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HomeMy WebLinkAbout17776 (32) . � _�� CITY OF DIAMOND BAR � � DEPARTMENT OF COIvIIviUNTIY&DEVELOPMENT SERVICES 2182i E.CopleyDrive "" (909)860-3195 Fax(909)861-3117 PRESS '-�' BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATI�N PERMR �� P!C Q ADDRESS �3� IV, ��!� C�'v, �I2/�E OATE �'"�3"bZ NUMBER N c� ISSUE ,rtJ��1, �Z TYPE OCC APN LOT TRACT DATE ✓� �� CONST. GROUP p OWNER �,��N1�3-S 7�By p ADDRESS �'�„ �J. R�, ZONING SETHACKS z CITY D►'�"Fr�.�� �92 21P �i•�76�'' TEL��J �'�/���/ FRONT RW ❑ g APPLICANT TEL. REAR O SIDFJSIDE STREET RW ❑ � CONTRACTOR SIDE ❑ o caY Ess ziP TEL. �-��F �T��2 W� /2F_Arslcz PROPOSED USE� rp � �F� o ARCH/ENG/ �z DESIGNER NO.DWEL NO. N0. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn p� OWNER•BVILDER DECLARAT�ON SFR/ADDIREM O � 1 HEREBY AFFIR�UNOEH VENALTV OF PE0.R7RY TMAT I AM E%EAIDT FRq.I TME CONTMCTORS L4 Garage/Carport W CENSEUWFORTMEFOLLOWW6REASON(9EG70�t.6BUSINE55ANDPROFE5510N500DE:ANYCITYOR (/j C.� COUNttWHIp1RE0UIRESA0ER/ARTOCONSTRUCT,ALiER,MPRWE.DEMOLISH.ORREPAIRANYStNUG W paUo/Deck � TURE.iRIOR TO RS ISSUMlCE.ALSO REOUIi1E9 THE MPUCAN7 FOH SUGH VERMIT TO flLE A 61GNED � STAtEMENT'M�T HE OH SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTMCTORS L4 � CENSE LAW(QUPTER Y(COI.�MENCPI�V/ITHSECTION 7000)Of DMSpN�OF TNE BUSINESS AND PRP u' POOVSpB FESSIONS CODEJ OA THAT HE OR bME IS EXEMPTTHEREFROAI AND TME BA515 FOR TME ALLEGED E%EMP- � TION.ANYVIOLATqNOFSECTiON7v71.6BIANYMCLIWNTFOPAiERMITSUBJECTSiHEMPLICANTTO Z Re•Rao1 � ApVM1PENALTYOFNOTMot1ETNANFNEHUNOREODOLLARS�f5oo7.): � OLASOWNEROFTHEPRDPERTY.OHMYENPLOYEESNnTMWAGESASMEIpSOLECOMPEN5AT10N, ❑ C01IiTBfCl81 � Z N7LL DO THE WORK,AND TME STRUC?URE 16 NOT INTENDED OH OFFERED FOR SAIE(SEC.7aI,BUSI� J NESS M70 VRDFESSIONS CODE:TME CONTRACTORS UCENSE IaW DOES NOT AFGLY TO AN OWNER OF � PROPERiY1MiOBUAASORIAIPlqVE57HEilEON,ANONMO00E35UCHM10HKHIMSEIFOHNERSfLFOR = Q THRIXIGHHISORMEROWNEMPLAYEES.PPDVqEDiHATSUp/1MVROVEMENTSARENOTIMENDEDON m QOFFERE�fOR3/LEIFIpwEVERTMEBUIDNGO11MPqOVEIAEMIS501DWRMNONEYEAROFCOlA0.E- Z TION.THE OWNER�BUILDER N'ILL HAVE 7/1E lUflOEN OF PROVMIO TFI�7 NE Ofl SNE DIO NOT BUILD OR � M7NOVEFORTHEPURP0.5EOF8ALEI. O 41150WNER OF TME VROFEHTI:N.