HomeMy WebLinkAbout17177 �� CITY OF DIAMOND BAR �
� DEPARTMENT OF CON4vtUNITY&DEVELOPMENT SERVICES �
�\�� 21825 E.Copley Drive
(909)860-3195 Fu�c(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE ��5� �APP h lat APPLICATION n PERMIT y P/C
ADDRESS(� �� DATE I l/ �T� � NUMBER � �f� p
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �:
p ADDR SS��q S 7 SAIOI�/i� GAn-yl�j�_� ZONING SETBACKS
Z CITY .+rC ZIP C�1TC�TEL.t9�_�¢�L� FFONT RW p
� APPLI ANT TEL. REAH p
�� SIDE/SIDE STREET RW ❑
CONTRACTOR I ��� SIDE ❑
� ADDRESS � � i 1 �
O PROPOSEDUSE n , �� . ! I; i^ � o �
o CITY ZIP �It7FL TEL.���i9/-?1er/ �) F
w ARCH/EN /
z DESIGNER � � J r `
a ADDRESS NO.DWEL. NO. - Np, 1 '
� CITY ZIP TEL. UNITS STORIES �EDROOMS
�
�n DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OVYIJER-BUILDER DECLARATION SFFVADDIREM
O
p I HEREBY AFFIiiM UNDER PEN�L7Y OF PER.VRY TNAT I AM E%EAIPT FRdA THE CONTHACTORS U• G3fZ90IC8fpOR
W CENSEUWFORIHEFOLLON'INGREASON�SEC.70.71.SBUSINESS�NDPPqFE55�ON5CODE:ANYCITYOH (n
U COUNTYWFIICMREOUIFESAVERMITTOCONSTRUCf.lLLTER�PROYE.DEMOLISH,ORREPNR�N'/STRUG W
W NFlE,PRIOR TO RS ISSUANLE.ALSO REOUIRES TH[11VPLICANi FOR SUCH PERAIIT TO FILE A SIGNEJ w �'dti0/DBtk
� STATF�ENT THAT HE OR SME IS LICENSE�PURSUANT TO THE PPAVISIONS OF THE CdiTMC70R5 ll• �
� CENSELAW(dUPTERY(COAIAIENCWOWITHSECTION7oao�OFDIV15qN]OFTHEBUSiNE55IW'JVRO� POOIISp3
0 FESSIONSCOOE)ORTMATMEORSMEISE%EAIPTTHEREFROMMDTNEBASISFORTNEALLECEDE%EMP- C7
V TION.ANY VIOLATION OF SECTION 7oa1.5 BY M!V APPLICANT FORA VERMIT SUBJECiS TH[APPLICAHT TO Z Re-Rocl
A dV1L FENALTV OF NOT MORE THAN FNE HUNDRED D011ARS�3500).):
ZOI,ASOWNEROFTHEPROGERTY,OqMYEMPLOYEESWIMWAGE50.5iHEIp50LECOMPENSATION, 0 COTmB�C1.7I �
WILL DO iHE WORK,M!U THE STHUCTURL IS NOT INTENDED OR OFFERED FOR SA�E(SEC.7W�,BUSI� J
� N[55 AND iROFESSIONS OOOE:iNE CON7MCTORS LICCNSE lAw pOES NOT APPLY TO AN OwNER OF
CIiOPEHiYVh708UILD50RIMD{L�VESTHEPCON.ANDNMODOESSUp1WORKHIMSELFORHERSELFOR �
� THi10lH'J/HIS OR HEN OWN EYPIOYEES,PRONDE�iMAT SUCM MPROVEMEMS ARE NOT RJTENDEO 0R m
QOFFEREO�ORSALEIF,iqWEVER731fBULDINCORI4PROVEMEMI550lDWITXINpJEYFAROFCOMPLE-
Z TION.TME OWNER-BUIIDER MnLL MAVE THE BURDEN OF VRONhC TMAT HE OR SHE�ID NOT BUILD OR
= WPROVEFORTHEPUftVO5EOF5�1�. � ,
W OI,ASOWNEROFTMEPROPERTY,MIE%CLUSIVELYfANTMCTINaNTTHLICENSEDCONTRACTORS
Q TO LONSTRVCT 711E VROJECT(SEC.7oa.BUSiNE55 Gd�VROFE59or�5 COO[:TME CON7MC70R5 LI� Valuetion V ApJ.AREA
W CENSEUWOOESNO7AFPLYTOANOVrtJ[ROFAPPOPERTYWF108UI1D50RMPROVESTHCREON,ANO
� WFIOCONTMCTSFOHSUCHGR0.IECTSVnT1ACON7MCTOR(5)LICENSEDPURSUAN7TOTMELONTMG QUANTITY DC-SCRIPTION FEE
Y TOHS lKENSE UW).
