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HomeMy WebLinkAbout17132 , __._ �.___._ .�_ ..- -- -- - -- -- ---.... . ........ ._ . . -----.. �� CITY OF DIAMOND BAR � DEPARTM�NT OF CONIIv1UN1TY&DEVELOPMENT SERVICES �My 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE ��� � . �Gz� APPLICAT�Q� v PERMIT � P/C ADDRESS DATE�[� NUMBER 7�� k c� ISSUE '( TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER .-h'�r ;lA_ " ADDRESS ')��S. i i.n ZONING SETBACKS w FRONT RW ❑ z CITY � ZIP TEL. REAR ❑ o APPLICANT l TEL. .0 ��� SIDE/SIDE STREET RW ❑ � CONTRACTOR �..,p � SIDE ❑ � ADDRESS pROPOSED USE � � t u � �GU.r .`OSK � CIN � _L���TEL 7 ��G w ARCH1ENGl Z�,A• [L LO L (�NA�I):! S C- • z DESIGNER � NO.DWEL. NO. NO. ow. ADDFiESS UNITS STORIES � BEDROOMS � CITY ZIP TEL. N DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION N Q OWNER-BUILDER DECLARATION SFR/ADO/REM O d 1 HENEBY AFFIRM UNDER PEIULiY OF PERAIRY 7YUT I AM EXEMPT FROM TIE CONTMCTORS U� GB2QDIC8�pOh W CENSEUWFORTHEFOLLdWINCREASOH(SEC.7071.5BUSINESSANOPROFESSIONSCODE:MlYGITYOH (n U �OUNT7WNId1REOUIRESAPERMRTOCONSTRUCT,KTERIIAPROVE,UEA10lI5H2ORPEGAIRANYSTRUC� W PdtiO/DBCk wTl1RE,GFIOfi TO RS LSSU�NCE.AL50 REW IRES TME APPLIGNT FOR SUCH 7ERMR 70 FILE A SIGNEO w r� STATEMEI7T hlAi HE OA SHE IS LICENSED PURSUANT TO THE PRONSIONS OF TNE CONTMCTORS LI• � CENSE UW(p/APTEH i IC01dMENCINa WITM SECTION 700C)OF pIYI510N]OF THE BUSiNE55 AND PRO� LL' PooUSpa iE55qN5 CO�E)OR THAT HE OR SH[IS E%E1APT TMEREFROM AND 7ME 8�515 FOR TNE�LLEGED E%E6�P• V 7qN.�N7YlOU1TqNOF5ECT10N7071.SBYANYAP7LIGWTF RAPENMITSV&IECTSTNL�PpL1CAryTTO Z R9•R00� ' � ACMLPENALiYOFNOTMORETWWFNEMWDREOD�IU (f5oo�r � ❑4ASOYMEROFTHEPROPEIITY,ORMYEMPLOYEE ITHWAGESASTNEIRSOLEfAMVEN5A710N, O CpmmOf[I31 Z VIILI DO THE WOR1f,ANO THE STRUCTURE LS NOT INT ED OR OFGERED FOR SAIE ISEG 70u.BU56 J NE55 AND VROFESSIONS COOE:THE CONTRACTORS 'ENSE Uw DOES NOT APPLY i0 AN OwNER OF N PROPERTVN7108UI1D50RIA1PROVESTMEREONAN VAIODOESSUCMWONKHIMSEIFOHMCRSELFOR = [t 7i/RpUQMMISORMEROK'NEMttOVEES,PRONDED 1ATSUd11MPROVEM[MSARENOTNTENDEDOR CL� W� OFFEREDFORSALEIF,HOWEYERTHEBUIIDINCORM� OYEMENTISS�IOMnTHINONGYEAROFO'JMVIE� � TqN,TH[OWNER-BUILDER YnLL HAVE TME BVRDEN O oqOVWC THAT ME OR SME DiD NOT BUILD OR � MPROVEFORiMEVURPO5EOF5ALE4 W OI�OMMEROFiHEDROVERTY.I.4E%CLUSIVE CAN7RACTPIGW;7NlICENSED[DhTMCTORS (= TO CONSTRUCT TME VR0.IECT(SEG 70�1 BU31NE$ �0 CROFESSIONS CODE:TNE WNTMCTORS ll� Vd11181i0n 7�v ADJ.AR[A W CENSEUWDOESNOTAPDLVTtlMIOWNEROF�DRODER7YYMOBUIIDSORIMPROVESTMERCON.M70 � NnptOMMCTSFORSUCHPRO,)ECT31Mh1ALONTMCTOA(S�LICENSEDPUHSUANTTOTN[CONTMG OUANTITY DESCRIPTION FEE � TOHSUCENSEUw). � OI�E%EAIPiUNDERSEG B.87C.