ZONING SETBACKS � CITY ZI TEL — FRONT RW ❑ APPLICANT TE REAR ❑ � SIDFJSIDE STREET RW ❑ CONTRACTO / ( SIDE ❑ � ADDRESS PROPOSED USE CffY�� �P1ZIP_�� i� w ARCH/ENG! t ` . /� �, � DESIGNER NOIiPl1�L� V�I��S tf''t"����s NO.DWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFiEANALUATION � ' OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFRiM1 UNDER PENALTV OF FEiWRV THAT 1 MI EXEMPT FROM THE CONTMCTORS lF G8f89BJCfl�pOR 1L CENSELAWFOHh1EFaLLOWNOPEA50N(SEG7o7t.6BU5WE3SANDiROFE55iON5CO0E:ANYCRYOR (n � OOUMTYNMIpIREOUWESAVEfU.IRTOCON57RUCf.ILLiERMPROVF,DEMOLI5/40RREVNRANYSTRUG W PdIlO/DBLIC Ti1RE PNOfi TO fT3 ISSUANCE I�L50 REOUIf1E5 THE MPIICANT FOR SUCH PERMIT TO FILE A SIGNEO V� 6TATEMEM THAT HE OFi SHE t5 UCENSED PURSUANT TO 7HE PRONSiONS OF THE CONTRACTORS LF W .� � CENSE UW(CHAVTER Y�COMMENCN6 WITN SECTqN)OOO)OF DMSION]OF THE BUSiNESS AN�DR0. � POOVSpB FE5,4iON5 CtOE)Ofi i11AT HE OR SHE IS D(EMPTIHEREFROM AND THE BA515 FOHTHE ALLE6E0 E%EMP• TION.ANYVqLAT10NOF6ECT10N7071.6BYAHVADRICAMFORAVERMITSUBJELTSTHEMPUCINfTO z Re-Roof � A CML iENALTY Of N07 L�ORE THAN FNE lUNDRED OOlURS(i5oo).): � 04ti'+CNMEROFTHEPROPERT'.ORYYEMOLOYEESW17HWAGESASTMEIRSOLELOIAPENSATION, � �mmercial . . - M1LL DO TME WORK AND TME bTRUCTURE IS NOT IMENDED Oii OFFEHED FOH S�LE(SEC.TP1�.BUSF J � NE55 AND PROFE551ON4 CO�E TME CONiMCTOR9 UCENSE UW DOES NOT MRY TO AN OwNER Of � VROVEHTYMAIO BUlDS OR MPROVES THEREON.MD MMO DOES SU(}1 WO(iK MIMSELF ON NEFlSEIF OR Q THq0U0lIH190RHER0INJEIIPLOVEES,iROVDEDTHAT5Up1MPROVEIAENTSMENOTMENDEDOR m ►L� OFFEAmfOH5ALEIF.lIOYYEVE0.7HEBUlDINfiORMAPROVE►IEHTISSIXDWITMNONEVEAROFCOYPIE• Z •TION,THE OV/NEREURDEH WILL W1VE THE BURDEN OF VROVINO iHAT XE OR SHE DID NOT BtALO OR MPROVE FOR THE W RPOSE OF SAI.E). W 04��A�FiMEVROPER7I:AMEXCLUSNELYCONTMGiNON7TiLY:EN5E000HTfUCTOR3 � SN LONSTAUCT THE PHOJECT(SEG 1D11,BUSINESS AND PROFE5910N4 COJE hiE CONTMCTORS U� V31U811 AQI.AREA CEHSE UW DOE$NOTMPLY TOAN OVMER OF A FROPERTY W/i0 BULDS OR W PROVES TMEREON,NiO � w�+ocorrrw�crsiorisua+vaa�crsrnrn�carrtnncra+�s�ucEr+smv�msuurrrotnEcorrriuo pUANTITY DESCRIPTION FEE � TORSLICEHSEUW.L��, , . O 1 MI IXEYCTUNDER SEG B.�O.G FOR THIS RFASON 4 U LL. � DATE OWNER V . � J � LICENSED CONTRACTORS DECIARATION w � IMEREBYAFi1RMUM)ERPENALTYOFPEiiIURYiHAilAA1LICENSEOUNDERGFON510N50FtHA7TER � , � �(COAWENCIN�WITHSECTION)Ooo�OF01Vi510N�OFTHEBU51NE55ANDVROFE5510NSCOOE.AN� Z ' YC W UCENSE IS N FUII F E AND EFFECT. � ��E�uss ��No.���-�os � _ .. . . � . V o,�h corrrAncroa n- W , . . � WORKERS'COMPENSATIONDECLARATION . . • . , � Q ,_ _ ' , . NIMEREBYAFFIRMUNOENiENALTYOFiEPJURYONEOFTHEfOLLOYANfiDEClAMT10N5: ' Z Q � IIWVEANDNILLAWNTAMACERTIFlCATEOFCONSEMTOSELF-INSUREfORWOFiKERS' 2 � COMPENSATION,ASGROVOEDBVSECTION�7ooOFTHEUBORCOOE,FORTNEPERFORA1IiNCE w pFT}IE WORK FOR WHIp1Ml4 PEiW1T19155UED. � � Q _IIUVEANO YALLI.UR(fA1N WORKERS'WMPENSATION INSUHFNCE.AS REWIREDBYSECiION ]7o00F iHE LABOR CDDE,fOR THE PERFORMANCE OF THE WOPoC f-0RYMICH iH15 PERMIIIS � ISSUED.G/VWOR1(ERSCOMPENSATIONWSUR1WCfCARR1ERANDDOLiCYMJ1ABERARE CONSTRUCTION _ �� � �iEq PLAN REVIEW __ ' — Z ���Ea ELECTRIC � ¢ 0 (RlSSEGTri1f1EIDNDTgEpC1,RETEppf7FEpEfa.fTSWap�EFupiEDOQ1Afs(Sim10RLE5S1 PLUMBING - '� Z ICERTIFYTHAiNTHEGERFORMI�YCEOFTNEWORKFOi1WHICHTHtSPEW.11TI5155UED,1 MECHANICAL ��f�� �� F Iu�"� (,'} SW�LLNOTEMVLOYANYiERSONIN/NYMANNER50AST08ECOME5U0JECTTOTNE 1 �� •' . ��ti, '�ifll1 N WOfiKERSCOMPENSATIONUW50FCAUFORNIA/WDAGREETMATIFISHOI.IDBECOME INSPECTIONFEE /�, S SUBdECTTOTHEVIOfIKERS'C0IAPENSATpNVflOYI510N50F5ECT10N�7000FTHEU80R ISSUANCE � � 2�•l ,� COOE.1 SHAIl FORTHWITH COMPLY WITHTHOSE PHONSpNS. �I;� �.��' � �-�j":'��'j � O ' SMIP �',T��ii_�;.1'.t.3 % �) p pATE: ' APPLICAM: . W ENERGY P/C WARNIN4:FAILURE TO SECURE WORKERS'CDMVENSA710N WVEMGE IS UNUwFUL IJaO SHALL BE �'y SUBJECfAfIFJAPLOYERTOdUM!NALVENAlTE311NOqVIIFINESUP700NEiM�OfiEDTHW5N10 ENERGYPERMIT DOILARS(f 100.0001.N ADDITION TO THE CAST OF COMPENSATION,DAMAGES AS PROVIDEO FOR IN J SECf10N])DeOFTNELA80RCODE,INTEREST,ANDATfORNEY5FEE5. RETENTIONFEE: � ��, CONSTAUCTION LENDING AGENCY PREALT FEE: � IHEREBYAFFIFUAUNOERVENALTYOFPERNRYT�UTTMEREISACONSTRUCTIONLENDWOAGENCV �I�. �%1 FOR TNE VERiORA1ANCE OF 7ME WORK FOR WHICII THIS PERMIT IS ISSUEO(SEG�ov7,CN.G). � � . � LENDER'SNAME C IENDER'SADORE55 . WICERTIFYTIUTINAVEREAD L1GT10NANOSTATETHATTIE/�80VEWFONI IS aRE�. TOTAL FEES � d I ACREE TO COMPLY WR11 C �COUN7Y ORDINANLES hN0 STATE U � TNCi TO BUdDIN6 ,/� J` � CONSTWICTION.AND EBY 110R2EREPRESENTATNESOFTH15 MER��� COMMENTS�1����� �� �`���� �'L���� /�BOVE��IEHTIDN FORWSPECTIONPUFPOSES. � , O � � � PE EENAME�PPIFfT) . � y SIONANNEOFVEfWITfEE D�TE � � RECFT.NO. PAID BY WWDATION . WHITE-0epeRment Copy.YELLOW�inante Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GflEEN--ApplicanPs Copy � . . � �- . ..Y....�ri i ... .-�� . '_ " . M . ♦. � ...'l'. • . .. . . ..f� � . ♦ . ..�.. ,.. . ... .. . � . l "-.. .-. . . � . - . . -.. .. .... . . .n .. . . .,. .. . . . . ..�. .r.... , ..,. i I CITY OF DIAMOND BAR ; %` ` : � � . iNSPECTiO�J REC�R� . , � : ---� - - , . - � , _ ., __.. . __ ._ : ; ;li����.��c��'�c)A�.� �����!� i!Xl�,�,���`'��.���'�►!��;�'���.�.��?l►�i:�- ��e.�'��'� �►��-y.��c����*� �I � _..�.,....�.�.�.,_ _._.___. ..., ...��_�......._.._...�....���. _. 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LANDSCAPE/IRRIG. •SEEP r ET/L.L. � ..�-".:�1 �-;'\• ON 51TE IMPS. u i,S AI R TEST FINAL ZOP�WG F(i1A!_COtVST. ' �• �p � FIRE DEPT. FINAL � FiNA.L HEATING _ �— HEALTH DEPT. FINAL �I":A�ELECTRIC- OEV. FEES PAID - t:' _ I -1'sdA,'..PLUt�1B}"JG _ _ ENERGY ; �_---- _.�u�Qc<t._fvd� ��-1 J�_' -�y,�.�.,-.. �.- ...-.••-•�r't -�-�� ?� .� li�.3 G=-l5-KS��c=, n, �.� '1" t 1,�� .. �. ( <�% .._iL`.� . ... .Y..r_.t.._ J... . . � C G;��P�I EN i S C-1'1•-�t4 �•r.�.Ga. 1{.1 � t ,t � a .oZ� �.3� �^3., � .I , i ,L � ��. , - _ � _ � -.., . . . , SEPTIC TANK SlZE � SEEP PIT/U SIZE — �.._.. ...��€ _.�,T..._. { , i � _ . \.i_ _ . _ � , .. ���� ,:� _ � +r,. �]� --- �. o .. \� — r-, L_l�. .�— ti � .,\ ) � .\ • .\ � .• . . . {%. . '_ . � ` '\� � `��.. ._. . .. �,_ �, .\.. _ ..__— . . '. . "r�' " .. .�1 _ _ . ' _ .. � � : _.......�_. . . ._,�,....�.. ... .,,_.�� , . .. _ i . .