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HomeMy WebLinkAbout17356 (32) / �\ 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���/�C�iP 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'--� � .