HomeMy WebLinkAbout17356 /
�\ CITY OF DIAMOND BAR EXP I R E D
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drivc J U PI 17 2002 pR ESS
(909)860-3195 Fax(909)861-3117
�`%� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE /�-- y APPLICATION PERMIT 7 i� P/C
o ADDRESS /�7�Q ����/(J���/�I�Q DATE �/�-O�D� NUMBEFi.�_2J� N
$ issue nrPe occ
APN LOT TRA T DATE CONST. GROUP
a OWNER w
"" ADDR SS ZONING SEiBACKS
Z CITY � ZIP L. — FRONT RW ❑
g APPLICANT TEL. REAR O
� SIDE/SIDE STREET RW O
� CONTRACT R
� � o � SIDE ❑
� ADDRESS PROPOSED USE �✓� �
o CITY ZI �f� EL_C��rC �
w ARCHlENG/ �� d
� DESIGNER
n. ADDRESS NO.DWEL. NO. NO.
� CITY ZIP TEL UNITS STORIES BEDROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFi1RM UNDER iENALiY OF VEfUURY 7HA71 MI E%EMPT FROM TME CONiMCTORS�4 Garage/Carport
W CENSEUWiORTNEFOILOWIN6REASON(SEC.70.71.SBUSWESSIJIDVROFESSIONSCODE:ANVCfiYOR (n
� COUNTYWHICHNEOl1iRESAPERMITTOCON57AUCT.ALTE1lMCROVE.DEMOLISH.ORREPAIRANYSTRUG W P8�i0/DBCk
� TURE,ORbR TO RS ISSUANCE AL50 REOUIPES T11E AVDLIGN7 FOR SU01 PERMIT TO FILE A SIGNED W
STATEMEM THAT HE OR SHE IS LICENSED VUFSUANT TO T11E OROVISIONS OF THE CONTRACTORS L4
� CENSE UW(qUPTEq Y(��MENCW6 VATH SECTION 7000)OF OIVISION�OF TNE BUSINESS NJO PRO- LL' POOUSpfl
fESS10N3 CODE)Ofl THAT ME OR SME IS EXEMPT 7HEREFROM AND THE BASIS FOR T1E ALLECED EXEMP-
TION.ANYVIOLATqNOFSEGTION70.71.4BYM7YAPPLICANTFORAPERMRSUBJECTSTHEAFPLICANTTO Z Re-Roo1
A GML VEN�LiYOF NOT MORE TMAN iIVE MINDRED DOLURS�f5oo).�:
� 04ASOWNEROFTHEPROPERTY.ORIAVEMPLOYEESWITHWAGESASTHEIRSOIECOMPEN5A710N, � COrtIrtl0fCl01
MALL00 THE WORK AN�THE STRUCTURE�S NOT INTENDED OR OFFERED FOR SALE ISEC.7M�,BU51• J
� NESS AND VROFESSIONS COOE:THE CONTMC70R5 LICENSE UW DOES NOT APPIV TO AN OWNER OF ?
VROPEHTY VAq BURDS OR IMPROVES iHEREON.I�NO W!q DOES Sl1CH WORK HIMSELF OR MERSELF OR
� THi10UCHHISORHERONMEIADLOVEES,VROV10E0THATSULHIIAPROVEIAENTSARENOTMEN�E00R CD
0 OFFERE�COR6ALEIF,HOWEVERiMEBUILOW60RIMPROVElAEN71S50LDVAMINONEYEAROFCOMOLE-
Z TqN,TNE OWNEH�BUIIDER WILL HAVE ME BURDEN OF GROVw6 THAT HE 00.SHE DID NOT BVItD OR
� IMPROVE FORTIE PURPOSE OF SME�.
