HomeMy WebLinkAbout17321 (25) _ ` _
�_
. �
_�r� CITY OF DIAMOND BAR -
DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190 �-r /
(909)860-3195 Fax(909)861-3117 v!�-Sl G� �� lj� PRESS
��^�' BUII.DING PERMTl'APPLICATION ,. �.0 FIRMLY
. o ADDRESS � � /��J �j APPLICATION � b PERMfT r� � "� P/C� _Z((�
DATE NUMBER I��d'�� T
� APN LOT TRACT SZ26 �_ DA EE � ONST. :� GROUP
� OWNER I
O
" ADDRESS O ZONING SETBACKS ' �-
Z CITYT�U//�� ZI TEL. RE�ART � RW O�
g APPUCANT TEL.
� SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE
CITY ZIP TEL.
oARCH/ENG/ ��,
� DESIGNER -� NO.DWEL. NO. NO.
ADDRESS U U NtTS STORI ES BEDROOMS
N CITY I� TEL
cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AR ANALUATfON
Q OWNEH-BUILDER DECLARATION SFR/AOD/REM
O
� I HEREBV AFFlRM WlDER PENALTY OF PERIURY THAT I AM E%EMPT FROA1 THE CONTRACTORS U- Gflf89B/CBfpOR � 2, � /[
CBISEUWFORTHEFOLLOWRlOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODEANYCIT'OR (n V
COUMYNTUpIRE0U1RE5APERAIRTOCONSTRUGT,ALTERIMPROVE,DEMOLJSH,ORREPAIRANVS7AUC- W PgIlO/DBCK
TURE,PRqR TO RS 159UANCE,AL50 REOUIRES 7HE APPLICANT FOR SUpi PERMIT TO FILE A SIONED w
STATEMENT 71iAT HE OR SHE IS IJCENSED W0.5UANT TO THE PROVISIONS OF THE CONTRACTORS ll�
� CEN3E UW(CHAPTER Y(CqINENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR6 � P�USPB
FESSIDNS CODE)OR TF1AT HE OR SHE IS E%EMPT iHEREFROM AND 7HE BASIS f-0R THE ALLEOED E%EMP-
TION.ANV VIOLATqN OF SECTION 7031.6 BV ANY MPUCANT FOR A PERMIT SU&IECTS THE APPIICANT T0 Z Re-Roof
� ACIVIL VENALTV OF NOT MORE 7TUN FIVE HUNDRED DOLURS(f600).):
� ❑I,ASONMEROF7HEPROPERTY,ORMVEMPLOVEESWITHWAOESAS7HEIRSOLECOMPENSATION, � CpmmBICl81 �
MIIL.L DO 7HE WORK M1D hiE STRUCTURE IS NOT INTENDED OR OFFERED FOR S�LLE(SEC.7a1,BUSI- J
� NE59 AND PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � , � .� �
PROPEHTYNM1qBUM1D$ORIMPROVEShIEREON.ANDWHODOESSUCHWORKHIMSELFOFHERSELFOR � J
[[ T1/ROUGH HIS OR HEfl OWN EMPLOVEES,PROVIOED THAT SUCN WPROVEMENTS ARE NOT INTENDED OR m
w OFFEA�PDRSALEIF,MOWEVER7HEBURDINOORIMPROVEMFNTISSOLDWfTFONONEYEAROFCOIAPLE-
� 'TIOH,THE OWNERAUILDER WILL HAVE 7NE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
Z WPROVE FOR THE PURi'OSE OF SAL�. .
� O I.AS ONMER OF THE PROPEHfV,AM EXq.USIVELY CONTMCTIN�WITH LICENSED CONTMCTOqS
W
� TO CONSTRUCT THE PRQIECT(SEC.761I.BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� VfilU9liOn ADJ.AREA -
CENSE UW OOES NOTMVLY TO AN OWNEH OF A PHOPERTY NT10 BUILDS OR IMPROVES THERE-0N,M!D
. �' � NM1IOCONTMCT9FORSUp1PR0.1ECT5WITHACONTRACTOR(S)UCENSEDPURSUAMT07HECONTAAG QUANTIN DESCRIPTION � FEE �
� TORS LICENSE LAW.�.
