HomeMy WebLinkAbout16908 (37) %
J� CITY OF DIAMOND BAR
i DEPARTMENT OF COMMUTTITY&DEVELOPMENT SERVICES
' ��� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS •
��%::� BUILDING PERMIT APPLICATION FIRMLY •
o ADDRIESS �9�-g .���(��K y�fc�� DATECATIO�N^D� �d I NUMBER� #,C
� ISSUE Ei TYPE OCC
APN LOT TRACT DATE�� D�� �f CONST. GROUP
p OWNER
"" ADDRESS �9 Z�I S'1�(L� /J G ZONING SETBACKS
z CITY ���,LIZ/S�L ZIP TEL. FRONT RW ❑
g APPLICANT TEL. REAR p
SIDE/SIDE STREET RW ❑
� CONTRACTOR � � �n-/ SIDE p
oADDRESS ' —r � PpOPOSED USE_�i�%r^ �✓.ic�/1�7� �/F_
o CITY WJ;L�"r ZIP TELy'
o ARCH/ENG/
`z DESIGNER NO.DWEL. NO. NO.
n. ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL.
�
v� DESCRIPTION Sd.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNEFi-BUILDER DECLARATION SFR/ADD/REM
O
p 1 NEREBY AFFIFM UNDER PENILLTV OF GERIURv THAT I IU.�EXEMPT FROA1 THE CONiMCTORS LI- G2r0gelCdfpOR
W CENSEUWFOHTHEFOILOWINGREA50N(SEC.7071.SBUSIN[SSANDVROFESSIONSCODE:MIYCITVOR (n
CJ COUNTYN711pIRE0UIRE5APERAIITTOCON57RUCLALTEF.IMVRJYE,DC1A0L15H2ORREPAIRANYSTRUG W pati0/Dbtk
TURE,PRIOR TO RS ISSUANCE.ALSO REWIRES iME ACPLIGNT FOA Sl1CH VERIAIT TO FIIE A SICNED
W STA7EIAENT 7HAT NE OR SHE IS LICENSEO GURSUAN7 TO TME OROVISIONS OF TNE CONTRACTORS L4 W
� CENSE UW(CHM7ER Y(COMMENCIN6 YAiH SECTqN 7000)OF DIV1510N�OF TH[BUSiNE55 MID PRO- � PooVSpa
FESSqN50DDE�ORTHATHEORSHEISEXEMPTTHER[FRpAAYOTHEBA515FORTHEALIECEDEXEMP- (�
V TqN.NiYYIOLATKKi OF SECTION 7071.5 BY ANYAPPLICANT iON�PERMIT SUBJEGiS THE APPLICANT i0 Z Fjg.Rpp}
� A CML VENA�TY OF NOT MOHE THAN FIVE MUNDRED DOLLARS(fSooJ.�:
p O�ASOWNEROFTHEPROPENTV,ORIAYE�PLOYEESNnTMWAG[SASTHCIqSOLECOIAPEN5A7lON, O COmmErCi31
Z W:LL DO THE WORK AND THE STRUCTURE IS NOT IMENDED OR OFiEHED FOR SALE(SEC.70a�,B'JSi• J
� NC55 ANO PROFESSIONS CODE:ME CONTMCT00.S IICENSE lAW DOES NOTAVPLY TO AN OWNCR OF j
V R07ERTV W410 BUrtDS OR MVROVES THEREON.AYD NM1IO DO[5 SUCH WORK HI45fLF OR HCRSELF OR
CL THqOUGHHI50RHERONMEMPLOYEES,PROVIDEDTHATSUGIRAvppVEI,lENTSARENOTINTFNDE00R C�
QOFFEREDFORSALE.IF,HOWEVEi�T1EBULDIN�ORIMVROVEMCMI550LDWRHI40NEYE�ROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL MAVE TNE BURDEN OF PROVING MAT ME OR SHE OID NOT BUIID OR
= W PROVE FOR THE PURPOSE OF SALE).
w 04ASOWNEROFTMEPROPERTY.MIE%CLUSNELVCONTMCTINGNn7H�ICENSEDCANTRACTORS
(L TO CONSTRUCT TH[PR0.IECT(SEC.70t1.BUSIN[SS AN�PROFESSIONS CODE:TME CONTRACTORS U� Valu3liorl G� ADJ.AR[A
W CENSEUWDOESNOTAPPLYTDil40VMEROFAPROPERTYMTIOBUILDSOHMPpOVESTNEREON.ANO
� N/qCONTMCT5�OR5UCHPROJECT5W1T11AC�OHTRACTOR(5)LiCENSEDPURSWNTTOTMECqJTRAC- QUANTITY DESCRIPTION FEE
� TORS lKENSE Uw.).
