HomeMy WebLinkAbout17662 (42) �� CITY OF DIAMOND BAR �
. � DEPARTMENT OF COIvII�UNtIY&DEVELOPMEN"I'SERVICES
21825 E.Copley Drive
'�`� (909)860-3195 Fax(909)861-3117 PRESS
����� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE 7 � ��r
o ADDRESS}'��.� �ITT � � APPLICATION PERMIT �r p I n�J ,p/C
��L �JL� DATE � � NUMBER `L `�v p
� , ISSUE �� ,�Y1 TYPE OCC
APN LOT TRACT DATE UP��CONST. GROUP
p OWNER
o ADDRES�S ZONING SETBACKS
� C ZI TEL � �j FRONT Ry�l ❑
S APPLICANT TEL. REAR ❑
� SIDFJSIDE STREET RW O
� CONTRACTO � SIDE ❑
� ADDRE�S
o� CI ZIP TEL e����
ARCFVENG/ �
z� DESIGNER NO.DWEL. NO. N ,
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
rn DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADDRiEM
O
p I MEREBY AFFIRM UNDER PENILLTY OF VERIURY TH�T I AM E%EMPT FROM iME CONTMCTORS Lb G0f0p9/CBIpOR
W CENSEUWFOitTHEFOLLOWIN6REASON(SEG7071.SBUSWESSANDGROFE��ONSCODE:ANYCITVOR (A
U COUNTyWHICHREOVIHESAiEM1ITTOGONSTRUCT,ALTERM7F10VE,DEM0U5H2ORREPqIRANYSiRUC- W Pai(OfDBCk
� 1LRE.iR10H TO RS ISSUANCE.ALSO REWIRES TME AP7LICANT fOR SUpI 7E WAii TO iILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISiONS OF THE CONTMCTORS lb �
.� CENSEUWICHAiTERY(CAMMENCIN6WI7HSECTION7000)OFUINSqN90F1HEBUSiNE55AN�PRO. POOVSp2
� iE531DNSC00E)ORTIIATHEORSHEISE%E�PTTHEREFHOMANOTHEBASISFORiHEALLEOEDEXEMP• (�
TqN.ANYVKKATqNOFSECilON7071.6BYANYAPP�ICANTFORAVEflMITSU&lECTSTHEAPVLICANTTO Z Re-Roof
A CML PENALIV OF NOTIAORE TH�H FIYE HUNORED DOLLAFS(SSOo).�:
0 04�30WNEROFTMEPROPERiY,ORMYEMP�0YEE5YnTHWAGE5A57NEIR50lECOMPENSATqN, 0 COmrtlOrClal -
Z WILL 00 THE WORI(/�NO 7HE STRUCTUqE IS NOT INTENDED OR DFFERED FOH SALE(SEC,7W�,BU51- J
� NE55 M!O VROFESSIOHS COOE:THE CONiRACTORS UCENSE LAW DOES NOT AVPLY TO AY OV/NER OF =
VROPERTY WIIOBUILDS OR pAPROVESTHEREIXJ.AND WHO DOES SUCH WORKMiMSELFOR HERSELFOR
� THROUCNHISORHERONTlEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTMENOEDOFi m
QOFFEREDFORSALEIF,HOWEVEi�TMEBUILDINQOFIMPROVEMENTI550LDWRMINONEYEAROFCAMRE-
Z TION,T11E OWNER�BUItDER w�LL HAVE TNE BUROEN OF PRONN6 THAi HE OA SHE DID NO7 BUILD Oq
� p7PflOVEFOATHEPURPO5EOF5ALE}
W OI.ASOWNEHOFTHEPROPEHf1:AMEX0.U5NELVCOMMCTIN�WRFILICENSEDCONTRACT00.4
� TO CONSTIIUCT THE PROJECT(5EC.7oN,BUSINE55 M1D PROFESSiONS COD[:hIE CONTMCTORS 11- ValUB�lOf1 AQI.AREA '
W GENSEUWDOESNOTAPP�YTOANOWNEROFAGROPERTYNTfOBURD50RIMPf7pyE5THEflEON,AND
Z� WNOCONTRACiSFOqSUCHPRp1ECTSWITH�CONTiUCTOR(SjLICENSEDPURSUANTTOMECONTRAC �UANT�TY DESCR�PTION FEE �
� TORSLICENSEUW.j.