❑I AM EXEMPT UI�ER SEC. B.8 P.C.FOH THIS REASON � ✓� �(,,,. ���
Q
3 DATE OWNER U �^� r+
� UCENSED CONTRACTORS DECLARATION W I ,� v
6 W � Wi
¢ I HEREBY AFFIPoA UNDER PENALTY OF VEiUURY T11AT I AM LICENSED UNDER PROVISIONS OF CHAPTER � 'T�.. � � �
� o(COAIMENClNO WITH SECTION 7000)Of DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z l�
W LICENSE IS BI FUl FORCE AND EFFECT. �j�r
� LICENSE CUSS LIC.NO. S` �r+ / � � '
�
V DATE CONTRACTOR �f i� d �� O
W ���� ��.
� � WORKERS'COMPENSATION DECLARATION Q v� . '
NI HERE/B/y AFFlRM VNDER PENALTV Of PERIU{7V ONE OF THE FOLLOWINO DECIAAATpNS: Z � Q � 1 v_
� (�QIHAVEANDWILLMNNTNNACERTIFICATEOFCONSENTTOSELF�INSUREFORWl7RKERS' a � � ,
2
��"� COMPENSATIOH,IIS PROVIDED BV SECT70N]70o OF THE LABOR CODE,FOR THE PERFORMANCE U � �O � ��
Q 7HE WOW(FOR WHICH THIS PERMIT IS ISSUED. �
1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,A9 REOUIRED BV SECTION
Q 37000F 7HE LABOR CODE,FOR 7HE PERFORMMlCE OF THE WORK FOR WHICH THIS PERMIT IS �
^ ISSUED.MY WORKERS'COMPENSATION INSURANCE RIER D POLICV NUMBER ARE: CONSTRUCTION �,
Q
� c�aaea PLAN REVIEW
Z� POLIC�NUMBER � ELECTRIC � ►
Q
p' (IF6SEC�ONNE�PIOTBEOOFP�FfFDOFifEaEw.fiBfORaNEMI�Ofi�DOUNsRtroIOR�ESSF PLUMBING i
W
Z I CERTIFV 7HAT IN THE PERFORMANCE OF THE WORK FOR WHICH TiIS PEFiM1T IS ISSUED,I MECHANICAL � ��� y�
C7 SHALL NOT EMP�Ov ANY VEH50N IN ANY MIWNER 50 AS To BECOME SU&lEC7 70 THE
(/� WORKERS'COMPENSATION UWS OF CAUFORNIA,AND AOREE TMAT IF I SHWLD BECOME INSPECTION FEE �
SUBJECT TO TME WORKERS'COMPENSATION PRONSIONS OF SECTION 700 OF THE LABOR
�j CODE,I SHN1 FORTNWITM COMPLV WI7H THOSE PROVISIONS. ISSUANCE Q
0 .��/' L
p DATE: �=f D~4/PPLICMfT: Y�/ O/ �/G� �SMIP :�I �
�w ENERGY P/C Y � ` _
WARNINO:FALURE TO SECURE WORKERS'OOMPENSATION COVEMQE IS UNLAWFU�AND SHALL BE �
�y SUBJECTANEMPLOYERTOCRIMINALPENN.TIESAN�CM�FINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000),IN/�DDITION TO THE COST OF COM7ENSATION,DAMAOES AS PROVIOED FOR IN
J SECTION 37oe OF THE UBOR CODE,w7ERESL AND A7TORNEY'S FEE3. � �+ �/
p� RETENTIONFEE: ��+��1 �,
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� I HEREBYAFFIqAI UNDER PENALTV OF PERJURV THATTHERE IS ACONSTHUCTION LENDINO AOENCV � �
FOR TNE PERPoRMANCE T//HppE W..,,O��Po(FORW/FyCF1 PERMIT IS ISSUEq\(SEC.70D7,CIV.C.�.
