HomeMy WebLinkAbout17725 (37) ._ . ..- " . _ _J-- . . ..._ .. . __ . . . . ._. . � _
�\ CTTY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY 8c DEVELOP1v�NT SERVICES �
N� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 Pf;E$$
"-�� BUILDING PERMIT APPLICATION FIRMLY
o ADDRESS a� 3�v3 �"1/�� �� . DATECATIO, 0� NUMB R�77/�✓r A/C
� ISSUE TYPE OCC
-- APN LOT TRACT DATE CONST. GROUP
p OWNER �d �(` '
p ADDR SS 2 O t' ZONING SETBACKS
gCIN i M ZIP St�6'S' TEL.90g-$bV'Ei9Ltq FRONT pW ❑
APPLICANT �' TEL.q�,-$60-694a R�R O
� SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE p
o ADDRESS PROPOSED USE N�.W S►�I'�+�Ci � E��.. S,'►tn l
CITY ZIP TEL. L�S
oARCH/ENG/
� DESIGNEfl NO.DWEL. NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
v� DESCRIPTION S0.FT. FACTOR PSF ADJ.AflEANALUATION
p� OWNEF•BUILDER DECLARATION SFR/ADD/REM
O
p I NEREBV AFFIRM UNDER PENALTY OF VERAIRY TIUT 1 M1 EXEMPT FpOM T/E CONTMCTORS LF Garege/Carport
W CENSEUWFONT/1EFOLLOWINOREASON(SEC.7071.6BUSMESSAMJPROFESSIONSCO�E:ANVCITYOR (n
U COUNT�WHICNREOUIRESAPERMRfOCONSTRUCT,ALTER,IMPROVE,DEA70LISH,ORREPAIRANYSTRUG w
Z IURE.7RpR TO ITS ISSUANCE.ALSO REOUIRES TME APVLICMfT FOR SUCH PERMIT TO FiIE A SICNED Pa110lOBCk
W STATEMENT iHAT HE OR SME IS UCENSED DURSUANi TO TME PFOVISIONS OF THE CONTRACTOHS LI• w
� CENSE UN�(CMAPTER Y(COAIA/ENCINO WITH SECTION 7000)OF DIVISION 7 0F 1HE BUS�NESS AND PqO. u- PooVSpa
FESSqN5CO0E)OR7HA7HEORSHEISfXEMP1THEREFfiOMAND7HEBASISFORTHEALLEGEOE%EMP� (7
VTqN.ANYViOlAT10NOF5ECTION7W1.68VANYMPLICANTFORAPEAMITSUBJECTSTHEAPP�ICANTTO Z Re-Roof O
AG L ENALTYOFNOTMOREil4WFIVEMUNOHEDDOLURS(f5oo�.):
� �ASOWNEROFTMEVROPERTY,ORMVEMPLOYEESWI7HWAGESASTMEIRSOLECOMPENSATpN, � COmm9fCl81 �
z WILL TME WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE�SEG 70N,BUSb
N NESS AND PIiOFES510N5 CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j
DROPERTY YM1108URDS OR IMPROVES THEREON,M1D N410 DOES SUCH V+URK NIMSELF OR HERSELF ON
K THROUGHHISORHERONTlEMP�OYEES.PROVIDEDTHATSUCHIMPROVEAIENTSARENOTINTEN�EDOR m
QOFFEREDPORSALEIF,110WEVER131EBUILOIN(iORIMPPOYEMEMISSOLOWITHINONEYEAqOFCOIAVIE
Z TION,THE OWNER�BUILDER WILL HAVE TME BURDEN OF PROVW(3 iT1AT HE OF SHE DID NOT BUILD OR
� IMPROVEFORTMEPURPOSEOFSALE�.
