HomeMy WebLinkAbout15092CITY OF DIAMOND BAR
DATE �-. {
NUMBER—
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
DATE CONST. GROUP
21660 E. Copley Drive Suite 190
FRONT RW ❑
(909)860-3195 Fax(909)861.3117
SIDEISIDE STREET RW ❑
BUELDING PERMIT APPLICATION
PROPOSED USE
PROPOSED
JOBSITE
ADDRESS 7 0 -L=C
APN LOT TRACT
/7
O',VNER CfJ.l'—)0 _C--I/Cl
ADDRESS & c -'S— �:,r /O E�
CITY 'L- ,'` y ZIPl lC TEL. n - '0 67.
APPL CANT CV!: -1Q+_ C J'0 TEL_ LO e- C 'SC
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCW'ENG/
DESIGNER
ADDRESS
CITY ZIP TEL..
OWN"EI-BUILDER DECLARATION
--N
I HCnEBY AFFIIIM UNDER PENALTY Or PCRUnY THA' 1 AM EXEMPT FROM THE CONTRAMOns LI.
CCNSC LAW FOR THE FOLLOWING RLASCN (SEC. 70.71 6 BUSTESS AND PRCFESS<X 5 COLEA.:Y CITY On
CM-NTY WHICH REOUW ESAPCRMr7 TO OONSTnLICT, ALTCFL NPPOVE. DCMCLIS1 L OR M PAA ANY STUC•
T1FIE. PRIOR TO Ii915SUANCE, A:50 REOL:IAC5 THE APPLICANT F041 SUCH PERMIT TO FILE A S:GKED
STA'EMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVIS'ONS OF THC CONTRACTORS LF
CENSE LAW (CFUPTER S (COMMENCING WITH SECTION 700C) OF D:VISION 5 OF DHE EUSINESS AND PRO.
FISSIONS CODE)OR TIHATHE OR SHE IS EXCMPT THEREFROMAND TIE BASIS FOR 7HC ALLEGED EXCMP-
TION. AhYVIOLATION OF SECTION 70.71.5 BY ANY APPLX.ANT FOR A PE RMI i SUBJECTS THE APPLICAN I TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSOC; )
O L AS OWNER OF TRE PROPEnTY. OR MY EMPLCYEES W'TH WAGE S Al DHEA SOLE COMPCh SATION,
WALL DO TMC WORK. AND TMC STRUCTURE 13 NOT INTENDED 014 OFFERED FOR SALE (SEC. 7044. BUS:
NESS AND PROFESSXNS COO, THC CONTRACTOnS LICENSE UN DOES NOT APPLY TO AN CWNEA OF
PROPERTY W'IIO BUILDS On IMPROVES THEREON, AND WHO DOES SUCII WORK H'MSCLF Ori H.( RSCLF OR
TNF100011 H'S OR HER OWN EMPLOYEES. PROVCCD THAT SUCH IMPROVELIC%TS Ani AOT N' ENDED On
OFTERED FORSALEIf,fVE1L THE BUILDING IXLMPFIOV[MCNi15SOLD WI: Nil ON=YEAR OF WNP:E-
TION, TIE OWNERAL=ER WILL FIAVE THE BURDEN OF PnCY.NG THAT FF. OR SHE CID NOT BL:P.D OIl
W PFIOVE FOR THF PURPOSC OF SALE).
CIL A,, OWNER OF THE. PROPERTY. AM EXDLUSIVELY CONTRA=%* WITH LICC%E ED CONTRA^ORS
TO CONSTRUCT THC PROJECT (SEC. 7544. BUSINESS AND PROFESSIONS M.1 TIE CON'RACTOR i LF
CC NSE LAW DOES NOT APPLYTOAN OWNER OFAPROPERTY wHo D'JA.CS on AAPnO.'E5 ThERrON AND
VA
4000N7RACTS FOR SUOI PROJECTS W'TH A CONTRA'ROnIS) LCCNSED AJnSUAN- TO THE CONTRACT
TORS LICENSE LAW).
Ell UNDER SEC. U. A PC, ICA TI4•.S RCA SON
[ l—
DA'E .6.,+
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFJWI UNDER PENALTY OF PC RJUnY THAT IAM L10E.NSrD UNDER !
'DER PROSIONS CF CHAPTER
S (COMMENCNO W:TH SMION 7O0[) OF DIY5ION 7 OF THE D'U5:NCS5 AND PFICFESS ONS COSC.AND
MY LICENSE IS N FULL FCnCC AP10 EFFECT.
LICENSE CUSS LIC. NO
DATE CONTRACTOrI
WORKERS' COMPENSATION DECLARATION
I FEREDY AFFIRM UN -,En PENALTY OF PEIL,T:FYO ONE OF THC FOL LOWING OECLAT ATIONS
—I HAVE AND WLLMAN7A.TA CERTIr•CA-E OF CONSENT TO SELF-IN3URE FOn WOHKE RS'
COMPCN5ATION, AS PROVHCED BY SECTION 5T D0 OF THE LABOR ECCE, FCR TIL PEn-ORMANCE
OF THE
WOn4C FOR M44H THIS PERMIT IS ISSUED
_I HAVE AND W.U. MAN'Atl WORKS. RS' COMPEl3A-gY INS::RAnCC. AS RECUR CD BY 3CCRON
5700 Or THE LArCn ODOC. FOR THE PC IT rORMANCE OF THC WORW'
K FOn •-ICH DrS PE PMIT IS
ISSUED. Loy NCM CRS' COM PE NSATCN INSJRA%CE CAP n:En ANO POLICY NUMEL n ARC.
