HomeMy WebLinkAbout16548 (15) �� CITY OF DIAMOND BAR �
� �DEPAR'TMENT OF COMMUNITY&DEVELOPMENT SERVICES
y 21825 E.Copley Drive �
(909)860-3195 Fax(909)861-3I17 PRESS
���� BUILDING PERMIT APPLICATION FIR M LY
o� JOBSITE APPLICATION �120 / PERMfT�/_ s P!C -
ADDRESS/D� �UL'��LOQK DATE NUMBE «� II
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER I�7 ��i�"/1
p ADDRESS ZONING SETE�ACKS
� CIN Q��ZIP TEl�_. FRONT RW ❑
�p APPLICANT f TE�9 ^�3oZ1 REAR ❑
SIDE/SIDESTREET RW O
� CONTRACTOR o ' i�,e���f SIDE p
ADDRES L-
Q C�T. � L Z�P c i PROPOSED USE tl�� K� �_
�fE . a���� /
w ARCWENG/
� DESIGNER �OU /��SG+C FpLT Ah� �-
�ii N0.DWEL. . NO. y NO. �
n. ADDRESS oC :!/.'Kf21> >
� CITY [�T���a ZIP T . -i'ltf��- UNITS STORIES BEDROOMS
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OYVNER-BUILDER DECLARATION SFR/ADO/HEM
O
p I HEREDY AFFIi1M UNDER PEWLLTV OF PEiLA1RY TMAT 1 AA1 E%EMPT FRdA THE CONTMCTORS Lb G32gB/C31p0A
W CENSEUWFORTH[iOLLOWIN6REA50N�5EC.70.71.5BU51NES5ANDiROFE55qN5LODE:ANYCITYOR (n
C� LOUNTYYR/ICHREWIRESAPERMITTOGONSTRVC7,ALTER�oROVE.OEMOL15H.OHREPAIHANVSTRUC• W
w TURE,PRqR TO ITS ISSUANCE,AL50 REWIRES TME APPLILANT FOR 5UCF1 VERMIT TO FlLE 11 SIGNED w 'F'ati0/DOCI( .. . . .
� STATEMENT THAT HE OR SHE IS UCENSED PURSUAN7 TD THE FROVISIONS OF THE fANTMCTORS Lb �
� CENSE UW(GIA➢TER Y(COMYENCINO YATH SECiqN)0001 OF DIVISION]OF THE B1151NE55 AND VRO- POO�SpB
Q FESSIONSCODE)ORTMATMEORSHEISEXE�IPTiN[REFROMANDTN[BASISFORTMEALLECEDE%EuO. �
V TqN.ANV VqUTqN OF SECTION 70]1.S BYANVAP7�IC/JR FOR A PERIAIT SU&IECTS THE APP�ICANT TO Z Re-Rao1 �Q
A CINL PENTLTY pF NpT MORE TNAN FNE HUNDflED DOILAFiS(f500).):
� ❑4���EROFTHEPROPERTY,ORMYEMP�OVEESYATHWAGESASTHEIRSOLECOMPENSATqN, � COTfTIBf�I3I
Z 1N�LL DO iHE WOAKµD TME STRUCTURE IS NOT INTENCED ON OFFERED FOR SiILE�SEC.7011.BU56 J
� NESS INO PROFESSIONS COOE:THE COHTfUCTOf75 LICENSE LAW p0[5 NOT APPLY 70/W OWN[R OF ?
GROPERTY 1N10 BU405 OR IMVROYES THEHEON.AND WHO DOES SUp1 WORK HiA15ElF 01i HERSELF OR
� THROUGHNISORHEROWNEMPLOYEES.GHOVID£DTMATSUCHMPROVEMENTSAR[NOTMENDE�Oq m
O O�FERE�FORSAlE1F,liOWEVERTMEBULDINCORI4PROVE4E"fTI550lDWITHINpJEYEAROFCOMv�E.
Z TqN.TME ONTIER�BUILDEH W.LL HAVE TME BUROFN OF PROViN�THAT NE OH SHE DID NOT BUILD OR
= IMPROVE FOR TME FURPOSE OF SALE).
w O�ASOW4EROFMEPROPER7V,AME%ClU4NELYCOMMC?MGN'ITMUCENSEDLONTFAGTORS
[L TO CANSTRUCT TME PROJECf(SEC.70��,BUSINE55 M1�VHOFESSIONS LOOL;THE CONTMCTORS U• VBIU2I1011 OO ADJ.AREA
W CENSEUWOOESNOiAVP�YTOANONNEflOFAPROPERTYNTIDBUILD50RY.�PHOVESTMEREON,ANO
� WFqCONTRACTSFOqSUCHVRQIELT5W17HACONTMCTOR(S)I�CENSEDPURSUANTTOiHECONTMC• QUANTITY OESCRIPTION �E �
Y TORSLICENSEUW).