❑4�OWNER OF 7HE GROPER7Y,AA1 E%CLUSNELY CONTMCTINd WITH LICENSED CONTMCTORS
� TO GONSTRUCT THE PR0.IEGT(gE4 7os�.BUSINE53IW�PROFESSIONS CODE:THE CO�tTMCTOR3l4 �Id1U8fI0n ����� ADJ.AREA •
W CENSEUWDOESNOTAPPIYTOMIOWNEROFAPflOPERTYWHOBUtLD50RIMPROVE57HEREON.AND
� W/IDCDNTMCTSFORSUCMPpO.1ECT5WITHAGONTMCTOR�S�UCENSEUVURSUANTTOTMECONTRAG QUANTITY DESCRIPTION FEE
� TORSLICENSELAW.}
0 OIAIAD(EMPTUNDERSEC. B.6V.C.FORTHISREASON U
u' DA7E OWNER � �
Z w
�Q UCENSE�CONTRACTORS DECIARATION W
¢ IHEREBYAFFIHMUNDEHFENh1TYOFVERIUiIYTHATIMILICEN5E0UNDEHVRDVI510N50FCHAFiER �
p., OICOMMENCINOWRMSECTION7000)OFDMSION90FTHE8USINESSANDPROFESSiON5C00E,/WD Z
X MY LICENSE IS M iULL FORCEANO EFFECT. m
LLl �
� UCENSE CLASS UC.NO. J
V OATE CONTRACTOR n- . .
W
� WORKERS'COMPENSATION DECLARATION 4
� IHEREBYAFFIRMUN�ERVENALTYOFOE0.NNYONEOFTHEFOILOWINGDECLAMtIONS: Z
� �IMAVEANDWILLMAiMA1NACERTIFlCATEOFCONSEMTOSELF-INSUFEfORN'ORNERS' _
C01.1PENS�TION,ASPROVIOEDBYSEC710N]7000FTHEUBORCODE,FOR7HEPERFORMANCE W
OF iHE WORK FOR WMIp17Hi5 VERMIT IS ISSUEO. �
0
_I HAVE M1D WILL MAIMAIN WOPoCERS'COMPENSATION ttJSURANCE,AS REOUINED BV SECTION J p
O J7000F THE UBOR CODE,FORTHE PERFORMMlCE OF TME WORK FOF WHIp1THIS PERMIT IS /5 n
ISSUED.MYWORKERS'COMPENSATIONINSUfUNCECARfl1ERANOPOLIC'INUMBERME CONSTRUCTION �
J
j C�aRiER PLAN REVIEW
� POLICYNUMBER ELECTRIC
0 (n+5SECiioNNEEnNo7eECLY�itEfE�OFnEaEPo.fiBPDROF£VIUOREDDd1AR5(S+W10RtEssl PLUMBING
"�._^�_
Z I CERTIiY 7MA7 M THE PERFORMANCE OF iHE WOwC FOR WHICH TNIS PEW.�iT IS ISSUED,1 MECHANICAL ��`� 'P� '� '-- � -�
C} SMALINOTEMPLOYANViER50NINANVMANNER50A5TO8ECOMESUBJEC7TOTHE ��- �' �
y riORKER5COMPENSATpNUWSOFCALIFORNIA,ANDAGREETMATIFI5110UL0BECOME INSPECTIONFEE
SUflIECT TO 7HE WORNERS'COAIPENSATION PROVISIONS OF SECTION]700 OF THE UBOH
COOE,t SHALL FORMWITH COMPLV WITI TF105E GROVISIONS. ISSUANCE . J•
p OA7E: APPLICANT: SMIP r��� � S�
w ENERGY P!C
� WARNINO:f�RUREiOSECUFEN+ORI(ERS'COAAPENSA710NCOVERAGEISUNLAWFUL./NDSHALLBE ` �
�y SUBIECTANEMPLOVENTOCRIAIINALPENALTIESANDCNILFWESUPTOONEHUNDREDiHOU5AN0 ENERGYPERMIT .R-��� •
DOLLAR5�f10e.000),INADDITIONTOTHECOSTOFCOMPENSATION,DAIAAGESASPROVIDEDFORIN _. -
."'_.... -_..�._ J
� 6ECTIDN�70lOFTNELABORCODE.INiEREST,MIOATTORNEY5FEE5. R�ENTIONFEE: / ^ •
nW. CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
O
� INERE9VALFIRMLIN�ERPEN/�1TYOFGERIURY7HATTHERE�SACONSTRl1CT10NLENDIN6AGENCY
Z FOR iME FERFORAIANCE OF TNE WORN FOR WNILH THIS iERMIT IS�SSUE�(SEC.70Y7.dV.C.).
