HomeMy WebLinkAbout17762 (32) CITY OF DIAMOND BAR �— � �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21625 E.Copley Drivc (909)860.3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE 2�cC� ��Z OaK I�C►,o I I APPLICATION � � � PERMIT �"1��..'�J P/C AODRESS J DATE NUMBERI � 1�����l � ISSUE �^, I� TYPE OCC APN LOT � TR/1CT -�'y8�1$7 DATE ` v� CONST. GROUP p OWNER �jNdp�l�� �`cl'�cs LLL ADDRESS �`f$O TdRFbV��CE f�V�D ZONING SEfBACKS gcirr'TOR�A1« ZIP�"70So3 TEL.3�G►.S�C��O FRONT RW ❑ APPLICANT TEL. REAR p � SIDE/SIOE STREET RW ❑ � CONTRACTOR 1 G SIDE O � ADDRESS VZ • � CITY •� ZI Te�..2 D- PROPOSED USE o ARCHlENG/ w �ESIGNER NO.DWEL. NO. NO. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECLAFiATION SFR/AD�/REM O p I HEREBY AFFlRAI UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE CONTMCTORS Lb G3299/Ce1pOR W CENSELAWFDRTHEFOLLOWINOHEASON(SECJO]1.6BUSINESSMIOPROFESSIONSCOOE:ANVCITYOR (n U COUN7YWHICHREOUIRESAOERMRTOCDNSTRUCT,ALTE0.�Dti�VE,OEAIOLISH,ORREGA:R�M'STRUG W PylIO/DBCK � NRE,VRqR TO ITS ISSUANCE,ILLSO REOUIRES THE A➢GLICANT FOR SUCH PE WAIT TO FILE A SICNCO w � STATEMEM THA7 HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTiLlC70RS U- .� CENSE LAW(CHAOTER Y�COAIMCNCW6 WITH SECTqN 7000�OF DIVISqN 10F THE B1151NE55ANO PRD- � PooVSpa fE5510N5CO0E)ORTTIATHEORSHEISE7lEMPTTHEHEFROMANDTHEBA5I5iORTHEALLECEDEXEMP• (� VTKKi.ANYYIOIATqNOFSECilONT071.6BYANYAPP�IGANTFORAVEFMITSU&IECTSTNEAPPUCANTTO Z Re-Rool F A CML VENALTY OF NOT MOftE TF1AN FNE MUNDRED 001UR5(5500�.�: � OI.ASOWNEROFTNEPROVERTV,ORAIVEMPLOYEESWITMWAGESASiHEIR50LEC01.1PEN5A710N, 0 COTTBfC181 � Z WILL DO THE WORK.ANO THE STRUCil1RE�S NOT IMEN�ED OR OFFERED FOR SALE(SEC.7W1.BUSI- J N NESSAND VROFESSIONS CODE:TNE CONTRACTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF ? VROFERiY WNO BUILDS OR IAIGROYESTHEREON,AND NMO DOES SUd/VJ01iN HIIASEIF OR N[RSELF Oq K 7HROUGHXISOqHEROYINEA�PLOYEES,PROVIDE0T/UTbUp1qAPROVf1AENT5ARENOTWTFNDE00R m W OFFEREOFOHSPLEIF,F10wEVER7HEBULDiNGORtlAPROVEME4TISSOlDMA7MNONEVEAROFCOMPLE� 0 TqN,THE OWNER�BUIIDEfl WILL HAVE 7HE BURDEN OF PqOYINa TMAT HE OR SHE O�D HOT BUILD Ofl Z NIPROYEFORTMEPURPOSEOFSALE� _ ❑L1150WP7ENOFTHEVROPEHTY.AMEX0.USIVELYCONTRALTINON'IMLICENSEDCONTMCTORS � TO CONSTRUCT THE VRQIECT(SE0.70p,BUSINE55 