� O I AM IXEMPT UNDCR SEC. fl l P.C.FOR TMIS REASON Q
� U
� �
OATE O4�NER H
0 W
� LICENSED CONTRACTORS DECLARATION W
1 NfREBV AFRAM UNDEH PENALTY OF PERJUHV THAT IAM LICENSED UNOER PROVISIONS OF CHAPTER V.
p, !�COMMENdNfi WITH SECTION 70ao)Of DIVISION 70F TME BUSINESSIWD GROFESSiONS LOOE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT. m
LLl �
0 UCENSE CUSS C 3 G IIC.NO. "�� � � �
V ATE�� � COMMCTO ` � a
�� X-� �:.-�v WORKERS'COMPENSATIO cCLARATlO�� U
N INEREBYAFFIRMUhVERVENALTYOFPERR1RYdJEOFTHEFOLIAMfNGDECLAMilONS. Z
� �IHAVEANDWILIMAINTNNACERTIFICATEOF�pNSENTTOSELFdNSUNEFORWONI(ERS' _
GOMPENSAiqN,AS PROVIDEO BV SECTION 7]OOOF TME UOOR COOE.FOR THE PERFORMANCE �U
' OF iNEN'ORK FORVNIICH THIS VERMIT IS ISSUEO.'-� ' �
O
w _IHAVEANDNALLMAINT�!NWORKERS'CONPENSATIONINSVR/VJCE.ASREOl11REDBv5EC7qN 1 /� �
Q �7o00F iHE lA(iOR COOE.FOfl iHE PERFORIA�NCE OF THE WORN FOR NmiCH THIS PERMITIS 1 i►�( )
ISSUED.MYYK7RKER5'WMPENSATIONINSl1RANCECARRIERANDPOLICVNUMBERARE: CONSTRUCTION (/ `-'
J �.�/� �
j CMRIER,�/KP�IIG�_�{��L� PLANREVIEW
Z ro��crNuuoEq j,(1L�aj�^S'i��—�E ELECTRIC
¢
� (R65[Cf10NNEmN�TBCWMIETEDOFMPERMT6FdiONE11ULi1EDDOl1AR5(S�Oo�O(iLF55) PLUM6ING
Z 1 LERTIiY THA7 W THE iERFORMANCE OF THE WORK FOR WNICN THIS PERUIT IS ISSUED,1 MECHANICNL
C7 SHALLNOTEMPLDYA4VPEPSONIN�NYMMNERSOASTOBECOMESUO:ECTTO7XE
� WOPKERS'COAIVENSATpNUri50FCAL60RN10.µ0AGR[ETMATIFISHOlAD8EC0lAE I4SPECTIONFEE
SUBJECT TO TME WORKERS'COAIPENSATION PROVISIdJS OF SECTION]]00 OF iHE LIBOF '
rj � �cooE,i sHu�coannvin�wr�v�r Nnn��t O .. ISSUANCE �—` ' ' � ����_�
O' 0�111.J—/.—��.— APPLICANT: �� SMIP � ^_.` / .— ...�..- .� l�
wWA N:`:FAI(LG ETO S[CURE WO 'COAIPENSATqN COVEMCE IS UNUwFUL I�ND SNALL BE ENERGY P/C �T j� , �n��
� SUOJECi AN EMPLOYER TO CfUMINAL PENAlTtES AND CNII i W ES UP TOONE HUNDREO THOUSANO 1 V 1 �-`�
DOLURS(5100,OOOI.��DITIONTOTNECOSTOFLOMPENSATqN.DAMACE5A5PROV'DEDFORIN ENERGYPERMIT
� SECTION]T060FTHELA80RCOOE.NTEREST,NiDATTORf:E�"SFEES. (��ENTIONFEE:
o CONSTRUCTION LENDING AGENCY ���• � __
PRE-ALTFEE: t--�
� INEREBVAFiIR1.1UNDERPENAI7YOFGERIURYTHAT7HERE15ACON5TRUCTIONLENDINGAGENCY
FOR TME FEHFOflMANGE OF THE WORK iOR WHICH TMIS GERMIT IS ISSUED�SEG�Du�,CIV.C.).
Z
w
� LENDERSNAME
F- LENDER'SADDRESS
� TOTAL FEES 1 I
� ICERTIFYTHATIHAVEFEADTH�SA7PlICATqN�NOSTATETHATTHEA[30VEWFpRMATION15CORRECT. I I J /
W IAGREETOCOMPLY'MTHALLCITYANDCOUNTVORDiNANCESANDSTATEUWSRELATINOTOBUILDiNG "�
� CONSTRUCTION.AKDHEREDYAUTFIORIZEHEPRESCNTATNESOFTHISCOUNTVTOENTERUFONTNE
� NTqNE�VROPERTY FOR IkSVECTION GUFPO5E5.
