HomeMy WebLinkAbout16999 (23) �` CITY OF DIAMOND BAR
� DEPARTMENT OF COMMIINTTY&DEVELOPMENT SERVICES f��
��y 21825 E.Copley Drive
_ (909)860.3195 Fax(909)861-3117 / PRESS
�`%�� BUILDINGPERMITAPPLICATION .• FIRMLY
o DDRIESS '�=Z' ` �uC��l ���'L��' DATECATION 2� D� NUME3ER� � p/C
c� ISSUE TYPE OCC
APN�- LOT TRACT DATE CONST,,:- GROUP
p OWNER "u-' � T ( /
" ADDRESS ''j�� ��rC.Ic.7�Vt . ZONING SETEiACKS /
g CITY ,�?_1Lt�w+u:l �C�✓ ZIP TEL�� FRONT � RW ❑
� REAR ❑
APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTO 5(1ti1��\ �l� SIDE ❑
o ADDRESS "17- etn-n��n _•f;Cts' PROPOSED USE t=N C=l_61S� '�?C�S7�� ��/D
o CIN �C� 1�.� ZIP�ja.�I EL —j . � �A)�f'C�-�., r?�.E� ,.yl
w ARCH/ENG! t �
�z DESIGNER NO.DWEL NO. NO.
n. ADDRES�S UNITS STORIES BEDROOMS
� CITY ZIP - � TEL. -� • � 1
� �ESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
�
¢ OWNER-BUILDER DECLARATION SFR! D REM a
O
p 1 HEREBY AFFIRAI UNOER VENALTY OF PERIURY THAT 1 AM EXEMPT iFOAI TME CONTMCTORS li• G0f0go/CBrpDR
W CENSEUWFORTHEiOLLOWINGREASON(SEC.7o]1.SBUS�NESSANDVii0iE5510NS000[:ANYCIttOR (n
ZCOUNTYNNICHRCWIRESAPERMI7TOCONSTRUCT,A`TER.Mt�ROVE,DEI.ICLISH,ORREPAIRA4Y5TRUG W P81i0/DOCI(
w TURE,PRIDR TO ITS ISSUANCE,AL50 RL�UIRES THE APPLICANT FOR SUCM PEiWIT TO FILE A SIGNED w
STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO TNE FRO`/i5iON5 OF THC CONTRACTORS U•
� CENSE UW�CHMTER V(COMMENCING WITM$EGTION 7000)OF CIYIS�ON]OF TM[BUSINE55 M"J PRO• u' PootlSpa
FESSIONSCOOE)OR 7H�THE OR SHE IS E%EMPT THEREFROM AND 7M[BA515 FOR TMEIILLEGCD ExEMP•
VTION.ANYViOL/ITqNOFSECT10NT0]1.SBYANVAaPIICANTFORAPERMITSUBJECfSTMEMPIICANTTO Z FlA•ROC�
� A CrvIL iENAL7Y OF NOT MORE iNAN FIVE HUNDRED DOlUR5If50ol):
ZOL.��'NN[ROFTHEVROPERTV.OR4VEUPLOVEESWITHWACESASTNEIHSOIECOUPENSATIDN. O Commercial
WILL DO iME WORK,AND THE STRUCTVRE IS NOT INTENDED OR O�FEAFD iOR S.LLE�SEC.7a�.BU51. J
NESS/iN0 VRDFESSIONS CODE:THE CdRMCTORS LICENSE LAW�OES NOT APPLY 10 AN OWNER OF
N VROPERTYW1qBU0.D50RIMPROYESiHEREON.ANOWHO00E55UGIWORKHIMS[LFORHERSELFOR �
[[ THROUGMMISORHEROWNEMPIOYEES,VROV10EDTMAiSUCNMPHOVEMENTSARENOTNTENDEDOR m
QOFFENEDFORSALEIF,/IOWEVER71iE8U�l01NGOHUAPqOVEM[NT455IXDmiMINONEYEANOFCOu7�E�
Z TqN,THE OWNER�BUILDER W:LL HAVE THE BURDEN OF VROYINa TNAT NE OR SH[�IO NOT BUILD OR
= IA1PqOVE FOR 7HE OURPOSE OF SALEi �
W OI���FROFTNEDR07EHTV,AMEXCLUSIVELVCOH7qACTWGWITNUCEK5E000NTMCT00.5
¢ TO CONSTRUCT THE PR0.IECT(SEG 70�t.BUSINC55 AND VNO�ESSIONS fADE:THE CONTRACTORS Lb V01U3SiCf1 ADJ.AREA
W CENSEUN�DOESNOTAPFLYTOANOWNEROFAPROPERTVWMOBUILDSORIMPROVESTHEREON.A4D
� VY1pCDMMCT5FOR5UCHFROJ[CTSWITHACANTMCTOR�S)LICENSEDPURSU/�MTOTNECONTqAG OUANTITY DESCRIPTION FEE
TORS LIGENSE tAw�.
