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HomeMy WebLinkAbout14375 (32) CITY OF DIAMOND BAR Jy.'1 ��-����-� DEPARTMENT OF COMMiJATITY&DEVELOPMENT SERVICES ( t / _ � � 21660 E.Copley Drive Suife 190 (909)86a3193 Fax(909)861-3117 `/PRESS BUII.DING PERMIT APPLICATiON FIRMLY oJOBSITE L/ n APPLICATION PERMIT L ' P/C ADDRESS �'�7�Z I`�N��'�� �r v� �� DATE � NUMBER / �� N $ 155UE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER S L-� G✓�'7V Fj ADDRESS ZONING SEBACKS CITY ZIP TEL. FRONT RW ❑ APPLICANT UAi C !'JM TEL.� REAR ❑ SI�ElSIDE STREET RW ❑ � CONTRACTOR �(� c �/� ' SIDE ❑ ADDRESS � p PROPOSED tJSE, L.3 � CITY ZIP�� TEL. o � �u - �.�. o � ARCFUEN(�J DESIONER NO.DWEL �� NO.���'—� ��N��TT��� AD�RESS UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF AOJ.AREANALUATION ¢ ONMER-BUILDER DECLARATION SFRN4DD/REM O p I HEREBY AFFlRM UNDER PENALTY Oi PEIiRJHY THl17 I AM E%EMPT FROM T11E COMRACTOA6 LI- Qg�B����rt G7 CENSEIAWFORTHEFOLLOWWGNEASON(SEC.709�.6BUSINESSMIOGROFESSIONSOO�El1NYCRYOR (n �� OOUNfYMRpGN11E0UiRESAVERMRTOCONS7RUCT,l14TER,MPROYE.DEMOUSl7,OHi1EPAIRANY5IAUP W pgtIOlDBCk Z MIE,PRIDR 70 RS IBSUANCE,JLL90 REW IIlES T11E AVPLICANf FOA BUpi PEIiM1T 70 FILE+1 SIONED �� BTATENENT THAT HE OR fJiE 1S 110ENSFD PURSIIANT TO 7TIE PROVISIONS OF THE CONTRACTORS ll• w CENSE U1W(CHAPTER�(OOMMENCW�MA7H BECTION 70D0)OF DMSIDN 7 OF iHE BUSME55 ANO PRO- � POOYSpB FESSpNS CODEJ OR TFIATHE OR SHE IS IXEYPT 7HEREFRO/A MI�7}E BASIS FOR iHE ALLEDED E1fEMP- TIDN.AN'lWOLATqNOF6ECTIONT031.69YMIYAPPLICMlTFONAPERMRSUBJECTSTHEMPLICAqTTO Z Re-Rooi � � ACML PENALT/OF NOT MORE�HM1 PNE MINOPEO DOLiM4(i5o0�.): . . OI.ASOYMEROFTHEPf�PEIiN,ORMYEMPLOYEE9W1MWMiE9A9TF1EIR90LECOMPEN5A7qN, � COf11f11BfC181 WILLOD THE WOFY6 AND TIiE STt1UCTURE IS NDT MENDEO OII OFFERE�WR SALE(SEC,70a1,BUSI• J NE6E A!A►IqFESSIONS COOE:7HE CONTRACfORS UCENSE LAW UOES NOT APPLY TO AN OWNER OF 1� � iROPFATYMM1i09UILOSORMiPROVES7NEHE0N.MI�VYNODOESSUCHWORKHI4SELFORNERSEIFOH = � 1IN0110H MS OR HER OWN EMPLOYEES.PROWEO THAT SUCH RAPRDVEMENI3 ARE NOT MTENDELI OR m OfFERED fOR SALE If,/qN1EVER 1MEB41LONOOR YPFlOVEMEMTIB 90L�YATlWNONE YFAROFCON0.E- TION.TNE OWNER8IRDER WILL MAVE TXE BURDEN OF PROYN�THAT HE OR CHE OID NOT BUIID OR NAPRONE FOR 7HE PIlHP06E OF 8ALE4 �� W OI,ASOVMERDFTHEVROPEFRV,dM1IXCLUSRIELVCOMMCT1NOWlf}1LICENSEDCONTMCTOHS � �• � �O CONSTRUCT T}IE�RO.IECT(6EC.la4,BUSINE9S AND PROFE9910N3 ODOE:tHE CONTHACTOR9 ll- VelUetlOn ADJ.ARFA CENSE L11W OpES NOTMPLY TO AN OWNER OF�iROPENTY WH0 BUMDS OR IMPRDVES TMEREqV,MID YMFIOODNTRACT6WRSUCHPRQIEC76WITHl1OOfiTRACfOR�S�LICEN6EDPURSUANTTOTNEGqiTW1C� QUANTITY DESCRIPTION FEE _I lORS LICENSE UW.1. � � ❑I AM EXEYFT LNiDER SEC. fl�P.C.FON THIS REASON � U � F DATE OWNEH � UCENSED CONTRACTORS DECLARATION � , � IMEHE6YAFFW,IIMDERPENALTYOFPERtt1RVTYlATIAMLICENSEDUNDENVROVISpN30F PTER •�OOUYENCWflMfIiMSECfI0N700o�OFOMSION90FTNE&1StNESSAN�PROFES5iON5 E,ANO MY 110EN9E IS N Ml FOfiCE AND EFFECL � � FF� ' � LICEf�ISE CL0.SS LIC.NO. 0 Z! � DATE � � CONTMCTOR� -- � WORKERS'COMPENSATION DECLARATION a � I MEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF 7HE