HomeMy WebLinkAbout11880 (9) �� CITY OF DIAMOND BAR �
' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
> 21660 B.Copley Drive Suite 190
(909)660-3195 Fax(909)861-3117 PRESS
���� BUQ.DING PERMTT APPLICATION FIRMLY
N J08SITE yy ry APPLICATION C� PERMIT Q P/C
o ADDRESS `6�J SI`.!'c(�.x: P—iC�}�( �ti� . OATE �� I UMBE �� M
� APN LOT TRACT� �'' ISSUE TYPE OCC
DATE CONST. GROUP
g OWNER �QCI�'. I E ������ I/�.
LL" ADDR SS ZONING SETf3ACKS
0
� CITY I I� �IP STEL. ' I FRONT RW ❑
APPLICANT TEL. REAR ❑
� SIDEISIDE STREET RW O
CONTRACTOR SIDE ❑
� ADDRESS
PROPOSED USE
Ct7Y ZIP TEI..
o ARCWENG/
� DESIGNER NO.DWEL. NO. N0.
ADDRESS UNITS STORIES BEDROOMS
CITY ZIP TEL.
N DESCFiiPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BUILDERDECLAAATION SFRlADD/FlEM ' �
O
p I HER�V AFFlfiI UNDER VENAITY OF FERURY TMAT t Au E%EMPT iROM TV1E CON7MCTORS LI• G2f8pe/Ce�pOR
W CEHSEUWFORTI�EFOLIOMIINCREA50N(SEC.7W1.6BVSINESSANODROFESSiONSCOOE:ANVCITYOR , (n
C� �OUNiYVW11CHRFIXII{tE5A7EAAIRTOCONSTAUCT.ALTERIMPRpyEDEMOl15M,ORREPAIRANYSTRUG W P8110/DBCI(
� iUIlE,iR10R TO RS ISSUANCE./�W RC�UIRCS TF1[MPLICANi FOR 6UCH PFRIAIT TO fILE A SIGNED W
STATEMENT iHAT HE OR SHE 4S UCENSED%IRSIIANi TO 7HE PRONSIq:S OF TNE CONiRACTORS LF
� GENSE NW�GNFiEHi(COMMENCWO WITH SECTION 7000)OFDIVISION]CF THE BUSINESS M!D PN6 � PooUSpa
FESSIONfiCOOE�OqTMATNEP95HEI5E%EIAPTTHEREFROMAN�MEBASISFOHTHEALLEOE�EXEMP- (�
TICfI.ANYYIOlATK7NOf5ELT10N7W1.6BYMIYAPFLICANTiORAVERMI75U0JECT5TNEAPPLICANTTO Z Re-Rool
� ACIVIIPEHALTVOFNO'fMOREi1/ANFNE/NNOREODOlUR5ff5oo)J' ' ' J
� 0�1150WNEROFTMEPROPEP7'I.ORMYEMP�OYEESVnTMWAGE5�5TNEIRSOLECOA17EN5ATION, O CpmmerCial
M7LL DO THE WORK AND TME STiX1CTURE tS NOT RfTEI�ED OR OFFERED fOR SALE ISEC.7ott,BU56 J
NE54 ANO DROFESSIONS COOE:TME CONTMCTORS LICENSE LAW OOES NOT APPLY TO AN O`MIER OF
� yqppE(7ryyqqpUlpyORMPROVESiHEREON.ANDW/10DOES;AICHN'ORKHIIASEIFORMERSfIFOR �
� T/IqOIXiHHt50RFIERONMEMPLOVEES.OROVIDEOTUT5UQ1w1PPOYEMENT51lRENOTNTENDEDOR m
IL ,OFFEREDFORSAIE.IF,MOWEVER7ME8ULDIN00RIA1Pi10VEMENTI550lDWITMINONEYEAROFCOMA.E
ZTION.THE OWNER�UILAER WILL HAVE TME BURDfN OF DROVWO TNAT HE OR SHE�IO NO7 BUILD Ofl
� MPROVFFORTriEPURPO5EOf5ALE1. '
W O4�OYMEROFTHEPROPERTY.MAIXCLUSNELVWNiRACiNGNnTNLIC[NSEDCOMRACTOFS
� TO CONSTRUCT 7ME FROJECT(SEG 70M.BUSME55 AND iROFESSIONS COOE'TME GONTMCTORS U• V8Il18IlOf1 ADJ.AREA
C&13E UW DOES NOTMPLY TOM!OYR�ER OF A PROPERTY YA10 BUM.DS OR IAIPROVES THEREON,M9
� WIqCONTMCi9fOH5l1CHCHOJECTSWITNACONTMCTOf1(5)LICENSEDPUflSUANTiOTMECONTMG avanmTr DESCRIPTION FEE
fOHS LICENSE lAW). t
� I AM E7[EM UNOEH B.t P C.FOq 7N15 REASON 1 LC /
3 �> /�, � � /1^Q '
u" OATE OWNER � V
� � ` ^ W .
