HomeMy WebLinkAbout18100 --.^__.....�. . _ �- ---.�. -
�_
�� CTTY OF DIAMOND BAR
DEPARTMENT OF CONIIvIUN1TY&DEVELOPMENT SERVICES
��y 21825 E.Coplry Drive
(909)860.3195 Fax(909)861-3117. PA E$$
��'-�� BUILDINGPERMITAPPLICA'I'ION FIRMLY
o� JOBSITE ' 1 APPLICATION� '5� PERMIT P/C /;
ADDRESS��d�- �a�l�,�WO�� �F- - DATE `� � � GZNUMBER IOQ p l,/ " Z
$ ISSUE TYPE OCG
APN LOT_T TRACT OATE CONST. GROUP
p OWNER
o ADDRESS C C ZONING SETBACKS
z CITY � P TEL C FRONT RW ❑
g APPLICANT �� TEL.'�� 8 � � �� REAR ❑
� _ SIDFJSIDE STREET RW p
a� CONTRACTOR ' .. , • ♦ ^n Z SIDE ❑
o ADDRESS PROPOSED USE �7 O �O��J'
o CITY ZIP TEL.� • 3 - y�
wo ARC NG
DESIGN �
a�j NO.DWEL NO. NO.
n. ADDRESS •o Q u
� CITY ZIP�� L p UNITS STORIES BEOROOMS
v� 1
<n DESCRIPTION SQ.FT. FACTOR PSF QDJ.AREANALUATION
p� OWNER-BUIL�ER DECLARATION SFFUADD/REM �
O .
p I HEAEBY AFFlPoA UNDEA PENALTV OF PEiWRV THAT I AM EXEMPT FROA1 THE CONT ORS l4 � Garape/Cerport
W CENSEUWiORTHEiDLLGWINOREA50N(SEC.70.71.68US�NESSANDGROFESS�ONS .ANVdTYOR
U COUNTy�M11pIRE0UIRE5AVERMITTOCOMSTRVCT,ALTE0.�MPROVE.DEMOLISH.OFi AIRAN'/SiRUG W P8110/DOCk (�
� TURE 7R�DR TO RS ISSUANCE.ILSO REOUiqES TNE IPPLICANT FOR SUCH VE TO FIIE A S�GNEO �
� SiATEMENT THAT HE OR SHE�S LICENSEO PURSUANf TO iHE GROVISIONS OF E CONTMCTORS LF
CENSE UW(CNAP7ER Y(COM1A6p1CW0 VATH SECTION 7o0oJ OF DMSION�O HE BUStNE5SAN0 PP0. � PooUSpa
� iE33lONSC00�ORTHATHEOR31(EtSEXEMPTTHEREFROMMlDTHEB FORTHEALlE6EDE%EA1P• (ry
TION.IWYVIOLATIDNOFSECT�ON7W].6BYANYAPPLICANTFOHAVEA SU&IECTSTHEAVPLICAN7T0 Z RB-R00}
�„_ ACMLVENALTYOF NOT MOHE iF1AN iNE HUNDRED DOlUR3(i5o0
Q plASOVMEROFiHEPROPERTY,O0.MVEM�LOYEESWITN ESASTHEIq50tECOA10ENSATION, 0 COmf11B�C181 �-
Z WILL DO THE WORK MID THE STRUCTUREIb NOT�MEN�ED OFFERED FOR SAIE ISEG 70N.BUS4 J
� NESS AND FROFESSIONS CODE:THE CONTHNCTORS LICE UW DOES NOTAPPLV TO AN OWNER OF ?
