HomeMy WebLinkAbout17735 (43) �
, . - . _ . _ .
--- �.._..__ � - - i_ _ . --- T____ _.__._. .
�,` CITY OF DIAMOND BAR ��
DEPARTMENT OF COrRvIUNITY&DEVELOPMENT SERVICES
,��� 21625 E.Copley Ihive
(909)860-3195 Fax(909)861-3117 PRESS
"%r�'` BUILDINGPERMITAPPLICATION FIRMLY
y J08SITE /,/ , / // APPLICATION PERMIT / P/C
o ADDRESS �7'U� �L�/vG? K�l'10LL S DATE S�Z' NUMBER�L� Y
c� ISSUE TYPE OCC
APN LOT TRACT DATE 3I�(D Z� CONST. GROUP
p OWNER f�l�_CH1//Ul-� S ZONIN�KS
o ADDRES S'
g CITY � ZIp EL9 FRONT RW ❑
APPLICANT TEL. REAR O
SIDElSIDE STREET RW O
� CONTRACTOR SIDE ❑
� ADDRESS d
� CITY ZI �� TEL PROPOSEDUSE ` ��
o AqCHlENG! I � ,� �
� DESIGNER NO.DWEL NO. NO. ,
ADDRESS UNITS ' STORI S _
� CITY 21P TEL � BEDROOMS
� DESCRIPTION SQ.Ff. FACTOfI PSF ADJ.AREA/VALUATION
� OWNER-BUILDEH DECLARATION SFWAOD/AEM
O
p 1 HEREBY AFFlRM UNOER PENALTY OF PERAIRV iHAT I AM E%EMPi FROM THE COHfMCTORS L4 GaragelCarport
W CENSEUWFORTHELOLLOWINOREASON(SEC.70.'11.68USINESSANOPROFESSIONSCO�E:ANYCITVOR (�
U �JN7YMMIpIREWIHESAVERMI7TO00NSTRUCT.AL7ERa1FPOVE.DEMOLISH,ORHEPAIRANY3iRUG W h0S1O1D0Ck
� TURE,PRqR TO RS ISSUMICE.AL50 REW IRES THE APPLICANT FOH SUCH GERMIT TO fILE A SIGNED W
STATEMENT THAT HE OH SHE 5 LICENSEO PURSU1�Nf TO THE PiiOV1510N5 OF THE CONTMCTORS L4
$ CENSEUW(LHAPTEq/(COMMENLMN4WITHSECTION7000�OFONISION70F711EBUSINESSANDPHO � PooVSpa
FESSIONS COD�OR TMT HE OR SME IS E7(EMPT TF7EREfROM AND TNE BASIS FOR THE ALLEGED E%EMP•
� TqN.ANYVIOLATI0NOF6ECTI0N70�1.68VANYMPLICFNTFORAVERMITSUBJECTSTHEAPDLICAN7T0 Z Re-Rool � `�'� d"� �
A dV�L VENALTY OF NOT MORE THAN iNE MINDREO OOLLARS�f 50�].y
Z ❑4ASONMEROFTMEPROPERT:ORMYEYiLOYEESWITHWAGESA5i11EIR50LECOMPEN3�T10N, ❑ COmrtiBftl01 '
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�EO OR OFFEREO FOF SAIE(SEC.1W0,BUSb J
NESS IND PROFESSIdJS COOE:THE CONTRAC70RS LICENSE LAW DOES NO7APP�Y i0 AN OWNER OF
� iROPERT`/WMOBUlO50qIMPiqVE57NENEON.ANDVMODOESSUGHWOfiKHIMSEIFORMERSELFOR �
Q THROUGHHISORHEROWNEMPIAVEES.GROVWEDiHATSUq/1MPpOVEMEMSARENOtINTENDE00R m
QOiFEREDPDRS/LEGFqWEVERTMEBUL0iN60NIYDROVEIAENTI550LD1MTNINONEYEAROFCOMRE-
Z TqN.TXE OWNER�BUIIDER YALL/4�YE TME BUROEN Oi PROVINO T/UT NE OR SHE DiD NOT BUI�p OR
= MGROVEFORMEPUHP0.5EOFSALE).
