HomeMy WebLinkAbout17515 (33) �� C1TY OF DIAMOND BAR
"J�, EXPIRED
� i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES JU N 1910Q2
21825 E.Copley Drive
(909)860-3195 Fax(909)861•3117 PRESS
���o�� BUILDINGPERMITAPPLICATION FIRMLY
¢ ADDRESS , b QL(J E✓� /� APPLICATION I �1 .'yI PERMIT`� 1 P/C
c OATE }� (� NUMBER1 I 1 #
$ ISSUE NPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
� ADDRESS 20NING SETBACKS �
0
z CITY 21P TEL FRONT RW ❑ .
g APPLICANT TEL. SID�IDESTREET RW ❑
� CONTRACTOR n SIDE p
� ADDRES pROPOSED USE / �
o� CITY ✓1 ZIP��TE /�d � �
ARCH/ENG/
z� OESICaNER_ NO.DWEL. NO. NO.
n. ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
v� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADDlREM
O
1 HEREBV AFFIRM UNDER GENAITY OF VERrilRY THAT I AM E%EYPT FROM TNE CONTMCTORS LI• G8f8g0/Cd�pOR
W GENSEUWFORTHEFOLLOWINf3REASON(SEC.7W1.66USINESSANDVROFESSIONSCOOE:ANYGIiYOR (n
V COUNTYWHICNFEOUIRESAPERMITTOCONS7RUCLQTERudPROVE,0EM0U5H2ORREPARANYSTRUC• W PaIiO/pBCk
� NRE.PRIOR TO(f5�SSUANCE ILSO REOUIRES THE AV7lICANT FOR SUCH PERMiT TO FILE A SIGNED w
� STATEMEM THAT HE Ofl SHE IS UCENSED VURSUANT TO THE PROVISIONS OF TNE CON7fuCTORS U•
CENSE UW�dUiTER a(C041AENCWO N7711 SECTION 7o0a)OF DIVISiON]OF T11E BUSINESS AND CRO• V' PooUSpa
� FESSIONSCOOE)ORiHATHEORSHEISExEUPTTNEREfROMANDTIIEBASISFORTHEALLECEDEXEMP- C7
TION.ANVVIOLAiIONOFSECTION70]1.6BYANYAPVUCANTFORAPERMITSUBJECTSiHEAPVUGWTTO Z Re•Roo1
A GVIL VENALTY OF NOT MORE THAN FNE INNORED DOlURS�f50o)):
0 OI��WNEROFTHEGROPERTY,ORMYEMPLOYEESWITNWAGE5A5THEIRSOLEGOMPENSATION, � CORITBtCIaI
Z WILL DO ME WORK,AND TNE S7NUCTURE IS NOT IMENDE�OR OFFEREO FOR SALE�SEC.7a11.BUSI• J
� NESS AND VROFESSIONS CODE:THE CONTMCTOPS LICENSE UW DDES NOi APPLY TO AN OWNER OF ?
PROPEHTY W/IO BULDS OR IMPROVES TNEHEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTMROUGHHISORHEROWNEAIPLOYEES,VHOVIDEDIHATSUCHIMVROVEMENTS�RENOTIMENDEDOR m
� OFFERmiORSALE1F,IqWEVERiNEBU1LDINGORIMPROVEMEN!ISSOLDWITHINONEYEAROFC0IAPLE-
Z TION.THE OMTIER�BUILDER WILL HAVE 7HE BURDEN OF iROVIN6 THAi NE OR SHE DIO NOT BUILD pR
� MPROVEFOqTHEFURV65EOF5AlE}
w OI,ASDWNEROFTMEPROPERTY,AMEXCLUSNELYCONTMCTIN(SWRIILICENSEUCONTMCTORS
[= TO CONSTFiUCT TME PROJECT(SEC.7D1�,BUSME55 ANO PfiOFESSION3 CODE:THE CONTf1�CTORS U- valU0I10f1 ADJ.AREA
W CENSEUWDOESNOTMPLYTOANOVYNEROFAPR07ERiYWHOBU1LD50RMPROYESMEREON,MlO
� N?qCONTMLT5FOR5UpIPROJECTSW17M�CONTMCTOR�S�LICENSEDVURSUANTTOTMEGONTMG QUANTITY DESCRIPTION �E
Y TORS LICENSE UW.).
0 O IAM EXEMPT UNDER SEC. B.i P.G FOP THIS REASON Q
+� U
� DATE OWNER �
� W
� UCENSED CONTRACTORS DECLARATION w
� IIIEREBYAFFlRMUNDERGENAITYOFGERNRYTMATIAMUCENSEDUNOERPROVIS10N50FCHAP7ER Vr
p. f(COMMENCINOWITMSECTION7000)DFDIVISION70FTHEBUSINESSANDVROFESSIONSCODE,AND Z
� UCENSE C�55 `j{/�D EFFECT. ��^u� �
!�' m
� LIC.NO. �
V OATE � CONTRACTOR 6J.
