HomeMy WebLinkAbout18371 _�� CITY OF DIAMOND BAR �
� DEPARTNIENT OF COMMUNTfY&�DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
"���' BUILDING PERMTT APPLICATION FI MLY
� JOBSITE APPLICATION RMIT � P/C
o ADDRESS � -� � � �/� ' DATE NUMBER N
$ ISSUE PE OCC
APN LOT TRACT DATE CONST. GROUP
°C OWNER
0
o ADDRESS_ _ ZONING SETHACKS
gCITY V��,K,_ ZIP TEL � � � FRONT RW O
APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
� CONTRACTOR o q.. SIDE p
ADORESS
� CITY ZI TEL. er� PROPOSED USE O s. '_ cw✓
o ARCH/ENG/ `
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
cn
cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFWADDlREM
O
p 1 HEREBY AFFIRM UNDER iENALTV OF PEiWRV THAi I AM EXEAIPi fROM THE CONifUCTORS LI� G8fLQ0/Ca�pOrt
W CENSEUWFORTNEFOLLOWIN6REASON(SEC.70]1.6EUSINESSANDPNOFESSIONSCDOE:ANVLITYOR (n
U COUMYVMIp/pE0URE5A0ERMrtTOCONSTRUCT,AL�ERPA�ROVE.DElA0U511,CRqEPA1qANVSTRUC- �J,J pa��apeck
� TURE,VRIOR TO RS t55UANCF,ALSO REOUYiES TNE APPIICANT FOR SUCN PERMiT TO FlLE A SiGNED W
STATEMEM TUT HE OR SHE IS UCENSEO PURSUAHT TO THE PRONSiONS OF THE CONiMCTORS Lb
� CENSE UW(�PTER f(COMAIENqN�WITH SECTWN 7000)OF DrviSION�f�F THE BUSINE45 ANO PRO• � POOVSpB
� fE5SpN5CODE)ORTHATMEORSnE15E%EMPTTM�REFHOMANDTMEBASiSFORTHEALIEGEDE%EMP• C7
V TION.ANYVIOUTIONOFSECTION7071.58`lANYAPPIIC�Ni fOR11PERMITSUBJECiSTMEAPV�ILANTTO Z Re-Roof � �
ACMLVENALiYOFNOTMOfiETHANFNEMUNDREDDOLUR5ff50o)Y. '
Z ❑4A50'NNEROFTMEVROPENSY.ORAIYEMPLOVEESWiMWAGESiISTHEIR50LECOMPENSATON, � COmmefCi01
WILL DO THE WORI(IJJD THE STRUCTURE 6 NOT IN'ENOEB OR OFFERED fON S.LLE(SEC.7a�,BU51- J
� NESS ANO PROFESSIONS CODE:THE CONTMCTORS LICENSE UW OOES HO'APPLY TO AN OWNER OF ?