F LICENSED CONTRACTORS DECLARATION � -� . ,
� „ w .
INEREBYAFFUWUNDENPENILTYOF�E0.RIRYTUTIAAILICENSE�UNDERPH01/ISqNSOFCHAPTEH �. LO.�L�, `'
(L Y�COYMENCNOWRHSECTION7o0o)OFDMSIONiOFTh'EBUSINESS�N00{iOCf551ON5CO0E.AN0 Z
X WUCENSEISNFUI.LFORCEANDE�FECT. �� m �
u� �
� UCENSECUSS LIC.NO. � j I �
�
V DATE CONTRACTOR a
W
t� WOFKERS'COMPENSATION DECLARATION , -�
a
N U
N INEREBY�FFIRNUNDEPiENILTYOFiERNRYONEOFTHEFOLLOWINGDECLAMTIONS. Z
Q
� �I�VEANDWILLMANTNNACERfIFIGTEOFLONSENiTOSELFdNSUREFORWORKERS' _
COMPENSATION,ASVRDVIOE98YSECTION77000FTMEUBO�70DDE.FOM1iHEPERNRIAANCE w
OFT7E WONC FOR WH1d1 TN�S PERMi16155UF�. , �
Q
�_I MAVE INO WILLMAINT/1N WO(IKERS'COMPENSATION MSUMNCE,A.4 HEOl11FlED BY SECTION
Q �7oaOfTNEUHORCOOE,FORiMEOERFOWAANCEOFTM[WOR1(FORWH�CHTHISVERIAITIS
� ISSUE0.MYWORKER5CdAPENSATqNWSU{LWCECARRIERIWOPOLICYNVMEFRAftE: CONSTRUCTION
>, Cuani[n PLAAJ REVIEW
zpaicrr+uueEa ELECTRIC
.�
� (MSSECIUNNE�NOTBECd.TlETIDO�TKF£tiMTISFORONEHI�ORLDDOLL13tSISto010flLE551 PLUMBING
w ICERTIFYTHATWTHE7EFFOflMANCEOFTMEWOWCiOflWMIp1THI5PERNi76155UED,l MECHANICAL
(�,'} St1ALLNOiEMPIOYAM'PERSONMAM'IAANNEHSOASTOBEC0I.IESUBJFCTTOTHE
� WORKEHS'CpA7EN5ATIONUWSDFCALIFOHNIIlAN�11GfiEETMATIFIS+KKADBEGOME INSPECTIONFEE � ��
S SUBJEGTTOTMEWONCERSCd��vENSATIONDRONS10N50FSECTIp�71D00FTNEUBOH �SSUANCE �
CODE.I SNALL FORTNW�TN COMPLV WI7H iHOSE PROVISIONS_
a SMIP
p DATE: APPLICANT: ;
� WMNINQ:iAIIUACTOSECUREWOHKERS'COMPENSATIONCOHENAGEISUNUWFUL,ANDSW�LLBE ENERGYP/C ' 4��
.�y 5�18JEGTANEMPIOVERTOCiUMtNALFEN/1�TIESMACMLFWESUPTOONEMUNORE0TqU5ANU ENERGYPERMIT T y
pOl1MS(f i 00.0007.N/.DORIDH TO T1E COST OF COMPENSATION.OIIM�G[5�5 PROVIDED iOR IN Gl�'l�
Q SECTION]7oe0FTHEUBORCODE,NTEREST,ANOATTORNEY5FEE5. ' RETENTIONFEE: �]II�71S�y�p�.�.y
arVSLLJuyV t11V1J,fi
pw_, CONSTFiUCTIONLEN�INGAGENCY �, PNE-ALTFEE:
O