CARRIER
PoLCY MJMOEn
rM SE -ION NEED NO' BC OCMlrrEDOrTE PfFYd: IS FOR OW. HUNDICD DOLLARS war: On LC55,
1 CERP.rY THAT N THE PERFORMANCE Or THE WORK FOR WHICH TRIS PERM:' IS ISS ED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNEn SO AS TO BECOmI7 S'UB:ECT TO DIE
WORKS RS' COMPENSATION LAWS OF CAA rFORNIA. AND AGREE TKA' IF I SHOULD BECOME
SUDJCCT TO THE WORKCnS'COM^ENSATXN PRO':IS,Ghs Or SECTION ]7000: THC LADOn
COUF.1 SRALL FDRTHW:THCOMPLY WInH THOSE PRC'JISIDNS
DATE. APPLICANT
WAM:NG' FALUr,C TD SECL:nE WORK(nS• C06HPENSAr KDN OOVCn AGE IS LKUWrJL.AN) SHALL BE
SUEUECT AN (MPLOYEn TO CR'U'NALPCNALTIE S Aho C.V.L FCES UP TO OK C 14UNDRCD IPM'SA.ND
DOLLARS 13100.000., N ADO:TION TO TILE CO;T OF CCUP[NrA' ION. DAMAC.:S AS Pn0'YIOED FO(I IN
SECTION ]DCF OF DIC LABOR CODE. N7ERCST-AND A'Ton%En FEES.
CONSTRUCTION LENDING AGENCY
1 F4RCBY AFFIRM UNOFn PL MALTY Or PETLV nY THAT DIME IS A CONSTRUCTION LEND_Nr.. AGENCY
FOR T2 PERFORMANCE OF T2 WORK FOR W 1%101 TH•5 PERMIT IS ISSUED (SEG 55FT. C:V C.).
LENDERS NAME
LENJCRSADORCSS
I
CER :FY THAT I HAVE READ TIOS APPUCA70N AND STATE THAT 7HE ABOVE NFORMA' ION IS CORRECT.
I AGREE TO COMPLY WITH ALLCITY AND COUNTY NTY OPOWANCES AN -0 STA -11 LAA-. RELATNG 70 BUILDING
CONS iRUCTION. AND
:.:
HEREBY AI4Gn:ZE REPRESE NIA: IVES O F TI NIS COUNTY 10 EN. [It UPON DIE
ABOVE MENTIONED PROPERTY Fon INSPECT ON PURPOSES
PERMITTEE NAME IPRNT, — rt
(y4F.IF/�%=(-;f %�o — l 1 —0 Q.
SIGNArUI i— I: OF PLFIMII iii IIA'.,
PRESS
FIRMLY
APPLICATI N I PERMIT I P/C
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DATE �-. {
NUMBER—
ISSUE
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE 13—
PROPOSED USE
PROPOSED
NO. DVIEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. ARE.AIVALUATION
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MCCHAMCAL
INSPECTION FEC
ISSUANCE
SN.Ir
ENERGY P,'C
ENERGY PERMIT
RETENTION FEC:
PRC -ALT FEE:
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TOTAL FEES
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COMMENTSQV--(?LL— 1-0
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NO. _�A
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WHITE—Deparment Ccpy, YELLOW--Fna..we Copy. PINK—Assessor Copy, GOLDENFIOD—Fila Ccpy, GREEN—kp:.cant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
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FLO-,A JOIST
Fl GS.!F0R.l.lS.,STEEL
F-1 11A RE07.1,TS
ELECTRIC GROUND
j-1-u-r-j-6--EP'FL-0--C-'R -DLJGT
GROUND PLUMBING
UNDER FLOOR
SLAI: GRADE
I FIREPLACE- FOU.NDATIO.Nl
TEMP rOVV'ER
FIREPLACE BOND BEAN1
VVATER SEFiVl-= f..:r) FIT. DOND BEAM.
I -ATHING :-1-s r -T. 13OBEA".",D BE
H00r: Sl H:
ROOF COVE -'R
FINAL POND BEAM
PRE -GRADING
R101JIGH Hr ATI
-ICHING
ROUGH ELKTRIC
ROUGH GRADI'-
7-
PI ULIEING I I
j j FINISH GRADING
�BTEST
POOL ELECTRIC;
::XT LA--H,"ZIDING
POOL FENCIN'G
POOL FINAL
0'--- IL! NO I. -: U L AT 1 O'N'CF
OFF SITE
D E: 1) 1 GAT 1 ON S
FINAL ENG.
TANIK,
LANDSCAPE/IRM-11.
I ON SITE I,'.'.PS.
':'::ST
FINIAL ZONINS
FIRE DEPT. FINAL
-AFING
H -ALTH DEPT. FUNIAL
i -ECTr-l?.:";
DEV. FEES PAID
PLUMB;NG
E'r.'9 Fi 0.1 Y
IMENTS
SEP TICTANK S!-,.=
SEEP PIT/U SIZE