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HomeMy WebLinkAbout11959 (5) CITY OF DIAMOND HAA" DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVIC � _ � 21660 E.Copley Drive Suite 190 �����' BUQ.DING PERMIT APPLICATION • FIRM Y � JOBSITE A ' � APPLICATI�� I"] PERMIT l P/C Q ADDRESS �< < � ��'�' DATE � � NUMBER� _ It � ISSUE TYPE OCC APN LOT TRACT pATE CONST. GROUP � OWNER ADDRE S ZONING SETBACKS CITY I TE . FRONT RW ❑ APPLICANT T �E� � SIDEISIQE STREET RW ❑ CONTRACTOR L SIDE ❑ g ADDRES CfTY ZIP T L. . PROPOSED USE � ARCHJENG! ` . T • � � DESIGNER ND.DWEL. • ,I�O. � NO. � CDDRESS ZIP TEL. UNITS � STORI�S � BEDROOMS�_ y DESCRIPTION SQ.FT. FACTOF PSF ADJ.AREANALUATION � OWNER-BUILOER DECLARATION 5FR/ADWREM � 1 MEREBY�FFIRM UNDER PEWLLTY OF PERJURY hiAT I AM EXEMpT FROM TiE CON7MCTORS LI• Gg�g�e�� CQiSEUWWR7MEFOLLOWINOREA90N(SEC.7031.lBUSINESSANDVROFESSbN50D�E:ANVCITVOR (J� O�IMIYWHICNREIXAf1ESAPERMITNCONSTRUC'T.AITERMPFiOVE�OEMOIISH,ORRERI�RANYBTRUG �.0 (.�9Li0/D6CI( TURE PRIOH TO 1T8 19SUMICE.ALSO 11EW IRES 7HE APPLICAM WR BUCM VERMIT►O FILF A fIaNED w S7ATEIJENT TUT ME OA 8HE B LICENSED PURSUM(f TO 7ME PHOVISION9 OF TNE GONfRACTORS U GEN9E WN(OUPTER Y(OOMMENCINO YA7H SECTIDH 70001�dNSqH�OF 7NE BtAINE53 MA PRO- �'�' Po0US�18 F fE83qNS COD�qi 7NAT NE OR SHE�g EXEMPT 7HEREFROM�IVO THE BA513 FQF THE ALLEOED E7�MV• TpN,ApYNOLA710NOFSECTION7W1.6BYANYAPPLICANTFOHAPEAMITSU&IECie7HEMPLICMJT70 � � Re-Roo1 � ACML PFN�LTY OF NOT MWtE TIIAN fNE NUNORED DOLURS q600)J: OI.A80NMFAOF7MEPipPERT/.ORNYEMPLOYEESW�TMWA0E3ASiHEIR50lE00MPEN9AilON, (] GpmmB�CIBI 1MLL DO 7NE WO(Y(,N7U THE STRUCiURE IS NDT INTENOED Oq OFFERED FOR 9ALE�SEG 704{,BUSI� J ME85 AND PiqFE5810NS OOU@ THE CONfRACTON3 LICENSE LAW OOES NOT APPLY TO AN OWNER OF � PROPERiYNIFpWRDSORMPROVEBTNEREON.ANDVM1lODOESSUCHVlORKHIMSELFORHERSELFOi1 ' � � iMNOUGHMISOiINEROWNE7�@IOYEES.PROVIDmTN71TSUCX�APfiOVEMENTSARENO7INTENOEDOfl ' m OfFEqEDPoR SALE IF,IqWEVEFL 7HE BULDINOOR NAP110VEMENTI6 BOID WiTIi1N qJE YFAR OFCp4PlE- SqN,1MF OWNEIYBUIIDER WILL FIAVE 111E OUROQ!OF VqOVINa iHAT HE OR iHE 010 NOT BUILD Ofl MAPROVE POR T11E PUNiOSE OF SALE} ,� 