HomeMy WebLinkAbout12538 (6) �` _ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES
21660 E.Copley Drive 5uite 190 �
� (909)860.3195 Fax(909)861-3117 PRESS
�A���� $UII.DING PERMIT APPLICATION FIRMLY
oy JOBSITE S S 1�A�`'T P Z DATEICAl70N ��.�"7.^. q NUMBER�_ It� ��S
ADDRESS [
� ISSUE TYPE OCC
APN LOT�� TRACT DATE CONST. GROUP
�j OWNER A"EG:[�
"" ADDRESS ZON1N0 SETBACKS
� CITY ZIP TEL. FRONT RW ❑
APPLICANT TEL. REAR L1
SIDE/SIDE STREfT RW ❑
na CONTRACTOR S ( SIDE p
g ADDRESS o
CITY ZIP TEL. PA�POSED USE ' ' �-�-k- 1�ATi d .n��i ,i� pY�
� ARCHIENG!
DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BUILDER DECLARATION SF EM
O
8 1 NEREBY AFF7AAA LINDER PEN/�1.7Y OF PERNRY 7HAT 1 AM EXEMP7 FROM Tf1E CONTMC70H5 LI- GBfEga/C81pDR �
CENSEtAWFORTNEFOLLOWMQREASON�9EC.imt.60U9WES5ANOPROFE95YDN5COPEANYCITYOR (�
COUNTYMMICFIREIXARESAPEFlMRTOCONSTRUCT,AL7E0.M�10HOVE,OEMOLISH,ORREV.URMIYSTRUG W petb/Deck
IUAE PHqN TO ITS�8UMICE,AL50 REOUIFtES 7}IE�PPL�CANf FOR SUGM PERMIT TO FlLE A SIONED
BTA'IEMENf 7FNT HE OR BHE 18 LICENeED Pi1NSUANT TO THE VNOVI5101�6 OF TME CONTMCTORS LF - -
CENSELAw1�1ERYI�MMENCINOWITHSECTpN7000)OFOIVISIDN80FTHEBUSINFSSANDPRO- ��' Pa��Pe '� •
FESSIONS COOEj Oil TI1A7 HE ai 6ME 16 E7(F1,1PT THEREF(10M AND TIE BASIS FOR TNG A4LEOED ExEMP-
TION.ANVYqLA710NOFSECTION7W1.39YN1YMPLICAMfWRAPERMITSUBJEClBiMEAPPLICM7�7U Z Re-Raof ' ., •
� ACMI►ENALiY OF 1bT MORE TIAN FIVE NUNDRED OOlUA3 fieablJ� . . ,. - �
� OI,�ROWNEqOF7MEPilOPERTY.ONMYEMPLOYEE9WI7HWAQE5�13THE1RSOLECOMPEN5ATION. O C0111A19fCI81
WILL DO 7HE WORK,ANO 7HE STRUCTURE 16 NOT INTENDE�OR OFFEHEO FOp 6AlE(6EC.7w6 BU6F �l
NE55 AND PfOFESSIONS L'lJOE:TIE CONTMCfOR3l10EHSE UW DOES NOT APPLY TO AN OWNER OF ? ,
� PWDPERTYWFIOBUIlD90RMPROVESTHEREON,ANDWHODOESSUCYfWORNHIMSELFORHERSELFOR
Q TNROUON WS Oil MEA OWN EMPLOYEES,PiqVIOEOlHAT8UfX1 MPPOVEM6Nf$ME NO?M'ENDE�DR m
` � OFFEREDPoNEALEIFFIDN'E11ER7MEBULGINQORIMPROVEMEMI38qDWITMMONEYEAFlOFCOMPLE-
TION,TNE OWNEMUILDER W:LL MAVE iHE BUfDEN OF YROVWO THAT HE OR 6HE DID N�T BU4D Oli
MVf10VE FOR111E PURPOEEOF SALEI.