FOLLOWING DECU 710N9: V" � _IHAVEANDWLLNAINTNNACERIIFICATEOFCONSENTTOSELF•INSURE FWORKERS' � J 2 , OdAPENSRTION,AB PROVIDED HY 8ECTON]700 OF iHE L/BOR CODE,FOR YMEPERfCqIG11NCE �U OF hiE WOIiK FOR NTIICH T116 PERMIT IS ISBUED. -��� � � ,. '1 FMYEAND VYILL WUNTMN 1VORKERS'OOMPENSATION MSUWWCE,AS RE �D BY 9ECTIDN / l_ 97ooOFT1E 1A80H COUE,FOR?HE PERWRAIANCE OF 7HE WORK FOH CH THIS PEAMR 19 ;? � ISSUED.MY WORKEH9'COMPENBATION INSURANCE CARRIE MIO POL NUMBERME: TAU ON • � jCAppIER � �` a iEw � POLICYNUMBER ECfRIC 0 (fH69[Cf17NNFIDNOTBEO�NPI.ETmOFTfPEFiMfSFORONE DalAitSRtm10RLE561 (� IUMBING ZI CERTIFYTHAT NTHE PERFORNANCE OF hIE WORK FOR WHICH iHIS PERMIT IS ISSUEO,l MECHANICAL r y BWtLL NOT EMPLOY ANY PBRSON IN ANY MIWNER SO A9 TO BECOME SUBJECT TO 7HE --� WOHKERS'CpAPENSATpN UWS OF CALFOHNIA�NDAOREE TMAT IF I SFIDULD BECOME INSPECTION FEE � 6UB.lECf TO TNE NfORKEHS'COMPENSATION PipROVISIONS OF 5ECTION 370o OF TNE LABOR CODE, SM i0 Ihi COMPLY WI��PROVISIONS. � ISSUANCE p DA7E;� APPLICANT. � SMIP f1C/` (1 �.' 100� a � � �T%O._���i WARNING: AI E TO SECUREMARKERS'G061PENSATpN COVERAGE IS UNUWFUI,AND SHALL BE ENERGV P/C � 6UBJECTANEMPLOVERTOCRIMPIALPENALTIESMIDCMLFINESUVTOONEHUiDREDTFKKISAND ENERGYPERMIT ����I:IMONDAA'a, OOIWa..Ef10D.0oo),IN ADOITION TO 7HE COST Of COMPENS�TION,DAMAGES AS PRONDED FOR IN -- A A J SECTION970eOFTNELA80RCODE.INTEREST,ANDATtt7RNEY5FEE3. DI�j�"I\�(�ti["�'.�Y RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-AlT FEE: � 1 HEAEBVAFFIRM UNDER PENALTYOF PERJURY iliRT h1ERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORAIANCE OF THE W01iK FOR WHICH THIS PEpM�T IS ISSUED ISEG 90V7,CIV.C.�. � . � LElY1ERSNMIE � LEIV�ER'SAODRESe ICERTIFYTFiATIHAVENEADTHISAPPLICATIONANOSTATE711ATTMEA90VEMfORM�710NI500HHECL TOTAL FEES a ���� � IAORE'TOCOMPLYNfITHALLCRVANO0IXINTYORDWANCESAlIOSTATEUWSREIATMIfilOBU1LDING � CONSiRUCTION,AND HEREBY AUT110RIZE REPRESENTATIYES OF TiIS COUN7Y 70 ENTER UPON TNE � �BOVEJAENTqNEO VROPERTV PDR INSPECTON PURPOSES. COMMENTS � f�G(R/ S � l�/�/ � PERMITTEENMIE(0�� ��/� w �� C / • � &ONATUREOF PE � DA�,TT - , RECPT.NO. PAID 8V VALIDATION WHITE-0epeRmerrt Copy,YELLOW—Flnence Copy.PINK—Assasaa Copy,QOLDENROD--File Copy,GREEN—P�pplicanl's C,opy -:._.�--�.,.. CITY OF DtAMOND BQ,R � Ih1SPECTION RECURD • E: 1 � • d � � � � � � � r SET BACK FLOOR JOtST :•. � . . FTGS/FORMSlSTEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CO�I�UIT SLAB GRAQE FIflEPI:ACE FOUNDATION TEMP PaWER FIREPLACE�60ND BEAM ' WATEA SERVICE MiD NT. BOND BEAM ROOF SHEATHING -8"FC`BOND BEAM � � � FRAMINGNENTILiATI�N FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHl�IG ROUGH ELEC7RIC � • ROUGH GRADING ROUGH PLUMBING FiNiSH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING� POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWA�L NAILING DEDICATIONS SEWER ! FINAL ENG. SEPTIC TANK __._ LANDSCAPFJIRRIG. SEEP PIT/L.L. . ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. Z FIRE DEPT. FINA� FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC ( � DEV. FEES RAID � FINAL PLUMBING ENERGY � � � COfilIMENTS SEP71G TANK SIZE SEEP P!T/U SIZE -