HomeMy WebLinkAbout17672 J� CTTY OF DIAMOND BAR �
DEPARTIv�NT OF COMMUNTIY&DEVELOPMENT SERVICES
21825 E.Copley Drivo
(909)860-3195 Fax(909)861-3117 _ PAESS
"'�»�' BUILDING PERMIT APPLICATION FIRMLY
JOBSITE n + /��� APPLICATION PERMIT P/C
o ADDRESS_�I'10�`_G�I�YCIJ�II� r' D! [-��Ci". DATE � O NUMBER��� k
c� ISSUE � v/1 TYPE OCC
APN LOT TRACT DATE �� CONST. GFiOUP
� OWNER
O
o ADDRESS ZONING SET9ACKS
z CITY ZI TEL. - FRONT RW ❑
g APPLICANT '��„ REAR ❑
SIDFJSIDE STREET RW ❑
� CONTRACT SIDE ❑
� ADDRESS
� CITY ZI TEL. �.I PROPOSED USE
� w ARCH/ENG/
w DESIGNER NO.DWEL NO. N0.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BU�LDER DECLARATION SFRlADD/REM
O
p I HEREBV�FFlRM UNDER CFNALTY Of PEiWRY THAT 1 AM E%EMPT FROIA TNE COMTMMORS ll- GefepB/CeryOrt
W CENSEUWFORTHEFOLLOVlINpHEA50N(SEC.70.71.68u51NESSANOPROFE5510NS00DE:ANYqTYON (n
U COIMTYVMIpIHEOU�RESAVERMRTOCONSTRUCT,ALiEi�IMPROVE.DEMOUSH,ORREVIIRANVSTRUC• W p81I0/DBCk
� NRE,iRqR TO R9 ISSUANCE,ALSO REOUIRES'ME APPUCAN7 FOR SUqI PERMIT TO FILE A SK,NED W
STA7ENENT 7WlT NE IXi SHE l5 UCENSEO PURSU+IM TO TME PROVISIONS OF iNE CONTMCTORS LI•
� CENSE LAW(CHFPTEfl Y(COMMENCWO W1TM SECTION)000)OF DMSION J OF THE BUSINE53 ANO PHO� V' PoollSpa
FESSqNSCOO�ORTHA7HEOHSMEI5E7(EMPTTMEREFROMANOTHEBASISFORTMEALLEGE�EXEMP• (�J
� TION.ANVVIOLATIONOfSECilON7071.68YANVMPLIGWTFORAPERAIITSUBJECT57HEAPPUCANTTO Z Ra-Roof O
F, AGMLiEWLLTIOFNO7MORE7HANiiVEMUNDREODOLIARS(i5ao).k
� 04�w^�WNEROFTHEPPOPfRTV,ORMVFMVLOVEESWITHWACESASMEIqSOLECOMDENSATION, O Opmm9fClel -
WILL 00 TME WOPo4 AND TME SiRUCTURE IS NOi�NTENDED OR OFFERED FOq SAIE(SEC.70�/,BUSI• J
NESS AND VROFESSIONS CODE:THE OONTRACTORS LICENSE LIiW DOES NOT ADGLV TO Ml OWNER OF
N PROPEPTYNTIOBUILDSORIMPpOVESTMEREON,ANDVA10D0E55UCHWORKMIMSEIFORHERSELFOR �
Q THROUGH/USORHEROWNEIAFLOYEES,PROVIDEOTHATSUp11MPROVEMENiSMENOTINTENDE00i1 CD
0 OFFEREDFORSALEF,IpWEVEfliHEBUIDINOORIMPROVEMENTIS� IWITMINONEYEAROFCOMPLE
Z T10N.THE OWNERBUIDEN WILL IU1VE iME BUROEN OF PPOYINa iHAT ME OR SHE DiD NOT BNLO Ofi
� pAPROVEFORTIEPUR005EOFSi4E�
w OL�O�EROFTNEiROPERTY,AME7fCLU5NELYCOMMCTINOYATMIICENSEDCONTMC70R5
Q TO CONS7RUCT THE VR0.IECT(SEC.)Ou.BUSINESS AND PROFESSIONS CO�E:THE CONTMCTORS ll• VO��etiql ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOVmEHOFAPROFERiYWIpBUIlD50qIMPROVESIHEHEON,AND �
Z WHOCOMMCTSFORSUCHOROJECTSWI7HACONTMCTO{i�S)LICENSEDFUHSl1ANTTOTHECONTM6 pUANTITY DESCR�PTION FEE
Y TORSUCENSELAw�.
