HomeMy WebLinkAbout16980 (42) �` CiTY OF DIAMOND BAR
� � DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES �
��� 21825 E.Copley Drive
(909)860-3I95 Fax(909)861-3117 PRESS
��%�� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE �7 J�/� 1 �/� APPLICATION PEFMIT P/C
o AD�RESS� � ' \ Rw •'� � �y DATE � �� NUMBER� q
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER
o ADDRESS ZOyING SETBACKS
z CITY ZIP TEL. FRONT RW ❑
g APPLICANT TEL. REAR ❑
SIDE/SIDESTREET RW ❑
� CONTRACTOR G � SIDE ❑
� ADDRE �^(l,dD ; rl. ►4lDVG
� CITY �' IP TEL. J PROPOSED USE �P"IG� WD��
o ARCH/EN / �
w DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STOfiIES BEDROOMS
� CITY ZIP TEL.
cn
cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFR/ADO/REM
O
1 NEREBY AFFIRM UNDER PENILLT'OF 7ERlURY THAT I AA1 EXEMPi FROM TH[CONiMCTORS lF GaragelCarport
W CENSEUWFOHTMEFOILOWINGREASDN(SEC.TWI.SBUSINESSAYDGROFESSIONSCODE:IWYCITYOR (n
C� COUNTVWHILHREOUiRESAPERMITTOCONS1i3UCT,ALTER�MDROVE,DEIAOIISH,ORREPAIRANYSTRUC• W Patio/peck
Z TUfiE PHIOR TO RS ISSUANCE,ALSO R[WIRES THE APGLILMli FOR SUdi VERMIT TO FILE A SIGNED
W STATEMENT THAT HE OR SHE i5 LJCENSEO VURSUANT TO THE PROVISIONS OF TNE CONTRACTORS L4 W
� GENSELAW(CHMTERY�CpAMENCINCWITHSECT10N7000�OFDMElON70FTH[BVS�NESSMIDPRO- �- PooUSpa
FESSqNSCODE�ORTHAiMEOq5HE�5EXEMPTTHEREFROMANDTHEBA515FORTHEALLECEDEXEMP•
TION.I�WVIOLATIONOfSELT10N7071.S8YANYAPPIILA`lTiOR11iE��TSU&IECTSh7EAPPUCANT70 Z �@�ROOI
A GML PENALTY OF NOT MOFE T1UN FIVE MUNDRED OOLURS�f5�()�):
ZO1�50WNEROFTHEPROPERTV.ORMYEA�PLOYEESWITHWAGE5A5THEiHSOIECAM7ENSAT10N, � COmmOrCiel
WILI DO TH[WORK AND THE STRUCTUR[IS NOi INTENDED OR OFFEFlED FOR SALE(SEC.70s�.BU56 J
� NESSANDDROFESSIdJSCODE:TMECONTRACTORSLICENSEUwDO[SNOTAPPLYTOANOWNEROF
VR07ER'TVWLIOBUILDSORMICROVESTMEREON.ANDNMODOESSUCHWORKNIAISELFORMCRSELiOR �
CL THqIX1CH HIS OR HER ONM EMP�OYEES,PRONDED THAT SUCN IIAPROVE�IENTSARE NOT INTENDEO OR m
OOFFEREDFORSKEIF,IIOWEVERTMEBVILDINOOHIMPROVEMEMISSqDWITMNONEYE�ROFCOMPLE-
Z TqN,TM[OWNER�BUILDER WILL MAVE TME BURDEN OF PROVIN6 iMAT M[OR SME�ID NOT BUILD OR
� IMPROVE FOR TME PURPOSE OF S�LLE).
w OI,ASOWNEROFTHEPROPERTY,MIE%LLUSNELVCONTMCTINGWI7HLICENSEDCONTRACTORS
[[ TO CONSTRUCT TME PRQIECT(SEC.7os�,BUSIN[SS AND VROFESSIONS LOD[:TME CONTRALTORS LI� Valuel:al ADJ.ARE-A_
W LENSEUWDOESNOTMPLYTOIINOWNEROFAPR07ERTVWHOBUILDSORMPROVESiHERCON.ANO
� 1M�OCONTMCTS�ORSUG/PROJECTSWITMACONTRACTOR(5)LICENSEDVU0.,UANTTOTM[OONTMG QUANTIIY DESCFiIPTION FEE
Y TORSLICENSELAw).
