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HomeMy WebLinkAbout16932 (35) CITY OF DIAMOND BAR ��� � DEPARTMENT OF COIvA�fUN1TY&DEVELOPMENT SERVICES E X P I R E D 21825 E.Copley Drive '" (909)860-3195Fax(909)861-3117 ,1UN 19 ?�02 PRESS �`-.� BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE 13f5 s� Le�D� DATECATION Q'13'�I NUMBER���C ADDRESS v c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER Q, Q Y/C-�� ADDRE�S ZONING SETBACKS Z CITY . ZIP TE59 7 FRONT RW ❑ g APPLICANT TEL. SID SIDE STREET RW ❑ � CONTRACT SIDE ❑ � ADDRESS , PROPOSED USE � CITY C_.�GU� ZIP TEL. w ARCWENG/ d� DESIGNER AD�RESS NO.DWEL. NO. NO. � CITY ZIP TEL UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFRlADDlREM O p 1 HEREBY AFFIRM UNDER PENALTY DF PEiWHY THAT I AM E%EMPT FPOM TME CONiMCTORS l4 GaragelCarport W CENSEUWFOHTHEFOLLOWINGREASON(SEC.7071.6BUSINESSANDiROFESSIONSLODEANYCITYOH (n U COUNTYWHItlIREOUiRESAPERMrt7000N5TRUCT,ALTER.IMPROVE.DElAOL15H2OFREPAIRANYSTRUG W P0ti0lDeCk � TURE.PRIOR TO ITS i55UANCE.ALSO REOUWES T11E h7VL�LAN1 FOR SUCH PERMIT TO FIIE A SIGNED w STATEMENT THAT HE OR 6HE IS LICEN5E0 PURSUANT TO TME iROVISiONS OF TME CON7PACTORS ll• � GENSE UW(CNAPTER i�COMMENCINC V11TH SECTqN 7000)OF DNISION 7 OF THE BUSMESS MlD OHO� � PooVSpa FESSIONSCODEIORTHATHEORSNEISEXEMPTTNEHEFROMANDTH[BASISFOATHEALLECEDEXEMP- TION.M1YVqU7qNOf5ECT10N7o77SBYANYAPPLICANTFOR�iERMITSUeJECT57HEAPPLICMfTTO Z Re-Root � ACNILPENRLTYOFNOTMORETXANFNEMUNDREDDOLURS(SSaO)J: � OI���ENOFTHEPROPERiY.OR1AYEMPLOYEESMlIiHWAGE5A5TFIEIflSOIECOMPENSATqN, 0 COrtIrtlBftl81 � Z MIILL DO THE WORN.!WD THE STRUCTURE t5 NOT INTENDED OR OFFEHED FOR SALE(SEC.70N,BUSI• J NE55 AND DROFESSIONS COOE:THE CONTMCTOHS LICENSE UW DOES NOTAPPLY TO AN OWNER OF � VROPER7YVJNODURD50RIMPROVESTHEREON,AN�WHODOESSUCHWORKHIMSELFORHERSELFOH = Q TNROUGHHISORHEROWNEMOLOVEES,GROVIDEDTMATSUd1147ROVEYENTSARENOTIMENOEDOR m 0 OFFER[OFORS11EtF,HOVPEVERIMEBUILD�NCORIMCROVEIAENTISSOLDIMTNMONEYEAROFCOAIPLE• Z TION,THE OYINER-BU�IDER WILL HAVE THE BVFDEN OF pROVWO T141T ME OR SME D�D NOT BURD OR � MGROVEFORTMEPUHPOSEOFSALE} W ❑4�OWNEflOFTHEPRDPEfiTY,AMIXCLUSIVELYCAMMCTW6WITHLICENSEDCOhfTMCTOflS [L TO CONSTFUCT THE VHOJECT(SEG 70M.BUSINE55 AND PROFESSIONS CODE:TME OONTMCTORS LI- VdIU01iC(1 ADJ.AREA 11J CENSEUWDOESNOTMPLYTO/U10WNEROFAPRO�ERTVWMDBUILDSORIMPROVESh1EREON.AND � W/qCONTMGTSFORSUCHCNQIECTSWITNACANTMCTOF(5)UCENSEDPURSUFNT70TMECONTRAG OUANTITY DESCRIPTION FEE � TORS LICENSE UW). 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B.t V.C.FORTHIS REASON U � � LL OATE OWNER ~ W � LICENSED CONTRACTORS DECLARATION w � I HERE9YAFiIRM UNDER PENALttOF VEiLM11RY THAT IAM LICENSEO UN�ER VROVISIONS OF CFUPTER � p„ Y(CqAIAENCIN6 NrtTH SECTqN 7000)OF DMSION]OF THE BUSINESSAND PROFESSIONS CODE,AND 2 X IAY UCENSE IS N ML RCE D EFiECL m lll � �c� 59�a�� 0 LICENSE SS _LIC.NO. � F- � V OATE � �J lJ I CONTRACTOF7 • I a W � WORKERS'COMPENSATION DECLARATION 4 � U � IHEFiEBVPFFIRMUNDERPENlLLTYOFPERNH`/ONEOFTMEFOLIAMAN6DECURAT10N5: Z 6 � �IHAYEANDWILLMNNTAMACERTIFICATEOFfANSEMTOSEIF-INSUREFORWORKER9' $ � COMPENSATqN,ASGROVIDEDBYSECTION77000FTMEU80RCO0E,FORTHEGEHFORMANCE �U `� OF THE WORK FORNMIp/TH15 PEHMIT IS ISSUED. � O� Y_INAVEMIDVALL6WMAINWORKERS'COMPENSATIONINSURANCE,IISFEOVIREDBVSECTqN 97000FiHELABORLODE,FORTHEPERFORMANCEOFTHEWORKFORYYHIp1TMISPERMITIS � ISSUE�.MYWORK�q5�P S��CMHiERANDPOLICYNUMBERARE: CONSTRUCTION 11/1 � CARRiEB T I/�J PLAN REVIEW � POIICYNUMBEH ELECTRIC J � �nusecrnr+r+emr+oteear.