HomeMy WebLinkAbout13454 (29) J� CITY OF DIAMOND BAR• ' � C�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive 5uite 190
(909)860-3195 Fax(909)861-3117 PRESS
��*�� BUILDING PERMTT APPLICATION FIRMLY
o ADDRESS �S8� S 1 I V[ r L!�11� DATE CATION�/'z /�'� NUMB R �,�� K,C
[
� APN LOT �"� I TRACT 3 2-'f o a pA� '�.�—� Z--"�I TMP� OCC
CONST. GROUP
p OWNER 211 1 �7. �.� � G
o AD�RE�S / � • H nG �u� !3 jv�l. ZONING SETEIACKS
E1
Z CITY CDS'Itl �.SR ZIP�Z� TEL 7/�I--GLX-�{3[O FRONT RW ❑
g APPLICANT TEL. REAR �
� SIDE/SIDESTAEEf AW p
CONTRACTOR 0oC {Rt �, SIDE ❑
� ADDRESS '�O'7�` r PROPOSED USE Q�v���nc -�If�s't�
o CITY�iUc'l5ti� ZIP C�75�TEL�jal��i'�%'�1&� �
o ARCFUENG/
� DESIGNER NO.DWEL NO. NO.
a. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION
�
p� OWNER-BUILDER DECLARATION SFRlADD�AEM
O
p I HEREBY AFFlPM UNDER PENKTY OF FEMINY TU71 AM EXFMPT FROu TNE CONTRACTOnS l4 Garepa/Carport ' ' - � •
W CENSEUwFOqTHEFO�IOWwaHLA50N�5EC.70.tt.68VSNE55ANDPROFE55qN5CODE.ANYC(TYOR (�
C� WUHfYNT71p7RE0UWESAPEflMrtTOCONSTRUCT,AITEfIMPROVE,DEMOl15H2ORREPAIRANYSTRUC W PatiolDoGc
LL� 111RE,VRIOR TO R4 ISSUANCE.AL50 REGlIRES TNE�PPLICANf FOfI SUQI VERMIi TO FIIE 1151CNED W
.� STATC4ENT TMAT NE OR SHE IS 110EN5ED PURSUANT TO TME Vi00N510N5 OF iME CONTRACTOFS LL .
� CENS[lAW(QIMTER Y fGU�AYENCWO WITH SCCTIOH 7000)DF DMS�ON]OF THE BUSINE55 M!D PNO- � PooVSpa
iES51DN5 COOE7 Oq 1FI�T XE Oi15NE IS EXEIA07 TMERE iROM AND iME B+L515 FOR THE ILLEGFD EXEYP.
iqN.MlYYIOlAT1ONOf5[CTIOH7071.�BYANYAPGLICPNTFORAFEflMITSU&lECT51NEMVL�CANTTO Z Re-Roof
� ACMLPENAIT/OFNOTMOREiNANiIVEHUNDREDDOl1AR5(f5o0I.1:
� O�ASOMMEROFTHEPROPEFfT`l.ORUVEMPLOVEESWiTNW�GE5A5THCIq501.EGOuvENS�TqN, 0 (;pmmBrCial � •
YALL DO TME YdOFiK,ANO iHE STRUCiURE IS NOT INTENDED OH OFFERED FOil SALE(SLG'lo1�,BU56 J
NESS IJA PROFESSqN3 COOE:TNE CONTiUCT00.5 LICENSE LAw�OES NOT ADPLY TO AN OWNER OF
� PHOVERTYNM1�OBV0.DSORMPRpVESTHEREON.ANDN?1DDOESSULHWORKNIM^aFLfOqHCRSELFOR � ' �
� T1QidlOHFI50R NER OMT1 ElAPlO�'EES.VROY�OED TIUTSUC711MPqOVEMENTS ME NOT NTENOED 011 m
QOiFEREDtOHSAIEF,NW�EYFR�BV0.DM00R61PR0'�EUEMtSSdDWRHINONEYEAROFC01A7�E-
Z TqN,T11E GWNER�BIAtDER WILL NAVE 7ME BUNOEN OF PNOVW6 THAT N[Ofi SME DiD NOi BVItL OR
� NPRDVE GON TME RIRPOSE OF SALF�.
w O�ASOM'NEROFTHEPiqPERT1:AMEXLiUSNELYCONTMCTN6WITMLICCNSEDCONTRACTORu
� TO CONSTRVCT TM[Pf10JECT(SEG 70a�.BUSiM1E55 ANO PNOFESSIONS LOD[:iHE COHTRACTOPS U• tilyW9tI0f1 ADJ.AREA
CENSE U1w DOES NOT AOVLv TO AN OMMFR OF A OROVERTY VAIO BUM1DS OR IMPROVES THEREON./JJO
�Z WFIOCONTMCT4fOR5UG7iRQ7ECTSMATHACOMMCTOR(S)UCENSECPURSU�WTTOTNECONTMG pUANTIN DESCRIPTION FEE
� 70itSUCENSEUW.1.