� O I AM EXEMP7 UNDER SEG. B.l P.C.FOR TN!5 REASON Q
O U
ti.. �
DATE OwNER U
Z W
� LICENSED CONTFiACTORS DECLARATION W
� IHEREBYAFFIHMUNOERPENALTYOFiERNRYTHATIAMUCENSEDUNDCROROVi510NSOFCHAP1Efl �
� Y(COMMENCP�qWIT115EGTION70o0�OFDM510N70F7ME8U5:NE55�NOPROFE55qh5fADE,AND Z
��� MY LICENSE IS M FULL FORCE ANO EFFECL / m
� LICENSECLAfS,S� L�C.NO.�J�J��-_���(� �
~ DATE_�X—9.1�-0 I coriTrucroa��,t/ r��..�"�- a
ui
� WORKERS'COMPENSATION DECLARATION -�
a
� U
� IHEREBV�FFIRYUIJ�ERVENALTYOFPERNMONEOFTMEFOLLOWINCDCClAMTIONS: Z
a
� �IMAVEMlDK9LLMAiNTAINACERTIFIGTEOFWNSEHrTOSELF•INSUREFDiiM/O�iKERS' _
CpAPENSATqN,/�SVPOVIDEDBYSECTION77000F7NEU[30RCOOE,FORTM[FERFORMANCE w
OF TME WOFK FOR WHIp1 THIS FERMIT IS ISSUED. �
�
W _I HAVE AND VYRI MAINTAM YlORKERS'COMPENS�TqN INSURANCE,AS REWiR[D BY SECTpN
Q a7ao OF T17E UOON CODE,FOIt in[PERFOiiMANCE OF THE MroRK FOR MT1ip�iMIS CERMiT15 / � J G Q
ISSUE�.MYWORNERS'COAIPENSATIONINSURANCECAARIERANOVOIICVNUuOERARE: CONSTRUCTION � ,
4
� URRIER PLAN REVIEW
Z POIICV NUM6ER ELECTRIC
Q
� �n+ssEcnor+r,[mr+aroc�r.M�oan[v�anRsra�aE�u�rnmoowwsR�a7a+�ut PLUM6ING
Z I CERTIFY 1lUT N TME�ERF011MANCE OF TME WORK fOR WHICH TNIS PERMIT IS ISSUED.I MECHANICAL ---- —^—�
(} SHALLNOTEM�LOVANYVEp50NINANYMANN[RSOASTOBECOMESUBJ[CT70THE '� I�//
N '�_�^
WORKERS'CD�APENSATIONUWSOFGLIFOHNI�ANDAGREETMATIi1511011LDBEC0�1E INSPECTIONFEE � - � �
S SUBJECTTOTHEWORKERS'CAA1vEN5ATION7 . �510NSOF5 ]�' THEU80R
1 SHALL FORT w:rn ca+v�r wim T os �sior+s ISSUANCE
/�� � L'
O DA7E: �'a APPL�GNT: �^"'- SMIP � � � O
0
J WAAN�NO:FNLURETOSECUREYNRI(ERS'CAMPENSATIONLOVCMG[ISUMAWFUL.ANDSHAILBE ENERGYP/C I
� SU0.IECTANEMPLOYERTOCR:MINAIPENALTIES/N'JCN:LiwESUPTOONEHVNDREDT/qUSAND ENERGYPERMIT � �CT• �
WLLA(i5(f 100.000).N ADOITION TD THE W ST OF f,OMPENSATqN,DAM�GES AS PROVIDED F011 IN
� SECTqN�7oBOFiHEIABORCOOE.INTERE57,/WJA7TOiWEYSFEES. RETENTIONFEE: ^ r
nW. CONSTRUCTION LENDING AG[NCY PRE-ALT FEE:
O
CL IHEREBYPFFIRMUNDERPENALTYOFPERM11qYTHATTHEREISALONSTRUCTIONLEND'NG�CCNCY
n' FONTHEVERFOFUTANCEOFTHEWORKiORW111p1TXI5VERMITI51i5VED�5EC.7097,CIV.C.�.
Z
W
� LEN�ER'S NAIAE
S
� LEHOER'SAWRESS
¢ ICERTIFYTHATIIUVEREADTNISAFPLICATIDNANDSTATEiHATTMEA90YEPiFORAIATqNISCOFRECT. TOTAL FEES J��� �O
w IAGREE TO COMPLY WITM ALL CRY/ND CAUNTY OR�INANCES AND 57ATE U'NS REUTINO TO BULOINC
� CONSTRUCTION,ANDNER[BV�l1TNOR12ER[VPCSCNTATNESOFTHISCOUNTYTOENTERUPONTH[
Z ABOVE-MENTIONED PROPERTV LORINS�ECTqN PUROOSES. COMMENTS
� � � �jV�.,
�
m PE(iMITTEE H E 1 � �
¢ �J`/ � �
�
V"� �
� SIGN�TUREOFPERMIifEE DATE `,��1
� RECPT.NO.��7 H PAID BY � d _VALIDATION
WHITE-0epanment Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApDl�canCs Copy
. . ..; . . . . . . .. .. . - r . -. � _. ... ..... . . . .� .. , . .. . . ...
