HomeMy WebLinkAbout12661 (14) �`_ CITY OF DIAMOND BAR ��(P�RED
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Dcive Suite 190
M (909)86a3193 Fax(909)861-3117 N 0 U 2 2 2000 PRESS
����^��� BUII.DING PERMIT APPLICATION FIRMLY
Q ADDRIESS � �� I r"CI'1U d APPLICAl10N { i � PERMIT� P/C
p DATE � � `�r NUMBE N
� fSSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
� OWNER r' 2'Z �
ADDRE S i o) ZONING SETBACKS
CITY � ZI TEL� -7��D FRONT RW ❑
APPLICANT � TE FiEAR ❑
— SIDE/SIQE STREET RW ❑
CONTRACTOR 1✓� SIDE p
ADDR S �
g CITY ZIP TEL ' PROPOSED USE 0l3 � �
� w � 5
ARCH/ENG/
DESIGNEA NO.DWEL. NO. NO.
ADDRES5 UNITS � STORIES �_BEDROOMS
� CITY ZIP TEL
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUA710N
� OVYNER-BUILDER DECLARATION SFR/ADD/REM
eI HERFBY AFFlRAI UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE OOMRACTOAS LI- GB�tQB/CBfpOA
� CENSEIAWFOit7HEfOLLOWINOREAuON�SEC.7W1.6BUSINESSANDPFlOFESSIDN9CODE:ANYCT'OR ; (�
COUNTYYAYCNREOlAHEBAPERMRTOCOfJSTRUCT,KTER�P��.DEMOLI51i3OFF1EFAIR/�NYSTRLLC- • �,�J patio/Deck
TURE,PRIOR i0 RS 159UMICE,pL30 REOUIRE9 7HE MPLICAM"FOH SIJCl1 PEFIMIT TO FILE!1 SIONED �
� BTATEMEM TNAT XE OR SHE I6 LICENSED PUR5UANT TO THE PHONISIONS OF THE CONTRACTORS U• �
� CENSE UW(CHAPTER i(COMMENCINO WITH SECTION 7000�OF DIVISION]OF THE BUSINESS Ml�PPO- P001/S�18
iESSIONS CODE)OR 7NAT NE OR SHE IS E7�MGTTHEREFROM AND THE BA415 FORTiIE ALLEOED E%EI.P-
7qN.M1YVIOLATqNOF6EC710N7W7.6BYANVAPPLICMITFORAGERMITSUBJECTSTHEAPPUCMJ7T0 Z po-Hoof � �OQ
� IICML VEKIL7Y OF NOT MORE 7HAN FNE HUNDRED OOLURS(isoo).):
04���EROFTHEPROPERTV,ORMYEMPLOYEESWIhIWAOE9A9TiEIRSOLECOMPEN9ATIDN, O COf11T6fC181
WLLL 00 THE WON(MD TY1E SiRUGTUHE IS NOT INTQIOED OR OFFERED FOR 9ALE(SEC.7oN,BUbI- J
NE53 AN�PROFESSION9 CODE:T17E CONTMCTONS UCENSE LAW DOES NOT APPLY TO AN DWNER OF j
� PIpPERTYWFiO8U0.D90RMVRDYESiF1EREON,MAWFI0DOE55UCHVYOqKHIMSELFORHERSELFOR
� TWIOUGHHISORHEROWNEMPI.OVEES,PROVIOEDiHATSUCHIMPNOVEMENfSARENOTMTEN�E�OH m
OFFERED FOREKE IF.NONl6VEit 7NE BULDWOOR MIPROVEMENf L4 SOL�WfTHW ONE YFAR OFCONPLE-
iION.THE OWNE0.BLlILOER MALL HAVE TFIE BUR�EN OF VROYMN3 TII.l7 NE OR SME DID NOT BUIID OR
■IPi1DVE FOA 7HE PURP0.SE OF&1LE).
