HomeMy WebLinkAbout17323 (25) � �
l �
' ���
� CITY OF DIAMOND BAR `�
DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVIC
21660 E.Copley Drive Suitc 190 d'f�� l �j
� (909)860-3195 Fax(909)861-3117 �/�� ���U v'� PR ESS
�'^„'� � BUII,DING PERMIT APPLICATION FIRMLY '
o A�DDRIESS �g� DATE CATIO '� O NUMB R 3 a3#/CL/ `-2
� APN LOT ACT �S�z�b�I ATE I`���I ONST. GROUP
°C OWNER S
O
p ADDRESS V ZO ZONING SEfBACKS
�W CITY / r ZI �7i TEL � REART RW ❑
APPLICANT „S' ,� TEL. SIDE/SIDE STREET RW O
� CONTRACTOR SIDE ❑
� ADDRESS
� CfTY ZIP TEL. PROPOSED USE
P� ARCH/ENG/ G -
� DESIGNER V/.� ��l � NO.DWEL. NO. NO.
ADDRESS NITS STORIES BEDROOMS
� CITY TE �
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
¢ OWNEA-BUILDER DECLARATION SFR/ADD/REM 3
O
0 I HEREBY AFFlRM UNDER PElUL7Y OF PERJURV THAT 1 AM IXEA/PT FROA/THE CONTMCTORS LI� GHf89B/CBfPOR
W CEHSEUIWFOR7YfEFOLLOWINORE130N(SEC.70.71.68USWE59M1DPROFESSIONSCODE:ANYCITYOR (n
�� COIHfTYWHK�HREWIHESAPERMRTOCONSTRUCT.ALTERIMPROVE,DEMOLISN,ORREPAIRANVSTAUC- W
�Z 7URE,PRIOR TO R3 ISSUANCE,PLSO REWIRES THE MPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Dedc
� STATEMEHT THAT HE OH SHE IS IJCENSED PURSUANT TO 7HE PROVISIONS OF THE CONTMCTORS Ll- � _
� CENSE UW(CHAPTER V(COMMENGNO N7TH SECTION 7000)OF DMSION�OF THE BUSINESS AND PR0. PaoUSpa �
FESSIONSCODE)ORi}IATHEORSHEISE%EMPTTHEREFROAIMlDTHEBASISFORTHEALLEdEDE%EMP- �
TION.ANYVIOLATIONOFSECTION7W7.6BYANYMPLIC�NTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A dVIL VENALTY OF NO7 MORE 7TMN FIVE HUNDRED OOLLAHS(i6Do).):
� ❑I,A60WNEROFTHEPROPERTV,ORMVEMPLOVEESWITFIWAOESASTHEIRSOLECAMPENSATqN, COmR18fCi01 � �
WILL DO h1E WORI(AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR S/�LE(SEC.7a1,BU54 �
� NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE L�W DOES NOT APPLV TO AN OWNER OF j -
PROPERTY WFq BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WOR1C HIAISELF OR HERSELF OR
� T/tROUGH HIS OR HER OWN EAIPLOYEES,PROVIDED THAT SUpi WPROVEMENTS ARE NOT INTENDED OR m
OFFERED�OR 9ALE IF,//OWEVE0.7NE BU0.DINOOR IMPHOVEMENT IS SOID N7THIN ONE YEAROF COMVLE-
Z �•TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWO THA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOq TNE PURPOSE OF SALE).
(yJ ❑4 ti+^ONRIER OF THE PROPEHTV.AM E%CIUSNELV CONTRACTWO N7TH LICENSED CON7RACTOq3
[[ TO CONSTRUCT THE PRQIECT(SEC.7oN,&131NESS AND PROFESSION9 CODE:THE CONTRAC70R5 L4 V81U9f10l1 ADJ.AREA
W CENSEIAWDOE3NOTAPPLYTOANONRJEfiOFAPROPERTVWFqBUILD90RIMPROVESTHEREON,AND
� YMIOCOMRACTSFORSUp1PROJECTSWfTHACONTRACfOR(S�UCENSEDPURSUAMTOTHECONTRAG QUANTITY DESCRIPTION � �E .