04�aMNEFOFTffVROVENIY,AIAE%Cl.U3�'/AYCOMNACTINOWfMLICENSFDCONTMC70F5 TO CON6TRUCT iNE PROJECT 18EG 7oN,�USINESS AND PHOFESSi0119 ODOE:THE CONTRAC7pRS ll• V81U9�bn ADJ.AREA � CEN6ElAWDOEBNOTMPLYMANOM�NEROFAPROPER7VWHOBUILDSORIMPpOVES1HEREON,ANO NROOONTMCTSFOH8l1qiPNOUECTSWITIIACONiRIICTOpI6�LICENSEDPUR5UAN7TOTNECONiRAt' (�UANTITY DESCRIPTION FEE � TORS UCENSE LAWJ. ,..) O IAM DfEMi7 UNDER8E4 B.8 P.Q fOR 7HI5 REASON q U ��..OItTf.... .. . . � OYVNER . • F�- � -. ..,.. � � ' W LICENSED CONTRACTORS DECLARATION �j � INEREBYAFFIiWlMOERPEWLLTVOFPER.A1i1Y7MA71AMLICENSEDUNOEHVHOV1510N50FpMPiER Vi � •fCOMMENGNOWI7FISECT10N70oo)OiDM5bN80FTMEBUSINESSANUPFiOFE56qN9CO�E,M10 z �V W LICENSE IS W F'ULL fORCE AND EFFEC7. m p ucoasE cuss uc.rra. � f— V DA7E � COMTRAC70R � WORKERS'COMPENSATION DECIf�RATION Q � IHEREBYAFFlRMUNDENPENALTVOFPERIUiIYONEOFTHEFOLLOWNOOECIAfLITIDNS: V N a Q _IMAVEANDWILLiMINTAINACEHIIFIGTEOFCdNSEPlfTOSELF-INSUREFORWORKEflS' _ �� CpAPENSATI0N.h8PRW�DmBYBECTiONJM00FTHELABORCODE,FOR7HEPERFORM.WCE W pF THE WORK Fqi WHIGf 7M15 PERNIT IS ISSI�D. � � _I WIVE MO WILL INUMAIN WORKEI`S'COMPEN311TqN INSUMNCE,AS REWIFED 8Y 3ECTION 97000FTHElABORCOOEFORTHEPERFORMANCEOFTHEN'ORKFORNMICHTHISPERMITIS ���a— � ISSUED.IJYNR�fiKERS'G01�17FNSATIONINSURANCECARRIENANDPOLICYNtIMBEPAqE: CONSTRUCTION � �qq�Ep PLAN REVIEW � POLIGVNUMBEP E4ECTRIC �}Y;gEdIpN1iEIDNpTBECOMRE'I�OF7ViEPEW.C�IBF9RONElu�Of1�00�1AR4(Stao�OqLESS4 PLUM6ING � ICERTIF7Tl1ATMTFIEPERFORAAANCEOFTMEWORKFOflWHICNT115PERMIT131$SUW.I MECHAN�CAL (� Sf4LLLNOTEMPLOYMIYVERSONINAN'/MANNERSOASToBECOME9lJBJECTTOTNE �7 'O D � WDRKEPS'COAAPENSAiIWUW50FGLLIFORNIqAND�OREETWITIFISMOVLDBEGOME INSPECTIONFEE S SUBJECT70THEWORKER3'COMPENSATIqVPRONS�ONSOFSECTION�7ooOFTH6UBOR 000E,i srwt conn�rnn�ca.+a�r wm�nase vaowsior�s. ISSUANCE a SMIP � DA7E: APPLICANT. . WAIWINa:FAILURETOSECUHEWORRERS'COMPENSATIONCpVERAGEIBUNLAWFUL,MID3MALL8E ENERCaYP/C �y 8U&IECTANEMPIOYERTOCRIMINALPENAL7IESANOCMLFINESUPTOONEHUN'�Rm7MOU5AN0 ENC-RGYPEFMIT pOLLARS�{t�0,000),W/ID�ITION T07HE C0.5TOF COMPEN$ATqN.Du.7AGE5 AS PROYIDED FOR tN J SECTqN�7000FTHELABORCODE,MTERE97.M1DATTORNEY'SFEES. RETENTIONFEE: p� CONS7RUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBY�FFIRMUNCERPENAL7YOFPERIURYTIIATTHERE�SACONSTRUC710NlENDINpA�ENCV FOR THE YEHfORG1ANCE OFTNE YVORKlOR WMIG7 iM15 iERM1T IS ISSUED�SEG 70Y7,CIV.G.