HomeMy WebLinkAbout12979 ��_ CITY OF DIAMOND BAR � )
; DEPARTMENT OF COMM[JNITY&DEVELOPMENT SERVICES /
� .> 21660 E.Copley Drive Suiu 190
(909)860-3195 Fax(909)861-3117 PRESS
�'�"� $UILDIIVG PERMIT APPLICATION FIRMLY
o ADDRESS �S� / Sf I►«I" �ne DATE � �� NUMBER "` r t
y APPLICATION PERMIT _�� P!C
� APN L T TR CT b V ISSUE TYPE OCC
DATE ' CONST. GROUP
� OWNER
ADDRESS ZONING SETBACKS
CITY ZIP�,�TEL.� - 6 FRONT RW ❑
APPi.ICANT TEL. REAR ❑
SIDE/SIQE STREET RW O
CONTRACTOR_ f ' ti LL. SIOE p
� ADDRESS � — PROPOSED USE
CITY ��S6 ie�+ �`,�o ZIP 2 TEL v
� ARCH/ENG/
DESIGNER NO.DWEL. NO. NO.
ADDHESS UNITS STORIES BEDROOMS
� CITY ZI TEL.
t� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUAl70N
p� OWNER-BUILDER DECLARATION SFR/ADO/FtEAA
O
1 MEREBY AFFIRM UNDER PENALT/OF VERJURV TNAT I M1 E%EMPT FROM THE L'ONiRAC7OR9 LF GefHBB/CaryOM
CENSELAWfON7}IEiOLlO1MNOHEAAON(SEC.7o31.6BU91NE55ANODROFES510NSCODE:ANVCITYOR (�
COUMYWHIdiqEOUIRESAPEHMRTOCONSTRUCf.ALTERIMPROVE.DEAAOLISN.ORFEPAIRANYSTRUC W QB�IOIDlCI(
7UHE,PRqR TO 175 183UMICE,ALlO REOUIRES TFiE APPUCAN7 FOR 611CF1 PERMI7 TO FILE A SIONED W
BTATEMENT THAT HE OR 8ME IS LICENSED PURSUANf TO THE PFIOVISIONS OF 1HE CONTRACTOH9 L4
CEN�E lAW(CNAFTER Y�OOMMENCINO 1YITH BECTION 7000)OF�IVISION J OF TFIE BU9INE55 AND PRP � POOUSPB
FESSqNSGOOE�Oq7HATMEOR5HE13F%EMPT7MEflEF(10MAN�iHEBASI5FOH7HEALLEOEOFJ(EMP• �
TqN.ANYV10{ATIOMOF9ECTION7081.6BYANYAPpLICANTFOR�PERMIT8U9JECT5iXEAPPIICANTTO Z Re�Roal
� llC1VIL 7ENALTY OF NOT MORE TFIAN FIVE HUNDqED DOCURS(i500).k
❑I.A60WNEilOFTHEPROVEiiTY.ORAIYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COmm9rGiel
YYILL DO iHE MfORK AND 7HE STRUCTURE 5 NOT INTEN�ED OR OFFENED FOR SALE(SEC.7014,BUSb J
NESS AND PiIOFESS10N5 CODE:TMF CON�FUCTORS IICENSE LAW DOES N07 APPLV TO�M ONMER OF ..^�,.
� Pi10PERTVWI�OBVILDSORMPROVE9T11EREON,ANDNMO00E58UCHYYORKHIMSELFORHER6ELFOH
THNOUGHHI60itHERONMEMPLOYEES,VROVIDEDTHATiUCHMPROVEMENTSARENOTINTEN�EDOR m
GFFEiIm FDR SJ4LE F,NOriEVER,hIE BUILDINO Ofl MAPFIOVEMFMI9 SOLD W17NN ONE YEAR OF GOMPI,E '
fpN,TNE OWNER�BULDER N1LL MAVE TNE 6UHOEN OF PROVINO T1M7 NE OR SNE DID NOT BUILD OR
MifpVE WH 111E YURPOSE OF SALE�.
❑I,I�S OMrt1ER OFTHE PROPEHfY,AN EXCLUSIVELY CONfRACTINa VN'IM LICENSED CONTRACTORS
TO CONSTHUCT THE PRO.IECT(SEC.70/4.BUSINESS ANO PROFESSIONS CODE THE CONTRACTORS LI- VelUetlOn ADJ.AREA
CENSE lAW OOES NOTMPL�TOAN ONMER OF A PFOPERTY WFIO BUIIDS OR IMPROVES THEREON,ANO
MIlIDCOMFUCTBFORBUCFIPROJECTBNttTHACONfFAC70R(S)LICENSEDPUHSU�NTMTNECONTMG QUANTITY DESCRIPTION FEE
� 70RS IICENSE LMv.).
O I AM IXEMPf UNDER SEG B.3 P.G FOR h115 REASON �
� OA7E OWNER !-
W
� LICENSED CONTRACTORS DECIARATION �
� 1 HEREBYAFFlPoA UNDER PENALT'OF PERIURYTHA71 AAA LICENSED UNDER PROVISIONS OF CNMTEfl �
� •(COYMENCNO WRFi 8ECTION 7000�OF CIVISION]OF TNE BUSINHSSAND PROFESSIONS CODE,ANO 2 � (�' (�I'I
MY UCENSE IS N9 FULL ND EFFECT.