� O I MA E%EMPT UNDER SEC. B.f P.G FOR TMIS RE�SON Q
� U
� DATE OWNER �
O W
F LICENSED CONTRACTORS DECLARATION w
� IHEREBYAFFIfUlUNOERPENALTYOFPERJURYTHATIAIAUCENSEDUN0ER7{10VISIONSOFCHAViER �
d 9�COIAMCNCINOWITMSECTION7oo0)OFDNI510N70FTHEBUSINESSANDPROFESSiON5CO0E,AND Z
X M1'UCENSE IS W FVLL FORCE AND EFFECT. tl
o C 3 ci uc.No. ���1�� �
� ucENSEcuss J .y� �
V DATE_S" Z� ^� / CONTRACTOR/y�rccsy. a
w
� WORKERS'COMPENSATION DECLARATION a
� I NEREBV�FFIRM UNDER PENALTY OF PERJURY ON[OF TME iOLL01MN0 D[CUMTIONS. Z
� I HAVE M!D WiLL MA�NTAIN A CERTIFICATE OF CpNSENT TO SELF-INSUR[fOR VpRKFRS' _
Q 7EHSATqN,ASGROVIDEDBV5ECT10N�7000FTHELA00flCO0E.F0�iTHEGERFORMANCE U
Q OF 7NE WORK FOR YVF11p1 TH15 PERMiT I5 155UED. �
W _INAVEANDWILLYAINTA�NWORKER5COMVENSATqNINSURANCE,�SREWIREDBVSECTqN
Q 7700 OF THE UBOR COOE.FOR THE PERFORMMlCE OF THE WORK FOfl YAIIGNTHIS GEiiMIT IS �•
ISSU[D.MY WORKERS'GOMPENSATION INSURANCE CARRIER N:D POLILY NUMBER ARL: CONSTRUCTION
juaaiEA � �f ��� PUW REVIEW
� POIICYNUMBER�� • ELECTRIC ' ' I
Q
0 (f}USSECiIOr+NEmNOTBECdwtiEiEUOFnfPEiY.(fBR%iduEHUDn[DDaUu'i5(S�x)rnlEss} PLUMF3ING
W
Z I LERTIfV THAT Pl THE PERFORAIANCE OF 7HE N'ORN FOfl WNICM TMIS VERMIT IS ISSUED,1 AfECHANICAL
C7 . SHILLNOTEM.FLOYANYPERSONWANVMANNERSOASTOBECOMESUBJELTTOTHE
(p MIDRNERS'COMPENSATIONLAWSOFCALIFORNU�AN�AGREETNATIFISMOULDBECOME INSPECTIONFEE
S SU6IECTTOTHEwORNERS'CO�AVENSATqNPROVI5�oN50FSECTqN�/oaOiTHEIAeOR .
CODE,1 SXALL FOqT1Vnh1 COMP�Y WITM THOSE PRON51CN5 ISSUANCE
� SMIP �—_��--•-`--'--- - -- �^
p DATE: APPLICANT.
J WARNING:FAILURETOSECUREM'Oi1KERS'COMPENSATqNCOVERAGEISUNLAWFUL.ANDSNALLBE ENERGYP/C
LL SUBJECTANEMP�OYERTOCRIMwALPENPLTIESANDCMLFWESUPTOONENUNDREDTHOUSAND ENERGYPERMIT
OOIURS�f100.000).M 1DDIT10N TO 7HE C0.5T OF COMPENS�TION,�AMAGES AS PROVI�ED FOR IN ����/}/�
� SECTION170eOFTM[UBORCOOE,NTEREST,ANDATfORNEV5FEE5. RE7ENTIONFEE: 1 �/�/
a CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
� IHEREBVIIGFIRMUNOERPENA�TVOFPERIURViHATiHERE1F.ACONSTRVCTIONLENDINQAGENCY
FOR iHE PERFORMMIGE OF TrIE WORK FOR WNICH THIS VENMIT IS ISSVED(SEC.]ov�,CIV.C.�.