AND PROFESSIONS COOE:TME CONTRACTORS L4 V01U2U00 ADJAREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAVROPERTYNT108UIlDSORMPROVESiHEREON.M!'J � WMOCONTMCTSiOFiSUp/GR0.)ECTSWITNACONTMCTOR(S�LICENSEOPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE � TORSLICENSELAwJ. � 01 AM IXEMP7UNDER SEC. B.d P.G FOR THiS REASON U I � � / � � LL' DATE OWNER V !' !L / _ _� .f Z W N`1�N �� ¢ LICENSED CONTRACTORS DECLARATION W Oc I HEREBV AFfIRM UNDEH OENALTV OF 7ER1UM THAT IAA1 LICENSE�UNDER VRONSIONS OF CHAGTER � p„ f(COAIAIENCIN(i WRH SECTION loDo)OF�IVISqN 7 DF THE BUSINE55 AND VROFE5510NS CODE,ANU Z �X AIVLICENSEISINFULLFORCEANDEFFECL m � LiCENSE CUSS LIC.N0. J V pqTE CONTRACiOR a .._ _.. ..W . � WORKERS'COMPENSATION DECLARATION a � IHEREBYAFFIRMUNDERPENALTYOFPEIWPYON[OFTHEFOLIOwINGDECLARA710NS: U "—' a O _IHAVEANDN�LLM�UNTAINACERTIFICATEOFLONSENTTOSEIF•INSUREFORWONKEFS' $ � COMPENSATION,ASPROVI�EDBYSECTIONJ7000FTHELABORCODE,FORTHEPERFORMANCE w �FTME WOFK FOR WHIqITH15 PERMIT IS ISSUEO. � G v IIUVEANDWILLMANTAINWORNERS'CAMPENSATIONINSURANCE,ASREOVIREDBYSECTION Q J7000FTHELABORCODE,FORTHEPERFORMANCEOFTMEWOFKFORWHiCHTMISPERMITIS � ISSUED.I.(VWORKERS'COM ENSATION NSUMNCE RRIERANOPOLICYNUMBERME: CONSTRUCTION 7 CARRIER ��� �V`�� PLANHEYIEYV O POLICYNUM9ER ZZ�I"'O Z L�� (L' ELECTRIC p (1}�SECf)J�INEmNDTBE�.YlETE00F1�EPERMT6FORONEH.lDPEDDOLLMSlt�001�11E55} PLUMBING Z I CERTIFY THAT N THE PERFORMANCE OF THE WOPK FOR WHICH THIS VERAIIT I5155UED.1 MECHANICAL (} SHALLNOTEMPLOVANVPERSONINANYAIANNERSOASTOBECOMESUBJECTT07HE � WORKERSCd.�PENSATIONUWSOFCAIIFORNIA,ANDAGREEiMAi�FISIKKILDBECOME INSPECTIONFEE '� S SUBlECT TO hIE WORNERS'COMOEN5AT10N iROVISqNS OF SECTION]�oo OFTNE LABOR CAOE,I SWLI FORTM'ATH COMPLV WIT/THOSE iROVISIONS. ISSUANCE 0 SMIP p DATE: APPLICANT: � ENERGY P!C WMNtN(3:iA�LURE TO SEWRE WORNERS'WIAPENSATqN COVERAGE IS UNUINFUL.AND SHAt18E � SUBJECTANEMPLOYERTOCIiIMINALPENALTIESANOCMLFWESUPTOONEHUNDREDIT�MISAND ENERGYPERMIT DOlLARS(S I00.000).IN ADDITION TO THE CAST OF COAIPENSATqN,ONdACES AS PROVIOED FOR IN J SEGT10N7�oeOFTHELABORCODE,INTEREST,ANDATTORNEY5FEE3. RETENTIONFEE: � � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHfREBVAiFIR1AUN0ERPEN�LTYOFPEfLAIRVTHATTHEREISACONSTRUCTION�ENDW6AGENCY