� LENDER'SNAME /���V�� �-�• / � . - , �
�F- LENDERSADORESS
� I CEHTIFY THAT I HAVE READ THIS MPLICATION AND STATE TNAT 7NE ABOVE WFORMATION IS CORHECT. TOTAL FE ES . ^1 ` ('
� I A�REE TO COMPLV N7TH hLL CT'M!D CIXINTY ORDINANCES AND STATE UWS REUTINO TO BU0.DRW � J1���,�j 4 �
CONSTRUCTION,AND HEREBV AU7HORIZE REPFESENTATIVES OF THIS COUNTY TO EMER UPON THE . J
ZABOVE�MENTIONED PROPERTV FOR WSP C710N PURPOSES. COMMENTS � ' � -
� �_1
�
m VERAIIT7EE E(PRl / � � • �
¢ /U -D I `
�
�/j 51ONA OF PERMfTfEE �ATE RECPT.NO. PAID BY VALIDATION �
~ WHITE—Department Copy,YELLOW�Inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's opy
CITIf OF Dl�il���BQ� ��i6� �
1�9SP�C�'806�1 R�C��3¢� `
a � . . . .. , , ,. � . �e
e �. �
�_
� �B �. . �. e � e. . $ E"'G-� �k ('yVy.�f,.,y�� d
v
� �� �. �� �• � *� � � UU��r'lS�l`�U� r...
SET BACK FLQOR JOIST
FTGS/FORMS/STEEL FHA RECIMTS ' `
ELECTRIC GROUNQ UNDEA FLOOR DUCT .
'GROUNQ PLUMBING UNpER FLOOR.CO(�IDUIT
SLAB GRADE FIREPLAGE FOUNQATION • �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE M1D HT. BOND BEAM
ROOF SHEATHtNG _� . 8 FT. BOND BEAM
FRAMlNGNENTILIAT'ION � . _�.,. FINAL BOND BEAM
ROOF COVER FRE-Ci ADIiJG. . -
EiOUGH HEATING , BENCHtNG,�. �� -
ROUGH ELECTRIC &.� _ ROUGH GRADING '
RDUGH'PLUN181NG� FIN{SH GRADING
g" _
SFiOWER/TUB TEST � POOL ELEC7RIC
EXT. I..ATH/SIDING POOL FENCING
WALL INSULATION (�-s_p , POOL FINAL
CEILING INSULATION J---� QFF SITE IMPS. •
DRYWAL.L NAlLING �G _` pEDICATIONS
SEWER . • FINAL ENG.
SEPTIC TANK � LANDSCAPE/1RRlG.
SEEP P!T/L.L. ; � � ON SITE IMPS.
GAS AIR TEST G ' FINAL ZONING
FINA�COiVST. . �/ FIRE DEPT. FINAL --
FINAL HEATING ---� HEALTH DEPT. FINAL
FINAL�ELECTRIC . ' DEV. FEES PAID �
FIPJAL F?LWMBING � � � � ENERGY _��'�
- ����'��G..� • ��_., , _��_ �
. . � ���� d 's � '.
COMMENTS ��z,�o-�, ,c���.��.— . __ _ . _ —� — - �_ �
�•13.�i �.( �.w �____—
� � r —�__
_ —�
f_ - '�� -- � .
r .;�'� v— •L. —�. . � —_— — . . — .
� r ,�„ �
• ' � �
SEPTIC'TANK SIZE
SEEP PIT/U SIZE ---------
� �,�;� .,<��� �', :�,.
�,�.����� a�,,� .�;a�,�r
;�,,�' �4'
�t'�� '�'�'��`x�x���'��a;'�* '
�,r71,'', A � ''� .y"��„� . �
��..y�;."$�f`t'Jm�'H.y";�=. �°* +�.ca:A.���� _ �._._...
. �' -- g ��� -
v.�`�'�i''�v���R '`� �..
x r �
; ��.. '�. .`__
��1 .. ���������Y�r�+� ._..._._�..,_
a
«S1•, ,� � ���,rnt � �
yAy�+t ��y;k��a�'��y 4,v�, .�,��'�' '
,��'�':;:�. g .E:�p �9'+���� . . ��t . .
�n= D