HomeMy WebLinkAbout16504 (78) _�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
� (909)860-3195 Fax(909)861-3117 �� �� PRESS
�����\ BUII..DING�PERMPI'APPLICATION FIRMLY
N JOBSITE APPLICATION �_' 4��-1 PERMIT _I� _�('� � P/C `_
o ADDRESS � DATE � � NUMBER j lA�\?�1 p �
� ISSUE TYPE � OCC
APN LOT TRACT �oZ1�i�D� DATE CONST. '- GROUP
� OWNER -� ' � I
o ADDRESS ' ZONING �^SETBACKS �" -
Z CITY ZIP TEL.�g=7�/1/� . REART . . RW p
Q APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE O
� ADDRESS '
CfTY ZIP TEL. PROPOSED USE
� ARCWENG/
� DESIGNER />r r0 'V - NO.DWEL. NO. NO.
ADDFlESS I'"S '�s f�r� 1�. ' UNITS STORIES BEDROOMS
� CITY San��t Ann ZIP� TEL.'��t��d47�7 '
cn DESCRIPTION SQ.FT. ACTOR P ADJ.ARE LUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM �
O �
p 1 HEREBY AFFiRM UNDER PENAL7V OF PERRIRV TFiAT I AM EXEMPT FROM 7HE CONTRACTORS U�
L{l CENSEUWFORTHEFOLLUWRIOREASON(SEC.7o31.5BUSINE55M107ROFE5SIONSCODE:ANYCrtvOR � Gerage/CarpoA O � I
� COUIT'MMICF1fiE0UIRE5APERAIRTOCO115TRUCT,ALTER�PROVE.DEMOLISH,ORREPAIRANYSTRUC• W P9110/DBCI(
�Z 7URE,PRIOR TO RS ISSUANCE,�LSO REOUIRES 7HE APPLICMlT FOR SUCH PERMIT TO FILE A SIONED w
STATEMENT THAT ME OR 9HE IS UCENSED PUiLSUANT TO hIE PROVISIONS OF THE CONTRACTORS L6
� CENSE LAW(CHAPTER Y(COMMENCWO WITH SECTION 7000)OF DIVISION 9 OF THE BUSINE33 AND PR0. LL' POOUSPO ^ � �
FES9qNSOODE)OR7TU7NEORSHEISIXEAIPT7HEREFROMANDTFIEBASISFORTI1EALlEQEDEXEMP- (�
V TION.ANVVqLATIONOFSECT10N70J1.68VANYAP7LICANTFORAPERMITSUBJECTSTHEMPLICANTTO Z Re-Rao1
� A CIVIL VENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f6o0)J:
� ❑Lti+^ONMEROFTHEPROPER7V,ORMVEAIPLOYEESWI7HWAOESASTMEIRSOLECOMPENSATION, � CpmmBfC �
WILL DO 7HE WORIC ANO THE STRUCNRE IS NO7IMENDED OR OFFERED FOR SALE(SEC.7aI,BU51� J
� NESS AND PqDFE9510N5 COOE:THE COHTMCTORS LICENSE LAW DOES NOT MPLV TO AN OWNER OF � {+..��' (1,
PROPEHTYYYFiOBUpDSORIMPROVE9THEREON,MIDWHODOE95UCHNOHKHIMSELFORHERSELFOR - � V
� hIHOUd1HISORHEROWNEMVLOYEES,VHOVIOmT1ATSUCNWFROVEMENTSARENOTNTENDEDOR m
� �OfFEREDWRSALEIF.V/OM�EVER7MEBUL.D�NOOfiIMPROVEMB1T4450LDWITHINONEYEAROFCOMPLE l
Z 'TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVPI�TUT ME OR SME DID NOT BUIID OR .
