HomeMy WebLinkAbout17956 (33) l...__-
. � _ _. _.
CITY OF DIAMOND BAR �
�y�
-�� DEPARTMENT OF CONIIvfUNITY&DEVELOPMENT SERVICES �
� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
`%�' BUILDINGPERMITAPPLICATION FIRMLY
} JOBSITE 1 G 3 8 �,n�N<<< APPLICATION �� �G�(��ERMR � P/�
o ADDRESS DATE � NUMBER #
$ ISSUE � v?f TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER R:�Fa (��A,vN
AODRESS l b�8 �P��-I�LL ZONING SEfBACKS
z cirr Oi/fwwNL{ 14�v� ZIP TEL.q04 7iLJ-.562R REART RW O
g APPUCANT _N11�I2.+s I S}n+.a,v—C� TEL.'�/?�j-5S7D SIDE/SIDE STREET RW ❑
� CONTRACTOR M ic.{►AiL 'S;in�.vC S _fjI0�=4£�:•D/_�S SIDE O
ADDRES ' � �
c
� CITY ZIP�t7�-`]TEL ���9 L-'.L9-'S D PROPOSED USE A � Y� �-�
w ARCH/ENG/
z DESIGNER NO.DWEL NO. NO.
nw, ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BUILDER DECLAFATION SFR/ADD/REM
O
p I HEREBY AFFIRM UNDER PENALTY OF VEfWNY TMAT I AM E%EMPi FROM TME CON7MCTORS LI• G3�8g0/C21pOR
W CENSEUWFORTMEfOLLOWIN6REASON(SEC.70]1.5BUSINESSANOPROFESSIONSCODE:PNVpTYON (n
U COUNTYVMItliREOUIRESACERMITTOLONSTRUCT.ALTERIMPR0VE,0EM0U91.ORREP�IRANVSTRUC• W PatiolDeck
�LNRE,PH10R TO RS ISSUANCE,AL50 REW IRES TME ADPLICANf FOR SUCH PERMIT TO fILE A SIGNED W
� STATEMENT 7HAT HE OR SHE IS LICENSEO VURSUANT TO THE iROVi510NS OF THE CONTRACTORS L4
.� CENSE lAW(CMAPTER V(COMMENqN6 WITH SECTbN 700D)OF DIVISION J OF TNE BUSINE55 AND PRO- u- PooVSpa
� FESSION500DE)ORh1ATHEOH5HE15E%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP-
V TIDN.IWYVIOLATIONOFSECTION7071.6BYANYMPIICANTFOR�PEHMIT5UB1ECT51NEAPP�ICANTTO Z RaRoot
� ACMIPENALTVOFNOTIAOFETWWFIVEHUNDREDDOlURS(15007.): ,
0 DIASO�NNEROFTHEGROPERT/,ORMYEMPLOVEESWITHWACESASTHEIRSOLEfAM�ENSATION, � COrtIrtIBfClel
Z NALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70H,BUSI• J
NESS AND DROFESSIONS OOOE:TNE COMRACTORS LICENSE UW DOES NOTAPPLY TO M10WNER OF
� VaOPERTVYN�OBU0.DSORIMPROVESTHEREON,ANDwHODOESSUpiWOHNHIMSELFORHERSEIFOR �
[L THROUCHHISORHEROWNFA1ClOVEES,DROVIDfDTHAiSUCMVAPROVEb1ENTSARENOTMENDE00R m
W pFFEREDiORSALEIF,11Uh'EVER711EBULDINCORIIAPROVEMEMISSOLDWITMNONEYEAROFfAA1PlE•
� TIDN.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PRONNO THAT HE OR SHE DIO NOT BURD OR
Z MiRWEFORTMEPURPOSEOFSALE}
= O4�OWNEflOFTHEFROPERTY./ME%CLUSNELYCONTMCi1NGW1iHLICENSEDCONTMCTORS
� TO CONSTRUCT 7HE PH0.IECT(SEC.70N.BUSINESS AND VNOFESSIONS CODE:THE CONTMCtOHS LI� VaNdtlOfl ADJ.AREA
W CENSEUWDOESNOT�7PLYTOANOWNEROFAVROVERTYYR108UM1DSORIMPROVESMEREON.AND
� N'HOCONTMCTSFORSUCMGPWECTSWITHACONTRACTOIi(SjUGENSEDGURSUANTTOiHECONTMG QUANTITY DESCRIPTION FEE
� TO0.5LICENSELAW.).