PROPERTY WHO BUILDS OR nAPROVES TN[REON,AND NMO OOES SUp/WORK HIMSELF OR HERSELF Oq
Q THROUGHHISORHERON'NEMPLOYEES,GROYIOEDTHAT:UCNMPNOVEMENTSARENOTIMENDEOOR m
LL1 OFFERED FOR S�LE IF,NOV/EYER TME BUI�DtNO OR IAAPROVEMEMi IS SOLD WITMN ONE YEAq OF COMPLE-
� TION.TNE OWNER�BUILOER WILL MAVE TME BURDEN OF VROYINO:MAT HE OR SNE 0�0 NOT 6UILD OR
MVROVE FOR TME PURPOSE OF S�LE4
= 04ASOVYNEROFTNEPROPERTY.AMEXCLUSNELVCANTMCTINGNATHLICENSEDfANTMCTORS
W
� TO LONSTR4CT TME OHO,IECT(SEG 7au.BUSINESS AND GROFESSiONS COOE:THE CONTRACTORS LI• V21U3ti0O � ADJ.AREA
W CENSEUWOOESNOTAPPLYTO/JIOWNEROFAVROVEAiYYhqdUII.O50RMPROVESTHEREd1,M1D
� WFqCOMMCT5FOR5UC110ROJECTSWITNACONTMCTOF(S�LICEhSEDPURSUANTTOTMECONTMG- QUANTITY DESCRIPTION �E
� TORSUCENSEUWL ��
� O 1 AM E%EAIPT UNDER SEG 8.t V.C.fORTHIS REASON Q
� U
LL �
DATE OWNER U
Z W
F LICENSED CONTRACTORS DECLARATION W
� I ItEREBY NiFIRM UNOER GENALTY OF iE0.1URY iMAT I AM UCENSED UNDER iROVSIONS OF CMAPTEF �
p„ 9�COrnMENCWOWIM5ECT10N7oao)OFDIV4iONiOFTHE8U51NE55�NOPP.OlESS�ONSCODE,AND Z
X MY LICENSE IS M FUII FORCE AND EFFECT, m
Ltl
� LICENSECLA55 LIC.NO. � Z' J
V DATE 1"s �— COMRACTOR a
W .
� WORKERS'COMPENSATION DECLARATION Q
N U
� IHEFEBVAFFIRMUNDERPENALTYOFVE0.IURYONEOFTHEFOILOW:NCDECIARATIONS: 2
� �IHAVEAND1MLlMAINTNHACERTIFICATEOFCONSENTTOSELF�NSUREfORNqFNERS' $
COMPENSATpN,ASVROVIOEOBY4ECTION71o00FTHEUBORLOOE,FORTHEVERFORMANCE W
Q OF THE WOFK fOR MAIICH TH�S iERAIIT IS ISSUED. �
W _IHAVEANDMnLLMAiNThINWORNERS'COMPENSATIONINSURANCE.ASREOUIREDBVSECiION
� 3T0o OF THE IABOH CODE,FOR ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS � � �.�/\
ISSUED.MVWORKERS'G PEN�TIONINSUFANCECARR�E/g uaocoucr+urneenu�e� CONSTFiUCTION l )
� GRRiER ' O PLANREVIEW '
0 POIICVNUMBER_ 3�I�L` ELECTRIC
� (hnSSECIIG�NEFDNOT8E0ChftETEDOFhEPERMT6iOFiONE�II�R[DOOlUR51itro1WlE55� PLUMBING
Z ICERTIFYTMATNTNEPERFO{UAANCEOFTNEWOfiNFORWHidITH4PERMITISI55UED,1 MECHANICAL
CS SHALLNOTEMIPLOVANYDERSONINANYMANNERSOASTOBECOMESUBJECTiOTNE
uJ IkORNERS'COuvEN5A7qN�AwSOfCAl60RNIA,ANOAGREETNATIfISMAUlDBECOME INS?ECTIONFEE
'� SUBJECTTO THE WORKERS'CWOENSATqN VHOVISiONS OF SECTqN f7o00F TNE IABOR ��
CODE,I SI/ALL FORTM/1TM COMPLY W IiH TMOSE PROVISIONS. I SSUANCE •
� l .cs` N ,by� ✓ �.,r,�'�'.q
p DATE: �1PRICI1Nf: �, e �071^ SMIP
� WARNINC:iA0.URETOSECUREWORKERS'COMOENSATIDNCOVERAGEISUNLAYhUL.►NDSH�' ENERGYPlC
LL SUOJECTANEMPLOVE1iTOCfUA1WALPENALTIESANDCNILFiNESUV700NEHUNDREDT/10U5M10 ENERGYPERMIT
OOlLARS(l100,000),W ADOiTON TO THE COSTOF COMPENSATqN,D/�MACES�5 PROVIOED FOH IN
� SECT10N370eOF71�EtABORCODE.wTEFEST,ANDATTORNEYSFEE3. RETENTIONFEE: r
Q
ow.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: '
O
CL �NEREBYAFFIRMUNDERCENKTYOFPERJURVTHATTHENEISACONSTRUCTIONLENDINCAGENCY
� FOR ME PENFORAIANCE OF THE WORK FOR WMiCH THIS PERMIT IS I55UE0(SEC.7007,CIV.C.). .