� ❑I MI E%EAIPT UNDER SEC. B.�P.C.iOR TNIS RFASON q C 1�
� � �G � }✓
� � .
OATE OVMER U � �I71Gt'l.�J
W
¢ LICENSED CONTRACTORS DECLARATION W
[L 1 HEREBYAFFIfUA UNO[R PENQTV OF PERJURY THAT I�Y LICENSED UN�ER GROYiSIONS OF GHAPTER Vr
d o�COu1AENpNG Wi7N SECTiON 7000)OF DIVISION]OF TME BUSINESS AN7 PHOfE55�ON5 LOOE,IWD Z
X 1AV LICENSE IS W FUU.FORCEANO EFFECT. m
0 LICENSE CUS ���.No. !�4Q o l Z j
V DATE y b CONTHACTOA��(,�'F��� a
W
. . _ . ... WORKERS'COMPENSATION DECLARATION I�� 4 P����„/ �
� � ✓1 V
� IHEREBYAFFIPMUNDERPENALTYOFPERNRYONEOFTHEFOILOWINCDECLAMTa4s: Z ��
a
� 1 MAVE AND W:LL MA:NTAM A LER7IFIGTE O�CONS[M TO SElFdNSURE FOR WORKERS' S
� CpMnENSATqN,A50ROVIDEDBVSECTION7/ooOFTMELABORCOOE,FORTNEDERFORMANCE W
OF THE WORK FOR WHICH TMIS PERMIT IS ISSVED. �
G
W _INAVEANDYV�LLMAINTAWWORNER�COMPENSA7qNIN5URANLE,ASREWiREDBYSECTION
Q 97aoOFiMEUeO�COOE,FORiM[PERFOFA�ANCEOFTHEwORKFORMMipITHISVERM1T15
� ISSUED.MYWORK S'COMPENSATIONINSUMNCECARRICRAND70lICYNUTADEAARE: CONSTRUCTION
� ��i'Q F��l.� - 1 �.r�_c1�1�=zLY, 1
CARRIER PLAN REVIENJ
� POLICYIiUMOEH EIECTRIC --- `
� (1YiSSECIIONNEmNOiBEO[l.iiE1EDOFhEPEM.RISFOHONEHJK7REJ00lLUiSR10�OfiLE55) PLUMBING (�'�l '�-'�'r�'1-'"�"�-
W MECHANICAL � �"`J �� U
Z 1 CERTIFV TM�T N THE PERFORMIWLE OF TNE WORK fOR WMICH TMIS PERMIT IS 55UED.1
(J SWLLLNOTEMPLOYANVVERSONIN�NYMANN[FSOASiOBECOn�ESU&1CCT70TME �
� WORKERS'COMVENSATqHUW50FLALIFO�iN11AhDAGFEETHATIFISHOULDBECOME INSPECTIONFEE
S SVOJEC7TOTHEWORKERS'COMPEhSATIONVROViS�ONSOFSECiqN710oOFTH[LAE30R I ,
cooE,i sw�u.voar�+win�couv�r vnn+rHose vnowsaNs. ISSUANCE
� SMIP I:•-e�''
p DNTE: APPLICANT.
J WARNING�FAIURETOSECU1iEN10RNER5'COIAPENSATIONCOYERAGEISUNUWFUL.ANOSMK�BE ENERGYP/C LI-�""���-�
� SV0.JECTANEM7LOYERTOCRI1IiNALPENALTIESANDCNiLFINESIIPTOONEHUMJREDTMOUSAND ENERGYPERMIT
DOlURS(f t0a.00a).P!ADDITION TO TN[C0.5T OF C01A�ENSATION,DAMAGES AS DROViDEO FOR IN
� SECTION�7oeOFT1ELA0oRCODE,WTEREST,ANUATTORNEY'SFEES. RETEP(TIONFEE:
2 CONSTRUCTION LENDING AG[NCY PRE-ALT FEE:
O
Q IHEREBYAFFIRMUNOERPENA�TVOFPE0.IUMTHATTHEREIS�CONSTRUCTIONLENDINC�CENGY
� fOfiT11EGERfORMAYCEOFTHEWORKFORVJHICHiMISPE��TI5155UED(SEC.7oY'1,CIY.G).
Z
w
� IEN�CfiSf�IM�E
S
F- IENDER511DORE55 � n
wI CERTIFY TMAT IHAVE READ MIS MPLICATqN AND STATE 1W�T TMC A90YE INFORMATqN IS CORRECL TOTAL FEES � L.3�
� 1 AGREE TO COM7LY VlIiH AILffTY AND COl1NTY ORDINANCES AND STATE Uw5 PELATNC i0 BU4D�NG
� CONSTRUGTION,ANDMENEDY TApRIZEPEPRESENTATIVE50FTN15LOUNTYTOENTERUPONTIIE .
