HomeMy WebLinkAboutNo Permit Number �� CITY OF DIAMOND BAR
/ �� ��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE
: d , 21660 E.Copley Drive Suitc 190'
(909)860-3195 F�(909)861-3117 ' PRESS
�'°�'f BUILDING PERMIT APPLICATION FIRMLY
yy. JOBSITE / �� APPLICATION J 1� I_ -�f PERMIT � PIC
o ADDRESS /. � 1"` /�_ DATE l� �� � NUMBER �t
$ APN LOT AC ISSUE 7yPE �C
g OWNER - �A� CONST. GROUP
ADD SS ZONING SETBACKS
C Z EL. - FROfVT Ryy �
APPLICANT ���,�, ., REAR �
SIDE/SIDE STREET Ryy ❑
CONTRACTOR SIDE �
� ADD S
CITYI�L�II�- ZII�- TEL'.,� � PROPOSED USE ,-.
�� ARCH/ENG/
ADD ESS � ' NO.DWEL NO. NO.
CITY Z�p T UNITS STORIES BEDFOOMS
� EL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
q� OWNER-BUILDER DECLARATON SFR/ADD/REM '
O
I HEREBY AFRRM UNDER PENALTV OF PEiWRV THAT I AA1 EXEMPT FRON TME CONTqAC70R5 LI• G9f8gB/CB�OR
CENSEIAWFOR7NEFOLLOVNNGREASAN(SEC.703t.6B181NESSANDP1lOFESSIONSCOOE:ANVCITVOH � (f�
COIAffYWHIpIRECUIRESAPFAMITTOCONSTRUCT,AL7ER�PRWE,DEMOL15Fi,ORREPAIRANYSTRUG ; W P811dDpCk
iVRE,PRqH TO R6168UANCE,A190 REOU WES T11E APPUCANT FOR SUCH PERMIT TO fILE A SIGNED �
STATEFAENT MtT ME OR 8HE IS UCENSEO PURSUANT TO 7HE PROVIStONS OF T1E CpiTMCiVqS LI•
CENSE LI1W(CMAPTER a(COMMENCMO MTH SECiION laa0)OF UIYISION 7 OF TF1E lUSINESS AND PR6 � PooVSpe
FE83qNS00DE)ORTl1ATNEORSHEISEXEMP7TMEREFROMAND7HEBASISFORTXEALLEOEDE%EIAP- . (7
T10N.ANYNOLATIONOFSEC'f10N70J1.69YANYAPPLICAlITFORAPERMITBV&IECTSTHEMPLMANiTO _ Z Re-Roof
F A CNIL PENALT'OF IqT MORE 1HAN FNE MUNDRED DOLLAR31=Soo�.�.
O OL�^+�NR�EROFTMEPROPER7Y,ORMYEMVLOVEESWITHW�WES�SiHE1R50LECOMPFNSATION, COf111I1B�C191 -
Z W�LL DO TIE MAHK M10 iHE S7RUCTIJRE IS NOT IMENDED OR OFFEREO FOA SALE(8EC.7o�I,BUSI• Q
� N65S AND PROFE8510N5 CODE:TME CONTMC70R8 110ENSE LAW GOES NOT MPLY TO AN OWNER OF
P110PEATYYYFiOWLDSOtiINPROVESIHEREIX{ANDYYFp00E98UpiWOflKNIMSELFOflNERSELROR �
� fHROUGHN�80RIffN01MiEMPIOYEES,PFIOVIDEDTMAi8UO71MPpOVEMEM9MENO7IM'ENOEDOFi Ln
OFFEHED PDRBAI.E IF MON'EYER TME BULDMIOOR IIAPHOVEMENT IS SOtD WfT1YN ONEYEAR OF COMPLE-
TIDN.TNE OYI7YER-0U0.DER M7LL WLVE 7HE BURDEN OF PROYWO THAT HE OR 6HE OID NOT BUILD OR
IMPROVE FOR iME PURPOSE OF BALE)• :
W OLASONNEROFT}IEiROPEiffY,M1EXCLl15IVELYDOH7RACTNONrtTHUCENSEOCONTRACTOqS
� TO CON57RUCT 7ME Pfm.lECf(EEC.7W1,BU31NE53 AND GipFESSIdiS COOE:THE CONTRACI'ORS U- V8I119IIM ADJ.AREA
CENSE LAW DOES NOT APP�Y TOAN OWNER OF A PROVFAT/Vhq BUlDS OR MPRWE9 THEREON,AND
NM1iDCONiNACT6F0118UCNPHOJECT6NATNA00HiMCTOR�B�LICENSEDPURSUANTTOTHECONiRAC. QUANTITY DESCRIPTION FEE
� i{7fiS lICE1JeE lA1N.1 .