O L�5 OM�NER OF iHE PROPERIY.AM ERCLUSNELV CONTRACTING WIl/1lICENSED CONifUCT00.5
Q TO CONSTRUCT iNE PROUECT(SEC.7aN.8U51NE55/WD iROFE5510N3 CODE:TME C0.VTMLTORS U• VeluetlOfl A0.1.AREA
W CENSEUWDOESNOTAPPLYMANWYNEROFAPROPERTY1NiOBUILDSORMPROVESTMEREON.AND
� NM1IOCOMMCiSFOqSUCJ17RQIEMSWITHACONTMCTOR(5)LICENSEDPURSUANTTOTMECONTRA6 OVANTITY DESCRIPTION � FEE
Y TORS IICENSE UW.).
� OIAMEXEMPTUNDERSEC. B.IP.GFO{ITNISREASON 4
� U
�
� DATE OWNER V
W
�Q UCENSE�CONTRACTORS DECLARATION W
[L IHEREBVAFFIRMUNDERPENALTYOFGERNRYTHA7IAMLICENSEDUNDERPROVISIONSOfCHADiER V,
p„ O�C0IAMENLWOMAMSECTION7000�OFON�SION7DFTMEBUSINESSANDVROFESSIONSLO�E,MN Z
X IAY LICENSE IS IN FLLL fORCE AND EfFECT. m
� UCENSE CUSS�IIC.NO. ��y � � �
V DATE C��-'i�'�D� CONTRACTOR f�I a
_ w _ �i�
� WORKERS'COMPENSATION DECLAAA710N 4 ,
� IHEREBVAFFlN.IUNDER7ENALTYOFGE0.1URYdJEOFTNEFOLLONnN60EC1.AM7iON5: V
N Q
� _IIUVEANDWILLMAMTAINAGEfiT1FICATEOFCONSENTTOSELFaNSUREFORWOHKERS' 2
COMPENSA7pN,A50ROVIDE08VSECTIONl7ooOFT11EUBORCOOE,FORTHEPERFORMANCE W
OF THE WOFK FOR WHlpl THIS PERMtf IS ISSUED. �
O
��IHAVEANDWILLMNMAMWORNERS'COIIPENSATIDNINSUMNCE,ASNEOl11RE�BY5ECTION //�� .
Q� �7000FTNEUIBOROOOE,FORTHEPEHFORMANCEOFTMEWORKFORWHIp1iMI5VERMITIS 1
� ISSVED.NY W�ORKERS'COMPENSA7qN INSURANCE CMHIERANO FOLICYMIAABERME: CONSTflUCT10N .7
� CARRIER � PLAN REVIEW
Z po��cy NuuaEp • ELECTFIC
a
o fn�ssfcnorrn�r+neeoor.�rmoFneew,rrsroAa�Ftr�000tt�nsR+oo�oAtEss} PIUMBING
Z ICERTIFYiNATINTHE�ERFOPMANCEOFTHEWORNFORWMIpITM15VEiWITISISSUED,I A4ECHANICAL
(} SHALLNOTEM7LOYANVPERSONWANVMNINEHSOASTOfiECOME5U8JECTiOTME
N WORKERS'GOMPENSATIONUNaOFCAIIFORNI�,ANOAGREETHATIFI51iIX1LDBECOME INSPECTIONFEE
S SUBJECTTOiHEM�ORKERS'COMPENSATIONPHONSIONSOFSECTqN]7000FTMEUBOR /��
COOE,I SHALL FORTMVIiH GdAPLV WI1H TIIOSE GROVISiWlS. �SSUANCE �/n/�
� ��Oa" ____:� ��(� SMIP � T]
A DATE: APPLICANT:
w ENERGY P/C
� WARNING:FA0.URE TO SECURE WOFKER5 COMPENSATION CA E IS UNtAWfUL,ANO 5H111.8E
�y SUBJECTANEMCLOYERTOCRIMWALVENALTIESIW�CMLFWESl1VTOONEHUN�flEDTMWS.WD ENERGYPERMIT
UOLUHS(f 100.000I.IN ADOIiION TO THE COST OF COMGEN$ATION,DNA�WES AS PflOV�DED FOR IN
� SECTiON�70e OFTHE U00R CODE,MEHEST,ANDAiTONNEY'S FEEA RETEfYTION FEE: •OD
d CONSTRUCTION LENDING AGENCY PRB-ALT FEE:
� INEREBYAFFIRMUNDERiENA17YOFVERJUflYTMATTHEREISACON57RUCT10HLENDWOACENCY
z FOR iME PEH�OHMANCE OFTME WORN Wq WHiCHTHIS PERUIT IS ISSUED(SEG]oa7,GV.C.�.