D I MI E7(EMPT UNOER SEC. B.�F.0.FOR iH15 REASON Q
� U
�l" DATE OWNfR �
Z W
� LIGENSED CONTRACTORS DECLARATION W
� IHEREBYAFFINMUNOERPENALNOFGEfiA1RYTHAiIAMUGENSEDUNOERGROVISION50FGMnPTER Vr
d Y(COMMENCWOWRHSECTION7000)OFDMSqN70FTMEEUSiNESSANDPROFE55lONSGODE,�ND Z
X MYLICENSEISNFULLFORCE/WDEFFECi. �
o � 7SsJ� �
LICENSE CIASS C��LIC.NO. �
V �DATE h��'�' 'G L t'/!�/�6,/�' ` J
CONTMCTOR�.��+�r
W
� WORKERS'COMPENSATION DECLARATION a
� 1 XEREBYAFiIRM UNDER PENAL7V OF GERlUNY ONE OF iME FOILOWING DECLAMTqNS: Z
� �IHMEANDWILLM��NTNNACERTIFIGTEOFCONSENTTOSELFJNSUREFO(iYK1RKER5' _
� CpAPEN5AT10N,A5PROV1DE0BVSECTIONl7o00FTHEUBORCOOE,FORTHEPERFORMANCE W
Q OFTME WORK FOR WHIp1 TNIS PERMIT IS 155UED. �
_IHAVEANOWILLMAIN�AINWORKEFS'COMPENSATIONINSURANCE.ASHEOUIREDBYSECiION � -`
Q ]7000FTNELA[30RCODE,FORTHEPERFORMANCEOFTHEWORKFORWHIq1TH15CEAMITIS ()
� ISSUED.MY�RKERS�'COaA�IPENSATIONINSURANCEGRRIERANDPOLICYNUM[lERARE: CONSTRUCTION �
> CARfiIER� L�' .� PLANREVIEW
� DOLICYNUIlBER � �i �._'1— ELECTRIC
0 (nisseenorrn�mrareeaada�teooFnf�rn,�rsr�a�i+uar+mooua+sg,oal��ss) PLUMBING
Z I CERTIFYTMAT W TME PERFOMIANCE OF THE WORN fOR WMtCN iH15 PERMiT IS ISSUED.1 MECHANICAI
C7 Sw4lNOiEMPIOVANY7ERSONWANYUANNERSO�STOBECOMESU&IECTTOTHE
vj WpqKERS'CdAPENSATqNUW50FCALIFOPNI/�µDAGREETHATIfI5/qUIDBECOME INSPECTIONFEE
S SUBJECT i0 THE WORKERS'COMPENSAiqN YROVISIONS OF SECTqN 77000FTIIE U90R
CODE.1 SHALL FORMJATN COMPLY WITM TFqSE PRONSqNS. �SSUANCE
� SMIP
p DATE: APPLICANT:
� WARNINO:FA�IUREiOSECUREWORKERS'COA�PENSATqNCOVEMCEISUNUWFUI.AND5HML8E ENERGYP/C
�y SUB.IECTANEMPLOYERTOCNIMINALpENALT�ESAN�GVILFINESUPTOONEHUNDREOTMOU5AN� ENEFiGYPERMIT
DOLLARS(f IOO,Oaa),IN ADDITION TO THE COST OF COMPENSATqN,D.WAGE511S PROVIDED FOR IN
¢ SECfpN37000FTMEUBORCOOE,INTEREST,ANDATfORNEY'SFEES. RC-TENTIONFEE:
OCONSTRUCTION LEN�ING AGENCY PRE-ALT FEE:
� IMEREBYAFFIqMUNDEFVENALTYOFPENUPYTMATTHEREISACONSTRUCTIONIEN�INCACENCY
FOR ME PEAFORAIANCE OF TNE WORK FON WHICH TMIS GfRMIT IS ISSUED(SEC,foY7,pV.C.�. .
Z
W
� LENDEN'S NAME
� LENDERSADDRE55
� TOTAL FEES
� ICERTFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTFIEABOVEWFOHMATIONISCORRECT.
� IAGREETOGOMPIYWITMl1LLGTYMlOCOUNTYOR�INANCES�NDSTATEUWSHEUTINOi08UILDINC �
� CONSTRl1CTION,AN�MEREBYAUT110RREREPFESENTATNESOFTHISCOUNTYTOENTERUPONTNE
Z ABOVE�MENLIONEOi RtYFO INSFECTIONPURPOSES. COMMENTS '
�
�
�
m PEP/AITTEE H.W� 1In / I
� �� I
� SICNATUREOFPERMITTEE DATE I
� RECPT.NO. � PAID BY � VALI�ATION
I
WHITE—Department Copy.YELLOW—Finance Copy,PINK—AssessaCopy,GOLDENFiOD—File Copy,GREEN—Appticant's Copy ,
r _�. .. . , , ,. , „ , , . .. .. , .
, , . :: ,: .., .,.. . .., ,, ,�.,.,ti ..,::� v •.,�-�� ,,�, ,
�!�°P QF DI�rMCT�D tr-s!'nF�
If�'SFCC'i�i01�' rECO�D
�___._ ...,.�.. ___.___� _.� ________ ..-- -��. __._---.�..________. �J �
��i��vC��a�.��CC��i�k ���.�.`F�� �• �'�`S�lr�yE.t�',AN: _ . ',I1��..�"1.��.�-.'���'�:���� ������.... ,I�v.���..1^�6�.��.�1
..._..__..-W...:_._._��_.:_�._�_. � 1 __.....- ...._....�. �__..._r_......__.. .' .
FTGS/FORMSISTEEL - I`^__ FHA REQMTS .._ __ .._.__ .____�_______._:_
SET BACK -- .._- .. FLO�JR JOIST ' � � ;
� • I
ELECTRIC GROUND � U��ER FLOOR DUCT �
GROUND PLU�v1E31NG i UNDER FLOOR CUP,!DUIT
SLAB GRADE FIREPLACE�FOUNDF,TION
TEMP POWER FIREPLACE 60PJD BEAM
V�IATER SERVICE �� P.11D HT. BOND BEAM '
ROOF SHEATHWG Z��y�dZ ' _ 8 FT. BOND BEAh1 —�
FRAMING.NENTILIATION ,,�� ', ` I FINAL�OND 8EAh1
ROOF COVER G,dGll�L_�� � PRE-GRADING �
ROUGH HEAl'ING BENCNItJG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�fUB TEST POOL ELECTRIC
EXT. LATH/SIDING ( POOL FENCING
WALL INSULATION - POOL FINAL
CEILING IN�ULATION OFF SITE IMPS. �__
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK L.A�dDSCAPE/IRRIG. �
SEEP PITlLL. ON 517E I�JIPS.
GAS AIR TEST FINAL ZOfJING
FINAL CONST. , FIRE DEPT.FIP�AL
FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUM6ING ENERGY I
I
_ r)�� � ".'�" c)c�t,._ ._..�.___.., �� —
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U 51ZE
________.__.,
,�p �
i
,y��� `
I
� I � � �
I ,
._- —__--_.___._---_________� ...,