HomeMy WebLinkAbout16806 �g �� � CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)86a3195 Fa�c(909)861-3117 PRESS
��'TM'� BUII..DING PERMIT APPLICATION FIRML
y JOBSITE A �,J�/ �h c� � APPLICATION /� 11 PERMIT �1,,P/C
o ADDRESS �-`r 7�� Y 1 ��J �` , DATE � v 1 NUMBER OlU# —
ISSUE 1 f"� TYPE'� pC
� APN LOT TRACT DATE rl �v� CONST. GROUP
p OWNER Il�
p ADDRESS f(�FrL.S C� i t ZONING SETBACKS
�W CITY ZIP TEL ^�O`' $ REOART RW p
APPLICANT (�1�2'�'G2(ff,� TEL• • " SIDE/SIDE STREET RW ❑
� CONTRACTOR (,fJ �O • SIDE ❑
� CDDRESS ZIP r TEL.(��",_�1�1-lD PROPOSED USE � � �
�i ARCH/ENG/ . . . -
� DESIGNER �r�.• NO.DWEL. / NO. �NO.
ADDRESS UNITS L ' STORIES• .� BEDROOMS
CITY ZiP TEL.
�
�n DESCRIPTION' S�.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HER�Y AFFlRM UNDER PENPLlY OF VERIUHV THA7 I M1 E%EMPT FHOM TNE CONTRAC70RS LF Garege/Carport
11J CENSEUWFORTHEFOlL01MNOREA50N(SEC.7031.6BUSINESSANDPROFESSpNSCODE:ANVG7VOR (n
C� �qJ�.(NWry1CF1qEqJWE9APERMRTOCONSTiiUCT,N.7ER,IMPROVE,DEMOIISH,ORREPAIRANYSTRUG w
Z TURE,PRqR TO ITS ISSU/WCE,ALSO REOUIRES TNE APPLICMlT FOR SUCH PERMI7 70 FlLE A 51(iNED W PetlO/DBCK
STATEMENT THAT HE OR SHE IS LICENSED PU0.SUANT TO THE PHOVISIONS OF hiE CONTMCTORS L4
� CENSE UW(piA➢7ER o(COMMENCW�WITH SECTION)000)OF DIVISION 3 OF THE BUSINESS IND PRO- u' PooUSpa . , �
FE6SqN5 COOE)OR TIATHE OR SHE IS EJ(EMPT THEREFROM AND THE BASIS FOR THE ALLEOED EXEMP- (�
TqN.ANVVI0LAT10NOF3ECTION7037.6BYAHVMPLICANfFOHAPERMITSU&lECTSTHEAPPUCANTTO Z Re-Roof'' -
� ACML PENALTY OF NOT Aq(iE THMI FIVE HUNDRED DOILARS(f500).):
� ❑I,ASOWNEHOF7HEPROPERTV,ORMVEMPLOVEESWfTHWA�ESASTHEIRSOLECOMPEN5AT10N, � Cpmmercial .' -
WILL DO THE WORK M1D THE STRUCTURE IS NOT IN7EI�ED OR OFFERED FOR S/�LE(SEC.70N.BUSI� J
� NE55 AND VROFESSIONS CODE THE CONTRACTOR.4 LICENSE UW DOES NOT AFPLV TO AN OWNER OF � � '
PROPEHfY Nh10 BUp.DS OR IMPROVES iHEREON.AND WMO OOES SUCH WORK HIMSELF OR HERSELF OR '
Q THHOUGHWSORHEROWNEMPLOYEES,7ROVIDEDhUT5Uq11MPROVEMENTSAHENOTWTENDEOOR m
QOFFEAEDFOfl9ALEIF,FIOWEVER7NE8UILDINUORIMPROVEM@lTISSOLDWRHWONEYEAROFCOMPLE- ��
Z �•TION,THE OWNER-BUILDER WILL MAVE h1E BURDEN OF PROVINO TMAT HE OR SHE DID NO7 BUILD OR
� iMPROVE FOR THE PURVOSE OF SALE).