❑1 NA E7�AIPi UPDER SEC. B.i P.C.PoR THIS REASON U I � C
�y � N
DATE OWNEH F
� U .
LICENSED CONTRACTORS DEClARA710N W
� I NEREBY KFIflM UNDER PENALT'OF VEqJURT Ti�T 1 NA UCENSEO UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCNYO WITH SEC710N 70a0�OF DNISqN 90F THE BUSINE35AND VROFE5510N5 CODE,AN0 . �
�y MY LICENSE IS M FULL AND EFFECT. y
�� LICENSE SS LIC.NO. -� +�
� DATE '� CONTR11CT0 � ' �
= WORKERS'COMPENSATION DECLARATION 4
� I NEREBYAFFINA UNDER iENALTV Of VEqJURY ONEOF iNE FOLLOWINO DECLAMT10N5: Z
� _IHAVEANDYY1LlMMNTAMIACERfIFIGIITEOF00N5ENTTOBELFdNSUXEFORWORKERS' _
CdAPENSATIOM,AS VHOVIDED BY 8EC710N 97000F iME LABOR COOE,FOR THE PERFORMANCE U
Q OF 7ME WORK POR WHICF17Fi19 VERMIT IS ISSUE0. �
Q �I NAVE AND WILL MNNfA1N WOANEfl9'COMPENSATION INSUMNCE,A9 REOUIRED BY BEGTION
��9700 OF iHE LABOR CO�E.FOR TNE PERFORMANCE OF THE WOPR PoR WMICH THIS PENMIT IS
ISSUED.MYN'ORIF ' O�MPENSATIONINS N��CARRIERANDPOLICYNUMBERARE: CONSTRUCTION
jCARRIER �-� t/ P IEW
� POUCYNUABEN �L - � _EIECTRIC '
� m+ssEcrior,r��NoreEm►nFreooFn�vEa„rrsr+o�a�Nx�or�moou,wsmm�aR�ss� uvG
w
� I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH 1HIS VERMIT IS ISSIIED,I MECHANICAL
SHFLL NOT EMGLOY ANV VERSON IN ANV MANNER 50 AS TO BECAME SUBJECT 70 7NE
�p MIORKERS'CpA7EN5ATIONU1W30FCAL60RNI,�MIOAGREETXATFISFb1ADBECOME IN TIONFEE
SUB.IECT TO THE NK7HKERS'COMPENSATION PROVISION5 OF 6ECTqN 070o OF THE LABOfl ��j� ��
-rj �,i si+ut wrmnnn+cor�ri.r vnrn na,pse rRowswws. /�—� SUANC
� ��-�X� < #/Qu �� +�L C C- g
p DATE: APPIICANT-�
� WARNINO:FALURE TO SECUHE WORKERS'COMPENSATION COVEMOE IS UNUWFUL,AND SHALLBE ENERGY PIC �„c r � L� •AAn
BllB.1ECiANEMPLOYEHTOCRIMINAIPENALTESANOCIVILFINESUPTOONEHUNDFEDTNW3AND ENERGYPERMIT
JDOLURS(i100.000).IN MDfT10N TO hiE CO3T OF COMPENSIRIDN,GAMAQES AS PROVWE�PDR MI
8ECTION 970e OF THE U1BOR f.17DE,NTERE5T,ANO ATTOFNE`f5 FEES.
