HomeMy WebLinkAbout17564 �� CTIY OF DIAMOND BAR
� DEPARTMENT OF COIvIIvIUNITY 8c DEVELOPMENT SERVICES
21625 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 RESS
"-�'� BUILDINGPERMITAPPLICATION FIRMLY
v DDRESS �� ` l� ��C"�'t�Rv,/ �l DATECATION i ��(� ��PUMB R���� / i1/�Q�
1 �) ..�ri
� APN LOT TRACT D TEE 0 Z ONST. GROUP
p OWNER RIC.�G �Dlll_R- _
" ADDRESS '�M ' ZONING SETBACKS
Z CITY ZIP TEL. � �'U D FRONT RW ❑
S APPUCANT �aYZ2 �dLS TEL. ' � SID�IDESTREET RW 0
� CONTRACTaR w � � SIDE ❑
Q ADDRESS c7-b 7 W, J 1-�1 !c T"a�N
� CITY �1 k_��'n ZIP�(]�',�, TEL��ljL�-���' PROPOSED USE � � S�A.
� ARCHlENG/
� DESIGNER NO.DWEL. NO. NO.
a ADDFESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
c�i� OESCFi1PTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFWADWREM
O
I HEREBV AFFlFM UN�ER VENALTY OF PEiWHY THAT 1 AM E%EMPT Fi101.�7HE CONTMCTOHS ll• V•af898/Ca1�OK
W CENSELAWFORTHEFOLLOWINOpFJ�50N(SEC.7NI.SBUSMESSMIDPROFESSiONSC00E:ANVqTYOR (n
U COUNTYWNIp1RE0U�RE5APERMITTOGONSTRUGT.ALTERIMPFOVE.DEMOUSM.OHREPNRANYSTRUG W PdliO/DBCk �
� 7URE,PRIOR TO fTS ISSUANCE,AL50 REOUIRES ME APPLICAM FOH SUCH PERMIT TO FlLF A SIGNE� W
STATEMENf TMAT HE OR SME IS LICENSED PURSUM7T TO iHE FROVISIONS OF TME GONTMC70R5 L4
� CENSE LAW(CIUPTEH 9(CAMMENCWa MAT/1 SECT�ON 7000�OF DIV1510N 7 0F TNE BUSINE55 M1D VR0- � POOVSpB
FESSqNSCODEI�THATNEORSHEISE%EMPTTHEFEFROMANDTHEBASISFORiHE�LLEGEDE%EMP• (�
V TION.Mf'IVIOLATIONOFSECTION70�1.60Y�M'I�7LICAMFORAPERMITSUBJECTSTHEAPPUGNTTO z RaRoa1
A CNIL PENALTY OF N07 MORE 7HAN FNE HUNDRED DOlURS(l500).):
� O1�50WNENOFTHEPROVEHTV.ORYVElAOLOYEESWITHWAGES/STNEIRSOLECO/APENSATION, � Commercial -�
� 1MLL DO THE WORK,AND THE STRUCTURE IS NOIIMEN�ED OR OFFERED fOR SALE(SEC.7a�,BVSI• J
� NE55 ANO VROFFSSIONS CODE THE CONTRACiORS UGENSE U�M DOFS NOT APPLY TO AN OWNER OF ?
PiIOPEHiV WLIO BU0.DS OR pAPROVES TNEREDN.AND WHD OOES SUCH WORK MIMSE�F OR HERSELF OR
[C THROUGNHISOHHEROWNEMP�OVEES.VROYIOEDTNATSUCIIMPROVEMEMSARENOTINTENDEOOft m
QOGFEREDiORSALF.IF.IqWEVERTNEBULDINf30NI1.IGROVEMENTISSOIDWITMNONEYEAROFCOIAPLE•
� TqN,THEONT1ERbU4DER WILL HAVE TME BURDEN OF iROVWO iFIAT HE OR SHE D�D NOT BUIID OR
= IAAPROVEFOR111EPURPOSEOFSALE).