�
� LEhUER'SNAME
S
� LFNDER'SADORESS
� TOTAL FEES �
w 1 CERTIFY TMAT 1 HAVE REM TMIS APVLICATqN M!D STATETHAT TME AOOVE INFORMATqN IS CORREGT. •
p. 1 AGREE TO COAIPLY WITM ALL CITY ANO COUNiY ORDiNANCES AND STATE UN5 REUT W G TO BURDING
CONS7RUCTION,ANDHEREUYAUT/IOPo2ER[PRESENTATIVESOFiH15COUNTY70ENTERUFONTME /� _ •' �`-��
Z ABOVE�MENTIQVEO iROPERTYFOR IN57EGiqN WRPOSES. 1 J!7�,/� iJ'v`Q/��
p J�� COMUENTs��-�
� �'�--�_t_1�._.
m GEaM�i7EEM � op:nfi) `
N ����/
(n . PEHMITTEE OnTE
� RECPT.NO. PAID flY ,_VALIDATION
WHITE—DeDanmen[Copy.YELLOW—Finance Gopy,PINK—Assessor Copy,GOLDENFiOD--File Copy,GREEN—ApplfcanCs Copy .
,. ... . . ........ . . _,:.. ._ ..... - - - . ., .- -•�- -- - - • - - -
.. . . . , . ,. ,.,.. , • ., .. . � , �., . . . , . . , . .�. . , , . .. . . .. ,.
v! 1 ��' Cj�' ��l�y�,i�i��� f����=:
�I��C�'i={� .�iQf'•� r�L_{�Ci��
____ -_.--___..------ --•------�---------------�------• ------•---------------------�..__��_�� __.___�
I��F-'9�►=��;�lc�►�! r'.�'' 1►��:;:�:¢`'r'cl�. f��F-t.�c.c; + l�1���. ri�'��- I��F-'i����'��'cl�i�
---•........................:.-.......... -- .. _ ... ..... . . . .. _. .... .. ._._. ._. .. _ .._....__..__- - ---.....-..-�-_-�_.__.._._.._.
._�-- � - _ . . .
SET Bi`�CK : I ! FLOOR JC�IST i
I— -I- -----
FTGS/FOR��151STEEL r i � FHA RE�',1T5
ELECTRIC GROUND � ; ; � UtJ��R FLOJR DUi�T �I �
GROUfJD PLU��IBING � I___ __ I I Ui�JD�R FL_OO�i CU,"�!DUIT 1 ! ____
SLAB GRADE I I _ I I FIrS�PLACE FOUi•.DATIOiJ j I -
TEP,1P PO4VER I I ��.FIR�PLAC� r30�JD �iEn�.1 � T
VJATER SERVICE � __�_ I i F:'iD HT. BOPJD BEF�:1 � _
ROOF SHEATHIf�1G ��j"25�f � I I Fi FT. 60��D EEF,'�? • � i
—*
FRAhSiPdGNENTILIATIOPd I � I I FIiJAL EO�•JD BE/;P;1 �� _ I __
ROOF COVER �L.�?�( � � I FRE-GRAU�h:G I I
ROUGN HEATING I � 6EtdCHIiJG ___�
fiOUGH ELECTRIC I I__ _ �I ROUGH.GRCtDI�JG � �—
ROUGH PLU`"E31NG � I I FI��ISH uRADI?J� � �
SHO`�"JER/TUS TEST � i I � PUOL ELEC�tRIC —� �
EXT. LATH;5IDING j � POOL FE�.Cl�Ju � �
�"dALL RJSULATION � —} I i POOL�I�!AL _ j � _
CEILI�dG INSULATION � i OFF SITE I":iPS. _I_ __1
DRYIPJALL PdAILIfJG � � ; DFDICATIO�JS � _
SEVJER I I � FIPJAL ENG. I
SEPTIC TANK ��— � LAPdCSCAP�/IRRIG. �
SEEP PITlL.L.. I � ! OiJ SITE ItAr S. j
GFiS AIR TEST � � � FI�JAL 7_�"JI�!G �
FINAL CONST. �,...�_D I '�--���_ I ! FiRE D�PT. FRdfi,L � I
-z_.
FRJAL HEAT�NG � � HEt;LTH DEPI. FIPJ�',L � I
FINF,L ELECTRIC � � _ � DEV. FEES Pf,!D � �
FINAL PLU�1E31PJG � � I Et•JERGY I
� �
� J-- -�_"..T',_-':_ , ....-. ._.......�,.
.. ..._.,_--- - -- -
cor��r,nENTs
SEPTIC TAtdK SIZE
SEEP PIT/U SIZE - -
__�..._�;1,�;.--__----�...
����� _
�: -
�;