HomeMy WebLinkAbout16838 (42) �` CITY OF DIAMOND BAR �
I j DEPARTMENT OF COIvIIv1UNiTY&DEVELOPMENT SERVICES �-
,��y 21825 E.Copley Drive �
_ (909)860-3195 Fax(909)861-31(7 PRESS
��%�A� BUILDING PERMIT APPLiCATION FIRMLY
QJOBSITE ���j�{j CG ` Q i , �p�R DATE � � ����NUMBER � n
¢ ADDRESS 1. 1 V J APPLICATION PERMIT P/C
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �Jn (V.�11an.
o A�DRESS v Sn L ZONING SETBACKS
z CITY /1'd�+ ZIP �7 TELc42:�,ya� FRONT RW ❑
g APPLICANT �I15b�o QJ4��,45'1fl • �EL. REAR ❑
� SIDElSIDE STREET RW ❑
a� CONTRACTOR S T G f �}✓1►'� SIDE � ❑
� ADDRESS
� CITY ZI TEL.�7 Z� PROPOSED USE
w ARCH/EN /
z DESIGNER �' �
w NO.DWEL. NO. ��� NO.
n. ADDRESS
� Ct'TY ZIP TEL UNITS STORIES DEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADDlREM
O
p I HEREBY AiFIHM UNDEH PENALTY OF VERIURY THA7 I AA1 ExEMPT FROM THE CONTMCTORS U• G3f2gB/C2�Ofl
W CENSEIAWFORiMEFOLIOWINOREA50N�5EC.7N1.58:151NE55MlDPROFESSIONSCOOE:ANYGITYOR (n
C� COUNTYYMIp1NE0U1RE5A7ERMITTOCONSTHUCT,1LLTEf�lA/PROVE.DEMOLISH,ORREPAIRANVSTRUC• �(J PB�;�peck
� TURE,PRiOq TO RS ISSUANCE.ALSO REOUIRES ME�VPLICMlT FOR SUCM PERMIT TO fILE A SIGNEO W
� STATEAIENT THAT HE OR SHE IS LICENSEO M1RSl1ANT TO THE PROVISIONS OF THE CONTRACiORS Lb LL
� CENSE LAW(CHADTER Y(C04MENCINO MnTH SECTION 7000)OF DINSqN]OF TME BUSINE55 A4D PRO- P��SPa
FESSpNS CODE)OR THAT NE OR SHE IS EXEUP7 TNEREFR0IA ANO TNE BA515 iOR TME ALLEC[D E%EA1P-
V T10N.ANYVIOLATIONOFSECTION70]1.6BVMlVAPPIICANfiORAPERMiTSVBJEMSTHLAPPLiCANT70 Z Fjp-Rpp�
F ACMLiENA�iYOFNOTMORETHANFNEMUN�REODOLUR5�f500�.):
ZOI,ASONTiCROFiMEGROPERiY.ORMYEMPLOYEESWIiMWACE511SMEIq50LECOMPENSATqN, 0 COTRIBfCI�I
WILL DO THE WORK 1W0 THE STRUCTUHE IS NOT INTE�DED ON OFFERED FOF SALE(SEC.70u,BUSI• J
� NE55 AND VROFESS�ONS COOE:THE CONTRACTORS LICENSE UW DOES NO7AVPLY TO AN OWNER OF ?
VR07ENTY Nh10 BU0.D5 OR IYPROVES THEREON.IIND WHO DOES St1CN WOfIN HIIASELF OR MERSE�L OR
CC TMROUCHHISORHERONMEMPLOVEES,PROVIOEDTMAtSUCNIAIPROVEIAENiSARENO7NTENDEDOR CO
Q OFFEREDFORSALEIF,HOYt'EYERTNEBURDINCOHIMPROV[1AENTISSOIDWITMINONEYFAROFCOMPLE�
Z 71DN.THE OWNER�BUItDEfl WILL HAVE THE BUi1DEN OF PROYINO THAT HE OR SHE D�D NOT BUIID OR
� PAPHOYEFORTHEPURPOSEOFSALE} �
w 04ASOWNEROFTHEiROPEFTY,AME%QUSIVELYCONTMCTWCWITHL�CEM1SEDCONTMCTORS
Q TO CONS7RUCf TH[GR0.IECT(SEG.70u.BUSINE55 AND GROFESSIONS CODE:TNE CON7MCTORS ll• ValU3lian AQI.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAGR07ERTYYnpBUILDSORIMPROVESTHEREON.�NO
� H710LOMMCTSFORSUCHCRQIECTSWITHACONTMCT01i�5)LICENSED71JRSt1ANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
Y T00.5UCENSELAw).