PROPERTYYn108URD50NMPROVE57MEREON,MID DOESSUp1WORNHiMSELFORMERSELFOq
[[ THROUCHHISORHERONNEMPLOYEES,PROVID TbUCFIMPpOVEMENTSMENOTINTENDEDOR m
� OFFEREpFOqSALEIF,iIOWEYER,THEBU0.DINa NWROVEMEHTISSOLDWITHINONEYEMOFCpMP�E•
TpN,THE ONrt�ER�BUILDEH WILL HAYE TN RDEN OF PROYWO THAi HE OA SHE DI�HOT BUqD OR
= WPROVEFORTMEPURPOSEOFSALEI �
w 04�OM/MEROFTHEPROPE EXCLUSIVFLYCON7MCTW6WtTFILiCENSEDCANTMCTORS
Q TO CONSTRUCT TME PROJEGf(SE OII.BUSME55 MID VROFESSIONS COOE:TNE CON7HACTORS LI• VelU9tfOn � A0.1.AREA
L11 CENSEtAWDOESNOTMPI.VT ONMEROFAPROPEHNWM68�1LDSORIMPROyESTHfREOH.AND
r_ wHocoKrrucrscoRsucnv ECTSN7TMACONTRACTOH(S�UCE DiURSUANTTOTHECON7MP OUANTITY DESCRIPTION FEE
� TORSLIGENSEUW).
0 O IAM EkEMPT U ER SEC. B. .FOR THIS REASON Q
�i U
LL DATE OWNER � �
Z W
4 LICENSED CONTRACTORS DECLARATION W
OC IHEREBYAFfIRMUNDERPENAITYDFPERRIRYTHATIAML�CENSEDUNOERPRDV15lONSOFCIIAPTEA �
� Y(C0IAAAENCWOWIiH5ECT1�N7000)OFOMSION]OFTMEBUSINESSANODPAFESSIONSCOOE,AND Z
�� NY4CENSESINFIhLFOHCEANDEffECL m
0 UCENSECU S � UC.NO.�� � �
F�-
V DATE � CONiRACTOR � 'V.� � d
W
� WORKERS'COMPENSATION�ECLARATION a �
= U
� IHEFEBVAFi1RMUNDERPEN�U.TYOFFE0.IURVONEOFTHEFOLIOWINODECUMT10N5: Z
� _INAYEANDYIILLMAINTAW�CEFRiFICATEOFCONSENTNSELFaNSUREFORWORKERS' _
COAAPENSA7ION,AS PROVIOED BV SECTON 77000FTHE LABOR CODE,FOq T1E PERFOi1MrNCE W
0
X OFTHEWOfiKFORWNIq1iHI5DERAlITI5155uED. �
"=,,.�V IHAVEANDVALLMUNTAWYYOPo(ERS'COMPENSATpNINSURANCE.ASREWINEDBVBECTION G�
Q ]7000FTHELABOpCOOE,FORTHEPERFORMANCEOFTHEWOflKiONWHICHTHISPERM1T13 7
ISSUED.MY WORKER9' PE SATION WSUIiANCE GR F AND POLICY NUMBEH ARE: CONSTRUCTION I / .J.
J
j CARRIER _� PLAN REVIEW
Z POIICYNUlABER ��_p ELECTRIC
Q
o �rr�ssEcnoanEmrqree�r.st�ooFt�v�aMraa�aa�r�voataras�s+aoloq�ss} PLUMBING
Z 1 CER7IFY 7NAi IN 7HE PERFORMMlCE OF THE YAHK FOR N'HK7i iN15 FERMIT IS ISSUEO.I MECHANICAL
(7 6HALLNOTEMPLOYM7YVERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE
(n NfORKERS'COMPENSATIDNIAWSOFCALIFORNIA.MIDAGREETMATIFISHOULDBECOME INSPECTIONFEE
SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIDNSOFSECTqN]1000FTMEUBOR P'��'
O000e.isruucomMnnn+coua�rvnn�n+osevaowsans. ISSUANCE .
