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HomeMy WebLinkAbout13833 (24) CITY OF DIAMOND BAR � �� -- --- DEPARTMENT OF COMMUNITY&DEVELOiPMENT SERVICES � 21660 S.Copley Ihive Suitc 190 (909)860-3193 Fax(909)861-3117 PRESS �""�°� BUQ.DING PERMIT APPLICATION FlRMLY o� JOBSITE � APPLICATION � � PERMlT � p/C ADDRESS � DATE NUMBER I� $ ISSUE TYPE OCC � OWNE �-� �OT � T q T DATE CONST. GROUP ADD S ZONING SETBACKS CI ZIP � L. FRONT RW ❑ APPLtCANT TE . REAR p SIDEJSIDE STREET RVy p CONTRAC R SIDE p ADDRE � CITY ZI TEI. PROPOSED USE � ARCH/EN DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS y CITY ZIP TEL. ti DESCRIPTION SQ.Ff: FACTOR PSF ADJ.AREANALUATION p� OWNEF•BUILDER DECLAHATION p SFR/ADDfREM p I NEREBY AFFlRM UNDEA PENALIY OF PEFWflY THAT 1 AM E%EMPT FPOA1 7HE CONTRACTOpS LI- �.fl�9���Qn YJ CENSEUWFORTFIEFOLLOWINOREASON�SEC.7a37.6BU51NE55AN�PROFESSIONSCODE:ANYCRVON (n C.� COUMVNM1pfJIREpUIqESAiERMITTOCONSTRUCf,.LL7ERIMOROVE.DEMOUS/1,ORREPAIRANVSTRUG W �Z 7URE.PRIOR 70 R9 189UANCE,AL90 REGUIRE9 THE APPLICANT FOR BUqi PERMIT TO FII,�A 5N3NED � P8[i0/�BCIC � BTATFMENT THAT NE OR SHE IB LICEN6ED PURSUMlT TO THE PipVISION3 OF iHE CONfRACTORS U• CEN6E LAW(CHM7ER 0(COMME4CIN0 WITH BECTION 7D00)OF DIVISION a OF TME BUSINE53MIO Pq0 �' POOVSpe FE85qN5000E)qtTHATXEON811ElSf%EMPTTMEREFROMAN�TMEBASISFORTlIEALLEQEOEICEMP• (� TqN.IWVVIOlA710NOFSEGTION7v31.68YANYAPPLICMITFORAiER1AIT5U&IECiSTHEAPPLICMlTTO Z pe-Roof � IICMLPQYALT70FNOTMOFETiUNFNEHUNORED00l4ARSq500).): p OLASOWNEROFTHEPROPEflTY.ORMYEMPLOYEE3IMTHWAGE5A9THEIRSOLECOMPENSATION. 0 CpmmBrClel - Z WILL DD THE NfOiiK ANO THE STRl1CTUHE IS NO7INTENDEO OR OFFEFEO FOR SALE(SEC.7ou,BUSI- J � NESS AND iqOFESS10N5 CODE:T1E ODNTRACTORS LJCENSE LAW DOES NOT APPLY TO AN pWNEH OF j PqOGERTY NM1p BUM1DS OR W PROVES T/EREON,/Wp WHp ppES SUCH VARKHM45ELF Oq NERSELF OR 2 iMROUGH/NSOqHEROWN9.IPLOVEES,PROYIDE07HATSUCHNAPROVEMENT3ARENO7INTEN�EDOR m �� OFFEi1mWR8KEIF,Fp4VEVER7NEBUILINNOORMAPiqVEMEMIS50lDWITMINONEVEAROFOOAAPLE iION,TNE OYVNER�l11LDER YALL NAYE 7HE BUMEN OF PROVINO hNT ME OR SHE DID NO7 BUILO OR MVROVE PDHTNE NRPOSE OF SIILE�. . W DI,ASONMEROFTHEPROPEHTV,AME%CLUSNELYCOMMCTINGWITHLICENSEDCON�RACTORS � TO OONSTRUCT iHE