�¢ ❑IMIEXEMPTUNOERSEG B.iF.C.FORTH15RE ^ Q
U
t� ¢
DATE OwNER U
Z W
� LICENSED CONTRACTORS DECLARATION W
� 1 NEREBYAFFIRM UNDER PENALTV OF pEiWilY TNAT IAIA LICEYS[D UNOER PROVISIONS OF CHAPTER �
� i�COMMENCN6WITH5ECT10N7000�OFDIVi5KKi10FTiEBU51NE53ANOPROFE3510N4CODE,/WD Z
X MY ULENSE IS N FVLL FORCE AND EFiELT.
� UCENSECU C � / LIC.NO. u ` �V � �
V DATE � CONTRACTOFi�SYC//tJ/�1 � a
W
� I�% � OFiKERS'COMPENSATIONDECLARATION a
� I HE BYAFFIiUd IINDER PENAL7Y OF PERIURV ONE OF TNE FOLLOWING DECUJiAT10N5: Z
� .�1 HAVE AND WiLL AUIMAIN 11 CERTIFIGTE OF Cd�SENT i0 SELFdNSUR[FOR WORKERS' a
2
COMPENSATqN,ASFRdY1DEDBV5ECT10N�7000FTMEU80RGO0E,FOfITNEPERFORMMlGE W
OF THE WORK FOR WHiCH THIS PERMIT IS ISSUED. �
0
W _IHAVEANDWILL/AAMTAINWORNERS'COA�PENSATIONINSURANCF,ASREOUiREDBVSECTION � ` 1
Q ]�OOOF TME LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR VlHipl THIS PERMIT 14 3' ,. \ 1..
RSUE�.MYWONKERS'GOMVENSATIONINSVHIWCECAqRIERAN�POIICYNUMOERARE: CONSTRUCTION � w
j GRRIER-�rr�'TL FV�O PLAN REVIEW
� POIICYNUMOEa/.�`k�T��)J ELECTRIC
� SECf101JNEmN0T6CCd+i;ETEDOFlFfPEth�TBFOROhEF4f�CqC�DIXU�iLS1I�OC70RLFS5) PLUMBING
Z �EHTIFYTUTNTNEPERFORMANGEOFTHEN'ORKfORWHICNTMISPERAUT5155UfD,1 MECHANICAL
(J ALLNOTEMPLOVANYDERSDNNANYMANNERSOASTOBECAMESUBJECTIOTME � ,,`� ��r .
` R R�+VENSATqNUW50FCAUFORNIA�DAf �ETMATIFI DBECOME INSPECTIONFE �
S1/� ` C Tp�y�c WORKERS'C0IAPENSATIONPRON . I SECTIO 1000FTNELABOR " 't✓ ; _
N �1 � K�HAd. ORTHNnTHCOMPLYWI '�O m Ns. ISSUANCE n .0 .�
� � '3 ?0�1 ' �(,�—
p DATE7 � Q APPLICANT. _ SMIP /.
� WARNINC:FNLUflETOSECVREMNRKERS'CO � _ '.. COVERAGEISUPIIAW�UL,ANOSHAt18E ENERGYP/C �
�y SU&IECTANEMi'LOYERTOCflIMLNALPENALTiE ANDCMLiWESUPTOONEHVNDNEDTMOl1SAND ENERGYPERMI
DOlURS(i 100.000).N ADDITON TO TME CO57 OF CAMPENSATqN,DAMAGE$AS PROYIDED FOR IN
¢ SECipN770DOFTHELMIORCODE,INTEHEST,MIDl1TTOqNE�"SFEEi R�EFITIONFEE �'— – - -
oW.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IHEREBYAFFIRMUNDERPENALTYOFPE0.IURVTNATTMEREISACONSTRUCTIONLENDMGAGENCV
Zd FOfi THE PEflFORMANGE OF TME WOfiK FOF WIIICH iM15 PERMIT IS ISSUED�SEC.7a91,CIV.C.�.