� O IAM IXEMPT UNOfR SEC. B.l PG FOHTHIS REASON U
� �
LL" OATE OYMER V
W
�¢ LICENSED COHTRACTORS DECLARATION W
CL 1 HEREBYAFFIRM 11NDER PENALiY OF PERNRY THAT IMA LICENSEO UNDER GROVISIONS OF CHAPTEH Vr
d i�CWUENCINd WITH SECTqN 7000)OF DMSION]OF 7ME BUSINESSAND PROFESSIONS CODE,AND Z
X MY LICENSE IS 1N FUIL FORCE/W0 EFFECT. m
11J p ��� �
� LICENSECLASS l�—I L�C.NO. �,)...!G�I�Z �
1---
� on� /2'�1-U2 corrrAacroa NOMtc✓o,GKS a
w
� WORKERS'COMPENSATION DECLAFATION a �
� U
N IHEREBYhFFIRMUNDERiENALTYOFPERJUfn'ONEOFTHEFOIIOWINODECLAM710N5:
� Z
Q
� �IHAYEANDWILLMAINTAINACERTIFICATEOFCONSEMiOSELHNSUREFORVJUtNEfl3' _
Q COMPENSATqN,AS7ROV10EDBY5ECTION77000FTHEV�BORCODE.FONTMEPERWRMANCE �U
OFTME WORK FOR WHIp1TH15 VERMIT LS ISSUED. �
C
�IMAVEMlD1MLLMAIMAINWORKERS'COMPENSA7qNINSUiUNCE,A5RE0UIREDBYSECTION /�t /\�
Q 77ooOF7HELA90aCODE,FORTHEPEHFORMANLEOFTNEWORKFORWHICHTHI9PERMITIS � � �'1 �
ISSUEO.MY WORKER5 COMPENSATION INSUFIANCE CARRIER M1D VOIICY NUMeERME: CONSTHUCTION � v��
jCARRIER PLAN REYIEW
� PoLICYNUMBER ELECTRIC
� (MSSECTICNNEmNOTBECOM'LEfEDOFMPERMT6FOii0NE1MDPED00lUN3lt�W1���1 PLUMBING
Z XICERTIFYTNATNTHEPERFOWAANCEOFTHEWOPXFORWHiQ17H15PERMiTI5155UE0.1 MECHANICAL
(p SHALLNOTEMPLOYANYCERSONINANYMANNERSOASTOBECOMESUBJECTTOiME
� WORKER5C01APENSATiONLAwSOFCALIFORNI0.ANDAGREEiHATIF15110ULDBECOME INSPECTIONFEE
SV&IECTTOTHEWORKERS'COM�ENSATIONPROVi510N50F5ECTiON77o00FTHElABOR �SSUANCE
s CAOE,ISHILLLFORTMM7HCOMPLYYAIMTHOSEP�lOV15lONS. //JJ ` �
pDATE:����'OZ APPLICANT: ��,ll!��i'1�6L=— SMIP • ���
� ENERGY P/C
WARNIN6:FA4URE TO SECURE WORKERS'COA�PENSA7qN COVERAGE IS UNUWFUI.AND SHALL BE
� SUB![CTANEMPIOYERTOCRIMWAL7ENALTIES/WOCMLFWESUPTOONEHl1NORE�i/10U51W� ENERGYPERMIT
OOlURS(S�00.000),MI ADDITION TO THE COST OF COMPENSATION,ONAAOES AS PHONOE�iOR IN �h
� SECTIONJ70lOFMELABORCOOE,W7EREST,ANDATTORNEY'SFEES. RETENTIONFEE: v•
pW., CONSTHUCT�ON LENDING AGENCY PRE•ALT FEE:
O
� IHEREBVAFFIRMUN�ERPENAITYOF7ERJURYTNATTHEREISACONSTRUCTIONLEN01N6AGENCY
FORTHEPERFORMANCEOFTHEWORKFORWMICHiNI50ER1AITI5155UED(SEC.]DGI,CIV.C.). ^ �
� =l 1
� `
LENDERS NA1AE \
� LEN�ER'S�DORE55
