HomeMy WebLinkAbout17254 (� CITY OF DIAMOND BAR EX PI R E D
� � DEPARTMENT OF COIvIIvIUN[TY&DEVELOPMENT SERVIC�S
21825 E.CoplcyDrive JUN 1910��
' 'r° PRESS
(909)860-3195 Fax(909)861-311?
'-«�� 21715 BUILDINGPERMITAPPLICATION FIRMLY
�� JOBSITE � ,�q�relr i�► dr� diamo�d bqr APPLICATIO PERMIT ���r� P/C
ADDRESS DATE � 0 NUMBER1��"'�Y_ #
� ISSUE TYPE OCC
APN OT TRACT DATE CONST. GROUP
p OWNER �
p ADDRESS ZONING SETBACKS
z CITY�I�IYIO bG(Y ZIP TEL. ' FRONT RW ❑
�j APPLICANT TEL. REAR ❑
� SIDElSIDE STREET RW ❑
� CONTRACT�R CQ VC'FIO C SIDE ❑
ADDRE 0
PROPOSED USE �D uv
a CITY ZIP TEL � - 2 �—�- �p ��~1��;`
o ARCH/ENG/
� DESIGNER N�.DWEL. NO. NO.
a ADDRESS
� CITY 21P TEL UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV 11FFIRM UNDEH iENALTY OF iERJURY TMAT 1 AM E%EMPT iP.OM TME CONTMCTORS LI� G3t8g8/CB�pOft
W CENSEIAWFORTIIEFOLLOWINOREASON(SECJWt.6BU5WE55AN�GROFE55lONSCOOE:ANYCI1YOq (n
U COUNTyWHICHREOUIRESAGERMITTOCONSTiIUCT,IITEILIMPiiOVE,DEMOL15N,OHflE7NRANYSTHUG W PaiidDOCk
Z iURE PHIOR TO RS ISSUANLE AL50 REOUIRES 7HE APPIICANT FOfl SUCH PERMIT 70 FILE A SIGNED
W STATEMENT 7TUT HE OR SHE IS UCENSED PURSUANi TO THE PROVISIONS OF THE CONTMCTORS LI- W
� CENSE U'N(CHAPTER Y(COMMENCWO MATH SECTqN 700010F DIVI510N 7 0F 7HE BUSINESS IWD VRO� LL POOUSPa
p iES510N5CO0E)ORTNATNEORSHEISE%EMPTTHEREFROAIAND7HEBASISFOR7HEALLEGEDE%EMP�
V TIDN.ANYVIOUTqNOFSEGTION70J1.S8YANYAPPUCAMFORAPEM�IT5U8JECT5TMEAVPIICIWTTO Z pe•Raof
A CIVI�PENALTY OF NOT�/ORE 7HAN FIVE/NNDRED OOLURS(f5o0).��
ZOI,ASOWNEROFTHEPiqPER7Y,ORMYEMPLOYEESYATHWAGE5A5THEIRSOLECOMPENSATpN, 0 COTrtf9fCi21
NALL DO THE WORIC ANO TNE STRUCTURE LS NOT IN7ENDED OR OFFERED FOR SALE(SEG 7ou.BOSI•
� NESS AND PROFESSIONS CODE:ME CANTMCTORS UCENSE UW DOES NOT APPLY TO AN OWNEH OF j
VROPERTY WHO BUILDS OR RAPROYES THEREON.AND NTIOOOES SUCM V10RK HIMSELF OR HERSELF OR
� THROUCHHISORHEROWNEMPLOYEES,PROVIOEOTNATSUCMII.�PqOVEAIENTSAHENOTINTENOEDOR m
QOFFEREDFORSALEF,NOWEVERTNEBU0.�IN(IORIMPFOVEMENTISSOLDWITMINONEYEAROFGOMPIE�
z TqN,TME OVR�ER�BUILDE0.WILL HAVE TME BURDEN OF GROVWC TFUT HE OR SME DID NOT BNLD Oti
= WPqOVEiORTMEPURPOSEOFSILLE).
W ❑�ASOWNEROFTNEOROPERTV,AA7E%CWSIVELYCONTMCTW6WIMlICENSEDCDNTMCTORS
(t TO CONSTRVCT TME VRQIECT(SEC.70N,BUSINESS AND PROFESSIONS COOE TME CONTMCTORS U� V0IU0tlOf1 ADJ.AREA
W CENSEUWOOESNOTAPPLYTOANOWNEROFAPROVEHTYWHOBUILDSORIMPROVESiNEREON,AN� �
F� VJNOCONTMMSFOqSUCY1PRQlECTSYMHIICONTMCTOR(S�UCFNSEDCU0.5UANTTOTNECONTMG QU/WTITY DESCFIPTION FEE
X TORS LICENSE UW j.
� ❑IMI EXEMPT UNOER SEC. B.6 G.C.FORTHIS REASON Q
� U
� �
D�TE ONMER U
� W
F�„[ LICENSED CONTRACTORS DECLARATION W
[r 1 HERE9Yl1iFIRM UNOER PEIULTY OF VERNqY iHAT IAM UCENSED UNDER PROVISIONS OF CMAPTER �
d O��VAIAIENCNf1WITH5ECTION700o)OFOMS10N00FTHEBUSiNESS�NOPROFESSIONSCODE.AND Z
X MYLICENSEISMFULLFORCEMIDEFFECT.