W
� LENDEH'SNAME
� LENDER'SADDRESS
� ICERTIFYT/ATIHAVEREADTHISMVLICATIONANDSTATETHATTHEABOVENFORMATIONISCORRECL TOTAL FEES � 91� �O
W IAGREETDCOMPLYWITH/LLLCT'ANDCOUNTYORD�NANLESAN�STATEUWSREUTINOTOBUILDIN6
� CONSTRUCTION,ANDHEREeVAl1TMORIZEREPRE5ENT11TNE50FTHISCOUNTYiOENiERUPONTHE
ZABOVE-MENTIONEDPROPERTlFO INSPECTIONOUHVOSES. COMMENTS
0
� A4���ss�. parc�'4.
N PERMIiTEE E(PWNn � / . ' �t�Q2
���i
k�..1V
N SIGNATUH E�MITTEE DATET�
� FlECPT.NO. PAID BV C VAUDATION
WHITE—Department Copy,YEILOW—Finance Copy,PINK—Assessa Copy,GOIDENROD—File Copy,GHEEN—Applicant's Copy
.. ____�_.._ ._, ._..�__-__-.. . . ...
. . , . , • - ,.,, ,.. �,:•�. �,., ,�. _ , , . � . �. � ...
�IT't' �F' f�lk{"'t�i�:"C3 �l"�,E';
If�'S€�E�C"s iC�t� £�EC�f:J
-- . -
�._�_ �__�.____.� __ _�__. _
Iw°F-''1;.d�c,`'ri�,f�E �y.t r� .Ii�F-`� a_iE., ��,��i I���-'�:.��,¢ .�F:�c��Yl c)�'�G'=: �.I4��-`�;�=�;1��.i
__�____.___.___..._ __.�_.__._...-- --
__..__..__._. . . __...._._ _..__._.. __.__ __._._.._ __._._. _ ___----___.__._.___._______.___.___._�..�_
SET BACK ; � FLOOR JOIST
' FTGSlFORMSlSTEEL � � FHA RE�MTS
ELECTRIC GROUND � UNDER FLOOR DUCT �
GROUND PLUP,�BING � UN�ER FLOOFi CU��IDUIT �
SLAB GRADE --I FIREPLACE FOUNDATION I
TEMP POWER I FIREPLACE 80ND 6EAM I
WATER SERVECE � hJ',ID HT. �OND BEAM
ROOF SHEATHING ��//o't, �I.�_ 8 FT. BOND BEA�JI
FRAMING,NENTILIATION � FINA�BOND BEAh�1
ROOF COVER �� aZ� PRE-GRADING I
ROUGH HEATING • BENCHIr�G I
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBIP�G F{hJISH GRADING �
SHQWER/TUB TEST POOL ELECTRIC
EXT_ LATH!SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION 1 �FF SITE IA�PS. •
DRYWALL NAILING DEDICATIOtJS
SEWER FIPdAL ENG.
SEPTIC TANK LAN�SCAPE/IRRIG. �
SEEP PIT/L.L. ON SITE Ih1PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. p� �,/� � F!RE DEPT. FIPJAL
FINAL HEATING � � HEALTN DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING I � � ENERGY �
I
�_��
r :+;R. ,,�,, r1E��.
COMMENTS
SEPTIC TAfJK SIZE
SEEP PIT/U SIZE
��I� ;
i�r r
� '
��y .