O 4�OWNER OF T1E GROPEHIV,AM E7(CLUSNELV CONiMCTWO WITH LICENSED CONTMCTORS
� TO CONSTRUCT 7HE YFQ7ECT(SEG 70M.6USINE55 ANO YROFESSIONS CO�E:TME CONiMCTORS L4 V21U01IOfl � �� �— ADJ.AFEA
W CENSEI.AWDOESNOTAPPLYTOMIOYMEROFAPROVEFTVWHOBUILD50flIMPROVE3THEREdJ,ANO
� N?p�OMRACT5fOH5UCHFROJEGTSWITHAGONTRACTOR(S�LIGENSEOPURSUAMTOTMECONTMG QUANTIN DESCRIPTION FEE
� TO�iSLICENSEUIW.�.
Q ❑I AM DCEIAPTUNDER SEC 8.6 V.G fORTNIS NEiISON Q O. �
� U
l�- IQ-
DATE OYMER U
F LICENSED CONTRACTORS OECLARATION w
� I HEREBYAFFIqM UNOER PENAITY OF PERIURY 1WQ IM1 UCENSED UNDER PROVISIONS OF CHAPTER � � 1 r[�
d 0(COAIMENCWONA7HSECTqN7000)OFOMSION70FTNEBUSMESSANOOROFESSIONSCOOE,AND T�
�G MY UCENSE IS N FL1LL fOHCE AND EFFECT.
LLJ ��+ �
� UCENSE CLASS ��7 � UC.NO. J e
V DATE ��/` D 3 ...- CONTRACTOR � � d
W
� WORKERS'COMPENSAT�ON DECLARATION � •-
� IMEREBYAFFIRMUNDERPENALTYOFFE0.NRYONEOFTHEFOUAW�NCOECUMTIDNS: �
(� a
� _IMAVEANDWILLMAINTNNACERTIFICATEOFCONSENTTOSELFdNSUREFORM'ORI(ERS' _
COMPENSATqN,ASPROVIDEDBVSECTION77000FTXELABORCODE.FORTNEPERFORMANCf U
QOF iHE WORK FOR WHICH THIS PEFMIT IS ISSUED. �
Q �1 HAVE AN�WILL YAttfTAIN WORKERS'COMPENSATION INSUF�NCE.AS REWIqm BY SECiqN 1 '^
]70o OF 7HE LABOR COOE FON TV1E iERFORMMlCE OF THE WORK fOR WNiCH 7Hi5 PERMIT IS I l.l• 1`�O
d 4SSUED.MY WORKERS COM7ENSA710N INSUNANCE GNRIER ANO POL�CY NUM9ERAAE: CONSTRUCTION r� I c
4 I'�� PLAN REVIEW ( L-1 �O
7 GIRRIER D
� POLICYMJMBER ����� � ELECTRIC �O
¢ (i}455ECfX?INEmNJTBEOx.PLEfmOF7FEP6ATfBRJRONEFI�f+ED�OLLAiLS(Sido)ORlESS) PLUMBING ( `�l.S�
Z ICENTIFVTIUTNTHEPERFORMMICEDFiNEWORKFORwHICHTHISPEPMITI5155UED,l MECHANICAL `� � �� �'�^� 1�-�- ``-"""� LJ��s�
('} SHFLL NOT EMPLOV ANY VEHSON W M7V MANNER SO AS TO BECOME SUBJECT TO THE 1•' ' '� • ' ' ��,_%/
N YVORKERS'Cp.�PENSATIDNUW50FGLLIFORMl�M10AGREETMATIF15MOUlOBECOME INSPECTIONFEE
6UBJECT TO TME WORKERS'C0IAPENSATION CRON510NS OF SECTIDN]7o00F TNE UBOR /Ov. �^
CA�E.I SHALL FORTMVITM COMPLY YAM THOSE iROV15�ON5. ISSUANCE � i n"1 } ��n n�
/� ��� � vl�1 �p
� OATE:(�-_ APPLICANT. . �"' �A` SMIP ;
,,,W� ENERGY P/C �
� WANNIN6:FARl1RETO5ECUREMIORKERS'COMPENSAiIONCOVERAG SUNUWFUL.�N�SWLLLBE
(-y SUBJECTANEMPLOYEaTOCPIMItULPENALTIESMlDdVIIFINE5IIPTOONEFNNDREDTMWSAND ENERGYPERMIT ��;"� �
OOlLAFS(5100.0OO1.IN/�ODITIONTOTHEGOSTOFCOMPENSATION,OAM�GESASPqOYIDEDFORIN �� ' �
� SECTqN970lOFTHElA80HW0E,INTEREST,AND�TTORNEY'SFEES.