� ❑I AM E%EMPT UND[R SEC. B i V.L.iOR TM:S REASON Q
� U
� �
DATE OWNER V
� W
� LICENSED CONTRACTORS DECLAFiATION W
� INEREBYAFFIPoAUNDERPENALTYOFVE0.NRYT/UTIAIAUCENSEDUNDERVROVi5lON50FCMAGTER �
� Y(COMMCNCWOWITMSECTION70W70FDIVISION�OF7MEBUSINESS�NDYROiE55lON5CADC,AND Z
��� MY LICENSE IS IN FULL FORCE AND EFFECi m
� LICENSE 55 � IIC.NO.��°��Z j
V DATE �� '� Q CONTFL4CTOR���1- �f�(�-T�/ d
W
� WORKEFIS'COMPENSATION DECLARATION -�
a
� U
� IHEREBVAFFIPYUNDERVENALTVOFVE0.NRYONEOFTMEFOLLOWINCDEd.AMT10N5: Z
Q
� �I HAVE MlDK9LL MUNTAIN 11 LERTIFICATE OF WNSENf TO SELF•INSUR[FOH WORKEAS' _
CqAPENSATqN,115VROVIDEDBYSECTION71000FTNELA80RCO0E,FOfiTNEPERiORMANCE U
� OF iHE WORK FOR WHlpi fHIS VERMIT IS ISSUED. �
�
�I HAVE AND WILL MAINTAiN M/ORKERS'COMPENS�iION INSURANLE,AS REWIRED BY SECTpN
Q J7000i iHE LABOR COOE,fOR iME PEFFORMANCE OF THE WORK FOR WN�CH THIS PERMIT IS �/v
� ISSUEO.MYWORNERS'COA/PENSATIO NSURANCE RHIERAN�VOIICYNUM�ENARE: CONSTRUCTION ��9
Q
� CARRIER CT � V PLAN REVIEW
Z va�cY NUM6ER_ _�, ,�i r O ELECTRIC
¢
0 (M65ECf10NNEmNOT8GO0M1itFfEDOF7FEPERM76NOFGf2Hft(iC�00IWYSRt001«1LC55} PLUM6ING
Z I CERTIFY TUT N THE PERFONIANCE OF TXE WORN FOR WHILH THIS PERMIT IS ISSUED.I MECHANICAL
(�} SNALL NOT EA!PLOV ANV OERSON W ANY MANNER SOAS TO BCC/J�E SU�JECT iOTHE
� VYORKERS'W�aPENSATqN�AWSOFCALIFORNI0.ANDAGREETHATIFISMOlJLOBECOME INSPECTIONFEE
S SUBJECTTOTHEWORKERS'CO��PENSA7qNPROV1510N50FSECTiON]�OOOFTH[LABOR •
cao',i sM�{L FORTNw;rn cana�r win�rwse e�ov�rons. ��� ISSUANCE
p OATE:(� �)U/ AOPLICANT: j���f��� SMIP _�U
J ENERGY P/C
J WMNING:FAILM[TOSECUREY+OfUCERS'CAMPENSATqNCOVENACEISUNUwFUL.AN�bW�LLBE
�y SV0.IECTANEMPLOYERTOCR:MINALPENALTIESIWDCIVILiINESUPTOONEMUNDREDTHDUSAND ENEAGYPERMIT
WlUUiS(f 100.000).N ADDITION TO TME COST OF CqAPENS�TqN,D�MAG"c5 AS PROViDED FOR M
� SECTqN]7t!OF iH[LABOR CODE.INTEREST,AND ATTORN[YS FEES. RETENTION FEE: �''
ow.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� INERCBYALFIRMUNDERPENALTYOFPERNRYTHATTHEREISACANSTRUCTIONIENOiNG�GENGY /�
nZZ- FOR THE PERFORMANCE OF THE WORK FOR WMIp/7H15 PERMI715 ISSUEO(SEC.]oa�,QV.C.�. �T
y� LENDEf75 NAAIE�(ALy�� �
� LENDER'SAODRF55 �� �L � ���
� TOTAL FEES rT�a a
¢ 1 CERTIFY iMAT I HAVE READ THIS APPLICATIDN AND STATE iHAT TME ABOVE INFORAIATION IS CORRECT.