� O I M1 EXEIAPT UNDER SEC. B,a P.C.FOR TMIS REA..ON a
� U
LL' OATE OWIJER �
Z W
� LICENSED CONTRACTORS DECLARATION W
� IHEHEBYAFFIHMUNDERPENALTYOFPEiUUMTNATIAML�CENSEDUNDEHPROV15KKiSOFGHAPTER �
p., Y(COA/uENCMOWfTHSECT10N7000lOFONISiON]OFTHEBUSINESSANDPROFESSiONSCOOE,MA Z
X ►IY IICENSE IS�N fL4 FORCEAND EFFEGT. m
0 LICENSE CLAS 1y.,LIQ NO.,� j
V DATE �fi,� CONTMCTOR a
W
� WORKERS'COMPENSATION DECLARATION a
� IHEREBYAFFIRMUNOERPENALTYOFPERIURYONEOFTMEFOLLOWiNODECLARA71pN5: z
� _I HAVEAND WILL AI�INiAIN A CERTIFICATE OF CONSENTTOSEIF•INSUFlE FOH WOfiKERS' 2
CMIPENSIRqN,A57ROYDEDBVSECTION770oOFTHELA80RCO0E.FORTHEVERFORMANCE W
OF iHE WONN FOF WHICH TMIS PERIAIT IS ISSUED. �
0
� �IHAVEANOVIILLAIAINTAMWORI(ERS'COMPENSATIONINSUMNCE,ASREOUIHE08VSECTION /�
0 770DOF THE LABOR CODE.FOR TME PERFORMqNCE OF 1ME WORK FOH WMlpf 7H15 PEPMIT IS ����/ �
� ISSUED.MYWORKEi1�,CQAIPE�ATIONIN§y1WWCEC�RRIERMIDPOLICYNUMBERARE: CONSTRUCTION (
y CMRIER ��� ��I V� PLAN REVIEW
� PoLICYHUMBER � .��,.�j "� ELECTRIC
pp (IH6SEci�oNNEmroisEml�i;ErEooFnEPEw�fiswRa+EMl.raiEooaWl5R�wlaaLEss1 PLUMBING
� ICERTIFYTHA7MITNE�ERFORIAANCEOFTHEN�ORKFDHWHICHTHISVEM/ITISISSUED,1 MECHANICAL
(,'} SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE
uJ WORKERS'COMPENSA7qNLAW50FCALIFORNI0.ANDACREE7MnTFISHOIhDBECOME INSPECTIONFEE
SU&IECT TO THE YIORKERS'COMPENSAiION DROVISIONS OF SECTqN 970o OF TNE UBOR
s CADE. SHALLF RTF(WITHCOMPL�'WITHT EPROV.SqN{._ �^^ A ISSUANCE
l �
p DATE:� APPLICANI l� SMIP
� ENEFGY P!C
WAqNINO:FAIWRE TO SECURE WOFKERS COMPENSATION COVEMGE IS UNLAWFIA,AND SHALL 8E
� SUBJECTANEMPLOYERTOCRIMW�IPEWLLTIESANDCMLFWESUPTOONEMUNDRE�TF10U5AND ENERGYPERMIT
DOLLAHS(ft00.D00�IN ADDITION i0 THE CAST DF COMVENSATpN,D�A[1E5115 PROViDED FOR IN
J SECTqN�IoeOFTfEU1BORCODE,NITERESLANDATTORNEY'SFEES. RETENTIONFEE: �_
�
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
� IHEREBYAFFIRMUNOERVENALTYOFPERM1IRYTHATTHEREISACONSTHUCTqNlEN01NOA6ENCY
n- FOR TME VERFORMMICE OFTHE WORK FOR NMICH THIS PERMIT IS ISSUED(SEC.70Y7.CIV.CJ.