p pATE: APPLICANT. SMIP / . 'L�'
J WMNINO:FARURETOSECUREYqiIKERS'COMPENSATpNCOVERAGEISUNUM/FUL.ANDSHALLBE ENERGYP/C �
�y SUBJECTANFMPLOYERTOCW��NALPENALTIESANDCMLFWESUPTOONEHUNORmTNOUSAND ENERGYPERMIT
pOlUHS(f 100.000�,IN ADDI710N TO ME COST OG COMPENSATION.DM�AGES AS PROVIDED Fqi IN
¢ SECTIONa7oeOFT1ELABORCODE,MITEREST,ANDl1TTORNEYSFEES. RETENTIONFEE:
o ,�CONSTRUCTIONLENDINGAGENCY pRE•ALTFEE:
Q IHEREBYAFFIRAIUNDERPENR OFpEfiIURYiMAT ISAGMISTRUCTIONLENOWfiAGENCY �
d FORTME PERFOiiMANCE OFTHE K FOR WNI IS G6RIfiT IS ISSUED(SEC.�091,CIV.C.).
Z
W
� LENUEfYSNAME
�
� LENDEN'SADDRE33 /
� ICERTIFVTHATIHAVEREADiMISACPIIGiqNAN'JSTATETW�iTXEABOVEP1FORUATIONISCOHRECL TOTAL FEES � CL O� V� �. `
� 1 AGREE TO COM7LV WRH KL CRY AND COUNTY OPD WANCES M1D STATE UN5 REUTWO TO BUIlDINO / /� '
CONSTRUCTION,ANOHEREBYAUhqiiIZEREVRESENUTNE50FTN15CWNTYiOENTFRUGONTNE � %(J
Z ABOYEJAEN710NEOGROFERTYFORINSPECTIONVURPOSES. COMMENTS ^�
O �a�
�
m VERMIT7E E(VRI
� ra 0
(� S�GNA7uREOFqER1AiT7EE tE
� RECPT.N0. PAID BY VALIDATION
WHITE—�epartment Capy.YELLOW—Finance Copy,PINK—Aseessor Copy.GOLpENROD—File Copy.GREEN—ApplicanCm Copy
c, i .... ... .. . , �.. • � . • . _..._.. ._._.- , . . . �.--. „-T•;' • ....3. '�r:dn... ,.a;y.�.�"T�"�.�� � .,.. � fi.� :,.N.� , �.'y7. ,..-. .. . �' .. . .., . .
' CITY (�F [31Af�rOND BAR
1f�fSFEC�'tON RECORD �
!fR.����i����l .. _. �ay��� _: �,I�l�����1�a���: ,_.. . :. .�:1a`+�;��c�1�.y� : :;a�"-�`�i��:►!�=����`����. �
SET BACK ���. .–—�-- ~'��.. � FLOOR J�IST ' � +
FTGS/FORMS/STEEL ,��~1J�- FHA REQMTS ��
ELECTRiC GROUND � _ JNDER FLOOR DUCT • .�
GROUND PLUMBWG I I UNDER FLOOR CU�!DUIT ' i ; •
SLAB GRADE I I FIREPLf�CE FOUNDATION '
TEMP POWER I � I � F(REPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM '
ROOF SHEATHING � 8 FT. BOND BEAM •.�
FRAMINGNENTILIATION � � FINAL BOND BEAM
ROOF COVER I PRE-GRADING �
ROUGH HEATING � BENCHING• � �
ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBING ' ' FINISH uRADING
SHOWERITUB TEST • ; POOL ELECTRIC
EXT.LATHISIDING i POOL FENCING
WALL INSULATION � POOL FINAL
CEILING INSULATION OFF SITE IMPS. �
DRYWALL NAILING DEDICATIOPJS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRRIG. (
SEEP PITlL.L. ' � ON SITE 1MPS. �
GAS AIR TEST j FINAL ZGNING �
FINAL CONST. _���„� �/u, � FlRE DEPT. FINA! �
FINAL HEATING � I � HEALTH DEPT: FINAL
F1NAL ELECTRiC � f I i DEV.FEES PAID
FINAL PLUMBING � ; ENERGY �
� � �
� �
�,¢ �;,�� ��n r{�o¢�'��. ' �� ,
' � COMMENTS - _--- --__� W__�_ ._ -- _ _.._---- --- -- - - -- --
. . , �; ,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
� ���� :�
';l�f"� ��� . --
�, . .
�
� ;f .. .
, __._..� __�, 'i