� IHEREBYAFfIRMUNDERPENALTYOFPER1URYh1ATTNERE15ACONSl(7UCT��NIENDI1qAGENCY
GOi7 TNE pERFOR�/ANCE OF iHE WORI(FOR WMIQ1 TMS VERA/1T IS ISSUEO�SEC.�D97.pV.G).
� '
W
� LENDERS NI1dE
S
� IENDERSADDRE55
� ICEHTIFYTHAT�HAVERE/DT/dSMVLICAT10N1NUS1ATE7NATTNEA00VENFORMATpNISCARRELT. TOTAL FEES y
� IA(3flEETOCOIAVLYYIiTNJLLICR'/�NDCOUNTYORDINMJCES�NDSTATEU�AaTNdTOBUlDIN6
GOHSTRUCTION,AND HEFEBV AUTHORIZE REVRCSENTATNES OF THIS COUHTY TO ENTER UPDN ME
� /�BOVE�MEMIONEDifiOPERTYFORINSPECT10NR1RPO5E5. , COMMENTS
9 �f�(rf�✓� �f l�l`1f'I1r� //3�y' �
� OE EE N E(PRIN'�
� ���y� ��.��.��- 6-ZS=�l� .
N TUAE F�RIAITiEE OA(E �,
2 , �, RECPT.NO. PAIO BY - VAUDATION
F- WHITE-Oapartrnent Copy.YELLOY�-FNence Copy.PINK-Assessor Copy,GOLDENRO�File Copy,GREEN-Appl�cant's Cop�l
-�._._-_._---�—
r CITY OF DIAN90ND BAR
Ih]SPECTIOt�! RECORD
► -�' �e, .�� � � : • E - • � � s -
=�-.�.._ _.�_... _.
SET BACK ' FLOOR JOIST �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT, �.., , •
GROUND PLUMBING UNDER FLOOR CUhIDUIT
SL.AB GRADE FIREPLACE FOUNDATION� ,•� • - � � ' •
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAP,A
ROOF SHEATHIhJG 8 FT.BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELEC7RIC � ' � ROUGH GRADING
ROUGH PLUMBfNG � FINISH GRADING
SHOWER/TUB TEST P00�ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILIPJG IPdSULATION OFF 51TE IMPS.
DRYWALL NAILING DEDICATIONS
SEWEFi FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. F 27=T�' /���� � FIRE DEPT. FINAL
FINAL HEATING ' " ' ' HEALTH DEPT, FINAL
FINAL ELECTRIC �-27%3y �,/�j✓l� DEV. FEES PAID �
FINAL PLUMBING ,a�2� ,�' ������ ENERGY
� �i�M4+ r,•.i);�13t�-; .
CONMPJIENTS
. Y t���: ,
� � ' , '� �' .-� 4{V�.
SEPTIC TANK SIZE>�1�1����5'.�:�.���`�' '!'' ' ' ''
SEEP PIT/U SIZE '�"���1-�!'.1"''f'�' '� t ���
pa�
r�� �i
�
! _ _ .. - -
4 _. _ -