�ORTMSREASON U � ¢ LL' DATE OwNER � W F LICENSED CONTRACTORS DECIARATION W � IHERCBYAFFIRNUNDERPENALTYOFPERIURYTNATIAMLiLENSEDUNDFRPROVISIONSOFCWIPTER � (y i(C0IAMENCINCMrtTMSECTIDN7000�OF01V61ON70FTMEBU51NE55IWDPROFE55'ONSCCOE,AND Z X MY LICENSE IS N ML LOACE AND EFFECT. m lL � � LICENSE CUSS LIC.NO. � J V DATE COMRACTOR d W � WORKERS'COMPENSATION DECLP.RATION 4 � U N IHEREBYAFFIRMUNDEflPENALTYOFGERIUtiYONEOFTNEfOLIONAN6DECLAMT10N5: Z Q � _IMAVEANOW:LLMANTAINACEAI�FICATEOFCONSENTTOSELF-INSURLFOHYVORKFfYS' 2 �� � �pMPENSATiON.A5 PqOViDED BY 5ECT10N�7ooOF THE U00R CODE.FOR THE VERFORMANCE `U OFTH[WORKFORNMICMTMISPERMRISISSUCD. � � . � . W �INAVEANOWILLMAMlA:NWOFKERS'UJM7ENSATIONINSURANCE.ASHEOV�REOBYSECTpN O Q 7�OOOFTH[IABORCOOE,iOHTHEPERFOiLNANCEOFTHEWORNFORWMICHTNISPERMITIS �`.� ISSUED.MYIWRNER'COMPENSATIONIN RANCEC� ERANDVOLICYNU4�EPARE� CONSTRUCTION 7 c,waiEa�3y' !� � PLAN REVIEW � po��crNun�oen � ELECTRIC Q (fLaSSECIIOrvNEmN078CO0�.itFfEDOF71EPEfArt6fORO�M.WRL�DIXlJ�u(S�a)I�LESSA PLUMBiNG w MECHANICAL 2 I CERT6'V THAT N TME 7ERFOW..��NCE OF TN[WOP1C FOR WHIp1 THIS FERMIT IS ISSUED.1 _ _ ('J SMALLNOTEMPLOYANYiEf350NWAYYMANNER50l15TOBECOMESVBJ[CTTOTMC ".� �;_� �;' ���, y � WORKERS'CO6�PENSATIONLAWSOFCALIFORNIAMl��GREE7HATIF151KK1lDBELOME INSPECTIONFEE _ - SUBJEC7TOTMEWORKERS'COA�PENSATIONPROVISIONSOFSECTIIXJ�)OOpFT11EUFfOR �SSUANCE COOE.IS fORTMW:TNCOMPLVWI7HTMO5E ROVi ONS. R (� . � DATE:�� APPLICAPlT:_ I � SMIP �F� f Q �11�� � W1��' : ENERGY P/C J W�lLVIN6:fAILURETOSECUREWORKERS'C0IJPENS ONCAVERAGEISl1MAWFl1LANDSNALLBE �y SUBJECTANEMPIOYERTOCRiMINALPEIULTIESAN�CIVilfWESVPTOONEHVNDREDTMWSANO ENERGYPERMIT OOLUfiSIf t0a.0oo�.IN ADOITION TO THE COST OF COMPENSATqN.DAMIIGE5115 GROVI�ED FOII IN '^� �y � SECTUN7�DOOfTN[IABORO00E,NTERE3T,IW�ATTOIiNEY5FEE5. RETENTIONFEE: � � �- ---- � � ��_ � a CONSTRUCTION LEND�NG AGENCY PRE•ALT FEE: O � INERC6YAFit0.lAUNDER7ENALTYOFPERNHYTHATTMEREISACONSiPUCT10NLENDINUAGENCY FOR THE PERFORAINICE OF THE WORK fOR WHtd1 THiS 7E0.ulT IS ISSUED(SEC.]097.CIV.C.