HomeMy WebLinkAbout17865 (17) CTTY OF DIAMOND BAR �
���' DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
��� 21825 E.Copley Drive
(909)860.3195 Fax(909)861-31 l7 PRESS
�`%�`� BUILDINCPERMITAPPLICATION FIRMLY
o DDR1ESS�Lv��� �' {�S��U NT�t�I t��DQ�� DATECATION ��Q�(��UMBER I f��C S �/C O d.' I I
O
� APN LOT TRACT ISSUE � TYPE OCC
DATE �� �' CONST. GROUP
p OWNER �'
� ADDRESS �L � ZONING SETBACKS
c
z CITY ZIP TEL FRONT RW ❑
$ APPLICANT ! TEL. REAR ❑
� SIDElSIDE STREET RW ❑
� CONTRACTO �) SIDE ❑�
� ADDRESS
� CITY ZIP TEL. PROPOSED USE
� ARCH/ENG/ '
DESIGNER N0.DWEL NO. NO.
� ADDflESS � • UNITS STORIES BEDROOMS
N CITY ZIP�(,� TEL.'�l� L�/1 (�11)!�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNEF-BUILDER DECLARATION SFWADD/REM
O
p I HEREBY AFFlRM UNDER CENALN OF GE0.NRV THAT 1 AM E%EMPT FROM THE COMRACTORS LF Garage/Carport
W CENSEUWFORTHEFOILOWWGREA50N(SEG7Wt.SBV51NE5SAND�NOFES510NSCO0E:ANYGT'OR (n
U COUNTyNMICHREOUIRESADER611TTOCONSTRUCT.JLLTER�PA�E.DEAIOUSH.ORREDAIRANYSTRUC. W Patio/Deck
� TURE,PRIOR TO RS ISSUANCE,/LL50 0.EWIRES THE MFLICANT FOR SUC11 7ERUIT TO FlLE A SIGNEO W
STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO TNE Pf30N510N5 OF TME CONTMCTOF35 LF
� CENSE UW(C1IAPTER i(COMMENCWO YAiN SECTqN)000)OF OIVISION]OF TME BUSINESSAND PRO� � POOVSpB �
FESSIONSCOOE�ORTHATHEORSHEISE%EMPTiHEREFROM�NOTME8A515FORiHEALLEGEDE%EMP• (�
V TION.ANYVIOLA710NOFSECilON70.71.68YANVAVVLIGM7TFORAPERMITSUeJECTSTHEMPLIGNTTO Z Re-Hoof
ACML CENALTY OF NOT MORE THAN FNE HUNDREO DOLURS(5500).$
Z ❑I,ASONNENOFTHEPROGERTY,ORMVEMPLOVEESWIiHWAGESAS7HEIRSOLECOMPENSATqN, � COmmBfCiAI �
VALL DO TNE WORK,ANO THE STRUCTUFE IS NOT IMEN�ED OR OFFERED FOR SALE(SEC.7W�,BUSI•
� NESS AND PROFESSIONS COOE:THE CONTMCTORS LICENSE UW OOES NOT MVLV TO AN OWNER OF �
PROPERiYNMO8URD50RIMPilOVESTHEREON,ANDYMODOE55UpIWORKHtMSEIFORHERSELFOR
� THROUCHHISORHEROWNEMPLOYEES,PROVID£DTHATSUd11MPROVEMENTSMENOTMENDEDOR m
W OFFEREDFORS/�LEIF,MOVlEVEFLiMEeUqDWGORnAPROVEMENT1550lDwITMINONEYEMOFCOMPIE
� TION,THE OWNEH�BUILOEfl WILL NAVE iHE BUROEN OF PROViNO TMl1T HE OR 5/1E DID NOT BUILO OR
Z MPROVEFORIHEPURPOSEOFS�LE}
_ ❑1A50WNEHOFTHEPROPERTY.AMEI(CtU51VELYCONTMCTWGWITHIICENSE�CONTMCTORS
W •
� TO CONSTRUCT THE PRQIECT(SEG 7�u.BUSINE55 AND DROFESSIONS CODE:iHE CON7MC70R5 LI� V31U9l10f1 A0.1.AREA