� IMVROVE FOR THE PUH70SE OF SALE1
❑I,AS ONTIER OF 7HE PROPEHfY,AM IXCIUSIVELY CONTRACTMO VA7H UCENSED CONTMCTORS
� TO CONSTRUCT TFIE PROJEC7(SEC.7Ma,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOFiS LI- VelU81i011 DJ.AREA
W CENSEUWDOESNOTMPLYTOANOWNEROFAPROPEHTVWFIOBUILD90RIMPROVESTHEREON,AND
� WIqCONTRACTBFORSUCHPROJECTSWIhIACONfMCTOR(SjLICENSmPURSUANT70THE00NTRAG pUANTITY DESCRIPTION � FEE �
� TOR9 UCENSE UW.�. .
❑1 AM DlEMPT UNDER SEC. B.a P.C.FOR 7HI5 REASON U S[�v �
3 � Z � ,
u' OATE OWNER �
o � L � ,
� IICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRAI UNDER PENALTY OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � �
� Y(COMMENCWO M/ITH SECTION 7000)OF DIVISION J OF THE BUSINESS M1D PROFESSIONS CODE.AND Z
X. MY LICEHSE IS IN FUIL WRCE AND EFFECt. m ' �
LLI � `
� UCENSE CLASS A LIC.NO. .� � j
� wTECX�� �,�ri i)� corrtrucroa a .-
� WORKERS'COMPENSATION DECLARATION a �
� I HEREB AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOILOWIN(i DECLAMTqNS: Z �
Q l
� �HAVEMIDWILLMNNTNNACERTIFICATEOFCONSENTTOSELF-INSUREFORY.l7RKERS' = I `�O
� COMP@ISATION.ASPROVIDEDBYSECTION37000FTHELABOfiCOOE,FOR7HEPERFORMANCE U
O F TIE WORK FOfi WHICH TMIS PERMIT I$ISSUED. � `^\
VJ
I HAVE AND VIILL MNNTAIN WOFiNERS'COMPENSATION INSUHANCE,AS REW IRED BV SECTION
Q 370o OF THE LABOR COOE,FOR THE PERWRMANCE OF THE WORK FOR WH TiIS PERMR IS 1 rry�,
� �SSUED.MY RS'COMPEM6ATION I RM/CE CARRI LIC BER ARE CONSTRUCTION /` V 1�J � 1
� CARRIER G � PLAN REVIEW i V
� ���� ELECTRIC
0 ��� r+o7eeoonRErIDaFnEa�raro�aNEtunn�ooau�as�stro)atL�ry, PLUMBING
Z I CERTIFV THAT W T1E PERFOHMMICE Of THE WORK F-0R WHICH THIS PERMIT IS ISSUED,1 MECHANICAL �
(f SFIALL NOT EMPLOY/JIY PERSON W ANY MANNER SO AS TO BECOME SU&IECT TO 7HE
� WORKERS'COMPENSATION UWS OF GLIFORNI/�AND AOREE TNAT IF I SFqUTA BECOME INSPECTION FEE
SU&IECT TO THE V/OHKERS'COMPENSATION PROVISKKJS OF SEC770N 370o OF 7HE LABOR `�
s IS WI7HCOMPIVWIT/THOS/E�PROVIS10N5. ISSUANCE O v
� �//L` T� SMIP r�'
p �ATE: � APRICANT. �
w ENERGY P/C
� WARNINO:FAILURE TO SEWRE WORI(ERS'COMVENSATION COVERAOE IS UMAWFUL,M1D SH�LL BE ,
� SU61ECTANEMPLOYERTOCRIAIW/�LPENhLT1E5ANDGVILFWESUPTOONEHUNDREDTHWSMID ENERGYPERMIT U
DOLURS(f100.000).W/�DDRION TO hiE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
� SECTION 37oe OF TIE LABOF COOE,M7EHE5T,AND ATTORNEI"5 FEES. RETENTION FEE: /�
a CONSTFIUCTION LENDING AGENCY PqE-ALT FEE: �
O
� I HEREBV AFFlRM UNDER PEN/�17V OF PERIURV T THERE IS A CONSTRUCTION LENDINO AOENCV
FOR iHE PERFORMANCE OF E WORK FOR THIS PERMIT IS ISSU (SEC.30G7,CIV.C.).
