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HomeMy WebLinkAbout12968 l i�.. �. i�d � -- -.. . . _ J� CITY OF DIAMOND BAR �� � DEPARTMENT OF.COMMUTIITY 8c DEVELOPMENT SERVICES � 21660 E.Copley Drive Suiu 190 (909)860-3195 Fax(909)861-3117 PR ESS � ��'TM'�� '- , BUQ.DING PERMIT APPLICATION, , , FIRMLY _o DDR SS�7'c�o N�T1V C�T. ' DATECATION NUMB R_l 24�n� #`° � APN • LOT - TRACT - ATE ��''��� l 1 CONST. ' GROUP p OWNER -cs'. U ' ' p ADDRESS ' ` ZONING SETBACKS � CITY�1"'� ZIP TEL:3�a-IrG2� REART - - RW ❑❑ - APPUCAPfI' �-�� TEL. SIDElSIDESTREET RW --❑ � CONTRACTORI���.i%��C'�'-�il.l`>T�[.1.L�2S SIDE - - ❑ - Q ADDRESS - _ _ � CITY��'��T� ZI�� TEL.'S - PflOPOSED USE , o ARCH/ENG/ • , '; DESIGNER � N0.DWEL NO. NO. n ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn . ., OESCRIPTION SO.FT. ' FACTOR PSF ADJ.AREANALUATION � . _ OWNER-BUII..DER DECIARATION SFWADD/REM - " ' O - . p 1 HEREBV AFFlRM UNDER PENALTY OF PEKA7HY iHAT 1 AM E%EAIPT FROA1 THE CONTMCTORS L4 GaragelCerport � �� ' 11J CENSEUWPoHhIEFqlOWC10REl50NISEG7071.6BUSWESSANDPROFES510N5CODEMlYCRYOR (n � � -' - � - � {�7 COUMYWNICMREWIHESAVERURTOCDNS7AlICT,/LLTEi�MPROVE,DEMOLISH,ORRE7AIpANYSTRUC. 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O] D W C 7��('J�J{ Q LICENSE CLASS_ C�� LIC.NO.� ��_ J � o�rE `�--3— �cormucro a � WORKERS'COMPENSATION DECLARATION � � I MEREHV AFFlRAI UNDER PENAITV OF CERIURY ONE OFTNE fOLLAWING DECLAMTqNS: ' �� Z - � � � ' - ' � � _IFNVEM7DWILlMAINTNNACEHTIFICATEOFCONSEMTOSELF•INSUREiOAWORKER5 = COMPENSATION,ASPROVIDEDBYSECTION77oaOFTHEU�BORC00EfOHTHEPERFORMANCE U OOFTHEWORICFORVMICHTHISPEPoAtTISI55VED. � _�W1VE AND WILL MAMAfN WORKERS'COMPENSATION iNSUMNCE,AS REOVIRED BY SEC'TION � 77ooOfTHELABORWOE,FOfii11EPERFONMANCEOFTHEWOFiKFORWMiCHTMISPERM1T15 ISSUED.AIYN"ORKER5COMPENSATIONWSURANCECARR�ERM10POlICYNUMBERME CONSTRUCTION � ._.__. cuuuea 1��SZ��-Ct��3��7 C�/"`pt���. _.__.... ... .._ _ _ PLAN REVtEW ' ---- - - - -- - � � M7LICY M1IABER K_J I V'7 7 �l0 7�S� � � , 0 I�sEcnonr�mr+oreE�rIDOFnf�wtrswna+eMrnamoa.tKs�s�ao�a+�ssl PLUMBIN P Z ICENTIFYiHATNTIIEPERFONAANCEOFTHEWORKFORWHICHTH15DERMRISISSUE0.1 MECHANICAL - , �,}" SHKLNOTEMPLOYANVPEA50NWANYWfINER50�ST08EWME5UBIECTTO7HE � WORKER5COM7ENSATIONU1M90FCAL�FORNIA,ANOAGREETHATIFISIiOIhOBECOME INSPECTIONFEE - � " SUBJECTTOTHEVIORI(ERS'COMPENS IONSOFSECTpNa7ooOFTMELABOR � �7 COOE,ISMALLFORT/WITHCOMPIY iTHiMOSEPRO qNS. ISSUANCE �C� � �r�'[� L�. � 3 --�1 i u���y OATE:.2 �i APRICANT: ' 1y� � WAFNIN(i:FAIIURETOSECUREWORKER5COMPENSATIONCOVERAOEISUNUWFUL,ANOSM�LLBE ENERGYP/C r�T _� ►T�•J.7t�1 (-y SUBJECTMIEMVLOYERTOCRIIAPIALPFWILTIESMIOCMLFNESUPTOONEHUNDREDTNOUSAND - ENERGYPERMIT ujJ1LD �OLIARS(f too.aoo).N/��ITION TOTHE COST OF COMPENSATION.DAAUGES AS PROYIDED f-0R IN J SECTqN]7oeDFTHEtABOqCOOE,INTERE5T,MIDATTORNEMSFEES. RETENTIONFEE: ' ' � CONSTRUCTION LENDIN6 AGENCY PqE-ALT FEE: " O � IHEREBVAFFIRAIUNOEN7ENALiYOFGERIUR`/THATiMERE6►CONSTRUCTIdJIEN�W6A6ENCY FOqTNE OERFORMNJCE OFTME WORK FOR WHICH TXIS PERYi71S ISSUED(SEC.9097,dV.C.F � � � IEN�ER'S NAME - . . _ _ _ � IEN�ER511DDRE55 � ICERIIF'/TiATIHAVEi1EADTM1311FPLIWlT10NANDSTATEl/WTT1E/�BOVEWFORAIATqNI50DRRfCT. TOTAL FEES � � IAfiREETOCOAIPLYN7T1ALLCfTYANDCOUNTYORDIWWCESANDSTATEUWSFEUTNOTOBU0.DINU ' � ' , � CONSTRUCTION,ANDHEREBYAIfMORIZEREPRESENTATIVE50FTN15GGrtli'lTOEMERUPON7HE. _. . _ . ' � ABOYE-►IEMqNED VROVERiY FOR INSPECTION VUF705E5. COMMENTS � � _ _ ��1 �..