�ooFne�aMrraFona�w�a�no�u�sK��a+��ssl PLUMBING z ICERTIFVTHATNTMEPERFORMANCEOFTMEWONCFOHNT1Ip1TMI5PERMtTI5155UED,1 MECHANICAL (,�} SNALLNOT EMPLOYANV PERSCN IN ANY MANNER SOAS TO BE�E SUBJECT TO iME � WORKERSCAMPENSATIONUWSOFCALIFORM0.�ND�GREETHATIFISHOULDBECOME INSPECTIONFEE S SV&JECTTOTHEWORKERS'C06�vEN5ATl0 V VISiONSOFSECTKKJ�70oOFTHEUBOR ^� -.— . v� 2ISH FOIRTHWITICOMPlYWI7H PPOVIS S. ISSUANCE —I "� �'� � � � .J oI SMIP J 1':. �"^.y I _ p DATE: APPLICANT: - � ENERGY P/C WARNIN6:FALURE TO SECURE VIORKERS'COMPENS�TqN COVERAGE IS UNUWFUL AND 6HALL BE �y SUFfJECTANFMPLOYERTOCRIMWALPENALTIESANOCM�FWESUPTOONEHUNOREDTMOUSAND ENERGYPERMIT DOLURS(SIOO.00D),IN ADOIiION TO TME COST OF COMPENSATION,DAMAGES AS PROVIOED FOfi IN ¢ 6ECTqN710eOFiHELABORCOOE,INTEREST,I�NOATfORNEY5FEES. RETENTIONFEE' a CONSTRUCTION LENDINGAGENCY PREALT FEE: `�V• — - —---r----.. � IH[REBVKFIqAIUNDfRPENALTYOF0E0.1URYTMATTNEREtSACON5TRl1CT10NlENDINGAGENCY n- FOR iHE PERFORMNJCE OF THE WORN FOR WHICl17NIS FEPAIIT IS ISSUED(SEG]OY7.CIV.G). � � LENDER'S NAME � IENDER'SAD�FE55 ///� �� � ICERTIF/THA71HAVEREAOTHiSAPOLICA7qNANOSTATE7HATiHEABOVEINFORMATqNISCORRECT. TOTAL FEES ////n� W IAGREETOCOIAPLVWITHALLCITYMlOCOUMVORDINANCESANDSTATEUN5REU7WGTOBU0.0�N6 lY«'� � CONSTRUCTION,ANDHEREBYAUTHOWZEREPRESENTATIVESOFTHISCOUNfYiOENTERUPONTME ZABOVE� .NTqNEOPROPERTYFORINSPECTION arosEs. COMMENTS � .�e� _ � PEflMITTE (PHIHT) � O' Q N y SIGNATUREOFPEWai7TEE D�7E RECPT.h0. PAI�BY VALIDATION � � WHITE—DepaRmenl Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,GREEN—Applicant's Copy ., -. �.. �. U ,. � . , �. . , . • � ... . . _��,...?:p...CrC.,...��:-;�;:t':.r�":+�.q n�l,y.qr-� .-. _ -,.v.,.- . � -� .- ... .. ..i-y�.>�� , - � �iT�� o� ���,rti�or�� �ra�; ii�3Sf�t=C"i iOf� RECQ�i�f3 . _+ __ ---� -- - ......_ _-I: _..�. -- -; - - _. 'I�k-'��a��,�fC�11�S �j��'C�=. �i��-�C4=��--�� ..__�-__.____ ii `i:��r` (ua►�� �1,�4 ' ��E- .����;'�' j _, . �. � , . '��El C ol ,__.Y_--.____=----_____ . . .. :--- __-----�_._ __. __ -. . :�-. . I . " ,- �. -� '� _ ....__.____... --.-------.-,----.---- --_-_ __.�_._.____.�.__._.._._....____.._.___ SET BACK � ' � � FLQOR JOIST � FTGS!FORP�IS/STEEL �� FHA REQPATS I ELECTRIC GROUND I I UNDER FLOOR DUCT � GROUND PLUMBING � i UNDER FLOOR CU`,IDUIT SLAB GRADE I FIREPLACE FOUNDATION TEMP POWER � I FIREPLACE BOPdD BEAh1 WATER SERVICE MID HT. �OND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF C�VER PRE-GRADING I ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING i FINISH GRADING SHOb'VER/TUB TEST � � � POOL ELECTRIC EXT.LATH/SIDING }� POOL FENCING � NJALL IPJSULATION POOL FINAL CEILING IN�ULATION OFF SITE IMPS. QRYWALL NAILING DEDICATIONS SEWER � FINAL ENG. SEPTICTANK LANDSCAPE/IRRIG. � SEEP PITlL.L. OfJ SITE IP.�PS. GAS AIR TEST FINAL ZaNING FINAL CONST. �tRE DEPT. FINA! FIfJAL HEATING HEALTH DEPT. FINAL FIPJAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY � ��:a�r3' t���a:�(F{d � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE � R�� i r��� _, � , , _,, i , � � � � '