Z COMM[NTS
� 1
� �51i 1�'
m PERMiTTEE N . NIYT
(/) SIGN�IU� P NMIiTEE • Al��
� RECPT.�O. • PAID BY VAIJDATION
WHITE—DeOartment Copy.YELLOW—Finance CODX PINK—Assessa Capy.GOLDENROD--File Copy,GREEN—ApDlicanCs Copy
. .. .. . ..... . _._......,.. ... ...._. , .... - , _ _. _ . . - - -- - -
C!i'�" �i= CF1��,(;�1�dD i�l�Fi
611���'�L s E:��'� t'S[=CV�SEi
_ ..,_.. ---...�...__._..__.._..._._._._...._.___.._.....-----—_._.._- --._—___._--- . ...__.__._.__.._...�_.. ---------------- .��..._...______�
�►��`1���;��.:C��,)1''I r;_4�:'='. I►�F�fF�=!f:'!'"1:� �i'E:i:.i� `.'f(�1►'k Ci_4E.:., �i'F-`t:�l::�':�'e.�.'�
_ __.._---. _.__...__ ..__. ..._._.. .._ . .. .._. . ... . ... .... . . . ..... ...... _ _.__. ..--.. ._ . __._�_._..__.
, SET BACK ;� � ; FLO.)��JQ!;�i . .�. ,
-�� - ='=-'— ------
F=TGS!FORP.IS'STEEL ; I i�f.�,,��c��.�T� i I
ELECTRfC G�OUND �----� ---------- -- U^:DER FLOOR DUCT `-� ------� -
GROU^dD PLUPABIWG - --- I--- --` ------I lJ?JDGF FLOOR CJ�!7UIT I , i - ----
— - �-------t --------- ---- ------ -�- --- --
SLABGRADE I I--- I ` FIFi�PL!'�C=�FO'JlJD�>,TIOP: � � ' �;� .
TEMP PO4VER � ! � � f=1RFPL�CG ��O�J7 E>E:i,Pl �.
-�----= - ' _.
LVATER ScRVICE I - �--------�-�-��g,� ----� I h.'!�Hi. E�OPdD E3'tAP," --� �
R00=SHCATHING fp ,Z o .�,---e�_-----I_�_5 f-T. ^nUtiD F3��1•'.1 _ -- ��--------� ----
FRf,MiF�GNENTILIATIOtJ� �/J � I F IPJAL E's0^.D Ei�'fi!':i � 1
ROOFCOVER ��p �r/�yl-/4� ----i PR�-GR�.UR•!G ----- -I-----------I ----
ROUGH HEATING �� ' F '
� j Ei•.CF�I�:G __ ���
RbUGH ELECTRIC ; � ROU�,H GR/\DI?JG j
ROUGH PLUP.^3RJG I � � ; FI+JIShi G;C,DlfJG i
- ----------- --- -� i
SHOI;"JER,rfUB TEST � _ �`j F'OOL ELECTf�IC
EXT. LF,TH'SIDING � ;_('OOL FEf•:CI�S_�,____ __�_ i _ _
�"JALL IP�SULATION � I �� f'OOL FIi�F�L
CEILING INjULATIOiv � OFF 511�E I""FS. �
-�---- -------- ----�---- -
DRY�"JALL�JAILIPJG j � {I j f3EDICATlO'1S -�- - --
SE4"JER -- -I— --- ---------I I FINF,L EN�,.- ---I---- -
-----�--
SEPTICTANK 1 � I_I LAfJDSCP,PE�IRRIG._ �
SEEP I'IT/L.L. � � ---- ! a-O�d SITE I�.trS. --- �
G.AS AIR TEST � FI�JAL ZO�Ji�•1G
FINAL CONST. � —L�— "
j � � � �!tii. DtFT. FIiJP,! -
FINAL HEATING I I � 1 t1E:_:LTI-i D=f�T. FL"JAL �
FINAL ELECTRIC � � i DEV. FEES PAID i�J
FR�/1L PLU�.IBIPJG � -- j I E�dERG'f _---� _ � ----
� �
I 'r i�.,.�r....- x���:>.,-- ____.___.,.__--
-�-- - - -� - _ _ ---- -- - ----._...
CUP�IMENTS
.--�-- '�.
SEPTIC TA�JK SIZE
SEEP PIT/U 51ZE -- ----
___���_.w_.� - —
�'���
�V' � •
��.