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HomeMy WebLinkAbout12664 _ �hPIR�'Q �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY 8z DEVBLOPMENT SERVICES ��12 51002 �� 21660 E.Copley Ihivc Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���� BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE �A�� "' APPUCATION o ADDRESS �����C1 �!v�oV i�L'CY�I l�l �o RF�-1t?`� . DATE , `+I ��_ NUMB R S � ISSUE TYPE OCC APN LOT TF�tAC7 . DATE CONST. GROUP - o OWNER N d¢.'C'�N C��T�,KI tJ p ADDRESS � � � u , ZONING SEBACKS W CITY Q1a+JIDr,11D 'RAQ.. ZIP�f�f�L,�A TEL � FRONT RW O � APPLICANT ��1v_j' ��/�Q�'-�TQ' TEL �n_9�, �2 SIO SIDESTREET RW ❑ � CONTRACTOR t;� SIDE ❑ � A�DRESS ' POSED USE V.�Oa 1-L F CITY J'�,�141&..T •ZIP Z— TEL�?`j (f�b2 . i C �u�lso o ARCH/ENG! Z � DESIGNER NO.DWEL . NO. ADDRESS UNITS STORIES BEDflOOMS � CITY ZIP TEL. � DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECLARATION SFRlADDIREM O BI HER�V AFFIiW UNDE0.VENALTY OF FEiU1RY THAT 1 AM IXEMP7 FHOM iNE CONTMCTORS LI- G8(8Q6/CBtPOR �- CENSEUWFORTHEFOLI0WMN3REASON(SEG70.71,66USMESS�1NDPilOFESSqNSCODE:ANVqTYOH (� � COUIlTYNk1101NE0U1RESAPERMR7000N5TRUCLALTFRIMPROVE.pEAqL15N.ORREPNRANYSTRUC• . W PgtIq�DBCk � ' NRE,iR10R TO RS ISSUANCE,ALSO REOUIRES THE APPL�CMR FOR SUCFI PERMIT TO FILE A SIGNED W � S7A7EMENT 7HAT ME OR SME IS 110EN5ED fURSUAN7 TO 711E PROVISIONS OF THE CONTMCTORS lF . � CENSE UW(GiAPTER Y(COAIIAENCNa YATH SECTION 70a0)OF DM.^.ION 7 OF iNF BUSINESS AND CR4 �- P��Pa fE5S10NS COOE)OR 7TIAT ME OR SME IS EXEMPi iMEHEFROM M!D TIE BA515 FOR iME ALIE�ED E7CEMP• TION.ANYVKKALqNOFSECTION7071.68Y/VJVAOF�ICANTFORAiERMITSUBJECTSTHEAP7LICANTTO qe.qoo} � (J � A CML PENKtt OF NOT MORE TMAl1 CtVE HUNDREO DOlLMtS(fSoo).l: � ❑LASOWNEROFTHEPROVERTY,ORI.IVENDLOVEESWITHwACESI�STHEIR30lECOlAPENSATbN, CGIIR10fC�el - ' � � YALL DO 7HE WORK,IWD TitE STRl1CiURE IS NOT INTENOED OR OFFERED FOR SALE(SEL.10/!,BU51• J N NESS M7p VROFESSION4 COOE�iNE CONTMCiOR5l10ENSE Uri WES NOT A7PLY TO AN OWNER OF ? • PROPER'TY VRq BUKDS OR MPROVES THEREON.AND Y/HO DOES SUGI WORK HIMSELF OH HERSELF OR Q T1fi0U6HM4�RHEROMMEAIROYEES.VHOV��EDIHATSUtHIYPROVEMEHTSARENOTMENDEDOR m � ,OFFEAEDWFiS+�LEG.FIOWEVER71/EBULpNOORMP{10VEMENTISSOIDN'ITNINONEVEAHOFCOIAPLE• TqN,TTtE OWNEM1BU4,DER VALL NAVE THE BURDEN OF iROVNO 7HAT HE OR SNE D�D NOT BUI�p OR IAIPROVE FOR THE PURv0.5E OF SALE). W OI,Il40YMEROFiHEPROPEilfY,AA1E%ClUSNEIYCOMMCTNQWfTHLICENSE�COMMCTORS' .. � TO CONSTRIX:T iME PPO.IECT(SEG 70N.BUSMESS AND PROFESSIONS COOE:THE COf7TMCTpRS LF VelUe�lOn ADJ.AREA� � CENSEUWDOE9NOTMPIYTOANONR�EROFAPROPERTVMlHOBUILDSOHMVROVESiHEREON,AND