W
� LENDER'S NAME
S
� LENDER'SAUDRESS
� ICERTIGYTINTIIIAVEREADTHISAPPLICA7qNM1D57A7ETUTTHEABOVEINFORMA7qNI5CARRCCL TOTAL FEES � �
� IAGflEETOCOMPlYN7THALLCRVANOLOUNTYORDWANCESANDSTATEIAwSRELATINGTOBUIL0ING �
� CONS7RUCTIqJ.ANDHEREBYAUTHORIZEREDRESENTA7NE50FTH15COUN7YTOENTEFUGONTHE
Z AOOVE�4ENTqNED PROPERTY iOHINSVECTION GURVO5E5. COMMENTS
� �D S a �
m VERMITT L�Pr T)
¢ --���.��-��
�
� SiGNATURt E DATE
� RECPT.NO. . _PAID 8Y � VAUDATION
WHITE—Department Copy.YELLOW—Finence Copy,PINK—Assosso�Copy.GOLDENROD—Fde Copy,GF7EEN—ApplicanCs Copy
. ..... . . _ . .
+,:.� ,...�,.....� Y •. '',:.K:�a,..... � ...n-...•...• . . . .. �. • •1 .., ,_ } . _ . . ,. n., � . .... . . ..... . . . .. ..� _. . .... , . ..- . , . . .. . ,
CI I '.� '.�+! Cj�f�'.I.il:{�`'� �l��l i
' li�+Si�€=:�s i:.3i�' .�-iC_CC�.�:G?
__._ _ _________---- --- -- __ _ . ____._..__.�.._�_.
_ .. . .. _ _. __ ..-----.-_ . -- - ----- ---- --- • ---�,.
_._-------
� .� ` -1:,�,� '1 •�►:f ,r�.. :J � .)u r �� ^�; � •��
1►E=1�� �lf;'�1�;1�1 �i . i►!7. : 1 .. 1��=f, ,'�.:rt�-a► ry ..��_. I� �7.-__.�:..ec1�t
....-----..._...._..:. ._.. ...............I.. . .. .. . . ..... . . . I 1. . . .. . ._...- -- . _......_ _...._.. _...._..---._ . ...-�---._ . ...........-�---------
SET E3�',CK ; �LCnR JC'Si� I
— --- �--- :- .--- - -..---i-,-------- =----- ; _.:-----------
FTGS?FOR".1S;STEEL � � FHr";RFQ."TS �, I
ELECTRI�GROUfvD � i j : UPJJ•�R FLGQR DU�T i _—� _
-----•-------- ------ ----- - ---- -•--
-•- -
GRJUND PLU�."Eli•JG �_ � � UIdU�f� FLOOr^,CO��!DU1T � �
— - •— - ------ -• - ------...- -•------...-----
SLAB GRADE I �---- -----�-.I FIREPL��C� FOU�J�AI l�'rJ _'_ � _
TEP•.iP POVVER � � i FIF�EPLACE EiOND E��A��l __i �
�VATER SERVICF � I � i:11D t1T. BOtiD E3`!1"" I �
HOOF SHEATHIhJG I�^2�'��� �� - I I 8 FT. E�O���BFA�l � __� _
FRF�P•.'11NGNENTILIATION _. �_ �_� FIiJAL f�JiJD E3EF�P.1 _ I__ � _
ROOF COVER 1�-3I-OI�,--,�____ � �'�'=-GRF,DI�JG _ _ �__�
ROUGH HEATIfJG I I I �E�JCHIi•JG � J
ROUGH ELECTRIC i I I F?OU�N GRC,DI;•dG � �
ROUGH PLU�:^BI�dG j I �' Flr•dISH G�3ADIfJG �
_i__. �
SHOb^JER;'TUB TEST � I I_I �'���ELECTRIC �
EXT. LATH!SIDING I I I POOL FEi•JCIN; I � __
�^lALL IfJSULF,TION � I I �'��!�����'+� _� I
CEILIN� IN�ULATION I I i OFF SITE IP;S?S. I I
pRYVVPILL NAILIfJG � _ _� DEDICATIOiJS � _
SEVJER I I FI�J�L EPJG. �
SEPTIC T�1N1< � � l.E'�PJDSCF.PE/IRRIG. �
SEEP PIT/L.L. � � � � Of•J SITE 11�1PS. �
GAS AIR TEST �_ � 1 FI�JAL ZO�SifJG j I
FINAL CONST. �3l-� � �--.. ' F��E D�?T�FI"J�'�! I
� . ... ---
FIhAL HEP,TIPJG � � HEF;LTf-I D�F T. FINAL I I __
FI��E;L ELECTRIC � � j DE4'. FE�S PA�U _ � �
FINAL PLUi�1BING � � E�d�RG`( I �
i - f- -
I
I �_i, ��_.---� �.-_ —.__—___-- I --
— � . _..... .. _._. .. . ..... ...__ ----�---
cor��r�nENTs
SEPTIC TANK SIZE
SEEP PITIU SIZE ---��- - -
---____;'G i _�; - -- --
r�r�
� ; . . -