RETENTION FEE:
a CONSTRUCTION LEND�NG AGENCY PRE-ALT FEE:
O
CL IHEREBYAFFIRMUNDERPENALTYOFPE0.IURYTNATTHER[ISACANSTRUCTIONLENDIN6110ENCV
� FORTMEPERFORMANGEOFTNEWORKFORWHIp1TH15PERMITI5155UED�5EG]Oi�,qV.G).
� LENDERSNAME �
� LENUER'SADDRESS \�
w ICENTIFYTIATIHAVEAEADTHISIIOPL�CATIONANDSTATETIIATTMEABOVE1NiORMATIONISCAHPECi TOTALFEES�� �� � �v ^ �(,�� �O
� UCREETOCOMP�YWITH/LLLCT'ANDCOUtiTYOPDMANCE5AND5TATEUWSREUTINGTOBUI�DIN6 1 �/ �
� CONSTRtK710N.ANOHEREBYAUT/iONIZEREPRESENTA71YE50FiH�5COUNTYTOENTERUPONTHE
� PBOVE•MCNTqNEDPROPERTVFORINSPECT10N0URPOSES. COMMEMS
� r�+�11�T�tZ � � ' � �1 �c Av
�
¢ VERMIttEF NA1AE(PRll7n ��
(!� ~��
� SIONATUNEOFPER EE DATE
� RECP7�O. PAID BY L- � VALIDATION
WHITE—Department CoDY,YELLOW—Finanee Copy,PINK—Assessor Copy,GOLDENROD—File Capy.GREEN—Applicant's Copy
. , .�: — . . . . � .... . .r . .. e�4'. ,�: . .. r '•p . . . � ' ' r�- _ ... . " .,.�. . . ..�t.F. •• .. :. .. ,.I —. :. , .. , . . � � ' � '
��'I i� Q� ���4���1l� �S�-LR
It•b�i��G"s'iC.�f,, -�^t�Ct;���
1��-'�Ta�c,'�Cci��� .....���,w�_ .�� �►��'�.�o�c Ec�ny:..�.��,� l►���:� I�.G"Ce'1►`I � �y��,F'-� ;��rF-���c,,—�m���
. _ � . . � --.--._._-_____._._...____ ..____._.__=Y.�._,__
. . I FLOOR JOIST� _ ._. ____. I
SEf BACK.�. __ ____ --..I._ __ ---�- `
FTGSlFORt,AS1STEEL j 'Z'Z,rp�i _ ` FHA REQ�ITS
EL.ECTRIC GRbUND t'L26'L r UNDER FLOOR DUCT 1�.�
GROUND PWMBING �,_2--1 U�dDEF3 FLOOR CUNDUIT —i —�^
SLAB GRADE I FIREPLACE FOUfJDATIOt•�
TEMP POWER I I� FIREPLACE BOND BcAM I
WATER SERVICE _� I MID HT. �O�dD B�.AM __
ROOF SHEATHING I 8 F-T. 60ND BEAP�1 ;
FRAMINGNENTILIATION I FINAL E30ND BEAM I
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHIPdG
ROUGH ELECTRIC (Z.1-O R�UGH GRADING �
ROUGH PLUT��BING (�,Z��`��-�.� FIIJISH GRADIhJG
SHOWER/TUB TEST POOL ELECTRIC (�Z'�-�Z.
EXT.LATHISIDING POOL FENCIi1G 3/y p��1 *
VVALL INSULATI�N POOL FINAL� �dZ-Y-��/
CEILING INSULATION OFF SITE I6APS. �
DRYWALL NAILIfJG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK � LANQSCAPE/IRRIG_
SEEP PIT/L.L. ON SITE IP,QPS.
GAS AIR TEST i_22-pZ _ . FINAL ZONING
FINAL CONST. ���'�� ' FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FItJAL ELECTRIC DEV, FEES PAID
FINAL PI.UMBING � ENERGY
��'�="�'��=, i � ' :� .
. � _ _ - 1.. __._ - •-_._. ..__..._.__._____._
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�____�I'�� � 1
•r��� � .
�; I
,��