W CENSEUWDOESNOTAPVLVTOANOMMEROFAVROPERTYV1110BURDSORIMP0.0VESTNEREON./�N0
� 4N1000NTRAC75FORSUdiPROJECTSMnTHACONTRAttOR�S)UCENSEOPURSUNJTTO7HECONTMC OUANTITY DESCRIPTION FEE
TORS LICENSE UW.).�, -
Q ❑I AM EXEMFT UNDER SE0. B.t P.Q FOR T1115 REASON U ' � r��
U.. �
DATE OWNER V
Z W
F I UCENSED CONTRACTORS DECLARATION W
� IMEREBY/�Fi7RMUNDERPENAITVOFGERIUMTNA7IAMLIGENSE�UNDERPRON510N50fCMAPTEq �yr � �
p,,, Y(COMMENGW6WRHSECT�DN7000)OFOrv15qN70FTMEBU51NE55ANDPPAFES510NSCODE,AND Z
X LtYIICENSE IS W NLL FOHCEANO E�CT. m �
� L�CENSE C 5 � C�S� UC.NO. I� �
J I
V OATE �" -. .^ . �- CONTRACTOR y,� a
W
� �'i WOqKERS'COMPENSATION DECLARATION � �
N � U
� IHEREBYAFFIN4UNDERDENALTYOFVE0.RIRVONEOFTHEFOLLOWINCDEQ.AMTIONS: Z
¢
� �IHAYEANDN1lLMA1NTAMALERTIFICJITEOFCANSEMiOSELHNSUREfORMNRNERS' _
CqAPEN5A7qN,A5PROV10E�6V5ECTION97000FTHEUeORCO�E.fORTMEPENFORMMICE W
OF THE WORK FOR WMlql THIS VERMIT IS ISSUED. . �
�
�I HAVE AND N1LL MNNTAIN WORKERS'COMPENSATqN INSUR.WCE,AS REWIRED BV SECTION
O 97o00FTNELABORGOOE,FORTMEPERFORMANGEOFTHEWORKFORWNICNTM15PERMiT13
ISSUEO.MY WORLKE�R5 COMPENSATqN rINSU�w��r���'\GRRIER M1D VOUCY MJMBEHARE CONSTRUCTION �
jCARRIER �� `�T �F T l/1�/�J PLAN REVIEW � ,�'i_ 7'�'�
Z DOLICVNUMBER �Q�' � � ELECTRIC (_ `t• � t
¢ I
� RwsSEc�r�mr+oreeoons�rmoFnFre%rtsronaNe�onmoou�R+aqoa�ssl PLUMBING �,�: ��u
Z ICERTIFY THAT N THE PERFORM�NCE OF THE WORK iOF WHICM THIS PERMIT IS ISSUED,I MECHANICAL �� �
C7 SFULLNOTENPLOVANVCERSONMlANVIMNNERSOASTOBECAMESUBJECTTOTHE
� WORKEFS'COAIPfNSATIONUwSOFCALIFORNI�ANDAGREfiMATIFISHOULDBECOME INSPECTIONFEE
S SWJECTTOTHEYlORKERS'COMPENSATqNPROV15lONSOFSECTION]7000FTHEUBOH ^
COO.IS ALLFORhM/ITHGM�PLVWITH s P sia+ ISSUANCE �
M �,�j L
� (� c /� �//J �t���/rL SMIP ��--.�7�
p OATE: 1 O U.. APPLICANL_�ll� � /f
� ENERGY P/C
WARNINC:FAILURE TO SECURE WOAKER5 COMPENSATbN CAV[AAGE IS UNUWFUL,/JJD SHALlBE
�y SVBJELTANEMPLOVERTOCRIMINALPENALTIESANDCMLFwESUPTOONEMINOR[OTHOu5/w� ENERGYPERMIT
DOLURS(5100,000),N IDDIiION TO THE COST OF CAMPENSATION,DAMAGES A$PROVIOED FOR IN f.�+�
J SECTION770EOFTNELABORCOOE,INTEREST,ANDATfORNEY'SFEES. RETENTION FEE: _.-M .w
Q
a ', CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
O
� IHEREBYAFFIRMUNDERPEN�LTYOFPERIURYTHATTMEPEISACONSTRUC710NLENDINOA6ENCY
d FORTHEPERFORMANGEOFTHEWORKFORWHIpITM157ERMiTI5155UED(SEGJov7,GN.G.).