Z
W
� lEN0ER5 NAME
F- IENDERSAD�NE55
w TOTAL FEES l �3,�(�
I CEHTIFY THAT I HAVE REA�T111S MPL1CAtION M!D STATE THATTNfi�BWE wFORMATION IS CORqECT.
� IAGPEETOCOMPLYWfTHAILCT'MIDCWNTYONDINMICESANDSTATEUNSPELAIWOTOBVIWM6
� CONSTRUCTION.AND HENEBYAU7HORIIE REPRESEMATNES OF THIS COUNTY TO ENTER UVON iME
Z ABOVE�IAENT EOPPOPERTYFORINSPECTiONPUHPO5E5. COMMENTS
� �� ��
_
m PER1AITfEE (PRt
� SIGNRTUREOFPERMITT���� oy��q 1�--
� RECPt MO. PAID BY VALIDATION
WHITE-0epartmant Copy,YELLOW—Finance Copy,PINK—Aesessor Copy,GOLDENROD—File Copy,GREEN—ApplicanCa Copy
�� t��S�'�::i:W:'l4Li.yn�..Yrt�.1,.��T.��- -„�.v...._ '.'��..�. •^ �.. f. ...
5,, v10'_R...."R:'.i�:..l'.:i�.I-��E`.`.'.�M�i^.`"7i¢yC%rysu.l.'�i�61'hf7'9ia'C1al.,fF.i7cey�1F.��.. r'��.�'" . • ni:����w . ...r^.r.ew..v'.f1�r.ra�.�r
CITY OF DIANlOt!!D BAR
lPvSPEC i iON RECORD
----
T�___.� ��--�:.. .. _,._ -�, y �
1 � r�.��b � 1.,�1 �—. i \ �.. .y:� . : ' � C C� , �D � _ _ ��,,.���:J
:�...�1� ....+ �� �..��� � -���`�r�,,C,,{�0 �,IR,�.',���:<+�)..�.1� - �.=�e,'�., ::���_, , , --,, •
— —__ — .,_.. 4_ __ ... �_...__. . _ - A,�
SET BACK • • ~� FLO�R JOIST. '
FTGS/FORMSISTEEL � ; FHA REQMTS
ELECTRIC GROUND � UNDER FLdOR DUCT _
GRDUND PLUMBING UNDER FLOOR CUf�IDUIT , •
SLAB GRADE I I FIREPLACE FOUNDRTION I� � �
TEMP POWER I � I FIREPLACE BOND BEAh1 '
WATER SERVICE I ' MID HT. BOND BEAM
ROOF SHEATH�NG ���<2 �� � ' 8 F�'. BOND B�AM. '� j
FRAMINGNENTILIATION � FINAL BOND BE/1M
ROOF COVER ��f'��/� PRE-GRADING
ROUGH HEATING I I BENCHING �
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING � I, ; FINISH GRADING
SNOWERlTUB TEST � i , POOL ELECTRIC
EXT. LATHlSIDING ; i POOL FENCING �
WALL INSULATION POOL FINAL
CEIUNG INSULATION ! � OFF SITE IMPS.
DRYWALL NAILING j bEDiCATIONS �
SEWER � FINAL ENG.
SEPTICTANK � j LANDSCAPE/IRRIG. � .
SEEP PIT/L.L ! ON SITE INIPS. �
GAS AIR TEST � � FINAL ZONING �
FINAL CONST. � I ! FIRE DEPT. FINAL �
FINAL HEATING ! � HEALTH DEPT. FINAL �
FINAL ELECTRIC ; ' DEV. FEES PAID �
FINAL PLUMBING j � ! ENERGY �
i .
a - ;lr .to�c _ . .: ; • . �� .., � �� ,
_ � _. . --� - - � ,� .
COMMENTS
• ' , �.
; ,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
^.F��� :
. �
._. ,
�
_ _ . �
'�l� �j�,;
y
_ , � , ; . .
,. � .�...._.._�.__,.1 . �- _ , '; � ; , ,