0 LIC[NSECUSSB��C��i3� L�jq MIC�,�.Ha. �'�I'o^o6�'6 �
V DATE__-1�/LI_h(0 j CONTRACTOR �l'C a
W —�_'_
t� WORKERS'COMPENSATION DECLARATION ¢
NIHEREBVAiFIRMUNOER�ENALTYOFPE0.IURVONEOFTNEFOILOWINODECLARATIDNS: Z
Q
� �INAVEANOWRL�MT/UNACERnFICATEOiCONSENTTOSELFJN54REFORNK7RKER5' _
CAMPENSATqN,ASPROVIDEDBY5ECT10ND70oOF7HEUBONCOOE,FORTNEFERiORMANCE w
OF THE WORK iOR WHlpl TNIS PERMIT IS ISSVED. �
O
� INAVEIWDWI�L�AiMNNWORKERS'COMPENSATIONINSURANCE,ASNEOUIREDBYSECTION /// O
� 77000F THE LABON CODE.FOR THE PERFOFMANCE F THE WORN iORVYMICM THIS FERMR IS . l��J �
J ISSUED.MYWOFiKER[5�{1-M/PfE AT 1R.ANCE niEa�oaaicwNuueEA�we: CONSTRUCTION i ..�
j CARRIER���I�e�"1� PLAN REVIEW
� paicY NUMBER—I 1+— ELECTFIC
—�—J—
o �nassEcrour+Emwraemr.s�FrmoanEVEaursco�or+E�nm.urs6�aola+iEss1. PLUMBIN�
w
Z I CERTIFY TNAT IN THE VERFOPAIANCE OF THE WDRK fOR WHICH THIS 0 IT i5 ISSUE�,1 MECHANICAL ���� �'� ' 1 , � � �
(7 SHALLNOTEMPLOYMlYPERSON 50 TOBE • 0.1 TO7M[
N MlDRKERSCOAIOENSATIONUWSOFCALIFORNI AN AGREE UT� IS UlD6ECOME INSPECTIONFEE
S SUOJECTTOTHEWORKERS'Cd.�PENS IONPAO i5l 450F ECT N770 OFTrIE R
CO _,ISH I.�fORTHWI7HCOMPLYWI rras a isio . ISSUANCE
O • �
p DATE: O O' ppPLIG1NT: SMIP
� ENERGY P/C -
� WMNIN6 fAILURE TO SEWRE WOPoCERS'CO ENSAlION COVEMGE I5 UNUWFUI, SNALL BE 1
� SU&IECTANEMPLOYERTOCRIMINALPE 9M10CIVRFINESUPTOONEMUNOR D HOUSAND ENERGYPERMIT Lr������-�""'-�-- --
OOlUR5�it0o.000),WAODiTIONTOTNECOSTOFCO/APENSATION.DAMAGESASPR EOFORIN �'
� SEGTpN17oeOFTHElA90NCO0E,INTEREST,ANDATTORNEY'SiEES. RETENTIONFEE: �
nw. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
CC I MEREBYAFFIPM UNDEF FENALTV OF PERNRY TMATTHERE IS A CONSTRUC710N IENDINO AGENCY
n- FORTMEDERFORMANCEOFTHEWORKFORWNICHTHISPERMIiI5155UE0(SEC.7097,CIY.G�.
�
� IENDER5 NAME
� LENDERS/�ORE55 �
� ICERTIfYTMATIHAVERfA01HISAPPUCATIONANDSTATETHATT/E�80VEWFORA1AT10NISCORPECi TOTAL FEES � �� �
w IAGflEETOCOMPLVWITHI�LLG7Y/WDCOUNTYORDINANCE5AND5TAiEUWSREUT�NCTOBU0.01NO
� CONSTRUCTION,ANOHEREBYAUiF10R1ZEREPRESENTAiNE50FTHI5WVNTYTOENTEHUPONTHE
ZABOVE-MENTIONEDFROPER7YFORINSPEC7qNPURPO5E5. COMMENTS
= n
m MITTEE N (PRI f)
¢ 0 6
N SIG ATUP li DAT
� RECPT.N0. PAID BY� � VAUDATION
WHITE epertment Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
.i.� .. .. . ., ., . , . . .., , , . , ., .. �:-f ... �i . . p . ..iy ., �.� . • _ - . � . � . .. .. � �„ . s, i. � .
ciz� or- �i�r�;or.o a��
tc��sF�c�ior� r��ccr��
I►��-�R�=t€��'CaJ�I ^ e)_��r� ����=1�.!=d�;c'el:� �� 1�`R�i:.a=�c,`:�lc'1►�6 �j'����'� ,I►��-'1�13E1�c��� !
- - - _ _. __
___ ------------__.�___._ . �. _..--- — - __.._.::�_ .__ .- --._ ._._..._-•-- ---- --_-----__--____------_._.�___��-----�-
SET BACK � � � FLOOR.�bIS� 1';r.!. .: . ' i ' , , �`_
FfGSlFORMS/STEEL � I �FHA REQ�'�1TS • -
ELECTRIC GROUND � i UNDcFi FLOOR DUCT � �` • .�
GROUND PLUMBING I UNDER FLQOR CU�IDUI7 '
SLAB GRADE FIREPLf,C� Fd�MD'ATfON I �
7EMP POWER I FIREPLACE BOND BEAM
V�JATER SERVICE I MID HT. BOND BEAM �
ROOF SHEATHING O��/�_l ,� 8 FL BONI}6EAM.' •
FRAMING.NENTILIATION FINAL BON�BEAM�
ROOF COVER PAE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING I FINISH GRADING
SH�WERlTUB TEST POOL ELECTRIC
EXT.tATH/SIDING POOL FEPdCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
pFiYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANbSCAPE/IRRIG.
SEEP PIT/L.L. , ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. • FIRE DEPT, FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV, FEES PAID
FINAL PLUMBING ENERGY
�,
I ����-,T�� rt��«��� . ..
� — -- —------- --- �. . :� ,_, ..�..��..,_._......_.__� —
COMMENTS
� ,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
;'�� '
���� -
�
� , . , �
, , ,
------- --�`-_— --_._