Z .,, � � i^i _
l�.l
� LENDER'SNAME
� LENDERSADORE55'� Y
W ILEHTIFYTMATIHAVEREPDiHISAP7LICATION/W�STATETUTTNEABOVEWFqiMATIONISCORRECL TOTALFEES ��� �
p IAGREETOCOMVLVWITHALlGTY11NOCWNTYOR�INANCE511ND5TATEUWSPEUTINOTOBUILDINO
CONSTRUCTION,AW HEREBV AUf HORIZE REPRESENTA71VE5 OF TNIS GOUNTY TO ENTER UPON THE
- Z ABOVE-MEN710NEDP0.0VER7VFORINSPECTIONPUHVOSES. COMMENTS
� M I I'� `�P z�a -�t 30 -
_
¢ OEPI.�ITTEEN E Ri �I �
� '�
S�CINATUREOF E ATE �
N �� RECPT.NO. � PAID BY � � VAUDATION
� �. WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assassor Copy.GOLDENROD—File Copy,GREEN—Applicanl's Copy �'
. ,.. ` ..... ,. .. _ . .' . ' ♦ ' .. � •.�i. � ♦.. ,1 �. t, ' �/:. �J'i ", i � . . ' ) . "' . .. . , . . .. .,. ,-� .. ..
c�-r�� �r- ����r,rc���� �:��
ii�c�����:tor� t�'�GG��
� �`._.'.I`�i,�,'1f��►, __ T�r'`^1' ,1►v� �i- -IPx w�E.'9 =°s�-�1�"�l►`�-- -���1�['-�-- --�-I►w�:1M�_ae"�'e�:
��' '7 � ���;�.�_ , �y� _ ___... .�_.� n��- _-- - - --I------ - - _� !
..---- -• - - � ' - _
SET BACt' . l� Z�" i-- - i_�_FLOOR JOtST _.�_�__
-�� �- - � - --
FT'GS/FOR��IS/STEEL ' , � rHA REah1TS �
ELECTRIC GAOUND � + �_i UNDEr� FLQOR DUCT r �
GROUND PLUMBING _ _� ___ : Ui�DER FLOOR CUf��DUIT } � __
SLAB GRADE � I FIF�EPLACE FOJ��JD,4TION '
TEh9P POWER � � FIREPLACE BOND 6EAtv1 �i �
WATER SERVICE _�_ MiD HT. �O"JD BEAPA I
ROOF SHEATHING � �-8 FT. B—OfdD BEAhA �
FRAMINGNENTILIATION � , FIN� AL BOND BEAM ; I
ROOF COVER I I PRE-GRADING I I
ROUGH HEATING • BENCHING
ROUGH ELECTRIC ROUGH GRADIt�lG
ROUGH PLUMBRdG , FINISH G.RADING
SHOWERlTUB TEST � POOL ELECTRIC r?�D � �
EXT. Lf1TH/SIDING � ; POOL FENCIP�G fJ �Zi � _,
WALL 1NSULATION � POOL FINAL f j),OZ I `�I
CEILING IhlSULATION OFF SITE IMPS.
—,_.
DRYWALL NAILIPJG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LF,NDSCAPE/IRr�IG.
SEEP PIT/L.L. • O�J SITE IbAPS.
GAS AIR TEST '�JI� v , FINAL ZONING
FINAL CONST. � ' �IRE DEPT. FINA'_
FINAL HEATING HEALTN DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIPJAL PLUh1BIt�G ' ENERGY
, I —
--- - - - - -- - . ...�._ p=i"'"-,�=_..�_�_.._.�.:_.�._.:-.-�.__.1 -- -� -� -
, COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I''� _._______._.� _
� ' � , '
ti II
��� ��
��
- .
� , ��- _