TOfiS LICENSE LAW.).
� O I AM EXEMPT UNDER SEC. B.L P.C.FOR 7MIS REASON U � _ � ' �
,� ¢ Z. G �
DA7E ONMER F- � � ,
� w V. . O
LICENSED CONTRACTORS DECLARATION � 9
� w G� .
I HEREBV/�FFIRAI UNDER PENPL7Y OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ,
(= Y(OOIAMENCINO WIiH SECTqN 7000)OF DMSION 7 OF THE BUSINESS AND PROFESSKKJS CODE,AND Z �
X W LICENSE IS IN FULL FORCE M!D EFFECT. / � m ' � r ` � ^ � r , , �
lL u
� LICENSE CLASS LIC.NO. � h�. .
~ DATE � � d � CONTRACTOR d � e Q'r
� '_ �� WOFKERS'COMPENSATION DECLARATION Q �
NI HE AFFlRM UNDER PENALTV OF PERtt1RV ONE OF 7HE FOLIOWING OECUMTIONS: Z T
� I IiAVE AND WILL YAINTAIN A CEHT7FICATE OF CONSENTTO SELF-INSURE FOR WORKERS' a
2 \
COAIPENSATION,AS PROVIDED BV 9ECTION 37D0 OF THE LABOR CODE.FOR THE PERFOHMANCE U � � �,�/
Q THE WORK FOR NM1ilq1 THIS PERMIT IS ISSUEO. � � .
1 HAVE AND WILL MAINTAIH WORI(ERS'COMPENSATqN INSU{LWCE,AS FEWIRED BV SECTKKJ
Q 37a00F THE LABOR COOE,FOR THE PERFORMANCE OF THE WOR)(FOR WHICN 7HI5 PERMIT IS � �
�ssuED.Mr w�oa��cEp-/s•c�aaPEr+S�rar�I����gµ�Riggivro ao�ICv NUM�nae CONSTRUCTION
jCARRIER %�/ ��f��� 7'�%T �.f�l%7 C[) PLAN REVIEW � .
Z voucV NUMBER �I��/1/�� ELECTFlIC ��
Q
0 RtssEcinHr�rqreEoa�at�IDaFnfp�raa�aoNErunr�powws�Stoo�oa�Ess} PLUMBING
Z 1 CEFiTIFV THAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERAlI715155UED,1 MECHANICAL
� SMALL NOT EMPLOV ANY PERSON IN MIY MANNER SO AS TO BECOME SU&IECT TO THE �
� WORKERS COM7ENSATION UWS OF CALIFORNIA,AND AGREE TMAT IF 1 SHOULD BECOME INSPECTION FEE - _
SUBJEC770 THE WORKERS'COMPENSATION 7ROVISIONS OF SECTKIN 770o OF 7HE LABOR 1( � �
�j CADE,1 SHALL FORTHWITH CAMPLV WITH SE PROVISIONS. ISSUANCE , �Jv� ��
� .�-� SMIP 1 qq
p DATE: " O O/APRICANT: IIJ//..s �
� WARNINO:FAILURE TO SECUHE WORKEFiS'COMPENSATION CAVERAOE IS UHUWFUL.AND SH�V.L BE ENERGY P/C �� �
SUAIECT MI EMPLOVER TO CAIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ^ 1�'
LL DOLURS(5700,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAAIAOESASPROVIDEDFORIN ENERGYPERMIT \ ry`
- J SECilON370eOF7HEL/�BORCODE,IHTEREST,MIDATTORNEY'SFEES. ' .�/��� �
Q RETENTION FEE: �
O � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: /
� 1 HEREBV AFFlRM UNDER PENALTV OF PERNRV 7}UT THERE IS A CONSTRUCTION LENDINO A6ENCV ' ' �" ' � � '
FOR THE PERFORMANCE OF THE/W�,ORK FOR NM1iICH THIS 7ERMIT IS ISSUED(SEC.30G7,CIV.CJ. - _
� LENDERS NAME 1�✓� ' . . .. .