Z
W
� LENDER'S NAME
F= LENOER'SADDRESS
� TOTAL FEES � ,���
� ICERTIFYTHATIHAVEREADTHISAPVLICATIONANDSiA7ETHATTHEABOVEINFORMATIONI5fAR0.FCT.
W IAGREETOCOMPLYWITNALLCRVANOCWNTYOR�INANCESANOSiATEUWSFEUTWGTO0U1lG�NG
� CONSTRUCTION.A�:OMEREBYIIUTMORIZEREGRESENTATIVESOFTHI$�OUNNTOENTERUPONiHE �
ZABOYE�MENTIONEDPROPERTYFORINSPECTIONPURPOSES. COMMENTS
� ��� 10 �B'S"'
�
m VERM�TTEE NAUE IPfUNT7 �,.�
v
N SICNATVREOFPEAUITiEE �/T����
= RECPT.NO. PAID BV VALIDATION
~ � WHITE—Departmont Copy.YELI.OW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applic¢nYs Copy
ci;�� ar DEA����� �a�
� IfL�PE�T�C]t+ ��CO�D
����-�.?��'F� �����w1i�= �I�t��,��%��j�$ ;al�.��.���'���'1►_____ __°._.^_���!i�r.��,���:��@�� Q F�_�'
SET BACK � �� �j � FLO�R JOIST — ---_�__�---
FTGS,�FORMSISTEEL i i FHF�REQ�1TS �
—=-1-----—
ELECTRIC GflOUND f � ' UfJDER FLOGR DUCT ,� (
GROUPdD PLUMBING � � __� ' UNGFR FLOOR CUP�IDUIT � i _,
SLAB GRADE ! � ___.______ _I ; _FIREPLA_CE FOUNDATION i
TEM° POWER ( � � _ FIREPLACE E30PdD BEAM _
WATER SERVICE I � P�91D HT. flOND [3EA�J! �
—�-- — -- ��—__„.. ---�—
ROOF SHEATHi�dG —I�(,7g�2. � �_-- � � 8 FT. BOND BEAM —_
FRAMINGNENTILIATION I ����p�� � RNAL E30t�D BEAti' ,
ROOF COVER ���01— /l. �f `"""'`__i PRE-GRAi�ING !
ROUGH HEATING , BENt�NIi�G I
ROUGH ELECTFiIC T __�� ROUGH GR.ADING �
ROUGH PLUMBING ! I FI�vISH iaRADING �
SH�WER�TUB TEST � f'OOL ELECTRIC
--_ _ _� � -- —
EXT. IATH,`SIDING j POOL FENCI��dG _ __
WALL INSULATION � POOt FIfdAL
CEILING IN�ULATIOf� nFF SITE IMPS.
RRYWALL NAILING � DEDICATIONS
SEIh'ER F(NAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. � � GN SfTE IMPS.
GAS AIR TEST ( i FifJAI ZONING
FINAL CONST. � _ `i i FIRE DEPT.FINAL
FINAL HEATING _� __ � ( HEALTH DE�7. FINAL
FiNAL ELECTRIC � ' ( DEV. FEES PAID
FI,�AL PLUh1BING I ENERGY
� -- — --
-— ��J.,��.����."'-��.�..._:_<_.._ � .
CUMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE � — —
�.� �� — — --- .
�
! — —
.,+— i
i ---- ---
�}��P , ,�II -----
.��r I
. . � — —
,� ,�. � --
:�a � � . �
�x �.� , .
�. _.....�__.___.__.J....� --- —