� O I,A6ONMEROf 1HE VROPERTY.AM E1IClUSNELY CONTRI�CTIN(i WfTH LICENSEO CONTHACTORS
TO COHSfRUCT 7HE PRO.IECT(BEC.70N,BUSINE55 M1D►ROFESSION9 COOE:TNE CtlNTRACTOA3 Lb VelU8tl0n � ADJ.AREA
CENSE LAW OOES NOTMPLV M AN OMMEN OF A PNOPERTV WFIo BUMDS Oq IMPqpVE3 THENEON.AND
WFipWN�RACT6FOR8UpiPROlECf5WIT1�CONiRACTOR(8)LICENSEDPURSUANTTOn7EODNTRAG pUANTt7Y DESCRIPTION FEE
� TORS LIC@16E LAW.�.
�I M1 EXEMPT UNDEN SEC. B.6 v.C.FOR THIS REASON U �f.��-'P�
LL' DATE OWNER . � (�'�� � F_S I
� LICENSED CONTRACTORS DECLARATION �y s . .
IHEREBYAFFlRM UNDEH PENALTY OF PERIUHY h1AT1 NA L�CENSED UNDER PROVISIONS OF CHAPTEH
S �(OOMIAENCNOIMTH9ECTION70oo)OFOMS�ONaOF7NE&1S�NESSMOPROFESSIONSCOOE.AND Z U
LL� MY UCENSE�B N FUl1 FORCEMD EFFECT. i ,.,,r
� IICENSE CIhS ( LIC.NO. �����' v /� m .
�
� �ATE �- CONTRACTOR �`�1 a , �
� WORKERS'COMPENSATION DECLARATION Df�j� � �
� IMEREBYAFFINMUNDERPENALT'OFGE0.IURYONEOFTNEFOLIOWINODECLAMT1oN5: V
� Z
Q
� �_I HAVEAND VALL NAINTAN A CEHfIFlGTE OF CONSENT TO SELFaNSUHE FOR MOHKEAS' _
CqAPEN5A710N.A5PROVIDEDBY3ECTI�N�7WOF7NEtABOHOD�E.FORrF/EPERFORYANCE �U
OF ME WORK FOR N711di TFMS PERMIT IB ISSUED, �
�
_I MMEAND WILL MAIMAW WiDRICER3'COMPENSATION INSURANCE,AS REOUIREO BV SECTqN
QQ i7a0OFTHE LABOR O�OE,FOR iHE P6RFORMANCE OFTHE WORN FOR WHICH iH15 PERMR IS
13311ED.MVWORKE S'COLIPENSATIONINSUW�JYC^ECARfl1ERANDPOLICYNUMBERJIHE: CONSTRUCTION
� GIiRIEH �T/17A� C'"V�`-�'D PUN REVIEW �LO �
� POLICY NUMBER_ —Zl '�R� _I.I iJ_('7_ �,Q I� ELECTRIC ��
P `
� (Iliss[c�pNNE�r+oreECORiIEfIDOFIFEaEwArl4R)naNEHu�DaEODJ1.uWS�Sta�oa i 't. PLUM8ING �
W �
Z I CEflTIFY TIUT IN THE PERFOWA�NICE OF THE WORK FOR YNiltli THIS PERMIT IS ISSU�.1 MECHANICAL
(.ry SHALLNOTEYVtAYANVPER50NM/ANYMANNER50AS70BECONESl1&IECTTOTHE
y WORKERS'COMPEN5ATpNlAYY50FCALIFORNIhANDAGREEit1ATIFISHOULDBECOME INSPEC1lONFEE
SUBJECTT07HE WDRKERS'COMIVEN314TION CpOVI510N5 OF SECTqN]7000F 1HE IABOR
s OODE.I SHNL F�OyRTMWIftI COMPLY WITH'\TF70SE PROYISIONS. ISSUANCE ��
� DATE: O— "1 ��a+�l L�Cl t �SI.LY _ SMIP
� APPLICANT.
� WMNINO:FARURE TO SECURE WOqKEHS'COI.IPENSATqN COVERAGE IS UNUWFUL,AN�SHALL6E ENERGY P/C
�y SUBJECTMIEMPLOYERTOCRIMWALPENPLTIESANDCIVIIfINE3UPTOONEHl1NDREDiHOU3ANU ENERGVPERM�T �
D011AR6(t10D.00o�,N ADDITIONTO THE CO3T OF COMPENSATqN.DAIAAOES A5 PROVIOED FOR N
� SECTIDN970lOF7HElA90RCODE.N7EqEST,ANDATiORNE1"SFEES. pETENTIONFEE:�7 An �
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: L.iTY OF DIAMOND Biu�
� I HEREBYAFFIRAI UN�ER PENALTY OF PEFLURV THATTHERE t5 ACONS7AUCTION LENDING AOEHCY BtTII.DING AND SAFETY
FOP THE VERFONAIANCE OF 711E M/ORK W R WHICN THIS PERMIT IS ISSUED(SEC.3oW.CIV.C.�.