W
� LENDERS NAME �-- --
� LENDER'S�DORE55
� ICERTIFYTHATIIUVEREADTHISAPPUCATqNANOSUTETH�iT1EABOVEINFORMATpNISCORRECT. l�OTAL FEE (� ,,,�� � �
0. IA6REETOCOMPLYWIiHALLGRYANDCOUNTYOHDWMlCESANDST�TEUWSREUTWGTOBUILOIN6 �'aR ,r � (
� LONSTRUCTION,ANDHEREBYAU1110R12ERE7RESENTATNESOFTNISCOUNTYTOEMEHUPONTHE ' rj�
Z ABOVE-MENIIJNEO VFOPERTV FOR MbPECTION OURVO5E5. COMMENTS r
� y�8/C�Gi s� �i�7C'+C '`_,t''
m �._..._.--_ . ,
� VE EEN.UAE(V .Nn
� e�. ?�--tt'S 3 :s�a�-
� SICNA7 OF VE EE DATE
� RECPT.NO.� �PAIO 9Y VALIDAT�ON
WHITE—Department Copy.YELLOW—Finance CopY.PINK—Assessor Copy,GOLDENRO�File Capy,GREEN—Applieant's Copy
, . .. .-^ . � � . .. . . `� .. - • - .. � . , . .. .. . . .--, .. . '... , '' ' ..:x�....:i.,,` ,� � ._ ;.�... �. -� . �., ., -,.-_.--- - - --� � . . ,.
C1TY OF DIAMOR9D BAR �
� ' lh�SP�C E IOP�! REC�i��
,. �..._...-�..
__ .. . - -
�����-'�����: ... io����� 'tl�.��:���� � �� � ,���.�����l�j�►�.. � . .. . ��r'�';a� . i�i� ,�'�_�: .. `
_ ..�. _ �..._.._. __r _ __.__ W.^ _ '_ '
SET BACK • ' " ' 't!' FLOORJOIST ' �;
FTGS/FORMS/STEEL - FHA REQMTS
ELECTRIC GROUND ' 1 UNDER FLQOR DUCT
GROUND PLUMBING UNOER FLOOR CU�IDUIT '
SLAB GAADE FIREPLACE�OUNDATION
TEMP POWER � I FIREPLACE BOND BEAM
WATER SERVICE �_ MID HT. BOND BEAM .. ' ' • '
ROOF SHEATHING � � (JZ I 8 FL BOND BEAM�.� • ` •
� , �� -.-::��"_
FRAMINGNENTILIA'fION � � FINAL BOND BEAM
R�OF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERITUB TEST POOL ELECTRIC
EXT. LA7HlSIDING i P�OL FENCING
WALL INSULATION • � POOL FINAL
CEILING iNSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS � •
SE1h'ER ( FINAL ENG.
SEPTIC TANK � , � LANDSCAPElIRRIG.
SEEP PIT/L.L. � ON SITE IMPS.
.GAS AIR TEST FINAI ZONING
FINAL CONST: FIRE DEPT. FINA'_
FINAL HEAT►NG HEALTH DEPT. FINAL �
FINAL ELECTRIC '; DEV. FEES PAID
FINAL PLUMBING I ENERGY
, c{ ; �ir��,{���i�, , , �
�= ' __
- - - _ _ _ . �._-_---__,.>_,�r..._�._.�. -_--- ,
� - -- .._ . _..__ - ------ --- -, .. .___ _
;
COMMENTS
! �
i
� ��� . ' ��
;
f
SEPTIC TANK SIZE �
� SEEP PIT/U SIZE
, �.)�� ��
;����� . !�,,,
'i
� �
� �
;� �� .� � � � _z- ,,�� .