.. . ., .- ., ., . . , , . , . , .. , . . :�. .�.. .. . � .. . � �:�-. . . ., . . . , _ .
vi 1'i ��' S7��a�li�i'r�� CJf�,�
ir�'4�,�c :�e;; �=;�_�r:;►�
-- .. _. -_____-._._�---------------� ---- ------�------------- --- --_._____------------ --------____-----___._.____.
a =�=�c' c�+i � ,�;��_ ,�; -i=•E;Re , ,�, .��- �� � e ,o,i�'� ,� ;��;�� c.
l►�=1. ,'GI li _t_ _ I� 'i- -. 1�� I� 7. - ...��',l 1i�� i_ I (.`t "[ j�1..
-- --� ---.. .-.... ._... _.._. ... . ._.... .. .. . . .. _. ._ .,... _. . _... ... .... ...- -_- ____..,_.._....--
SET�ACK ! � ��LOOR J�;ST;? ' . .� � �. . .
- - -�- -------..........----- -----------Tc----- ----
FTGS!F�RP�1S'STEEL I � ' I FFi; REa',1�� �
ELECTRIC GROUf�1[7 --;- ------------- ' ! U�JD�R FL�OR DiJCT ; ;
GflOUPdD PLUi�^31NG^ 'I � � Ui•1D�R FLOOR COi�!DUIT � �
SLAB GRADE -- --- l ---__ --__- I i �If��F'LACE rOU.`.DAI"I.^.N ! i-----—.
TEP�AP POLVER I � I FIfiEPL.ACE BO�JD E��F,P.1 � .�
-- -- -- -1---- - -�-,-- --
VJATER SERVICE _`., �j I I I �:"!D fi7. �OfdD Br�,t" ------..� . , .� � ---
ROOFSHEA7HING�fI 17/ --I ,/�-.-�--�-----•- -----------_-- -�.-- _ , ,
�l I-�i�_ , .;--;�-. £ fT_t30"d�'�[3Et�'�.1 . ( � '
�—� _
FRAP.IRJGNENTILIA710N I __ � _ _ I FI�dt1L 60PdD BEAP:1 __ �____� _ ___
ROOF COVER �����-� {_' PRc-G il�DifJG__ �__ �
ROUGH HEATING � I _ I i_BEi•:CHiiJG _ I
ROUGH ELECTRIC _ � __ I I ROUGf 1 GRF,DIiJG _ j_�_ _
ROUGH PLUi•�1ER�G � _ _� j Fli•:ISH_G=1�,D1;•JG �
SH�L"JER,riUd TEST � �_ j i POOL ELECTRIC �
--• •------
EXT. L!',TH?SIDING � ; i POOL FE�.C!'dG �
l�"JALL INSULATIO�d—� �-- -� � POO;_Fli.�l\L -. _ �— -- -
CEILING IN�ULF,TION I I I OFF 51TE Ir".PS. —�_ _ �
DRY4'JF,LL fJAILIfJG � ; �EDIC�TIOfvS � �
SE�VER � ; FI�:AL EPJG. _1_ �
SEPTIC TA�dh � �_� LAPJDSCAF'E/IRRIG. �
SEEP PIT/LL. I • j O�J SITE Ir.1PS. �
GAS AIR TEST j � � FINAL ZOPdI�JG
FINAL CONST. j�j=(�.�o � _ ' ' �!riE D=PT. FINA!�
FIP�lAL HEF,TIPdG �_�_ � j�f�iE,4Li H D�PL FIPJAL _
FItJAL ELECTFiIC I � I � DEV. FE�S P�;ID �
t-•- --
FRJAL PLUP�IBING � i I I ENERGY _ I �� _
, }� i I �, f= SI:,i _..._.w_..__.____, .
.. ,.,,�. . _
, � . _.. . . : ,
. ., .
, - • -
_ . . .
- ------�-------------- ----,..._. _....._..... . .... ....._.._._.._—.._
COMPJIENTS _
SEPTIC TANF:SIZE
SEEP PITIU SIZE - - ----- —�-
__��__'�� _..._�, - --
`�y� _
, �
�: -
.;