n- FORTHE7ERFORMANCEOFTHEWORKFOHNMICHMISiEWAITISIS5UE0�5EC.]OD7,CIV.C.). Z w � LEIJ�ER'SNAME � LENOEH'SAODHE55 �'"/� � ICERTIFVTHATINAVEREADTMISAPDL�CATqNANDSTATETHATTHE/�BOVEMFORYAT10NI5CORPECL TOTAL FEES �j(� I `� — w I Af3RCE TO COMPLY WITH ILLL CITY M1D COUNTV ORDINMICES�IJO STATE UWS REUTN6 TO 8U0.DING � CONSTRt1CT10N,ANDNEHEBYAURIORIZEREPRESENTATNESOFTN15COUMYTOEHTEHUPONTME ZABOVE�MEMqNEDPROVERTYFORINSPECiIONPUftPO5E5. COMMENTS _ • K`•� � �r��I�c-- ¢ PERMITfEEN (P�NT7 I O � u,cd 3 y SIGNAT qE0 ERAIITTEE DA � � RECPT.�O. PAID BY VALIDATION WHITE—DepaRment Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant Copy :�,�. ' :;�.� :-.� ...�.....:.,,, ::�-... �an.��� �. '" .�.��li;-;. . , -��a.,r��i. �n; ., � . -,- •• � -,-- . .. . i, 4 . .. .� ....�� .., t ... . ... . . . , , � . � � . � ciz°t G F �31�o.PJ�OF4� C��.R i��s������flr� �;�co�� �_____�_.__... ...r__...__ .�.. .�____.__...__.,_.______.�._......__�.._,.._... .._� ._._ I►��-�'a�e�tll�?1►�!' �'Y '�I'.= 1►k-'i.����`'['¢�:� I►��-`i��_�� ��1(c;l►�k � . ��Y'��: . I��I-�:�=•�'"R'o)�# '� � _.�.. ' ' . ..,...._._..,_...__ ...._. .... _.__..._--- �--..�_ �, ..._._.--' .._......_..�___.�. I�----- —--.`..,_...r..� _. �.`_________�_.���_�....__�,....._ .. __._._ ....._.__... . � SET BACK ; � FLOOR JOIST ' , � j �. - - ` -- FTGS/FORMS!STEEL FHARE�P;1TS,,. . � ELECTRIC GROUND UNDER FLOOR GUCT � GROUND PLUMBING I UNDER FLOOR CUf�IDUIT SLAB GRADE FIREPLACE FOUNDATION I TEMP POWER I FIREPLACE BOND BEAM WATER SERVICE �__ _ P.�ID HT. E30ND BEt,P.� • �I ROOF SHEATHING II FT. BOND BEAM i FRAMINGNENTILIATION riNAL BOND BEA�,II � ROOF COVER I ^ � PRE-GRADING ROUGH HEATING E3ENCHING ROUGH ELECTRIC ��j�VL. � ROUGH GRADING _ ROUGH PLUP�IBING � � FINISH GRADING SHOWER�T'UB TEST �j POOL ELECTRIC EXT. LATH/SIDING � POOL FENCING WALL INSULATION POOL FINAL CEILING IN�ULATION OFF SITE IMPS. DRYWALL NAILIfJG DEDICATIOf4S SEWER FINAL ENG. SEPTIC TANK L�INDSCAPE/IRRIG. SEEP P!T/LL OPJ SITE IP�1PS. GAS AIR TEST FINAL ZOPJING FINAL CONSL � _ , + . FlRE DEPT. FINAL FINAL HEATING � �i=� ' � HEA�TH DEPT. FINAL FINAL ELECTRIC ���0,� .,C��� � DEV. FEES PAID FINAL PLUMBING � � ENERGY C}�:?"c1:—t(�ii;. _ _,�_._z.._�.__�_._..<._�._.�.__.�____.�,. COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE ..�._� . ►�� i I ,y�y�, ` - i i i �k � , -- .