HomeMy WebLinkAbout17051 (44) /� .
� '� /1 (A/' .
CITY OF DIAMOND BAR i�" Vy' 1 �
� �� - DEPARTMENT OF COMMUNITY&DEVELOPMENT'SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)B61-3117 PRESS
'�"� BUILDING PERMIT APPLICATION FIRMLY
y, JOBSITE ��/ ���� �LC � APPLICATIONG U PERMR P/C
o AODRESS �3 f✓ DATE � NUMBER�� N
� APN OT TRACT ' ISSUE � NPE OCC
� OWNER _
-�y✓Q'N�L'�A DATE CONST. GROUP
p AODRESS � .Q N /� f�— ZONING SEfBACKS
�W CITY - ZIP.�1��TEL ���� FRONT RW ❑
APPLICANT TEL REAR p
� SIDE/SIDE STREET RW ❑
CONTRACTO ��� ' SIDE p
qC ADQRES C �'►' i
o CfTY 'v ZIP 'L TEL /S PROPOSEDUSE r � �
� ARCFVENG/ i _
�z,� DESIGNER NO.DWEL NO.
� C�RESS Z�P TEL UNITS STORIES BEDROOMS
�
rn DESCRIPTION SQ.F7. FACTOR PSF ADJ.AREANALUATION
O OWNER-BUIIDER OECLARATION I SFR/ADO/AEM �
p I HEi�6Y AFF6iM UN�ER OEtULN OF PEtYA1RY TNAT I MI EXEMPT iROM THE CONTMCTOfiS U• G2faQ8/CBfpOR
Lt� CENSEtAWFORTI1EF011OW1NOREA5p1(SEC7Wt.5BU5ME55ANDiROFESSiOnSGO�E:ANYCtTYOR (n
S7 COUHf7N�Fqp1REOUIqESAVEMIRTOCON57NUC1./,LTERMPROVEDEMCLJ.^,/tOHREPIURANYSTRUG W
�� NRE,PRION TO RS 65UANCE.PLSO IiEWIRES iHE APPIICMlT FOR SUC11 DERMIT TO FILE A SiGNED w Patia/Deck
.� 6UTEMEHT THAT HE OR SHE IS UCENSED iVfiSUMR TO THE VROVISIOHS OF iN[CONTRACTORS l4 �
� CENbEUW�CHAiTENO(COIdMENCWOWITH5ECT10N)000)OfDIN510N]Oi'THEB'JSINESSMIDVRb PooUSpa
iE6.SqHSCOOE)OpTN�THEORSH[ISExEA1PTTXEREFROAIANDT/1E8!.SISFORTHEhLLfOEDE%ENP- (�
TqN.N7YVIOLATIONOFSECT10N7W/.6BYANVAPP�ICMffFOR�PERMtTSUEUECTSTHEMFLICANTTO Z Re�Root
F ACMIVENALTYOfNO7MORETNANFNENUNOREDDOLURS(t5[o).): ,
O OlASO'NNEROFTM[PROPERTY,OHMVEMPLOYEESWITMWAGES/STHEIRSOLECOMPENSATqN, � COTR19fCial -
Z YVILL 00 THE Y�ORK,AHD TME STRUCTURE IS NOT IN7EN�ED OR OFFERED FOH SKE(SEC.70N,BU54 J
N NESS NtD VROFESSIONS OJOE:THE COflTMCTOR9 LICENSE UW OOES NOT APPIV TO�Ul OWNER OF ?