� LEPIDER'SNMIE �/�//Li ` PU/��� b .
F— LENDEFtSADORE55
� I CERTIFY THAT I HAVE READ THIS APPLICATION MlD STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FEES �l I J J,6�
w 1 AQREE TO COMPLV N77H ALL CT'AND COUNTY ORDINANCES AND STATE UN5 RELA71N0 TO WILOIN(i �/
CONSTRUCTION,M1D HEREBV AUTIIORIZE REPRESENTATNES OF THIS COUNTV 70 ENTER UPON 7HE �
� ABOVE-MENTqNED PROPER7V FOR INSPEC Puavoses. COMMENTS �
� �J
�
m PE EE NAA1E(PRIM) � /)/�/ .
� 4V
�
gp F p DATE
�2 RECPT.NO. J PAID BY � VALIDATION
~ WHITE-0epertmenl Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
, . CI'�'X �� CD1�6Vi0il�� ���
� .
� 9@�9SPEC'�BOI� �ErCOfF�QD
_. . . . , . ,,�., . ,
.
, . . . , x a , .
Q � � �„,3��� m .� 9�r�,�.� A Q t�4�'� D �,. ,� '��
SET'�B'ACK; . _ - . .. , . .. � � � .�.. � , .
r � � FLOOR JOIST _
FTG /F�RMS/STEEC � FHA REQMTS � � ••
ELECTRIC GROUND �j - (-0( UNDER FLOOR DUC
GROUND PLUMBING �-�-,p(, UNDER FLOOR CUMDUIT
SLAB GRADE -' FIREPL'ACE F,OUNDATIORI � �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. B�ND BEAM
ROOF SHEATHiNG 8�. BOND BEAM
FRAMINGNENTILlATION FINAL BOND BEAM
ROOF COVEl� PRE-GRADING -'� �� ' ' '
ROUGH HEATfNG BENCHINGI,•,- - � �
ROUGH E�.ECTRIC ROUGH GRADING
ROUGM;PLUAlIBING. ' FINISH GRADING
SHOWER/TUB_TEST POOL ELECTRIC
EXT. LATNlSIDING POOL FENCING
WALL INSULATION J�_� OL FINAL
GEILtNG I�dSULATION fi OFF SITE lMPS.
DRYWAL��IAfLIFVG . i . � ,pEDICATiONS
SEWER � . 'i`: ' � FINAL ENG.
SEPTIC TANK' ' l..ANDSCAPE/!RRlG. '
SEEP PtT;L.�. � � . ON SITE IMPS_
GAS AIR TEST FINAL ZONING -
FINAL CONST. � FIRE DEPT. FINAL
FIlVAL.HEATING `• HEi4l.TH DEPT. FINAL
F(�V�L ELECTRiC .� " � DE FEES PAID
�Ii��P,�i'!_UMBING ,`� . NERGY `
�----__
�_ � - —
� ' - " b O ,�- ' .
CONIME(VTS . . �
- . `'J
_ ;
. . - � � � 4 '.` � .
� SEPTIC�'pNK�SIZE -
SEEP Pfl"/U SIZE -
4 .,.�AV(.� �� �G.
� iJV, ro.`.. . .
. o r,_;
o U S q �p
Y :K�^�,�., , 0 r��, ,
i �
A �
✓ °,�r '�" �f �;��1� � r
.{� �„�'`�t' fr r: !'� j �2. �' ` � �
t�a - >> r ---- —
.�"k S i�' ' �,�oNB: . .
di:\1+�;^ `.t '�Q_ ' ' .
� a R �.
l� �� 'r.�'
�.� `.�t,��_
w `��' f s' -
, : -� , � . -
,,= ,��� p �`���' � J
;b L ,ay'�a,.. n'C k ��v. , � ..- - _ � ' ' . .