L ABOVE�MEMqNEDPROVER OR SPEC710NPURPOSCS. COh1MENTS
O
J
�
¢ PE0.VITTEENIA�E�PR1 )
�
(n S�GN�TUREOFPERMI DATE
� RECP� _PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance CoDY.P�NK—Assessor Copy.GOLDENROD—File Copy,GREEN—ApplicanCs Copy
..... . . ..... .. . . . .
t, ..,, � :.. "•.;'°"�,'..:�'� . . � .. . .... . •." . .. , '""!.:'. . - . .. . .. - f
� �'��� C��:_ E7 l:�a.f'�I C l�i� �i l'�Fi '
il�'Sr-��C:""iG��i �LC:1�F��
_ . _ _ —� -—- __------——- - -- ----- - ...__----- - —- — --�---------— --- ---- ----— �.
I►�!-'�.a-.�„"I'(�,1i�1. �i�`�E = i�'F:i:�_� rf);s I�+E=1.�-��'�°f��l��i �i�'�i'= I►`!_'i:R�e��e;l:�
. ...._._ _.._ -•--� - ...._........_ ... _._.. . .. . . - - -
__.._ . . _..._ ......- .... ... .. .. -- '
5ET�ACK � i _ .. _-- -�- � --..._....----- ---•
, � ; FLOOR J�IST ; '
-- ---�- - ------•-- ------ --•-•---- ---- ---._.... _... -
FfGS!FOR��15,'STEEL i � ' i f�H:�f�EQ.'."TS "__I ___�
ELECTRIC GROUP•1D --j-- ------------�---;-IIfJ�ER FLOOR DUCT I
�
-•—-- ---=...------- ---•-- -- ----
GROU��JD PLUP�161P:G ' � . UFl���R FLUOR CUi•IDUIT � �
-- 1-------_:.---- ------.-�- - - ._.._�_------ ;-- ------ --... _.
SLAB GRADE I _ ' �_f_�IR�Pi_i1G= F7UP17l.i"10"�_I I
TEh4P POvJER � � -------- ; I FIREPLACE 60�JD BEti:'�; - �--� ----
l^lATER SEFVICE -i --- _-_� i C11D f-IT. BOND BE.;�." --i—- � --
ROOF SHEATHI�JG —�---�-.-- � � F FT. G�:�JD E3�!�".?---- � -
FRP.MING/�'ENTILIF,TIOPJ I I � ; F-1NAL�OIJD GEF,h." I
ROOF COVER I -_�--- --�-! P�;E-G:��;DI�•JG -----� -----�-- ----
_ i
ROUGH HEF,TIfJG I I I �E�•:CHIi1;a • - '• �
ROUGH ELECTRIC � � ,i fiOUGf-I GRl�DltJG __ � i
f;OUGH PLU��",E31NG _ I---- -_ ."I_j FI�•dISH uR�,Di?JG �
SHOI•"JER/TUB TEST i I I �'OOt_ELECI RIC
EXT. LATti!SIDING � I ; POOL FE('�Clt•!�; j
l"JF,LL INSULATIO"J � � J POOL FI��AL __ �_�
CEILING INSULATIO^J � � OFF SITE Ih^FS _�
DRY�"JF,LL NF,ILIiJG I I I DEDICL;TIUilS I I
SE4"JER � i FI�JAL E�JG. � �— _
SEPTIC TAPdK � ; �� ' _}� Ll,NDSCAPc�IRRIG, �
SEEP PIT/L.L. � • T O"J SITE Ii.rPS. �
G.�iS AIR TEST r I � FIiJAL ZO�JIt�G
U1-.�-- _� ---
FINAI_CONSi. � j' � . ��...._- •;� i r_t^n:, D�FT. FIPJA'_ -
� .' �-!----
PINAL HEF,TI"JG I �; � -r%- _ _.;� � HEALTH DrPT. FI"JAL
�
FINAL ELECTF�IC � " ( �-' I i DEV. FEES PAID
FINAL PLUh1r�ING ��, i' � EPd�RGY I t
j �' l-� .--�-;--��-f.��:,�` .�' � _
_ � �: .. . .. ... .. ........._ ......__ I
�" - - ----- _ ..
.--- - ---------- - -
.. � V IV;I�I�L 'V-..-
, . " _�
SEPTIC TA��K SIZE
SEEP PIT/U 51ZE -- - -
��..--'_11M-._'�.._----' --- -...-- - -
P
`�1� _ .
:.;� --
d,� -