�. Z w � LENDFR'SNAAI[ C LENOER'SADDRE55 /f O � ICEflTIFTTHRTIHAVEPEADTHISAP7L�CATpNANDSTATET/uTTHEABOVENFORMATqNISCORRECT. TOTAL FEES / ��' W IAGREETOCOMGLYYATH.LLLCITVAhOCOUNlYOR�INANCESANDSTATEUWSR[LA7iNGTOBUILDINu � CONSTPVCTION,ANOMEREBYAUTNOR12EREPRESENTATNESOFiH15COl1NTYTOENTERUFONTHE Z ABOVE�NEMIONEDOROPERTVFORINSPELTIONPURPOSES. CON.MENTS � = t�� � m PERMi7TEE NAN[(PW T) Q � J _ � SIGNATUiiEOFPER iT � ' A E RECPT.n0. PAID BY VALIOATION � WHITE—Department Copy.YELLOW—Finance Copy.PINK—Assossor Copy.GOLDENR06—F�le Copy.GREEN—ADP�icanPs Copy . .. 'v� l �.� e✓t'" ��1��1��i�7�3L' �yrii. . . � ���°.^k'�'t. . 1LsI�! re'iti.=C�:.�i❑ ._ __---_...----•- ___. .___ - -- - - - --., ------. _ ._ . ___..._-------• -•---•..------ --------- - I►��=i���e;=!'I�)�! ��,`;E;_ . I►�F-y:?���' T•.r��. I��F.1��-.c'�[lr1i�� e;%t'!'�. I��F-y:��c^[�f.� . ._ __ . . . . ..... . ...... .__ .. _.... ........ . - . .... . .. _.. .._ _._..... ..... . .. ......... ...._ . . . -- - --- - - ... --.__ .......---._._. . , I I � r��_oo�J�IST � scr a�,c� . ; , �— -�----------- - '— —• ------ FTGS!FDR"�A5/STEEL �, • FH:;REQ'�TS _� -----_ ...� - —�-�---- -- ---� --1_. ELECTRIC G?iOUfd� � i � Ui•:DER FLO�R DUCT __� � --- ------ --•---- -- - ,._ GROUND PLU�v1E31NG F I i U;1DER FLOOR CU?•!DUIT —,....--- ------•.,- -- — — I----......_. SLAB GRADE I � __ _.__I.I FIr�FPLACF f"OUNDl�TIO�J_ I __ I ____._ TEFJIP POI�"JER I I I I ���EPLACE 60ND E3EAP:1 l V'lATCR SERVIC= � � ` I � P.11D 11T. E�O�1D BEr1�.1 � ROOF SFiEATHING ;� 7/O � ' ' �2- --1--��2._l�-��.�_� n�. B�tiD ���,�,1 __I--- I FRP,P.IINGNEtJTILIATIOPJ� !_ � l_� FIiJAL EOi•JO E3�P,P.' � � ____ ROOF COVER Ar � � FRE-G�s�+DII1G I �� t lo l� -- �------- - AOUGH HEAT1fJG l I � EEr•d�f-i��•JG I ROUGH ELECTRIC _ I � fi�UGH GR�.DI�•Ju � � - !------- ------ ROUGH PLU�."31NG � .�-- - - .I Fi�JISH GRl�DIf�G � T -- SHO�"JER�fUB TEST i I I f'O:7L EL�CTRIC � EXT. L/�TH/SIDING-� I ; f'OJL rFP;GPl�, � 1;"!r"�LL INSULATION i- --- ---��-POOL FI�:AL - ----- - � CEILING INSULATIOtJ � ___1 I 0=F SITE I�;"?S. _____l_ _ DRY�"JALL NF,ILIPdG _�_ I � DEDICt;TlO'JS _ I _� •. SEL"JER � __ �_� FIiJAL ENG. __ SEPTIC TF,tvfC � I � � L/IPJDSCt,f'�lIRRiG. SEEP PIT/l.L. ( � �j or, SITE I�rPS. � �i � G.AS AIR TEST j FINf,L 7_ONIt:G � 1-l--^_ --1 ��.-�.- FfN/1L CONST. � � I � �!R� D�PT. FItJAL ' FIPJAL HE�',TI`dG � I _ I I F'EALT;-1 D=PT. F1�"JAL � {- _ f=1NAL ELECTRIC I � � DEV. Ft=ES PA!D J -�--- -- �� -- - FItJAL PLUP.1BIiJG I I I E=N�RGY -- -�-- ---�1-- .:: .-=_�� -;._..__.�._ .._ 4 i . -� CUMIVIENTS SEPTIC TAP�f< SIZE SEEF PIT/U 51ZE --- -- _—__._��i�_____.___ - — - i��� - �� .,