HomeMy WebLinkAbout14509 �• � � _ CITY OF DIAMOND BAR EX P I R ED '
DEPARTMENT OF COMMUHITY&DEVELOPMENT SERVICES
� ' 21660 E.Copley Drivo Suite 190 N 0 U 3 0 2000 PRESS
, (909)860-3195 Fax(909)861-3117
'�'.' �UII.DING PERMIT APPLICATION FlRMLY
�N JOBSITE 1�d 1 �/I VGI^ GYI • DATECATION , ,L ��MBE�����_ It � v �
ADDRESS -7
� ISSUE TYPE OCC
APN LOT TRACT pATE CONST. GROUP
r;�� OWNER � ^�
p ADDRE�S r • . ZOWING SE7BACKS
� CITY `ZIP TEL. FRONT RW ❑
APPLI ANT TEL( -r d REAR ❑
� SIDE/SIQE STREEf RW ❑
CONTRACTO ✓ � SIDE ❑
AQDRESS ppOPOSED USE ���
o CITY �V 21P !7 +TE " 410
� ARCFUENG/
DESI�NER NO,DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
y DESCRIPTION 5�.FT. FACTOR PSF ADJ.AREANALUATION
y
Q OIMNER-BUILDER DECLARATION gFq��pp�EM
O
I NEflEBY 11FFl17N UNDER VENAL7'�OF VEiWRY IFi�T I AM EXEMPT FflOM THE CONTNACTORS LI- G8f8gBJC81p0II
CEN9EL�Wi�i1TMEFOLLOWwOREASONISEG7o31.6B11SINE35ANDPROFESSIONSCO0E:MIYGTYOR (n
pWJNryNOM71RE0U1RESAVERMRTO00N5fRUCf.ALTEF4EIPHOVE,DFApL15H.ORAEPAiRANYSTRl1C- W P8tI0ID6Ck 2 �D
TUfiE,YR�OH 70 RS 18.9UANCE,ALSO REW IRES TME MPLICANT FOR SUCH PERMii TO FlLE R 610NE�
lTATEMENT 7FIAT HE OR SNE IS UCENSEO PURSUANT TO THE PROVIS10N5 OF TME COMTMC7iDRS U�
CEN9E UW(CFUVTEH Y(COMMENCINO WITH SECTIDN M�D)OF OIVISION 9 OF THE BUfi1NE5S AHD PRO- LL' PooVSpa
FESSqNS CODE)Ofl�1U�Tl1E OA 6HE IS EXEMPT TMEREFROM AND 7HE 8�515 FOR 7NE ALLEGED E%EMP�
TpN.ANYVqLA710NOFSEGTION7oa7.68VANYAPPLICANTFONAPERMI75U&IECTSiNEAPPLICIMTO Z Re-Rool
� J1 CMLOENALTY OF p0T MORE Ti1Vd FIYE MUNDRED DOlURS�i+�q).):
� 04ASOWNEROFTHEPROPERTY.OfiMYEMPLOYEESWITNWA�ESASTHEIR50LECAMPENS�TpN, � (,`pTRIBfC18I '
WILL 00 THE WORK,AND TF�9TPUC'IURE IS NOT IN7Et�OED OR OFFERED FOR SALE(SEC.7a�,9U56 J
NE85 AND MOFESSIONS COOE:THE CONTMCTORS LICENSE lAW OOES NOT APPIY N AN OWNEq OF' �
� PIiOPEfRYWFiOBU1�.40RNAPqOVES7NEREON.MIOYA/000E5SUp1VYOflKMMSELFORHER9ELFOR
LC �IWOUONNISOq1iEROWHFMOIAVEES,VRONDEDTHATSUCNiMPFOYEAAENT3AHENOTINiENOEDOq m
� OFFEREDPORBJILEIP,IIDV/EVER�BUIlDIN00RIMPROVEMENTISSOIDWfTHINONEYEAROFCpMPLE-
TION,THE OWNER�UIIDEH WILL FNVE TME BUR�EN OF PqOV WG 7HA7 HE OR SNE DiD/03i BUIID OR
IIAPRDVE FOH hIE PURPDSE OF BALE).
W ❑I./SONMEROFTNEPROPERTI;AMEXp.W�VELYCONfMCTINOWITHLICENSEDCOMMCTOq9
� TO CONSTRtICT TNE PR0.IECT(SEG 70M.BUSINESS AND PHOFESSIONS CAOE:THE CONTHFCTpRS U� V81U91'IOn AW.AREA
CENSE LAW DDES NOTAPPLV M AN OWNER OF A PROPERTY WFq BUIL�S OR IMPROVES 7NEREDN.AND
� WHOCOMRACTSFOHSUp1PROJEC731YIh1ACON7RACTOR�9�LICEN5EDWRSUANT70TNECON'fqACr OUANTITY DESCRIPTfON FEE
� tWISUCENSEIAW.).
❑IAM IXEMPT UN�EH 8EC. B.i P.C.FOfl iM15 qEA50N U
�
V" DATE OWNER U
z W
� LICENSED CONTRACTORS DECLARATION W
LL IHEREBY�FF{FMIUNDERPENALIYOFPEIWRY7HATIAMUCENSEDUNDERPROVISIONSOFCH�p7ER �
� /(COMMFNGNOYYITNSECTIaJ770o�OFOM510N70FTHE8U31NES3AN0PROFESSION3CA0E.AND Z
W UCENSE IS N FUl FOi10E Ml�EFFECT.