�EXCUI9NELY CONTMCTWO WfTM LICENSED GONTMC70R5 � CENS�E+UWDOESAOTAPR�OANONNEflOFAPRO ER�NRqBU4D50RIMPROVE�S�M HEON.AND' VelU0t10R ADJ.AREA � W11000MMCISFORSUGIFROJECTSVATHACONTMCfOF(SjUCEN5E0VUpSUANTTOTHECONTiUG OUANTITY DESCRIPTION FEE Y 70RSLICENSELAW.). � �I lUA EXEMP7 UNDER SEC. B.J P.C.FORTHI,�REASON U O y� 3 /� �/ c�_ i�— oC � OATE��"'I3'�VZ OWNEN � _W� U �Q UCENSED CONTRACTORS DECLARATION W 2 IXEHEBYAFFliu1UN�ERiENALNOFiEiWHYTHATIAMLICENSEDUNOERGROVI510NSOFCHAVTER V. p., •(CqdMENCINOWITHSECTION7oo0)OFOMSION�OFTXEBUSINESSIWOPROFESSqNSCODE,AND Z X W LICENSE IS N FULL FORCEINO EFFECi. m lll � � UCENSE CUSS LIC.NO. J �"j DATE CONTMCTOR a . W � WORKERS'COMPENSATION DECLARATION a = U N IHEREBYAFGIRMUNDERPENALT'OFPERJURYONEOFTMEFOLIAYfNGDEU11MTqN5: � Z Q � �IMAVEANDVALLMAiMAWACERTFICA7EOFCON5EN7TOSELF�NSUiIEFORWORKERS = LOMPENSATION,ASPROVIOEUBYSECfION�lo00FTMEUBORCODE.FORTHEPERFORMANCE U Q OFTHEWORKFOqWHIpITH157ERM1715155UED. � 0 _I MAVE AND VALL NNNTAN riONKEfYS'COMPENSATION INSUILWCE,AS REOUIqED BV SECTION �� O 77o00FTHEL�BORCOOE,fONTXEPERFORM►NCEOFiHEWORKFOqWHICHIH15PERMIiIS 65UEU.MYWORKERS'COMPENSATIONWSUMNCECMRIERANDPOLICYNUMBEfiARE: CONSTRUCTION �� � � CAfiRIER PLAN REVIEW � aa��cr r+tRnoEr+ ELECTRIC o �nassEcnonr�mwreemr.�rmocnf�wNrswraa�itx�onEOCoue��s+m�oa�ssl PLUMBING Z I CERTiFY iHAT W TNE FERFORIAMICE OF THE WORK FOH WHICN TNIS PE�iTLSISSl1E0,I MECHANICAL ('J SNALLNOTEMPLOYANYVERSONINANYMANNEfl30A3TOBECOMESUBJECTTOTHE � WDqKERS'COMPENSATIONLAWSOFCAIiFORNI��qD�GREETNATIFI5M0Ult1BECOME INSPEC?IONFEE � SUBJECT TO TF1E VlORKER5 C061PENSA710N VROVi510NS OF SECTION�70o Oi THE U[iOR s coo�.�swu.t.tonnm�rNcor.�a�rv�nrHnaseoarnnsions. ISSUANCE O p DATE: APPLICANT. SMIP �,F��_ � ENERGY P!C WARNINQ FARUftE TO SEWRE WOFlKERS'COMPENSATION COVEMGE 19 UNLAWFUI.MID SHALL BE � SUBJECTANEMP�OYfRMCRIMINA�VEN/�1TIESANDCMLFWESUVTOONEHUNOREDTHOUSANO ENERGYPERMIT DOIWiS If l0o.00al.W 11DUITION TO THE COST Of CAMPENSATION.DAMAGES AS PqOVIDEO FOR IN � SECTbN7]OBOFTN[LABORCOOE,INTEREST,ANDATfORNEY'SFEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE�ALT FEE CL