WIqCONTMCTSFOR5UQ1YRQ7ECT5YATHACONTMCTOR(5)LICENSEDPURSUNiTTOTNEGOMTRAG pUANTITY DESCRIPTION FEE , � TORS LICENSE UW� .. ... . '. . . . . � O 1 AM IXE1dPT U1DER SEG B.a P.C.FOR THIS RE/SON � � OATE OVMEH . � . . � . W � UCENSED CONTRACTORS DECLARATION w , � IMEREBY/FFIR/AUNDERPENALTYOFVEfWMTHATIM/IICENSEDUNDEHGHOVI510N90Fp1AP7ER � �� . p`„ �(COwAENCY7UWfTH5ECT10N7000)OFOMSION70FTHEBUS�NESSANDPPOFESSIONSCOOE,AN�. Z L� IAY IICENSE IS N FUIL FORCE AND EFFECT. � UCENSE CUSS `-" �� LIC.NO.��/ � � F- � � J v w� corrtrucroa (r a "' /3t�. 1 � WORKERS'COMPENSATION DECLARATION �! 4 � U � IMEREBYAFFIRAIUNDERPENAL7YOFPERIURYONEOFiHEFMLAWIN6DELUMTI0N5: Z � _IWNEANDWILLMAIMMIAC£RfIFICATEOFCONSENTTOSELFdNSUREFOFiN17HKER5' � COMPENSATqN,ASGROVIDEDBY9EC710N770aOFTHElA80ROODE.FORTHEPEAFORMMCE W � OF�1E WORK FOR MMICN iMLS PERMI7IS ISSUED. � � // 4 ��HAVE ANO WtLL MAMTIIW WORICERS Cd.�P[l1SATION INSURANCE.AS REOUIRED BY SECTqN 77ooOFTMELABORO00E,fORiMEVERfORMMICEOFTMEWORKFORWHK71TNI5PENMITIS � ISSUED.MYMpRICERS'COA�PEHSATIONINSUiUNCECAqR1ERM1DiOlICYNUA�BERARE: CONSTRUCTION � � CARR:ER �"7 ��' PLAN REVIEW . . . . ��T � ro��cYN�"+eEp W�Er Z'� S ���= ELECTRIC � �nass[cnoar��w7eem.s��noFn�aEmirswAor+EFuor�n0atfraR+�a+�ss1 PLUMBING z ICERTIFY7HATNTHEPERFORMANCfOFT11EWORKFORWHICHT111SVFR1AiTI5155UED.l MECHANICAL � - -��,�{ (r} $/U1INOTEMPLOYAN'lFERSOHINANYMANNERSOASTOBECOM[SU6IECTTOTHE /� � WOPo(ERSCOuvENSATIONUWSOFCALIFORNIAIWDAGREETHA71FI511IXJLDBECOME INSPECTIONFEE � F `� � �.�+ � °� S SV&lECT70THEWOPo(ER5WI.IPENSATqNVPOVI510N50FSECTION770aOFiHEUBOR � �SSUANCE + � /� WOE,1 SHALL^FORUTTIMIITH COIAPIY WITM TIiDSE VPOVI510N5. �* � f-� pDATE:'1-(7-�1 8 APPLICANT: ��,�'1p� SMIP . . i1�IG ANTI�A ...__ ! � � �ii WARNING:fALURETOSECUREWORKERS'COL�PENSATIONCOYERAGEISUNUWFUL,ANDSMILLLBE ENERGYP/C - � SUBJECTANEMPLOYERTOCWMNALVEtULTIESANDCMLFINESUPTOONEHUNDHEDTIWS.WD - -ENEflGYPERMIT ' - DOLLIRS�St oo,000),trl ADDIT70N TO TNE CQST DF COMPENSATqN.DAFUQES AS PNOY�ED FOR IN , J SECTION]10eOFTNEUBOFtCODE,NTEflEST,/�NDATTORNLYSFEES � RETENTIONFEE: � SCONSTRUCTION LENDING AGENCY pRE-ALT FEE: ' � IHEREBYIIFFIHMUNOERVENALTYOFPERRINYTMATiHEREISACONSTRUCTIONLENDINOAOENCY � FOR THE VERFORMANCE OF TME NIOtLC iOR WMlpl THIS iEflAIIT IS ISSUED�SEG 70W.qV.G�. � �� LENDERSNAAIE � � LFNOER'SADDRESS W ICERTIiVTNTINAVEREIDiN�SM7LIGlTIONANDSTATETHATTIEABOVEWFOiWATIDNISCOqPECL TOTAL FEES � � . � IMiRESTOCAMPLYN7THAl�CfiYANDGOIMTYORDINANCESANDSTATEIAWSREIATMl�T08U0.DIN� CCMISTiIUCTION.IND HEREBV AUi110RIZE ilEGitESENTATNES OF iH15 COUNTY TO ENTER UPON THE . . .. . . �� . � �AIEHTIONED iROPEflTY FOq INSPECTION PURPOSES. COMMENTS . . � ��P��N1�� r�=_!