PIiOPEHTY WNO BULDS OR IMPROVES iHEREON,AND VMO DOES SUpI WOHN HIMSELF OR HERSELFOR
Q T}1NOUGHHISORHENOWNEMPIOYEES,PROVIDEOTHATSUf]IMPROVEMENTSAqENOTMENDE�OR m
�OOFiENEDFdiSILEIf,F10MlEVER7HEBUtDIN00RIWDROVENEMI550lDWITHINpJEYFAAOFCOMPLE-
Z T10N,TNE OVNIER-BU0.DfR 1NLL HAVE TME BUliDEN OF VFIONN�THAT Hf CR SHE 010 NOT BUIID OR
� MPflOVE FOR T/1E PURPOSE OF SALE). �
W OIABOwNEROFTNEPROiEiiTV,AME%LlUSNFLYCOMMCTINOWfiHLICENSEDCONTMCTOR3
� TO CON57AUCT TME PHO.IECT(SEG 70N,EUSME55 AND GRO�ESSIONS COCE:TME CONiRACTDFiS LI- V81118i1Of1 ADJ.AqEA
CFt�E UW DOE9 NOTMPLT TO AN ONTiER OF A PHOPERTY YR1D BUILDS OR MVRDVES TMER[ON,AND •
� wr+ocoMw�crSForrsuaivacuEcrStvrnrAca+nucioru5)l�c�NSEDwr�sUurrron�Econrrua QUANTIN DESCRIPTION FEE
� ia+s uca+sE uw.y
O I MA EXEMPi UNDER SEC. B.t P4 FOR THIS REASON a
U
�= DATE OWNER � V
� UCENSED COPITRACTORS DECLAAATION ' w
J
� W
IHEREBYI�FFIpAUNDERVEWITYOFVE0.1URY711AilAA1UCEN5EDUNCERPqOVISiON50FC1/,1PfER V,
� �(COMMENCINOWITHSECiqN700o)OFDMSION]OFTHEBUSINESSANOPROFELSIONSCODE,AND Z
�� MY�ICENSE IS M FULL LORCE AND EfFECT. �
� LICENSE CUSS `^�� LIC.NO.� �� j
V DATE ��c�, CONTRACTOfi � d
W
� WORKERS'COMPENSATION DECLARATION ���. ¢
� IHERL9Y/IFFIRMUNDERVENALTYOFiEfWRYONEOFTHEFOLLOWINGDECUMTIDNS: z
� �IHAVEFNDWILLMAMTAINACENiIFICATEOFCONSENTTOSELFaNSUPEiOFW00.KER5' _
C011PENSATqN,ASGROVIDEDBY5ECT70Ni7000FTHEV8d7CODE,FORTHEPERFORMANCE 1U
OF THE WORN FOR Wr71CN TMIS FERMR IS ISSUED. , �
0 i
_I HAVE AND WIIL►UMTAIN WORKER.�i COMPENSATION INSUMNCE,AS REIXIIRED BY SECTION
Qd �700 OF THE UIBOR CODF,FOR iHE PERFORMANCE OF hIE WORK FOq WHICH THIS PERI.IR IS � ��-� O
�SSUED.MYIMORKERS'LOMPEkSATqNINSUR/�NCELARRIERANOVOLICYNUMBERM: CONSTRUCTION
� c.wruEn ��' rZ� '� PLAN REVIEW
� PaicrnuMeEa ELECTRIC
�nssccncwn��wreE�.s�r�acncaEa.+rs�na�Mra�c�Dau��,�o�or��ss� PLUMBING
8 ICERTIFYTHATNTMEPERFORMANCEOfiHEYlOW(FOflWNIpiTH6VERIAITI5155UED,1 MECHANICAI
SHALL NOT EM7LOY M1Y iER50N U1 ANY 4�NNER 50 AS TO BECOME SUOJECT TO THE
vj WORKER5COM7ENSATIONUWSOFCALIFORNIA,ANDAGREETHATIFISHOIiDBECOME �NSPECTIONFEE
S SU6IECT TO THE WORNEf35'COMDENSATION PRONSION OF SECTION]7M OF THE R -
coo s roan�hTMcor.�q.rwm�r�as ' �c++s. A ISSUANCE •
c
p DATE: C� APPIICAM: / SMIP � , O U
� ENERGY P/C
WARNINa�fAILURETOSEWREWOi1KER5'COAIPENSA7IONCOVERAGEISUNL FUL,AND NALLBE
�"y SUBJECT/�NEMPLOVERTOCR!1AINALPENALTIESANOCNILFINESUPTOONEHUNDREOTFIOUSAND ENERGYPERMIT
DOIURS(i100.0a0).N 11UDITION TO TME COST OF LOAIPENStiTION,pAAUGES AS PROVIOED FOR IN
� SECT�DN�70lOFTHELABORCOOE,WTERESIANDATiORNEV'SFEES. �i qE7ENTI0NFEE:
a CONSTRUCTION LENDING AGENCY PRE-AL7 FEE:
O
� IHCREBYAFFIRMUNOEROENALNOFDERIURVTHAT7NEREISACONSTRUCi!OHLENOWOACENCV
Z GOR TNE PERFORMANCE OF THE WORN FOR WNIGI THIS CERMIT IS ISSVED(SEG 90V1,CIV.CJ.