Z
W
� LEtOER'S NAA1E
� LENDFR'SAUDRE56
� 1 CERTIFY 7HA7 I HAYE REAU T113�PVUCATION ANO S7ATE TMT TME ABOYE W F011MATpN IS CORqECT. TOTAL FE ES L
� 1AfiREETOCOMPlVN7THALLCT'IWDC011NTYORDN�NCESANDBTATELAWSRELATINOTOBULDING .
ODNSTM11CilON,ANO HEREBY AUfHOPiZE REPRESENTATIYES OF THIS COUNTY TO ENTER UPON T1E
� -MENTIONEDGROFERTYFORINSPECfIONPURPOSES. . -� � COMMENTS
a � �
a FEHMfTTEE NAM � �
� � � �
y SKINA ERMt EE • , 'OATE
� RECPT.NO. PAID BY '' YALIDATION
ITE-0epartrnent Copy,YELLOW—Fnence Copy.PINK—Assesea Copy,GOLDENROD--File Copy,GREEN—ApplicaM's Copy
, ' . .. . . .. ,n���. q � . . . � .. . . r . �i ..., ' .. .i . � , �_ � '. � ` . . �� . . . . ,
.. .. . ... . . �,
cn-v oF ��a�sown B�R
INSPECTION RECt�RL3
. �, E , . o . . e � , . a .
S,�T{3ACK � � � � • FL�ORJOIST . '
FI'G5lFORMS/STEEL � 9a' FHA REC�MTS
ELECTRIC GROUND � UND�R FLOOR DUCT . �
GROUND PLUMBING / � �� UNDER FLOOR COI�IDUlT
SLAB GRADE FIREPLACE FOUNDATIQN �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE - MID HT. 80ND BEAM • ' ��
ROOF SHEATHING-- r�-1)-Qy tjQ.� 8 Ff.BUND.BEAM- �
FRAMINGNEf+iTI�IA`�IOiV -� FINAL BOND BEAM
ROOF COVER ;'°r �S J3 PRE-GRADING �
ROUGH HEATING �- � BENCHIIVG
F�OUGN�L�CTRtG Z � ��� ROUGN GRADING
FiQUL3H PLUNIBING �'�,.�, �_^� FINISH GRADING (
SHOWEFt/`fU T f POOL ELECTRIC _ �
EXT. r , p �T POOL FENCING
WAL�INSULATIpN � POOL FINAL
CEILING INSULATION -/� ; OFF S�TE IMPS. �
DRYWALL.NAILING . � ' DEDICA710NS ^
5EWER ' � j FINAL ENG.
- ----�- -
SEPTIC TANK , '.-� . LANDSCAPE/IRRIG. � �� _�
SEEP PIT/L.L. ��'- ' ON S1TE IMPS. �—
GAS AIR TEST , j FINA�ZC3NING i � �
FlNAL CONST. � .ss� � , FIRE QEPT. FINAL �--� �
FINAL HEATING ���'- — �� ; HEALTH DEPT. FINAL j � �
FINAL ELECTRIC � (-� �� ! i DEV. FEES PAfD ����y
FINAL PLUMBING �5 9� v� - I ENERGY i
SA.tti ' �cel. � / -i'1-4� 9 � ; i _
a E � ; a � i
CONiMENTS
. � ., ' - ,
,. ------
.�- ,r: .; M ��, �_ ` �---�
SEPTIC TANK SIZE "�" `" " � ` �'
f
SEEP PIT/U S1ZE :.i/!.F.!r'si,C"�P�iX�; . r ,� - -----------'
",i? �`�1; G)L1I�t ;iE�
� �_
'�'e�°� ��� ,���, � �� -b e���
_ -% %�-����-f��
. . � 'v'���2=T1