� RETENTION FEE:�ITY OF n��n'*.�� _
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: B UII,DIN(a����i
� IHEREBYIIFFIRMUNDEHPENALTYOFPERJURVTNATIHERE1511CONSTRUCTIONIENDINGMiENCY �
FOR TNE PERPoRMNICE OF TNE WORK FOR IYMICN TMIS iERMIT IS ISSUED(6EG 30Y'/,CIV.G�.
�
� LENDER'SNNAE
� LENDEH'SADDHESS
� ICER7IFYTIiIVTIMAVEflEMTMISAPPLIChT10NMIDSTATETMATTHE�BOVEINFOfiM�710N190DHqECT. TOTAL FEES
d IA(iREETO00h1PLYW17MIL�CRY�NOCIXINTYORDINANCESANOSTATEUNSREUTIN�TOBURDINO
� CONSiHUCTqN,Ap10 MEPEBY Al!lHORIZE REPRESENTATIYES OF THIS COUNfY i0 ENTEF UPON TME �
�BOVE-MEMIDNEU PFIOPERTY FOR INSPECTqN PUHPOSES. ��7/'J+
� COMMENTS �����
� PE, ITTE W �
� 7/ ��n �,�1`�. 6•C_
� • TURE OF PE E DATE
� RECPT.NO. PNDBY J�� VALIDATiON
YVFiITE—DeparlmeM Copy,YELL01N�Inance Copy,PINI(—#sseasa Copy,GOLDENROO—File Copy,GREEN—Applicent's C.opy
���
' ` ` CITY OF DI/�,NlOND BAR
- INSPECTI�N RECORD
., � � � . � . � + 1 � • � +
SET BACK . � FLOOR JOIS�-�.. , . . �'�, , ;
FTGS/FaRMS/STEEL FHA R�QMTS .', -
ELECTRIC GROUND UNDER FCOOR DU�T-`"'";' �•...�, .". :.�_. �. _', • ,
GROUNb PLUMBING UNDER F1.S2pFj CQ�IDUIT_.1' �
SLAB GRADE � FIRE�L•AGE��FOt3Nf}ATION �'� _ ` ' � � � `�'�_ .i . —,,'—�
TEMP POWER � FIREP�AG�BOND BEAM
WATEf�SERVICE --- MID HT.$OND'BEAM-'•-- - -- - • �' : - -
AOC)F SHEATHING� ' ��. ' _ .-', . , . 8 F1'. BOlVL1.8EAM._, . . _. ir _ .�., . . . _.. . ,
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADfNG
ROUGFi HEATiNG BENCHING �
ROUGH ELECTRIC L ROUGH GRADING
ROUGN PLUMBING FINISH GRADING
SHOWER/TUB TEST POQL ELECTRIC
EXT LATN/SfDING PQQL FENCING o .
WALL INSULATION P�OI FINAL :
CEILING INSULATION (JFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER � ' FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. .
SEEP PIT/I�.L. ON SITE IMPS.
GAS AFR TEST ,. - FINAL ZONING ;
FINAICQNST. -- � ' . : � � • -_ . `�,-. . FIRE DEPT. FINAL —
F�NAL HEATING ` '�•� HEALTH DEPT. FINAL � T
FiNAC ELECTRIC f Y ' � j DEV. FEES PAID �
�...-, �_ --
FINAL PLUMBING � � ENERGY �
� � — I � ,
�.
� - � +� � . _ _ . _.
�. ._ '� --- . , -. .- - -- _ � _ ._ . _._ . .
COMMENTS
..,
, , , s .
. . . � — — -- . ----- --
_. - . . �._ ,
.. .." , . _. j it _, .. �
. f � �
�
���` �� t...�..�1.. _. _ _ . . -- - •- -
SEPTlC TANK SIZE ' �
SEEP PIT/U SIZE �j���';t"?t'��tfi���Y'1'i:, . ______—_"
,.���,� ..��. .� ��
�
t• .. , , :. .
:, _
_ _ . . � ._. . _ . .. .. _ . .
. ...,._.._...,
. . . . . • � �