� O�A60YN�EROFIHEPROPEHTY,AME%CLUSIVELYCONTRACTINOWfTMLICENSEOCONTRACTORS
TO CONSTiR1Cf 7HE GRO.tECT(eEC.7as,BUSINESS M!D PROFES910N5 COOE TNE CONfRACTOR3 U- V81UHtICf1 �OO ADJ.AREA
CENSE UW DOEE NOTAVPLY TOAN OWNEH OFA PROPBiTV YYhq BUILDS�i IMPHOVE5 7HEREON,M7D
MAi000MMCT8FOR8UqiPRQ1ECTbWITHACOIITMC70R�SJLICENSEDPURSUIWTiOTHECONT1i11F QUANIITY �ESCRIPTION FEE
� lORSUCENbEIAYY.). �
OIIME%EMP7UNUER9EC. B.dP.C.FpRTMISREASON �
U
l� �
DATE OWNER . �
� LICENSED CONTRACTOFiS DECIARATION W
� I NEREBYAFFIiqd UNDER PENAL7Y OF PEMIRY TFNT I AM LICENSED UNDER PROVISIONS OF CHApTER �
i(OOGMENCWCI WI1M SECTION 7oao�OF DMSION 9 0F 7HE eUSINE3S AND PROFES510NS CODE,AND Z
� W LICENSE 6 N FULL FOIiCE AND EFFECT. m
� UCENSE C� LIC.NO. 1 �
o�� corrraacraa � r a
= WORKERS'CAMPENSATIONOECUlRAT10N f�� i� U
L-.
� 1 HEREBY I1FFlRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLIAWING DECLARATIONS.J Z
� INAVEMOWILLMAINT,UNACEIifIFIGREOFCONSENTTOSELFdNSUREFOfiWORKERS'
OOyDEN 6ATION,A4 PqONDED BY BEC710N�70o OF THE lABOR CODE,FOR THE PERFORMANCE W
_,. �NE WORK FOR WHICH THIS CERMR IS IS6UED. �
W /
� i NM1VE AND WILL MAINTNN WOHI{ERS'COLIPENSAT70N INSUfUNCE.�5 REOUIRED BY SECTION ^
4 37000F7HELABORCODE.FOR�FIEPERPORMIWCEOFTHEWORNFORWHICHIHISPERMITI5 / �
ISSUEO.WY WORKEAS'COYPENSATION INSURANCE CAFRIER AND POLICV NUMBEF ME: (/�� CONSTRUCTION � � ✓_
� GRPoER .� r, - • PLAN REVIEW
� POLICYNUMBER � � 'r� �M (�� .ELECTRIC
Q (iHssEemrit�No7eeoo�te7IDOF7�PErMi�s�aneM�nnram0u1�56+amaa�Ss1 PLUMBING
Z 1 CERTIFY THAT W 7HE PERFORMMICE OF iHE WORK FOR WHICH TMS PEHMIT 16 ISSUED.I MECHANICAL
�' SHN.LNOTEMPIAYANYVER50NWM1YMANNERSOA970BECOME9U8JECT707HE �
� YYORKRiS'CONPENSATIONUWSOFCALIFORNIA,/JiOACiREETNATIFISHOUlDBECOME INSPECTIONFEE
5 SUBJECTT07HEWOHKERS'COMVENSATpNPROVI510N50FSECTqN]TooOFTMEU80R
CODE,1 SN FORhMIM COIAPLY WIiH T E ROVIS ISSUANCE ���
p a��: r,J� �x' APPLICANT. ��_�tnQ SMIP s�
� WARNMO:FNLUHETOSECUREWORKERS'GOMPENSATIONCAVEHA(3EISUNUWFUt,� ENEFGYP/C ��1�G'T 1Vi'�RAR -
� BU&IEGTK!EMPLOVER TO CRIMMIIL V6NALTIES ANO CML FINES UP TOONE NUNDRE�iHOUSAN� ENERGY PERMIT QZ T$__n
� OOlWiS(i100,000�,INM01ilONTOTHECOSTOF00NPEN5AT10N,DAM�0E5113PROVIDEOFORIN DIJiLi7
� SECT10NY70lOF7HELABORCODE.INTEREST.M1DATfOiWEY'SfEE5. RETENTIONFEE:
OCONSTRUCTION LENDINQ AGENCY PRE-ALT FEE:
gIHEREBYAFFlPoAUNDEHPENALiYOFPEFUURY7HAT7HERE15ACONSTRUCT10NLENDiNOAGENCY
Z FOR 7ME PERFORMANCE OFTHE WORK fOR WHICH THIS PERMIT IS ISSUE�15EC.]oY7,pV.Q�.