{y ❑1,A9 OVMER OF 7HE PROPEHfV,AM IXCLUSNELV CONTRACTINO WRH LICENSED CONTMCTORS
¢ TO CONSTRUCT THE PRQIECT(SEC.7M1,9USINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V81U9fI0f1 q�,qq�
� CEN9E UW DOES NOTAPPLV TO MI OWNER OF A PROPERTV WFp BUILDS OR IMPROVE$THEREON,AND
NTiOCON7MC73f-0RSUCHPR0.IECTSWI7HACONTRACTOR(3)LICENSEDPURSUAMTOTHECONTRAG QUANTITY DESCRIPTION FEE �
� TORS LICENSE UW.). . ,
J
O I AM IXE/APT UNDER SEC. B.8 P.C.FOR THIS REASON Q
3 � ,
LL � (
DATE ONRlER � , ,,
� UCENSED CONTRACTORS DECLARATION W ' • I
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � �
� a(COMMENCV�I(3 WITH SECTION 7000)OF DIVISION J OF THE BUSINESS IND PROFESSIONS CODE.AND Z �
X A1Y LICENSE IS M FOfiCE AND FFECT. m
LLI f\ �
0 LICENSE\ClASS LIC.NO. J �
V DATE ` � CONTRACTOR �
LL
� WORKERS'COMPENSATION DECIARATION Q
• � 1 HEREBV AFFlqM UNDER PENALTV OF PERAIM ONE OF THE FOLLOV.�NO DECIARATqNS: Z ,
� _IHAVEANDWILLIdAINTNNACERTIFlCATEOFCONSEMTOSELFaNSUREFORWOHICERS' _
COAIPBlSATION,AS VROVIDED BV SECTION 3700 0F T}IE L�BOR CODE,FOR THE VERFORMANCE W
Q OF TME WORK FOR WHICH THIS PERMR IS ISSUED. �
�i HAVE AND WILL AWNTAPI WOfiKERS'COMPENSATION INSURAHCE,AS REWIRED BV SECTION
Q 3700 OF hIE UBOR CODE.FOR THE PERFORMANCE OF THE WORK FOR NT11CH THIS PERIAIT IS
ISSUED.MY QWO�RK�EHS'COMPE�NSATJI„ON/LjN�SUFUNCE CARRIER M1D POIICY NUMBER ARE: CONSTRUCTION �
� CARWER `�1� 1 w`-^� PLAN REVIEW�
I � coi.icrr�ur�eEa_ _ ' ` - � ELECTRIC �•� D
0
�-� �- (n�6sEcilaJrF�Mo7sEooMPLEfmoFnEPEaMrsibaor�lEHUwtlEooaiuis(ftoo�aaLESs). PLUMBING
Z I CERTIFV THAT Pl THE PERFORMANCE OF THE WOPK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL \
SMALL NOi EMPLOY M!Y PERSON IN ANY M/JlNER 50 AS TO BECOME SU&lEC7 TO THE r
(�/� WORKERS COMPENSATION LAWS OF CALIFORNI0.µD AGREE THAT IF I SHOULD BECOME INSPECTION FEE l��`
.� SU&IECT TO THE WORNERS'COMPENSATION PROVISqNS OF SECTION 77000F THE L�BOR 7� �
COOE,1 ALL FQRTHVII7H COMPLY WI QSE P VISIONS. ISSUANCE Y
� 1
p DATE:� ��` APPLICANT: �SMIP
, J ENERGV P/C • �`
- WARNINO:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS U L,AND SHALL BE
� SU&IECTANEMPLOVERTOCRfMINALPENPLTIESANDCNILFINESUPTOONEMUNDREDTMOUSAND ENERGYPEpMIT � � �
DOLLARS(f 100,000),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN
¢ SECTION 3708 OF 7HE LABOR CODE,INTEFEST,MID ATTORNEI"5 FEES. RETENTION FE : D O
. d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � �
O " I
� I HEFEBV AFFIqM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION I.ENDINO AOENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED(SEC.30V7,CIV.C.). � .