�'�' •�!�C/F�� ���l. . . � m o�witreewwe�va= 1 I }^ h� � F�. � .'L• ` • ��� ` `l� L�'�� lI . .. • �� V ' ,' � 8q1�TURE OF YERNU E �r� f 1 OATE � � . � - � RECP7:NO. PAID BY � ' VALIDATION � WHITE-0epaRment Copy,YELLOW-Finence Copy,PINK-Assessor Copy,GOLD NRO�Ie Copy,GREEN-P.pplieanYs Capy� � '2--1`-v� �C�c l`70 . fj.�'e „�-Lv�a��t..°�,• c�'`�..,� o�,�� . . . .�.._ ,. . ,, . .. _: . � .: �. ,. ...... . .:... .: , .. _ .. � , . � . . , �; . ... , .. , CITY OF DIAMOND BAR . ` ' INSPECTION'RECORD - ; ' ' � 1� • ! � • ' • � � � • SET BACK ' � ' �; FLOO JOISj;� ' �. . .., . ,, . , , , , . __.- . FTGS/FORMS/STEEL � � FHA REQMTS - - - - - - ELECTRIC GROUND -- _. . UNDER FLO�R DUCT ` ...- '._ -- : ; , ; , • �. GROUND PLUMBING � � UNDER FLOOR Cd�IDUIT. SI.AB GRADE - - - . . FIREPLACE�FOUNDATION ` - ..: ,' = ` , � ., 1 � � �TEMP POWER - - FIREPLAC�B'ONb BEAM ' ' ' " ' -' _ ' __- % WATER SERVICE - - - - - - MID HT.BOND'BEAM-' ' ' ' ' ' �'• �;. RODFSHEATHING - .. I�-1�=rj� � • 8 FT.BOND BEAM � � � � .,. . , ' FRAMINGNENTILIATION .�,,, ' � 'FINAL BOND BEAM , ROOF COVER : ' ' PRE-GRADING ROUGH HEATING- - - - . _.. ._ . _ __. BENCHING ' - 'AOUGH ELECTRIC - � -` ROUGH GRADING . AOUGH PLUMBING � - � � - � FINISH GRADING � SHOWERlTUB TEST - - -- - - POOL ELECTRIC EXT.LATH/SIDING POOL FENCING ; . WALL INSULATION � - POOL FINAL CEIIiNG INSULATION OFF SITE IMPS. DRYWALL NAIUNG DEDICATIONS � SEWER . -- ___ _ . FINAL ENG. SEPTICTANK _ _� LANDSCAPE/IRRIG. � SEEP PIT/L:L. - . - . .- t`�. ON SITE IMPS: GAS AIR TEST FINAL ZONING FINAL CONST. - - FIRE DEPT. FINAL � - - FINAL HEATING - HEALTH DEPT. FINAL . FINAL ELECTFiIC --- -" " DEV.FEES PAID FINAL PLUMBING ENERGY � �T' ��, . � �1 _ , �` _ _,. . . ,, ' r� , ,., F __ �. _. . _ . _. . . . . _ __ _ .__ ._. _ _ . _ . , . . __'_ '__'_._. '_ '_ _'... _ . . . COMMENTS - — � � _ _ _ ,__. . _ '� - . ; - . . � . _ (sY/��� — l . J , � , -r —: _• , t - � � 1 C _' ' _ .. . .. _._. . .. - . ' ' � . .. . . . . . . 1 ". �.�.`�:C� `+ _ , �` ; .j . . ... - . _ _.h �.I�.....�..t, �. .� . . . . .. . , ' . , , • , _ .,t ��Ciifr'!i':1:•.,�. �!•= '' '-i• i _, ;� ,: ... , :: -►��,;r!_�'�.: ...__ . _ . ,,-, .. , . - . - _ : _ . . . .. SEPTIC TANK SIZE - ' ' �� . _ -_ - . � � . . SEEP PIT/U SIZE - _ _. , � ,v — ; �� �r . .. � . . . •i ; . �_. � . . � . . - . . . � . � � � � . , � _ , �' �` �-',�""y" 'lT' '� '`� �`'�`')'�°a- : G� 5�—�b-o� -.�� . �;-''r�•�T'j •, `iY b��i(-•/ $�I" ��'�i • ' • ,��1�-� ` ) _ � � �y �. 1 l) " ! �' ,,I' • ,;� , . '; �� . � � , i.• i r -- ; � , . . 1 - _ . . J _ I - � I