`,V�`� . . . . � � . � � CERA11TgGN/JAE M) �+- — . ¢ `� 2�3�3S � 81GN�TURE OF VERMITiEE � DATE v. � RECPT.N0. PAID BY � VALIDATiO� � � �- WHITE—Departrnent Capy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—P,pqicanYa Copy � �-� � � � .. . . , . , , .. ...... ,.. , ... ... . . 1 .a- �. .�� . ' ..I. . .. , < S.',t. _ 1.��.y . � � , . . , i �.. , , ' ' .. ' , •n ' + .I� I � �I�'���F�i�IV10ND,BAR . ,.. , .,....,, �. .,. .. ..,.. -,�: � � -�� - "� `.'=_ , -' ., .,INSPECTION RECORD;� . ., , � . .'. . ' ��, _ . . ; _;- - r • � � • � � � ' • � � • ' SET BACK " ' ' � FLOOR JOIST ` .� ' - .. . ' " ' � FTGS/FORMS/STEEL � ��� ; � � . . ,- FHA REQMTS - �- �- - -- - -- - --- ` - --- , _ELECTRIC GROUND : - ___'_"_"_` ,__ _ � _ -_ : - UNDER FIOOR DUCT � " ' GAOUND PLUMBING � •� �UNDER FLOOR CO�IDUIT � ; -�-' 5LA6GRADE --- - -- - � - ; � FIREPLACE FOUNDATION --- =. -- '-. •. , ,. •� :; ' ' 'fEMP POWER - `''' - - - - ' ' � FIREPLACE BOND BEAM --:. -' `-`� ' '-- ` ' WATER SERVICE _�._:� ._:---.:_ - = - . .------._. MID HT.-BOND BEAM • �- ' - ' � . ::: •, ,_,,. , . ; , , - - -- RO�F SHEATHING - - - - " S FT.BOND BEAM . ' �` � ' � �, .. . . FRAMINGNENTILIATION __ FINAL BOND BEAM ' ' ROOF COVER ... ' ' PRE-GRADING ROUGH HEATING--- - - - - - - -- - - ---- BENCHING � ' ' ' � ROUGH ELECTRIC- � -- ' - � - - - -- �- ROUGH GRADING ROUGH PLUMBING " � - -"--- --- -� `I" -- " . FINISH GRADING SHOWEFUTUB TEST� � � POOL ELECTRIC ' � ' � EXT.LATH/SIDING t POOL FENCING ' � . . ; WALL INSULATION i POOL FINAL CEILING INSULATION � � OFF SITE IMPS. � DRYWALL NAILING i DEDICATIONS ' ' ! � SEWER__-- - --- ' - . '---_ - --_ - . FINAL ENG. . , � - - -- - _ SEPTICl'ANK ._ - � . . __._- _- . :_.___ . . .: LAN�SCAPE/IRRIG. � � �' SEEP PIT/L.L. _ _„-- -: ' _.. _ . ON SITE IMPS. ! ;` GAS AIR TESTi- - - - -- - FINAL ZONING �- -�: FINAL CONST.; -- -- ------ - - FIRE DEPT.FINAL " � FINAL HEATING--- - - -- - - ' � HEALTH DEPT.FINAL � . �FINAL ECECTRIC -�--� � �� -� � " DEV. FEES PAID - �" " � � � FINAL PLUMBING ENERGY � ; - � , , r . . i �l• 6 i " � . , . ' -. ! ... -- - - . . . , - . _� _._ .. . . I - , ,.. , ., . . COMMENTS --- __ . _ - - - - � . . ... , , .. - - - — , — . , � , - . ; � . - - . , � � . . , • . . . __ : � � • , _ -,. --- - -- '• --'i— - --�.�. sl. � , : _ � � - - - - ;:;a;�,� _ � , , - - '-�� n-�1 � ` - __ ?f; _ �1? ( . � i ; , . , _. , . - � - - . . . _. .. i�,: - " ' . • , . � , . , , , . , . . - . - . � � i � SEPTIC TANK SIZE � ` , , � ! , . � ; , _ , .. SEEP PIT/U.SIZE -, , ; _, . , �� -- - - _ . . . , - - -- -- - .. j � I - - __ =- :-- - --- , 4 . ; � - - _ - . . , . � , . , . , � . . -- - - -_ � . ... . , � -- � - - - ; �, - • - ' , , . - . . . - - ... _ - - _ � _ ;� _. _-__ � �( . : _ . ..� . ; , _ . ,. . -- •