IHEREBVAFFIRMIM�ERFENALTYOFPE0.RIRYTHATTHEflEISACONSTRUCTIONLENDINOAGENCY nZ- FORTIIEPER�ORMANCEOFTHEWORKFORWHiCHTF1ISPEiwIY1S155UED(SEC.3oa7,CIV.C.). � . W � LENDER'S NAME � LENDEF'SADONE55 � ICEPTIFYTHA71HnVEREIDTHiSAPPLIGTIONANDSTAiETHATiHE11BOVENFORM�7IDNISCONRECT. TOTAL FEES I��� � IADREEiOCOIAPLYYATHALLGTYANOCOUNTYCRDiNMlCESAN�STATEUWSREUTINOTOBUIl01N6 CONSTRUCTI�N.AND HEREBY AUfIqRRE REPAESENTATIVES OF THIS COUNTY TO ENTEN UPON TNE Z 1100VE-MEMTIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS �, r�s T6�% m ERMIITT RI �a„ co /�4"' 3—�3—oZ y G�TURE OF OERMITTEE DI1TE � RECPT.NO. PPJD BY VALIDAT�ON WHI7E—Department Copy,YELLOW—Finence Copy,PINK—A9sessor Copy,GOLDENRO�File Copy,GREEN—ApplicanCs Copy � .- - -,..r-•:a:,.. .:,....,.. ....p;r. -.:m.- . :v�..�._-cr;'{�.`-"S:w(S�'.^i.T�:t�Y3Ti'�"+..�::^.,N..x,e.-�, .:i:ll^'"!'"-. �,.. -,�`i,,,.�' "�'::•'r.::r.r.... , .-....,...� _ �T•r•��.,. Ci7Y �3F DIRfV�OND� BAR � I�fuSF�E�9 iOfd RLCC)i3D � . „ ,���-����.��TT�►�+.� � �1�� {���-�.�����r�,, ..:...:t�� ��'���°� . ;���� _ �►�� ��`. � _ � .u�.._..... __�_,�_�r_�.µ..._.� ���. _ �_..___. _ -.`� -- '� �� � SET BACK : � �-� .�-� � FLO�R JaIST ;� '� • • FTGS/FORMS/STEEL ' .', _,� FHA RE�MTS ELECTRIC GflOUND � UNDER FLUOR DUCT , - GROUND PLUMBING UNDER FLaOR CUNDUIT � I SLAB GRADE FIREPLACE FOUNDATION ' ' TEMP POWER i i� FIREPLACE BOND BEAM WATER SERVICE I �� � MID HT.BOND BEAP�I ROOF SHEATHING .. , ��'�vZ �,fFu_-� "�_I S Ff. BOND BEAM FRAMINGNENTILIATION � � FINAL BOND BEAM ROOF COVER / �� PRE-GRADING I ; 3 -�-��-U FiOUGH HEATING I BENCHING I I FiOUGH ELECTRIC i ROUGH GRADING ROUGH PLUMBING � FINISH GRADING � SHOWER/TUB TEST POO�ELECTRIC EXT.LATH/SIDING i I POOL FENCING WALL INSULATION ; � ! POOL FINAL • CEILING INSULATION i OFF SITE IMPS. DRYWALL NAILING j DEDICATIONS , SEbVER FINAL ENG. SEP71C TANK , LANDSCAPE/IRRIG. SEEP PIT/L.L. ' ON SITE IMPS. GAS AIR TEST � FINAL Z(�NING FINAL CaNST. - � I , FIRE DEPT. FWA� ' FINAL HEATING � I HEALTH DEPT. FINAL � FiNAL ELECTFIIC I � f DEV. FEES PAID FINAL PLUMBING I i I ENERGY � ( � `� ��Fi,O "1[1 C C` . . . � COMMENTS SEPTIC TANK SIZE , SEEP PITIU SIZE ._ . . �~�.._. . � - ': . _. _. _.� ,;,�1r� ,i�� _ .. _ : ; E ._..._._..���.�. _ � _ .