W
� WORKERS'COMPENSATION DECLARATIO a
NI HEREBYAFFlRM UNDER PENALTY OF DE0.IURY ONE OF THE FOLLOWINO DECURATIONS: Z
� IHAVEANDWILLMAINiAINACERTIFICATEOFCON3ENTTOSELF•INSUREFORWWU(ERS' ¢
CAy PENS�TpN,ASPROVIDE�BYSECTION77000FTMELABONCODE,FOHTHEVERFORAIANCE W
O OFiMEWORKFORNTIICHTHISPERMITI5155UED. �
_ /
� ��� IHAVEANDWILLMAIMAINWORKERS'COMPENSATqNINSUNANCE,ASREWIREDBVSECTqN , +/ S,
Q ]700 OFTNE LABOR CODE FORTHE PE ORA1 E OFTHE WORN FOR WHIdi7H15 PERMIT IS ( _ 1 ��J
J ISSUED.MYWO 5' PENS�Tp I SUM ECARRIERANOPOLICYNUMBERARE: CONSTRUCTION tD-�.
j CAARIER PLAN REVIEW
0 POLICYNUMBER
� ELECTRIC
0 (IfaSSEGTONNEFDNOTBEO�MftETmOFTVEPER1AR6iOROhEFUPDREDDp1MSR��)0�1LESSl PLUMBING
Z I CERTFY THAT INTME VERFOFUANCE OF iHE WORK FON WHICMTHIS PERMIT 15155UE0,1 MECHANICAL
U' SHALINOiEMPLOYANYPER50NNANYM/NNER50A5TOBECOMESU&IECTTOTHE
(n WORKERS'COMPENSATION UWS OF CAIIFORNII�AND 11GR THAT IF I SHOUID BECOME INSPECTION FEE
S SUBJECTTOTHEWORKERS'COMPENSATIONPROVIS NS SECTION]7oo0FTHEUBOR
COD S OfiTMMTHCOMPLVWITNTFIDSEPR I 5. ISSUANCE
�
� SMIP r �
p DATE: APPLICANT.
W ENERGY P!C
� WARNIN6;FA4URETOSECUREW'ORKERS'COMPENS�T HAGEISUNUWFUL,ANDSHALLBE
�y, SU8IECTANEMPIOYERTOCRIAIWALVENALTIESANOCML N SUPTOONEHUNOREDiHOUSAN� ENERGYPERMIT
DOLURS(SIaD,00o).WAOOITIONTOTHECOSTOFCOMPEN .DAMACESASPROVIOEDFOR�N
� SECTION3)0lOFTIELABORCODE,W7ERESi,ANDATTORN saccs. RETENTIONFEE:
oCONSTRUCTION LENDINGAGENCY PRE•ALT FEE:
� IHEREBVAFFIRIAUNOERPENALTYOFPERAIRYTHATTHEREISACONSTFlUCTIONLENOINOAGENCY
Z FOR iHE PERFOiiMANCE OF 7NE WORK FOR N711p/TMIS PERAl1TIS ISSUEO(SEC.70Y7,CN.G).
W
� IENOER'SNAME
F- LENOEiYSADORE55
� \
ICERTIFVTMATIHAVEREADTHISAPFLICATIONANOSTATETW�TTIE�BOVEWFORMATIONISCORHECL TOTAL FEES � J�
W IAGREE TO CpAPLY WIT L CIiV M10 COUNTY OR�INANCES AND STA7E UWS HEUTINO TO BUILDIN6 1
d
� CONSTRUCTION, BYAUT110H2EREPPESENTATNESOFTHISCOUNTYTOENTERIIPoNTXE
Z ABOVEJAEMIONE 'RT/FORINSPECTIONGUPPOSES. COMMENTS
�
J
�
¢ PER1AiTTEEN �FiLHn ��
�
(n SIGNATURE HMiTTE DATE -'�
� RECPT.�O. PAID BY � VALIDATION
WHITE—DepaRment Copy,YELLOW—Finance Capy,PINK—Assessw Copy,GOIAENROD—File Copy.GREEN—Applicanl's opy
. . 1 S;:w: .�.p ..., ... . � a ,..v . ��� .i..� , . . � , . �;, ..�..>�,. '�, . - tie.... .. . .� �•7.. ... .i�. �.,�'�.'. ,�.r• �. :1: .,�. . � .. .. ,
ci��� a� ��r�r�►oz�c� ��r�
IP�lSPEC�"I(3P�J RECGF�D
1���:�=?E;'�C���� '����r� __ (�yk-'�.l�f'�G��a�+..� l��!-7:�=��:['1�1►�f �Y�E¢'= :1►r�-�;�=+���'aJ��
._ � . .
-_-------------- -- ------- _ _ . _
__.._ �_.__.------_____. --�------.-------__.___-t--------.---._.____ ..�. ..____.._____.�----_ _._-
5ET BACK j �_ � � FLOOR JO1ST � �
FTGSIFORP�IS/STEEL _�� FHA REOM1.ITS
ELECTRIC GROUND � UNDER FLOOR DUCT �
GROUND PLUMBING UNDER FLOOR CU�IDUIT � �
SLAB GRADE FIREPLACE FOUNDATION i
TEMP POWER � FIREPLACE B�ND BEAh1
WAl'ER SEAVICE � MID HT. �OND BEAM
ROOF SHEATHING L?T'�'% �� ' � II FT. BOND BEAM
FRAMINGNENTILIATION � FINAL BONb BEAM
ROOF COVER � PRE-GRADING (
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING � � FI�JISH GRADING
SHOWERlTUB TEST j POOL ELECTRIC
EXT. LATH!SIDING � POOL FENCING ;
WALL INSULATION POOL FINAL I
CEIUNG INBULATIO�d � OFF SITE IMPS. �
DRYWALL P�AILIP�G � DEDICATIOfJS �
SEWER FINAL ENG. I
SEPTIC TANK LANDSGAPEIIRRIG. �
SEEP PITIL.L. OfJ SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAt CONST. � � �IRE OEPT. FIPJAL
PINAL HEATING � HEALTH DEPT. FIP�JAL
F1NAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
..�.__„�... _..
`'Jc_:?�� r,'�".:.ri¢._�..._...._____.._.___:
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U 51ZE
I��� I
,►�►� -
� �.� .
, . , .
� ; ' � -_