Z �
W
� LENDERS NM1E I �
1— LENDER'SADORESS �
S7� (�J /) /'
`i ICERTIFYTUTIHAVEREADTHISMPLICATqNAN�STATETHATTHE�BOVEINFORA1ATqNiSCORRECT. TOTAL FEES �� ]�] G '
� I A�HEE TO COMPLV N7TH ALL C7TY AND COUNTV ORDINANCES ANO STATE UWS RELATINO TO BUdDINO �\,J'{,/ J � � �
� CONS7RUCTION,M1D HEREBV AUTFiOHIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � ��
Z ABOVE-AIENTIONED PROPEHTY FOR INSPECTION PURPOSES. COM T �
� +
� � � '� '
I ¢ PE I EE P ��
�, �� a
� SIONATUREOFPERMITfEE E RECPT.NO. PAIDBY VALIDATION
� � WHITE—DepaAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--FlIe Copy,GREEN—Applk:anYs Copy
� �c�$'�'
-��' C6��( O� �9Qf�li��Qb ��a�
06�9.�'s(��C�'0��9 ����R� �
• ,� . . . .
. _ „ �',��—��,�y,-,,��7
��� �a a,� p � . ���., e � o ��b.v._ : 11U.J��ldl5l`.�U LI`JIIV • D 1 ° ���
-,. • . x.
, � , , o 0
�. �,
�,�..
SET BACK� • � . � FLOOR JOIST . �
FTGS,'FORMS/STEEL �_o j� ' ' " . FHA REQMTS � j ' �
ELECTRIC GROUND - UNDER FLOOR QUCT ~ ,
GROUND PLUMBING UNDER FLOOR CG�IDUIT ,
SLAB GRADE _ i � FIREPLACE FOUNDaTION ' '
_ , r
TEMP POWER I FIREPLACE BOND BEAM � �"' •
'WATER SERVICF MID HT. BOND BEAM � ' ' � . •
ROQ�SHEATH(iVG' ' � ., ', ?, . ,' ' { 8 FT. BOND BEAM �
FRAMttJGNENTI�lAT1�N p. � FINAL BOND BEAM ' � ,
ROUF COVF_R � PRE-GRADWG
ROUGH HEATING B HING
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWERrfUB TES7 POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING '
WALL IN�ULATION '�� OOL FINAL
CEILl1�dG INSULATION OFF SITE fMP5. �-
DRYWALL NAILING -(� ' DEDICATIONS •
SEWER FINAL ENG.
S�f�T9C TANK �ANDSCAPE/!RRlG.
SEEF PiT/L.L. � .: : ,..' ' QN SITE IMPS.
GAS A1R TEST FINAL ZOiVINC
FIiVA�i3ONS7. . �� ; � '( FIRE DEPT. FINA� �
FII�x�1�{EATING �, ��� � f-lEALTN DEPT. �INAL �` �
� FiNr,L ELECTRtC � DEV. FEES FAID
' :=�'^JR,�PLUIviBING ENERGY "
�.. � � --
� H m � a O An'n`. �r . ' �' � ,
! �i�������J
. . ` - , • _ - - -• . � .. �
� � _4
. . � � .. . . . • -; - . _
1
� ; �t � ' .
' 't • •
SEPTI�'T;4RIK SIZE --_ _ --�
SEEP PIT/U SfZ�
�-------- .-�-�
y �'� k_,�,., a� ����+fi":; .,��" — _
dn. �L„�.x f !.� . _
es, ,� ..�fM . '
' . ' '�, >�'. �,.. . . . .
��� ` r 1.
� a. ��� o � ` `
� � ,�� — .._._ —_._. __._.__.__�.
��
� �`� �= �- " - i
�� o:.
�,�� s.�� ' �` , � • , _ _
� �'ty�, ' . � � - .' . . , • . _' , � . �;
3�,t z. .'�+.�.� T 'x.. x r . . .
* � #.2# G''� '/��Rs' �
�� � � �� , .. _ � 1 ��; , -� . � �� . - . � _