❑4�OWNER OF TME PROPERT/,AM E7(CLUSIVEIY CONTMCT WO WIh1 LICENSED COMMCTORS
� TO CONSTRUCT TME PROJECT(SEG 70N,BUSINE55 AND VROFESSIONS COOE TiE CONTMLTORS U- V8IU0U0� ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEFOFAPROVEHT'M7�OBUM1DSORIMPROVESTXEREON,AND
� WIqCONTMCTSFORSUCHPR0.IECTSWITHACANTRACTOR�S)LICENSEDVURSUANTTO7HECON7MG OUANTITY DESCRIPTION FEE
Y TORS LIGENSE UW.). "
¢ OIAAlIXEMPTUNDERSEC. � B.aPC.FORTNtSREA50N U
�
S
-'�="' DATE - - OWNER V
� UCENSED CONTRACTORS DECLARATION W
� IHEAEBYAFFIRMUNDENPEN�4TYOfpE0.1UNYTHAT1AA1lICENSEDUNDENVRONSIOHSOFCHAGTER �
d o(OOAIUENCWaWITHSECTION�000)OFDIVISION70FTMEBUSINESSANDVROFESSIONSCOOE.AND Z
i; Yv IICENSE i5 IN FLII iORCE MID EFF CT. m
� UCENSE CUSS �� UC.NO. ��O/ � J
V DATE ^ �0 CONTRACTOR d
W
� WORKERS'COMPENSAT�ON DEGLARATION ¢
= U
� IHEREBYAFFIRAIUN�ERPENALTYOFPEiWRYONEOFTHEFOLLOWWGOECUMTIONS:
� Q
� �IHAVE/NDIMLLMAMTAINACERTIfICATEOFOJNSENTNSELFdNSUREFORV/ORKERS' _
COMPENSATqN,ASVRONDEDBY5ECT10NJ7000F7HELABWiCWE.FORTHEPEFFORMANCE U
� OFTNEWDRI(FOpNM�CMIM�SVEi1MITISIS5UE0. �
�
W _IHAVEANDWILLNAINTAINWORKERS'COMPENSATIONINSUMNCE.ASREWIREDBVSECTqN /�
Q i7oo OF TME U�BOR OOOE,FOR TNE PERFORMANCE OF TME WORK FOfl WHIpiTH15 GERMIT IS �" I ��
ISSUE�.MYNK7RKER5'COAIPENASATpNINSURANCECARRIERAN�DJPO�IICYNUM9ERME: CONSTRUCTION
� CAARIER S7�/T'TY ��-(h!/� PLAN REVIEW
� POLICV NUMBER---,���-.'���C—l=p,� ELECTRIC
� (MSSECi1CNNEmN0T8E00h�LETmOFhEPERMT6Fqi0NEFA1Wf7EDDOt1I1�R��J��`? PLUMBING
Z 1 CERTILV THAT IN THE PERFORMANCE OF THE WORK FOR WHlpi 7HI5 PEFMIT IS ISSUEO,I MECFIANICAL - "�T •` —'�
C7 SHALLNOTEMPLOYANVPERSONWANYMANNERSOASTOBECOMESUBJECTTOTNE "'`/r'""".� '..,..�
� 1MORKERS'C011PENSATqNUW50FCALIFORNIAI�NDAGHEETNATIF15HWLDBECOME INSPECTIONFEE -
S SUBJEMTOTHE�MORKERS'COAIPENSATbNiROV1510N50FSECTIDN77000FiHELABOR t, J
CODE,ISf1ALLFOFiTNATHCOMPIYWIiHTFqSEPROVI5KKJ5. ISSUIWCE _`�/11�_��f ��T_ 1
O a�v V ar ,
`p OATE:��APRICANT. � SMIP
� ENERGY P/C � �1
WARNiNO:FAILURETO SEQIRE WORKERSCOMGENSATION COVERAGE IS UN(AWFUI.AND SHALLBE
�y SUBJECTANEMPLOYERTOCliIMWAIiENALTIESANDCMLFWESUPTOONEHUNOR[OTMOUSAND ENERGYPERMIT ,��
OOILA/iS(f t o0,000).N/�DOtT10N TO THE C0.5T OF C0IAPENSATION,OMAACES ll5 PROVIOED FOR IN -- l
� SECTqN]TOeOFiY1ELA80RCODE.NTEREST,ANDATTORN[YSFEES. RETENTIONFEE: �J '^ ' �J