PRQIECT(9EC.70H.BUSINESS AFW PROFESSIONS CO�E�THE CONTHAC70R5 LI• V81UB11011 ADJ.AREA CENSE lAW DOE9 NOTAGPIY TO AN OMMER OF A PROPERTV NTID BUM.DS OR MPROVE9 iNEREON,AND � YN�OOONTMCTSWNBUCHVRO.IECTSVAhlACONTRACTpR(S)LICEN9EDPURSUANTTOTMECONTMF QUANTITY OE3CFi1PTION � ioas uc�sE uwa. FEE O I AM E%E6PT UNDER SEG. B.6 P.G FOq TFIIS NEASON Q � C3 � H �i u" DATE ONMER F- t � � LICENSED CONTRACTORS DECLARATION � 1HEREBYAFFlRAIUN�EqVENALTYOFPERIURYTFUITIAMIICENSEDUNDERPROVISqN3OFCNAPTER � � � •(OOMNENCWO WITM SECTION 700D)OF DMSION 70FTHE BUSINESS NIO PROFE5510NS COOE,M1D Z u� MY 110ENSE 16 N FULL FO AND EFFECT, m � LICENSE LIC.NO.� � •�+ � � DATE � � CONTMCTOR 6J. Si � WORKERS'COMPENSATION DECLARATION � yIMEAEBYAFFlWAUNDERPENALTYOFVERIUAYONEOF7HEFOLLOWW6�ECLAqATqN3: Z � _INlNEM1DNIILINAINTNNACERTIFICATEOFCONSENTTOSELF•INSUREFOFWORKERS' ¢ COMPENSATION,ASPROVIDED9YSECTION]70DOFTIEU�BORCODE,FORIHEPEHFORMIWCE U Q OF h1E WORK FOR WHIC117XI8 PERAIR IS ISSUED. � Q �1 HAVE/N�WILL MAINTAIN YfORKEq4 COI.IPENSATION INSURANCE,AS REQUIRED BV 6ECTION 97000FTHEUBORCOOE,FORTHEVERFORMANCEOiTHEWOHKFORWXICH7NL5PEHM1T15 ��2�HUMaEnnaE: CONSTRUCTION ISSUED.MVYN�RKE PEN9ATIONINSURANCE HANo � CAARIER . . .. . (�1 . . � POUCYNUMBEH � ELEC7RIC .. � (IHsaEc'noNrJE�N6reEao6�L€iEoOFn+EPEn�11'sfORONEtuoRE�Da1�vaSR�a�aitEss} UMBING Y.i'�-�'- W Z �CEFiT�FYTHAT W 7HE PERFORMANCE OF THE WOIiK WR WHICH THIS PEFMR 14155UED,1 MCCHANICAL C7 SHALL NOT EMPLOY NJY PERSON W ANY MANNER SO AS TO BECOME SUBJECT TO THE ^ (q WORKERS'COMPENS�TqNUWSOFGLIfORN11ANOAOREETMATIFISFIOl1��8ECOFIE INSPE NFEE [l� 1Q4� 6UBIECi TO7HE NfOpKERS'COMPENSATION PROVISIONS OF SECTION 970o OF THE IABOR 1�L�-�Q�Jv OOOOE,ISHALLFORTMM7HCOMPLYWITH EPROVISIONS. SUANCE �� �g �J�,�� �-� �R./�-- .� - CITY nF DIANi����"' p DATE: APPLICANT. � ���_,._Q•T� � fNERGYP/C Bj.III__D,I�IC's �N•. A��LT WARNIHG:F�ILLIRE TO SECIIRE NK7RKER5'CONVENSA710N COVERAGE IS UNUWFUL,M1D SHALL BE �y 6UBJECTANEMPLOYERiOCRIMINALPENALTIESANOCMLFlNESUPTOONEHUNOREDT110VSAND ENERGYPERMIT JDOLLARS Itl W,OOD),IN ADDI710N T07HE COST OF COMPENSATION,DAMAOES A$PROVI�ED FOR IN � SECTIDN370EOFT7ELABORCODE,INTEREST,ANDATTORNEYSFEES. F{ETENTIONFEE: CONSTRUCTION LEN�ING AGENCY PRE•ALT FEE: ¢ IMEREBVAFFqMUNOERPENALTYOFPERIUpY7HATTHEREISACONSTRUCTIONIENDINGAOENCV �Z• FOH TNE PERFORMANCE OF THE WOAN FOR WHICH THIS PERMIT IS ISSUED(SEC.309'!,CIV.CJ. W � IENDEWSNAME � LENDERSADDRESS l � ICERTIFYTUiIHAVEREApT11$APPLICATIONANCSTATETFIATTHEABOVENFORMATqNI3CORRECL TOTAL FEES _�(� � , � I MREE TO COMPLY VA7H AL.