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HomeMy WebLinkAbout18240 (19) � f� CITY OF DIAMOND BAR �" . I ,; DEPARTMER'T OF COIvIIvtUNITY&DEVELOPMENT SERVICES 21823 E.Copley Drive � '"�' (909)860.3195 Fax(909)861-3117 ' PRE$$ �.-•�. BUILDING PERMIT APPLICATION F LY N JOBSITE � ' /� � L APPLICATION rn � �] PERMIT � P!C o ADDRESS �/ OATE v � t•` NUMBER N c� ISSUE �� TYPE OCC APN LOT TRACT y DATE CONST. GROUP °C OWNER � 0 "�' ADDRESS O ZONING SETBACKS Z CITY � ziP��'f��. yb�9�o� REART RW ❑p g APPLICANT �- TEL.�.��(v SIDE/SIDE STREEf RW ❑ � CONTRACTOR � SIOE p Q ADDRES � CIN Z�p �, PROPOSEO USE o ARCWENG/ - �-- W DESIGNER NO.DWEL N NO. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 HEREBV AFflRM UNDER VENALTY OF VERAJRV THA71 M1 E%EMPi FROM THE CONTMCTORS Lb GBfSpB/C81pOR W GENSEUWFORTHEFOILOVlIN6PEASON(SEG.70]I.SBUSMESShNDiNOFE5510N5CO0E:ANYCITYOR (n U CDUNiYWMIp1REWIRES�PERMRTOCONSTRUCT,ALTEH.IMoROVE.UEMOLISM.CflREVAIRANYSTRUC• uf W NPE,iRiOR TO ITS ISSUANCE.ALSO REdJIRES iHE AGPIIGWT FOR 6UCM PERMIT TO FILE A S�GNFD W PB��BCk STATEMENT THAT ME OR SHE IS LICENSEO PUHSUAllT TO TME PHOVISIONS OF THE CONTfUCTOR5l4 � CENSE UW(C//APTER Y(COu1AENCINn MATM SECfION foo0)OF DIVISION�OF THE BUSiNES3 AND PAO- u' Pool/Spa FESSIONSCODE)ORTMATHEORSHEISEXEIAPTTH�HEFROMAN07MEBASiSFORiMEALlE6EDEXEMP- (' � TION.ANYVIOlA710NOFSECTION7WI.SBYANYAPPLICANiFORAOERMIT5U9JECT5TNEAPV�ICANTTO Z Ra•Roof � ACML►ENALT/OF NOT AqHE TYUN FNE MUNORED DOLURS(iSOD)�: • 04�5 OWNER OFTnE PROPERTY,OR M�EMPLO�EES WiTH W�GES AS inEfR SOLE COMPENSA7AN, Z � Commereial WII.L DO THE WORI(,M!D TNE STRUCTUNE IS NOT INTEN�CD OR OFFEREU iON SALE(SEC.7W�,BU51- J N NE55 AND PROFESSIONS COOE:THE CONTMCTOHS UCENSE tAW DOeS NO�A7PiV TO AN OWNER OF = PRODERN NM110 BULLDS OR IMPqOVES TMEREON.AND WHOOOES SUtl/WORN HIMSELF OR HERSEIF DR � 711ROlMMMISORNEROWNEMPLOVEES,VROVIDEOTHAT5UC11WPROVEMENTSARENDTINlE�DEDOR m w OFFEREOFORSKEIF,H04YEVERTMEBUILDINaORIA1PROVEMENTLSSOIDVnTwNONEYEAROiCOMPLE- � TION,THE OYMERbUILDER NnLL HAVE TME BURDEN OF PPOVINC!HAT ME OF SHE DD NOT BUILD OR Z IMPROVEFORTMEiUHPOSEOFSALEI = O�ASOWNEROFTMEPROPERiY.AMEXCLUSNEVCANTMCTINCWITMIICEN5E000NTMC70R5 W W CENS�EUWDOESNOTM LYTOANOYMEROFAPROP NTYWHOdU D90R�IMPRO�TM REON.AND Valuation ' ADJ.AREA � VAbCOMRACTSFORSUGIVRQIECTSWITHACOMMCTOR(S�LICEhSEDPURSUANTTDiNECONiRAC• OUANTITY OESCRIPTION �E � TORS UCENSEUW). 0 OIAMEXEMVTUNDERSEC. B.IV.C.FORTMISREA50N � S!✓/ � U � LL" MTE OwNER � Z U y .� � LICENSED CONTRACTORS DECLAFiATION W � 2 �o ovt•� �`Gc/`c I MEREBYAFFIRM UNDER PEWLLTV OF PEIiR1RY TMAT I Au UCENSED UNOEfl PROwSqN50F CNAPTER Vr � L p., 0(COMMENCI1q WITH SECTqN 7000)Of On'�SION�OF THE OUSINESS AND PP.OFESS�ONS CODE,AND Z X MYLIGENSEt51NFUlLFORCEANDfFFEGT. m L �u � UCENSE CLASS_,�,_�LIC.NQ. j V DATE CONTMCTOR�I � 6J. ' ^�"_�� lL /�/i��/� � WORKERS'COMPENSATION DECLARATION a � � 1 HEREBYAFFIqM UNDER PENALTY OF iE0.JURYONE OF THE FOLLOWiNG DEQARATIDNS Z C��.w/µ ,�� � �/f � _INAVEANDVIILLMNNTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATqN,A5 PROVIOED BYSECTON]70o OF TME IABOR CODE FOF TME VERFORMANGE �U Q OFiHEWORKiORWHIp1M15PERMiT13155UED. � � �IMAVEANDMALLMMNTNNWORKERS'CAMPENSATIONINSUR+WCE,ASREOUIREDBYSECTION Q 