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBVAFiIPAI UNDER CENALiV OF PE0.IUPV THAT THERE IS A CONSTRUCTION IENDIN4 AGENCY
�- FOR TME PERFORMANCE OF THE WORK iOR WHldl TMIS PERIJIT IS LSSUEO(SEC.J097,GV.C.�
Z
W
� LENDE7SNAME
� LENOER'SADDRE55 /�
Q , /�
ICERTIFYiMATIHAVEREADTNISAPPIICATIONIWDSTATETHAiTHEABOVEINfOfiMAT10NISCORRECT. TOTAL FEES � J+ ��
W IACREET000IAPLYWITNALLCITVANOCWNTYORDWANCESAN�STATELAWSREUTMGTOBUILDINC V
� CONSTRVCTION,ANONEREBVAUTHORI2ERE�RESENTATNESOFTHISCOUNTVTOENTERUPONTHE
ZABOVE�MENTbNED PROPEFTY FOR INSPECTqN PURVOSES. COMMENTS
0 � � r
_ � e �
� PE E N (iRiNn
� ���� �-?c� �l—06— p/
� S�GNA E FPE ITTEE OA7E ✓
� RECPT.NO. PAID BY � VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanTs Copy
`�:��1�; 1s,�c.b'.r;. :v; � ;ri,. , ,, .. �r �.�, ,r��. ., � . �� r . .-. , � � . .',7,� ..rr�� ..��._.. � . . . . ,.� . w .. ,� ' � �(' . •S:'ni....� .-. ,.�a. . . . .
rvl i'�' Qi= �I.G'.i'JrflR':D B/r�R
I��ES�=LC�IQi� �ECGR�
� I►�'Y'�"'.'�4�C .Ji� _}..�.1� I�F'9�_.E`:'F'�i.------- ---- �=�c;'�'C�7�Q.�F ,� --..� _ _ _ . .. ...
� „ _,s c � �E•� ��- : + ,� ��I��E�= � � ��:��'=: il��-�:�:c'a��-� '
,, .
�_""""_._......._'_""'" ""�'_."_.,. . . ' "" '__.._..._.._ .._.. . :.......... . _ . 1�" . ..__"�'—""_""'_ '_.�. ..._,._.._.__.��....��.�..�.... �
SE7 BACK ; • . � FLOOR J�IST ..�_ _.____..__... � _I
FTGS/FORMS/STEEL A ' FHA REQMTS
ELECTRIC GROUN� UNDER FLQOR DUCT �
GROUND PLUN1BItJG Ut��DER FLOOR.CU�IDUIT
SLAB GRADE FIREPL�CE F�UtJDATION i
TEMP POWER I FIREPLACE BOND BEAM I
WATER SERVICE _ _� _ MID HT. �OND BEAM �
ROOF SHEATHlNG /�/��o! �Q. �� 8 FL 60ND BE/',M _
FRAMINGNENTILIATION I , FINAL BOND BEAM
ROOF COVEFi PRE-GRADING
ROUGH HEATING BENCHItJG
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMEING � FINISH GRADING
SHOWER/TUB TEST ' POOL ELECTRIC
EXT.LATH/SI�ING � POQL FENCING
WALL INSULA�I�N POOL FINAL
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATI�NS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE I�JIPS.
GAS AIR TEST ( FINAL ZQNING
FINAL CONST. � �IRE DEPT. FINA.!
FINAL HEATING + HEALTH DEPT. FINAL
F1NAL ELECTRIC � � DEV. FEES PAID
FINAL PLUMBING � � � ENERGY
�
I �
c: -�-��,:•�,,�r;..�_
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
_��`.�.��
,��� --
, . ,. �
� ' , � .
___W'--� � .