�CfTY AND ppUl(iy ORDINANCES M!O STATE UYVS REIATMq TO BUIIDMO �J 'R CONSTRUCTION,ANDNEREBYAUTIICMIZEHEPqESENTA7IVE50FTNI5COUNTYT�IXTEflUPONTHE `��, A80VE IONm PROPERiY FOR INSPECTION PURPOSES. COMMENTS m ����-�����1�C PERMI Pql � � � �� y &ONA EOFPERA11TiEE DATE - � RECPT.NO. PAID BY VALIDATION � WHITE—Departmant Copy,YELLOW�fnance Capy,PINK--Assesaa Copy,GOIDENROD—Flle Copy,CaREEN—App�icenCs Copy �..�.,.n..r•..r — __ ,.. ._ , ;" � � crrir aF oi�r�awa e�A� ' t � `. 4 IIVSPECTICIM REC��i['� � � E � � � � � . � A r � � sEr aACK . ( �, F�oa�,�o�s7 � :., �. . : .; . - . f, �1'GS/FORMS/STEEL FHA REQMTS . • - ELECTRIG GFROUND UNDER FLOOR DUCT� :, , „ .,� � , GRt�UND PLUMBING UNDER FLOQR CC��IDIJIT ' SLAB GRADE FIREPLACE FOUNDATIO `- -. ' ,-� . : ;r, Y.� , .• TEMP Pt3WER FIREPLACE��{3�VD B�AM .... WAi'ER SERVICE . , _ : MID FfT.8C)ND�3EAM '-�,A.':. . y ',�.�- :"- -- ..,; RC}C?F SHEATHfNG ' ' . - . _ 8 FT.BUIV�B�Afv!- "• , • , . . .,, FRAMIMGNElyTII.IATlOhJ FlNAL BC7G�1�'}B�AM • �i�i . ROOF GOVER � PRE-GRADING ROUGH MEATfNG BENCHING Fi(?UGH ELECTRI� '7-��°`f ROUGH GRADING ROUGH Pt�UMBtNG FINISH GRADING Stit�W�RffUB TEST PC30L ELECTRIC EXT:1_AT�-iJSIDINt'a PC}04.FEIVCtNG , WAL.L It�ISULATIQA! PQ{)�FlIVAL .�`�` CEl�ING lNSULATIGN {�FF SETE IMPS. bRYWALL tVAlLING DEDiCATIONS �EW�� FiMIAL ENG. SEPTIC TANK LANDSCAPEIIRRIG. ' SEEP PITII,.L. ON SITE tMPS. C,AS AiR;TE�T FINA�ZONtNG FJ1t3AL'CrC}iV�T._ � '- � . ., , �. ��—1�-�`-��—,F.�IRE t3EPT. �tNA� i � IS�AI:HEl�TING _'', ' ` t - 'i ! HEALTH DEPT. FINAL �� i i _ � F(TdAI��L-EGTRIC . �` ` . i ' i � �;'.,►~�} � ; DEV.FEES PAlD �lNAL f�t�llMBlNG � ' ! EI�IEF3CaY i�� � � - k � , � ; � . j • #r � "-r.�'_.` .. _. . , a . ... , . ..... . . COMMEt'�ITS�``� � � , -_. __ _ $ _ �. - , . _ _ :��. •.� , ,.. ,..�� .. . . _ `...�... - -_ ,. . �. , . - ; -, _ , SEPTIC ThNK SIZE �EEP PITlU StZE �� , . ; y�, �, � � ._, , . , _.. , . � ....