7looOFTMELABORCODE,FOFTNEPERFORMANCEOFTHEWORKFOFYAI�CH7Ni5PERM1T15 ISSUED.MYWORKER5 PENSATIONINSUn�/yc,E,CARRIERANDPOLICYNUM9EHME: CONSTRUCTION jCAARIER��(�,�� PLAN REVIEW � POIICYNUMBER f ELECTRIC � (ile55EGTIDNNEmND7BE[p.RkTWOF1IEPERMT5R7ROhEt41rONEDO4UILS1fi0%qilE55} PLUMBING Z ICERTIFYiMATlIiHEVERFORMANCEOFTMEWOfIKFORWHICHTMSPENM�TI5i55UED.l MECHANICAL (7 SN�l�NOT EuoLOY uav VERSON W ANY IAANNER SOAS TO BECOAIE SUBJEC7 TO iME � y WORICER5COMPENSATIONUW50fCALIFORNI�AND�GREETI1ATICISMOULDBECOME INS?ECTIONFEE �� SUBJECTTOTHEWORKERS'COMPENSATION H�SiONSOF5ECT10N�7ooOFTHEU80R CODE.ISHALLFONTHWITNCOMVIYWITH EPN 5. ISSUANCE � SMIP p DATE: APPLICANL W J WARNING:FA0.UR[TOSECUREWORKERS' OMPENSATION MGEISUMAWFUI,ANDSMALLBE ENERGYP/C �y SUBJECTANEMPLOYERTOCRiMWALVEN/LLilESANDCNI ESUP700NEHUNOREDTHOUSAND ENERGYPEFiM1T OOLlARS(tloo.aool.INADDITIONTOTHECOSTOFCqAP SATqN,DM1AGE5A5PRONDEDFORIN � SECTION 170!OF 7HE UBOR CODE,N7ERESL ANOA770RNEY5 FEES. RETENTION FEE: � a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: ' O � IMEREBYAFFiflMUNDERVEN�LTYOFPERJURVTII�TTMEREISACONSTRULTIONtEN01NGAGENCY z FOft TME PER W RMANCE OF THE WOFK FOR WMIGI TNIS PERMIT IS ISSUED(SEC.�097,CIV.C.). lli � LENDER's NAME � IENDER'SADORESS w� TOTAL FEES 2,'�(�,�� ICERTIFT TMAT I/NVE REAO TH1511PVLICATqN ANO STATE TMAt 1HE�BOVE INiORM�TION IS CORRECT. p. IAGREETOCAMPLYVA7MQLCfTYANOCOUNTYOROINANCESANOSTATEUWSRELATINOTOBUILDING � � � CONSTiiUCT10N.A/:DMEREBVAUTFqRIZEREPNESENTATNESOFTH15COUNTYTOENTERUPONTME Z A80VE�MENTIONEDPROVfRTVGORINSPECTIONiURPO5E5. COMMENTS 0 J m ¢ GERMiTTEE N E _ � � � 5�6N OF iERY1T7 E DA7E . � RECPT.NO. � PAI�BY VALIDATION WHITE-0epartment Copy,YELI.OW—Finance Copy.PINK—Assessoi Copy,GOLDENR06—File Gopy.GFiEEN—ApplicanCs Copy .. .. .. ... .__.. _.. ................ ..:... . ...;. _ . . ... . ... , ...s......... . . .... __ . �... . , , � .. ._,... .. ... ..,..,.... . . ...,....,, , , - . - CIT`�' Of� DIAfilr4h�D� BAR : � . • I�ESPEC�t'lOril RECO�D , . '��,�-�� �° '� �- .x o '�.� ����.w....���;��1�.�� o �:; ` '�'e ' �f �� � :� -- � _ .��"'- -- SET BACK • • � . � �FLOOR JOIST � � , - FTGS/F�RMS/STEEL i � '_ � FHA REQMTS _ _ -�-- � � , ELEGTRIC GROUND UNDER FLOOR DU,.T .. GROUND PLUMBING � UhlDEFi FL�OR CU�dDUIT �. , • SLAB GRADE � FIRFPLACE FOUNDATION � TEMP POWER ( FIREPLACE E30PdD BEAM � WATER SERVICE - I MID HT. �OND E3EAM � - ROOF SHEATHING • - � 8�T,BOfdD BEAh1 ` ' FRAMING,NENTILIATION ' ' � � FIhAL EiaND BEAM ' ROOF COVER _ _i PRE-GRADING ROUGH HEATING BENt;HING ROUGH ELECTRIC R�UGH GR.ADING ROUGH PWMBING I FINISH uRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING � • POQL FENClNG WALL INSULATION I PaQL FINAL CEILING INSULATION �__I _ I OFF SITE Ih4PS. DRYWAL�NAILING ; � � DEDICATIONS SEWER ' j }! FINAL ENG. SEPTIC TANK � �—t : LANDSCAPE/IRRIG. SEEP PIT/L.L. � , I ON 51TE IMPS. GAS AIR TEST i t FINAL ZONIPJG � FINAL CONST. � � ' � ; ' �IRE DEPT. FINAL FINAL HEATING ; '. ; HEALTH DEP-f. FINAL FiNAL ELECTRIC � ' � ' DEV. FEES PAID r--- - - — � �INAL PLUMBING ' � ; ENERGY — \ -- � �o � a ' , CUMMENTS ' � SEPTIC TANK SIZE �SEEP PIT/U SIZE : j M�".' _ ' _ _ _ • .:.. . • ,.; . .. '��l��� ' r�� — --- , . .. ' _� �' - .�� , �, � . .. , ,. 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