�7 m
� LICENSE Ci�� LIC.NO. /��� � o �
� oare /� �S/9y oa�ucror+ — .� rtc F�'
� WORKERS'COMPENSATIONDECUIRATION i ,�3v � -�
+ U
N IHEREBYAFiIRMUNDEHPENALNOFPERKIRYONEOFh1EFOlLOWINGDECLAHATION�: " � .
y Z
Q
� �IWWEANUWILLMAIMAINI10EIiTIFICATEOFCONSENf703ELF-INSUREFORWORKFqS' _
COMPENSATION.ASPROVNEU978EC7ION37aoOFTHELABORCODE,FORTHEPEFFORMANCE W
OF THE WORK FOH WHICH iN16 PERMR IS ISSUEO. �
� \/
Q �[�.1 FLNEAND WILLMAIMNN N'ORKEpS'COM7ENSATON NSUMNCE,AS RE�UIRED BY SECTIDN /
�� 97000FTHEU180HCODE.FORfMEPERFORMANCEOFh1ENfORKFORNMICHTHISPERMIi15 (�
Q ISSUE�.MY WOPKERS'OOMPENSATION INSURANCE CAR ER M1D VOLF v Nu.�aea ute. CONS7RUCTION Y/ 1 I U
� CARRIEH �'�✓j a r � i s.,.�r 1'�� PLAN REVIEW
� vo��cr NUMSEa L�q Fj__.7_-_!'� �l��-T ELECTRIC
0 (IIY6SECIqNNE�No7BEm.FtE7EOOFhEPERMtISrrnaIEHU�nRED0ot1ARSRto�onLEss1 PLUMBING
Z ICEpTFVTNATMTMEPERFORYANCEOFiHEW00.KFOHYNiIpi7HISPERMITI515511ED.1 MECHANIC7�
(,�' 314LLLNOTE�.IPLOVANYPEIiSONINANVMANNERSOASTOBECOMESU&IECTTOTHE
� WORKEHS'COMPENSATpHLAWSOFCALIFOqN1AWtlDAGREETWITIFISHOt1LD8ECOME INSPECTIONFEE _�
� SUBJECTTOTHEWORKERS'CONPENSATIONPROVISIONSOFSECTION9700OFTHEL�BOR
cooE.� u.� xrmmrncowr�vmn+n�wSErRowswns. ' ISSUANCE •
p OATE:�!1�� �rrtic�wr J p 'N vV�l(n SMIP _�
� �� ENERGY P/C v
WARNINO:FNLURETOSEWHEW011KER5'COMPENSA710NCAVE AGEISVNUWNL, OSHALLBE
ry SV&IECTANEMPLOYERTOCRIMINALPENKTIESMlOCMLFINE UVTOONENUNDR THOUSANO ENERGYPERMIT
OOLLAR3(St0o,000),INADDITqNTOTHECOSTOFCOMPENSA710N.0AAUGEShSP OEDFOqIN
J SECTpN9TO80Fh1ELA80RCO�E.IMEREST,ANDATTORNEYSFEES. RETEN!!TIONFEE: � e
� CONSTRUCTION LENDING AGENCY PRE•IILT FEE;�� e CI�'Q�IAM�ND RAR
� v �
IHEREBV AFFlRM UNDEH PENILTY OF PERIURY'MhT THERE ISA CANSTRUCTION�.ENDING AOENCV
FOR iHE PERPDRMANCE OF T11E YlORK FOR VR71di THIS PERMI7 IS ISSUED(SEC.9oD�,CIK CJ.
� �-'��
� lENDEN'9 NAME
{— IENDEIYSADORESS
� ICEiiTIFMTM.e.TINAVEREAD7HIS�VPLIGT10N/iNDSTATETUTTNEABOVEWFORMATIONISOORRECT. TOTAL FEES
� IACiREE TO COMPLV NATHALL Cfi'V AND COl1NTY ORDININCESAND STATE LAW9 REUTINO T08UIL�INO �^/ �
CONSTHUCTION,M1D NER�Y AUi110fiIZE qEPRESENTATNES OF THIS COUNTY TO ENTER UPON iHE ��,11 n� �i�4r
S� �eovE.rnENrnr�EO vWovean wa wSPEcran ruRvoSES. COMMENTS �•� ���
9 a v�
m PEMARiEE NAIAE R�
� � R ��i /
� BNiNATUREOF Ei1MRTEE OATE
rt RECPT.NO. PAID BY VALIDATION
F HI7'E-De rtm Ca YELLOW--Flnence
pp py, Copy,RNi:-Aasessor Copy,GOLDENROU-File Copy,GREEN--Applicenfa Copy
, • . � .. ��. . � � . , , . . . . . • , r . .. „ . .. .
CiTY OF DI�N60ND BAR ` -
INSPECTION R@COE�D
� e si • s� - � s o � • • -
SET BACK ,Ct�, FLOOR JOIST • ';
FTGS/FORMS/STEEL �� FHA REQMTS
ELECTRIG GROUND UNDER FLO�R DUCT
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATION • �
TEMP POWER I FIREPLACE BOND BEAM —
WATER SERVICE MID MT. BOND BEAM � --
ROOF SHEATHfNG � 8 FT.BOND BEAM
FRAMINGNENTII.IATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC R�UGH GRADING
ROUGN PLUMBING FINISH GRADING •
SHOWERIT'UB TEST ' POOL EL�CTREC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION , POOL FINAL
CEfLING INSULATIUN OFF SITE IMPS.
DRYWAIL NAILING � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . LANDSCAPElIRRIG.
SEEP PIT/L.L. �N SITE IMPS.
GAS AIR TEST FINAL ZONING '
FINAL CONST a FlRE DEPT. FINAL ! •
FINAL HEATING a HEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID ;
FINAL PLUMBING ENERGY
� +� o
COMMENTS._.�.�, � -
1 zd � t
S�PTIC TANK SIZE
SEEP P171U SlZE
�� . . --------- -
P