� ICERTIFYTNATIHAVERFJATMISAPVLICRTIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES , � � �
W IACREETOCOMPLYWITHALLQTYMlOCOUNTYORDINANCESANOSTATEUWSREUTINGTOBUILDINO
� CONSTRUCiION,ANDHEREBVAUTHOWZERE�RESENTATIVESOFTNISCWNTYTOEt1TERl1DONTHE �Qa-�� �
ZABOVE�MENTIONE�OROPERTVFORINSPECiqNPUFPOSES. COMMENTS
� M�G�VhLC. SiiYtpNG15
� VEflMITTEENAME(P INT)
����r�.w►-v�-,cC� 1r-29—oz
� SIGNA7UREOFVERMITTEE D�1E
RECPT.NO. PAID BY VALI�ATION
� WHITE—DeDartment Copy.YELLOW—Finance Copy,PINK—Assessa Copy,G LDENRQD—File Copy,GREEN—Applicant's Copy
..v- .,, , �� , :"�:;'..< .. _ _ -.t-.. . ��u;.r,..'�� , .. ..,at..-a+', .�.. . . ..;�,Ya,� _� ..< .m;,;n,, . .. �a��:7�.v�r�;.r;��.� .. ., . _ . ,�,a�. . , c-.- , �. .: . . ..
CITI' Q�= L�iA(JI�t��D '�l�,f3
il'�l��EC';TOi� RECOF��
k`�' - ,a► . A�'�r_�_ ,.I I►�-� -....._�,�..�._..._._..,. �'���:i „� j� -------- , ,I r�:� — ,.._,
�li� - .-a"'c.��C� �i E w '� .��.c , � � .� -�c C.[� ►9 !s) `�t'�:. ► ;7���'dol��'
_�:-"-------._ ...__ _ ... __.,.__.. ._. ..___ _..._.____ ._�____�___-_.�_�____.___.__
5ET BACK � � � FLOOR JOIST �i �--v________.__.W�W
FrGS/FORMS'STEEL,���pz�—s,�� ' _ i FHA REQ�f1TS �
ELECTRIC GROUND / � � UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CU�IOUIT ,
SLAB GRADE I FIREPLACE FOUNDATION i
TEMP POWER I � FIREPLACE BOND E3EAM
LVATER SEAVICE � � MID HT. EOND SEAh1
ROOF SHEATHING ��" ' s FT. BOND BEnr� I
FRAMI�dG.NENTILIATION(li��dZ FINAL BOND BEAM i
ROOF COVER I ~ PRE-GRF,DING
ROUGH HEl,TING BENCHING
ROUGH ELEGTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST ; POOL ELECTRIC
EXT. LATHlSIDING � I POOL FENCING
WALL INSULATIOiJ i POOL FINAL i
CEILING INSULATION j �FF SITE IMPS.
DRYWALL NAILING � ` DEDICATIOfJS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IFRIG.
SEEP PIT/LL ' ON SITE IP�1P5.
GAS AIR TEST FINAL Z�NING
FINAL CONST. 'Z I . F!RE DEPT. FINA!
FINAL HEATING � � � HEALTH DEPT. FINAL
FINAL ELECTRIC � j DEV. FEES PAID
FINAL PLUP�1E31NG � ENERGY �
e)= �r' c�.-� +�Ci i��
__,_�._.�__..___��:=::.:__._, _._...
� cor,nr,nEN-rs -- - -- . _ ________ . ----- -
SEPTIC TANK SIZE
SEEP PIT/U SIZE
`�� -
;
�,w��� —
� , 1 . _