� LICENSE CUSS LIC.NO. ���l a
� MTE — CONTMCTOR a
WORKEAS'COMPENSATION DECLARATION �
N1 NEREBYAFFIRM UNDFR PENPLT'OF PERIURY ONE OFTHE FOLLOWING�ECUMilONS: Z
� �I HAVE AND N7LL MlUNTAW A CEpTIFIGTE OF OONSEM M SELF-INBURE FOR NpRKERS' _
COMPENSATION,A9PqOVIDEDBYBECTION�7000FTHELABORCO�E,FOATMEiERFORMANCE W
p OFTI/E WORK FOR WMIpiTH15 PEHMIT18155UED. �
({y-� �/�/—1 NAVE ANO YALL RIAINfAIN NKMKERS'CdAPENSATION INSUMNCE,AS flEW IRED BV SECTION
¢ / � 9700 OF TFIE LAWR COOE,FON THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
0 ISSLIED.MY Y/ORKERS'�A�SU�N�E CARRIER Ml0 POLICY NUMBER�RE: i CONSTRUCTION
� CAHRIER �j 'S � PLAN REVIEW
� POLICV NUMBEH ,����� ELEC7RIC
� (n+ss[c�aNr,�rareEao�rmoFn+EaEa�ar�srd�a��naa.tu�s(simla7�ss1 PlUM81NG •
Z I GERTIFYTN�T W THE PERFORMANCE OF TNE MORK fOR WHICM 7HI5 PERMiT IS ISSUEU,1 MECMANICAL ��
(J'' SFULL NOT BAPLOY 1W1'PERSON IN ANY MPNNER 50�S TO BECOME 6UBJFCT TO THE
� WORKERS'COMPENSATIONUIWSOFCALIFORN10.AN0AOREE7HATIFISHOUlDBECOME INSPECTIONFEE
6L9JECT TO THE MlORKERS'COMPENSATION VROVISIONSOF SECTION 970o OF TME UBOR
s CO�E.I SH�U.FOfiiHWITH COMPLV WItH E PROVISIONS. ISSUANCE �'
p OATE:� APPLICANT. A. /7/Pr r�Q'Y� SMIP 1QQQ
�� —�vvv
WARNINO:FAILURETOSECUREWORKERS'COMPENSATqNCOVERMiEISUNLAM/iUL.ANDSWILL9E ENERGYP/C
6UB.lECTANEMPLOYERTOCRIMWALPENALTESANOCIVILFINESUVTOqJEHUPOqEOTHWSAND ENER6YPEflM1T UFDIAMONDBAR
�, OOl1ARS�1100,OW),INADD171dJTOTHECOSTOFOJYOENSATION,�AMAGESASPqOVIDEOFORIN BUILDIlVG AND AFETY
� 6EC71ON970aOFTHELABORCODE.INTEREST,MIDl1TTOIWEY3FEE5. RETENTIONFEE:
CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
I HEREBY AFFIRAI UNDER PfN�LTV OF PERIURY THAT THERE IS A CONSTRUCTION LEN�WO AGENCY
FOF THE PERFORMJWCE OF TXE VYORK FOR WHICH THIS PERMIT IS ISSUED�&EQ 90Y7,CIV.0.�.
� LENDER'S NAME ,
LENOER'S AO�RESS
I CERTIFY TNT I WNE READ Ti15 MPLICATION AND STATE THATTHE ABOVE INFOMAATION 19 COqRECT. TOTAL FE ES �J �
1 M3REE TO COMPLY WITH ALL CRY ANO COUHfV ORDINANCES ANO STATE UWS REU171N0 TO BINLDINO
� CIX�STRUCTION,ANDHEREBYAUTIqRREREPRESENTATNESOFTFUSGOUNiYTOEMEHIJPONTHE
i1BOVE•MENTIOHED PROPERTY FOR INSFECTION PURPOSES. COMMENT$
� e
m iEWAITTEE�)•
� a -� -
y &GNATUHE OF PMITTEE DATE
.�r RECPT.NO. PAID BY VAI.IDATION
F WHITE—Department Copy,YELLOW—Finpnce ,PINK—Asaessa 60LDENROD—File
�oPY Copy. Copy,GREEN—ApplicanPs Copy
CITY OF DII�,IUlOND BAR
INSPEC"i'iON RECORD �
E i � • E ` � ! i .
t� '
SET BACK FLOOR J41ST� . -
FTGS/F�RMS/STEEL FHA REQMTS -
ELECTRIC GROUND UNDER FLOOR DUCT� � .
GROUND PLUMBING UNDER FLO�R CO�IDU�T
SLAB GRADE FIRE�'LRCE'FOUNDATION •- • �
TEMP POWER FIREPLAC�BONO SEAM
WATER SERVICE MID MT. BOND B'EAM - - • • -- -- -
ROOF SHEATHING ` 8 FT.B�ND BEAM , '
FRAMINGNENTILIATION FINAL BOND BEAM
RODF COVER � PRE-GRADING
ROUGH HEAT{NG BE,NCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING -~�~'�t--~ FINiSH GRADING
SNGWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDlNG � POOL FENCING �
WAL�INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
QRYWAIL NAf�lNG QEDICATI�NS
SEWER ( '2- - 5 FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRRIG.
SEEP PIT/L.L. � � : ON SITE IMPS. �
GhS AIR TES7 j FINAL ZONING �
FfNAL CC)NST. E � ! FIRE DEPT. FINAL ,
FtNAL f-IEATING i � �) ; HEALTH DEPT. FiNAL-�-�� � � ��
FiNAL ELECTR►C J I i ; DEV. FEES PAID � T�
FfNAL PLUMBING `j � i ; ENERGY � �
-� -
� ----- -----�
� ; � o a -. �
COt+�MENTS
1 '. , .
r' i�•.�..�. - .�..- --
.. . � f . . . . .-
SEPTIC TANK SIZE : - �
SEEP P1T/U SiZE �� -` �----- �-
' ,, �
�,�
� ..--