F- LENDER'SADORESS ^
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT TME ABOVE INF9RMATION IS CORRECT. TOTAL FE ES . v � i j1 ;' 1
� 1 A6REE TO COMPLv WfTH ALL CfTY AND CIXINTY ORDINANCES AND STATE UWS RELATWO TO BUILDIN6 . •3 ' � I I ;� I
� CONSTRUCTION,M!D HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON THE ' � �
Z ABOVE-MEMIONED PROPEHT`/FOR INSP TION PURP0.5E5. COMMENTS � '
_ � rGJ
m PERMITTEE NAA1E(PRI . � .
� � /O`�/
� sro OFPERMITT DATE RECPT.NO. PAID BY VALIDATION
� WHITE—Department Copy,YELLOW—Flnence Copy,PINK—Assessor Copy, OLDENROD--Fiie Copy,GREEN—Applicant's Copy -
�a�v o�¢�i��s��� �a�
IRlS��CTB�6l4 �E�C���
� �F,�. . . .�- ..
� ��,�d � -� 'a�R.. °' �� 'j,��.�y. .,�` o Q � _ � � . ' p� � c '
� �`J � A � ri,*
��,
SET BACK • - FLOOR JOIST� .__
FTGS/FORMS/STEEL FHA REC2MTS
ELECTRIC GROUND UNDER FLOOR DUCT • �`. �
GROUND PLUMBING ' UNDER FLOOR CU�fDUIT ' �
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
'WATERSERVICE MID HT. B�ND BEAM
ROOF SNEATHING � QZ ��_�� 8 FT. BOND BEAM.
- FRAMINGNENTILiATION ..n FINAL BOND BEAM
ROOF COVF_R PRE-GRADING . � .
ROUGN NEATING -(-�, BENCHING . '
ROUGH ELEC7RIC c��(�vz ROUGH GRaD.ING
ROUGH PLUMBING�' -(��L � FINISH GRADING
SHOWERrfUB�TEST POO�ELECTRIC —'
EXT. �ATH/SIDING .,L , POOL FENCING
WALL INSULATION • S b POOL FINAI.
CEILING INSULATION �'f�' OFF SITE IMPS.
DRYWALL NAILlNG �t, � D�DICATIONS -
SEWER FINAL ENG.
SEPTIC TANK lJ�NDSCAPE/IRRIG.
SEEP PIT/L.L. � ' - �' ON SITE IMPS.
' G?�S AIR 7EST �� , �jf� FINAL ZONING
FINA�'CONST' ��� � �IRE DEPT. FINAL (
FINAL HEATING � -. HEALTH DEPT. FINAL
FiNAL ELECTRIC DEV. FEES PAID � '
FINAL PLUMBING / - ENERGY
:�—� . � ., o ,� fk} r --— —-----
.-f j;
� CC7Ni�/IENTS - - -' ' - � - --- — ----- — . _. _ . _ .
;,� . . _
,
� � - -� �d
, ,
- � . . . , .
*�C�t1 � —._
SEPTIG TANK SIZE �
SEEP PfT/U SIZE
�
^°°� �.��,� �.��,�'
�� � s - � �
r t,��� ���� ����
a �
�U'.a.''tTJ;���c��,�?�.�.�„''q,4'[� 'h�`-.: � .
l t-p, ? � 3�? 4
���'�� d�. � 5 Y�'i` �
} �r. +T��1�i � � �;�,�: .
��ka'� h+��`�� �'�,3��
. °�`.��3�'�#���:,�"`�.��;�A —
+���#��r� j����''tm�;r �p - .
� � a x
���.a;°"�� '�'� �'�• 'ta�� � . ' . ,
f