W I
� LENDER'S NAME
' � LENOER'SADDRESS �
� 1 CERTIFY TIiAT I HME READ hIIS APiLICATIONAND STATETIUT THE ABOVE INfORMATqN 19 WfiRECT. TOTAL FEES � �� ��
� MaNEET0001AVLyN1THIlLLCrtYANDCOtR/7YOR0iN�NCE5AND5TATEUw5RFU7wGTO8VdDINO
� CONSTRUCTION,ANDMEREBYAUT/qRREREPRESENTATIYE50FiHISCOVNTY70ENTERUVONTHE
hBOVE�lAENTION[D VROVER7Y FOR INSPECf10N 7URPOSES.
0 COMMENTS
� ��'�" C � vG�',�
� VERMtTTEEN '�
N �
N SIGNATVREOFPERMITTEE OAfE �
� � '�. RECPT.NO. � PAID BY � VAUDATION
WHITE—Department Copy,YELLOW—Financr Copy,PINK—Assessor Copy,GOLDENROD—Fite Copy,GHEEN—ApplicanYs Copy
CITY OF DI�'af�fOiv�D.BAR
If�'SPcC i IOf: FFE�COF��
(,��,�Ti-�c-it°f�j�'`€��o� ��'�.����!-'i�=��'.JA !►`t�4�-'� �t�'�.��' . �, e��W�':� + :�f��.���e� ��c�;a���
. . _..,.._._._�:. _" _,. ..�e+�+,�+� re ^...ae�..�,.+�re � x . ,. �
SET BACK. I ' i. FLOOR J ST ! , -_ ! � ; _ ,
FTGS/FORP�"S,�STEEL ' ' j � FHA REQ!.'TS � __
ELECTRIC GROUND . ' UNDER FLOOR DUCT __
GROUND PLUMBING UNDER FL�OR CUi,!DUIT I _ __
SLAB GRADE FIREPLACE,�OUi�IDATION • ' 'i _ _
TEh4P PO�NER FIREPLACE BOPJD BEAh4
VJATER SERVICE � M{D HT. BOND BEAM ' '' �;
ROOF SHEATHING � � 7 O�• 8 FT, BQND B�A",, " �� � _
,FR.AMRJG,NENTILIATION� — — _ FINAL BON�J BEAM _
ROOF COVF_R � � ` "' PRE-GRADING
ROtIGH HcATINu � /�o BENCHIN,:�
ROUGH ELECTRIC I � ROUGH GRADING
R�JGH PLUMBING � FINISH uRADIPJG
SHOI�b'ER.�UB TEST POOL ELECTRIC _
c�T. LF,TH!S{DING POOL FENCING
:'�'ALL ivSULATiON POOL FINAL ^___
GEILiCJG irvSULATIOfJ OFF SITE IMPS. �
DR`ri,'JF�LL NAILING �EDICA7i:7i�S
�GWE� ( FINF,L E��lC;, �
SEPTICTANK , LANDSCAPE/IRRIG. � �
SEEP P:T/L.L � '. � ON SITE If+�1P5. I ^I �
GF,S P�IP.TEST � FINAL ZOMMG � i
FIN."�L.CQNST. FIRE GEPT. FI�lAL ; i—,
Fi^:":L NEF,TING � � HEF,LTH DEPT. F?NAL i � _ !_
!_�^.E-L ELECTRIC � DEV. FEES FAID ��^__i1 -- _` i
`^':.?.r.!_ PLU'�1a1�lG E��dERGY
� --- I �___._..,�._.._� �--- ------
ti I ti:� '` .._. _ _ _... .. �-- ---
� 1 - .
� ca��,�nn����s � � _
� . �
,_ _ _ ---- . -- --
.
SEPTtC TANK SIZE
SEEP PI i/U SIZ� -- --y-----
�.- rr�4�^_.__�_m_> , _ -- ---- — ----——
�� ' : . : -- -
�''I'� • . -- ----- -
� . + � :. ' - - -
{ , _----- --
.:'�.._. .._. _._ .�.f..._....__..____..1 ' . _ � . � � -----{