�. � � IENUER5IUME LENOERSADDRE39 ICEHfiFYTNATINAVEqEAD7HlSAPPLICURIWM103L1TEhUTTNEABOVEINFORM�TqNISCORqECT. TOTAL FEES � � IAAREETOOOIAPLYWIfHALLCfi'lANOCOIMfYOND�NANCESANDBTATEUWSRElATH0T0lUILD�NO , � CONSTRUCTION,ANDMER�VAUTMOfi12EREGRESEMATNESOFTXI5COl1NTYTOFMERIIPONTHE �ABOVEMEMpNED PPOVER?Y FUR INSPECfICYd PURVOSE9. �MMENTS 9 � � � ..� S' .�5� . Q v¢ n E wwe Ivwrm n N �� � UHEOFPERMITfEE �T RECPT.NO. PAIDBY VALIDATO t, WHITE—Oepartmern Capy.YELLOW—Finaxie Gopy.PiNK—Assesaw Copy,OOLDENROD--File Copy,GREEN—Applicanfs Copy � ' � � . . ,. . � . . .. .. �� . . . � , . �r .. .... . . .... ... � � .. . _ . te ,. , . , .. ... . ,. . ... , .. . , ., , GITY OF DIAMOND BAR ' - IN�FECTi�N RECORD ."' � � , 6 � ■ � � , q� . SET BACK �'. � ' FLOQR.JOlST , ',� � ••'` F(GS/FORMS/STEEL � FHA RE�ITS , _ - - ELECTRIC GROUND UNDER FI.�OR DUCT"� "' - ' - :�'.,. GROUND PLUMBING �� UNDER FLQOR GU�IDUIT '. ,•,` : � . � , SLAB GRADE� FIREPLAGE FDUNDATI�N � ���'- �� • • • - TEMP POWER FIREPLACE'BOND$EAM � � ' ' WATEp SERVICE - MID HT. BOND BEAt�F�• •�''` � =•� • � R�UF SHEATNING-� , . ? , " 8 FT.BO D BEAM, �. _ . . '^`" �RAMING/'V��ITICIATIQN - - � ' � FINAL BOND BEAM �� , ., ROQ'�,COVER �� • PRE-GRADING � ROUGH HEATl�IG BENCHING � ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING I FINISH GRADING SNOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING PQOI FENCING WA�L ItVSULATION " ' �` POOL FINAL CEILING fNSULATI�N � OFF SITE IMPS. DRYWALL NAILiNG DEDICATIONS ' SEWER � F�tVAL.ENG. SEPTlC TANK � j �ANDSCAPE/IRRIG. SEEP PITlL.I.. ; ON SITE IMPS. ` GAS AIR TEST � FINAL ZONING i FINRL CONST. �� FIRE DEPT. FINAL �( FINAL HEATING � HEALTN DEpT: FWAI� �, " F1NAL ELECTRIC � � DEV. �EES PAID ' ' FINAL PLUMBING I ENERGY � ' i � � • _ . ._..... COMNfENTS SEPTIC T�,NK SIZE SEEP PIT/U SIZE `- _.- � :. �, .. .,,,_._..... ;�'. _ ._ . -�--- \I , .. „', . ---+r-:---- .. � a � . . ., �5 , i . ' � . .,