W
� LEN�ERS wVAE
1-- LFNDER'SADDRE35
"- ICERTIFYTHATIIIAVEREAD7MISMPLICATIONANUST�TETUTTMEABOVEINFORMATqN19CORRECT. TOTAL FEES �
d IAORE4TOOOIAPLYN7THALLCITYANDCOUNTVORDWANCESANOSTATEUVYSRElAT9NOTO8uLLdNO
� CONSTRI1CilOµANDlEREBY AIfiNORIZE REVRESENTATNES OF THIS CIX1NT/TO ENTER UPON iHE .
A80VE•YENTIONE�PHOVERTY FOR INSPECTION PUi1POSE5. COMMEN7S
� A- rn/�TH � C�-
� ��� �E�
� � � . � ���� � P �
(n 8q OF 7rEE W7E
� pECPI:NO. PAID BY VALIDATION
WHITE-0ep9rtrnent Copy,YELCOW—Finenca Copy,PINK—Assessw Copy,60LDENRO�FIe Copy,GREEN—ApplicanPa Copy
CITY OF DIAMOND BAR
� � � � INSPECTiON RECORD
.` p � 1 � - 0 � , . � .
SET BACK � FLOOR JOIS;f;;`; , . � � �
FTGS/FORMS/STEEL FHA REQMTS -
ELECTRIC GROUI�tD UNDER FLOOR DUCT
GROUND PLUMBING UND�R FLOOR CONDUITi � _ _
SLAB GRADE FIREPL'ACE FOUNDATION - � �
TEMP POWER FIREPLACE BbNDEEAM ' � �� '
WA7EFi SERVICE MID HT. BOND BEAM - - �
ROOF'SHEATHING ' � � ' $FL�BbND BEAM . . . . .
FRAMIIVG,.N.ENTILIATIOIV � . � � FINAL BOND BEAM
ROOF C01iER PRE-GRADING
ROUGN HEATIN� BENCHIN�
ROUGH ELECTRIG ROUGH GRADlNG
ROUGH PLUMBING FINISH GRADING '
SNpWER/TU8 TEST � POOL ELECTRlC
�XT.LATH/SIDING I I POOL FENCING
WALL INSULATION -� �,i POOL FINAL
CEIUNG INSULATION I OFF SITE IMPS. i '
DRYWALL NAILWG ; j � DEDICATIONS '
SEWER i _T � FINAL ENG. I
SEPTIC TANK � i LANDSCAPE/IRRIG. J�
SEEP PIT/L.L. t C • ' F ON 51TE IMPS. —i
GRS AIR TEST , FINAL ZONIlVG j
FfNAL COlUST. i I FIRE DEPT. FINAL i -' �
�
FINAL HEATINC € ; i� HEALTH DEPT. FINAL ; —�— �
FINAL ELECTRIC ; ' DEV. FEES PAID ! �
FINAL PLUM8ING i � __^_� ENERGY j __�
� ' — � ---
�. * �, � _
, . „ #
COM�t/IENTS
6
, -�
�.��� -�f�� ,
S{�'4�' �` � u�::��� � �
:�;.:. ::,,.:.4:.::�,.�;;�, .i:.j,`., . ._ . . .. . - �
\7• -
SEPTIC TRNK SIZE. :. � ^ .� . :,;`�.,�.' '`
SEEP PIT/U SIZE — ��
,� — --
i
� , � _ .. . . � � . _ ' ... + . _ • .