W IAGREE TO COMPIY WITH ILLLCITY AND COUNTY OR�INANCES AND STATE UWS PEUT WG TO BUILDING �
� CONSTRUCTION..WDMEREBVAUTHOR12ER[PRCSENTATNESOFTHISCOUNTYTOENTERUPONiHE
z A80YE-1AENTIONED PROPERTY LOR WSPECTqN VURPOSES. COMMENTS� / O�����
o �� a ��L �,� n , �
m PERMIT7EENMAE oRi ���r-�r/___11f�-�,Qrj+�Q ,����
� � 1 J7
y SiGNA, � �' IR DATE �
� AECPT.NO. . � _PAID BY ' VALIOATION
WHITE-0epartment Copy.YELLOW—Finance Copy.PINK—Assessa Copy.GOLDENROD—File Gopy.GREEN—ApDlitanl's Copy
. . . . ............ �............_..,.. .,. , ,� • � � , - � r. 7 r . . , . . . .-"--- .. .
�I i 1' OF '�i��(��OI�3Q �f-�I�
6tE'Sr-'��C'�lOi� ��:CO;:D
I►��-'i��=f:I'I�.I►�� ' �1�G't:��_--��,k�'i::l:;c��rsa;.------I��k=f.l�:c ['l�'1►'! T����'C= �'I�`�`tE��e`�'ejC�
---------._....---- .........---..._._._ . .._...._. _. .._.......--- .._. . .
....... ... ........ .... ...... - --...__......_;..__...._..-----..._.....-----..._._----
SET BACf: � � � i FLO�R JDIST I I
FTGS'FORh9S'STEEL � ---------�-� f=HA REO"'T5 �-- � j-------
�----= — ---
ELECTRIC GROUPJD � � j I UiJD�R FLQ�R DUCT � j
GROUiJD PLUt•.1F�ING �_ � �I U�J��R �LC�R CU?�fDUIT � � _ _
SLFiB GRADE I � _1_� FIR�PLAC�_FOUiJDltTIOiJ__ I I
TEP�1P PO'vVER I I ___ I I FIRcPLACE BOND BEA�w1 __ �
4"JATER SERVICE -_� ---�___-- l_I P.11D FiT. �OPJD E3EAF.^ _ _ ;
ROOF SHEATHIivG � I._��f-T. BO�JD E3�AG•1
FRAPAIfJG!VENTILIATION I ( I FIPJAL EO�d� F�EA�� !
ROOF COVER � �_/f r,1�� � FRE-GRADI'r!G I
ROUGH H�ATING I � I I � BENCHRJG
ROUGH ELECTRIC I � I. RDUGH GRF.DIi•:G ___ }
ROUGH PLUPJBING � I I I ���'�ISH GRADf�JG
SHO�"JER,rfUB TEST I I I �'OOL EL�CTRIC
EXT. LATH!SIDING � I POOL FENCI�dia l �
b'lALL IPdSULATI0P�1 � } j POOL FINF,L �
CEILING IP�SUI.ATION � � OFF SITE 1�:1?S. �
DRYVVALL NAILI�4G � DEDICATIO�JS �
SEb"JER FINAL ENG. _l
SEPTIC TANK � LE'�PJDSCAPE/IRRIG. � I
SEEP PITlLL I � G�J SITE liiPS.
GAS AIR TEST � I 1 � FINAL ZONIPJG
FINAL CONST. I I I � �IRE DEPT. FI�JP�!. �
FIN/'�L HEF�TI�JG � HEALTN DEFT. FINAL
FINFiL ELECTRIC � DEV. FEES FAID
FINl1L PLUP�1�31NG � ; E�J�RGY �
�C=-'7—�� ,�7-� �_ � ' ,.�_ _____-._._� 1 _
_�____.�._
i .��- -.�.� ,.,-
. .
,. ..., . . . . :. �
---------------�-------�---- � _.. ._..._... .._-- - �-------. ... .. �
cor�r�nENTs
SEPTIC TANK SIZE
SEEP PITIU SIZE ^ --
1�� �^ �
I�I,f �
�. ; ,
��