� J
0 O IAA1 EXEYPT UND[R SEG 8.8 P.C.FOR THiS REASON U
� �
�l" DATE OWNER U
F LICENSED CONTRAC70RS DECLAfiAT10N W
� INEREB'IAFFYWIM�ERPENKTYOFPEIWt1YTFUTIAIALICENSEDUNOERPROY�5�ON50FCHAPTER V. 1 L.. r�i r � '^ . I p
p., ��GbNYGNCH�1MilI5ECT10N7oo0)OFDMSqN70FTiE0U51NE55�NDPpOFE+510N5CO0E.A.VO Z 7 "� � �v
X MY IICENSE�N M.l FORCE AND EFFECT. m • G O
4J
� 410ENSE CLASS � IIC.NO. �3� � � �.1, ,! s � ^
~ DATE CONT{iACTCR �i]M�►1� � �V V
' W et o.
� WORKERS'COMPENSATION DECLARATION a .
= U
N I HEREDV AFFIRM UNDGR VENtLTV OF 0E0.lURY ONE OF TNE Fd10VnN0 UECIARAT10N5:
� z
C
� �IMIIVEIINDN"LLMA.TITAINACEH!1FICATEO�CDNSENTTOSCLF�NSUR[fORWOHKERi' 2
� CpAPFNSATIDN.ASiRdViDEDBY6ECT10N7TJOOFTHEUBOACODE,FOATMEPERFORMANCE �U
Of iME KOHK FOR NMICH THIS PER41Ti5155UED.
� 2
�I XAVE AND W!LL MAINTAN VIORI(ERS COM7ENSITION IHSURANCE.AS REOUIRCD BY SELTION
O ]7W OF TNE L/I�OR OOOE,�OR iME PERfORMM7CE OF TM[WORN iOR WHid1TN15 PERe+Ii IS j . .' �,i
55UED.MVNOAKER5CdI7EN5�TIONy"�'URANC[GRRIERA4�DOLICVM140ERME: CONST�UCTION
� CA{iqIER � l� 1 PLAN REVIENJ � a�
� POLICYNUA6EN,_, � �� ELECTRIC y. ��/y �
�r�`."r' `
� (M55[CiIONhEmNO7BE0d.F�ETmCFhEPERMt6PDRddWDRCD00lUfL4Ri0�)d71L5S7 PLUM9ING �P !JI G. � �=•.� ,
W .. 1..:.'.'• '.. .T..'r�.�
Z ICERTIFYTTU7NiHEPERFOPoAnNCEOFTHEWO�KFORwMCHTHISVERURI5155VED,1 MECHANICAL '���
V' SHAILNOTEMPLOYANYPE�t50NNANYAIANNCR50ASTOBECAMESUBJECTTOTHE `.rS � ��� '��:�iJ "
� NlOPKERS'CY%APFNSATqNUW50FG11FOMlItiANDAGREETH�TIFISNOUlDBECOME INSPECTIONFEE �•�•
S SU&1ECTTOTHEWdiKERS'COMPENSATqNVROVI510N50F5ECT10N77aaOFiHEUBOR ISSUANCE Q� .•J1�"" �
cooE�s�uu co�mrvnrH courir vnn�nase vrohsans.
� SMIP
p DATE: AVPLICANL ' .
� ENERGY P/C
WAANINO�FAll1RE TO SEUJRE WORKERS'COL�vEN5A710N COVERACE IS UNIAWFUL.ANO 51uL1 BE
ry SUBJECTANEMP�OYERTOCRIMINALPEN/�LiIESIWDCMLFINE5UPi00N[INNDR[DTIIX7SWD ENERGYPERMIT
ppLLARg(i��.�).�N ADD�TION TO THE COSTOF COMPENSAiIDN,D/�dAGE3 AS PNOVIDED FOR W
¢ 6ECTION�7asOFTHEL/�ORCOOE.NTEREST,IWD�TiORNEYSiFEA RETENTIONFEE
a CONSTRUCTION LENDING AGENCV pRE-ALT FEE:
O
� �MERFBVAFFlRIAUNOERPENALiYOFPERA1RYiHATTNENEISACONSTFUCTiONIEND�NOAGENCY
z fOR iHE FENFOFMANCE OF THE M'ORK FON M/NiCH TNiS P£RuIT IS ISSUEO(SEC.f0Y7,CIV.F).
W
$ �ENDfR'S NAUE
� ►ENDER'SADDPESS +]
WICERTIfYTHATIFUVEPEADTIISAPPLICA710NAND5TATEiNATTNEABOVENFORUAT10NI5CORRCC2 T�TAL FEES �� // �
p� IAGRE':TOCOMVLYM7THNICR��NOCOVNTYOti7WMlCESANDSTATEUwSPEUTINOTOOUiIDINO ,
CONSTRUCi�ON.1W�NERCBV ILLfT110iiIZE NEGRCSENTATNES OF iHIS CWNN TO ENTER UPON THE
S� �eovE�uerR�oneD vnoaEA7Y�t it+5vEc7�on WacosEs. CONMENTS
9 �,�w�:h1.�l,�,l or/�-u-fc,. f-f-P.i Ap����-
a �aM� EN � ,�, ���Z/y9 .
� ��y
vj 6iCNANfiEOFVE'7'TEO O�TE
� l/ . �Ecar.No. vaoev _ v�uo�nori
WHITE-0epetim0nt CopY.YELL�W—Flnance Copy.PINK—As�assor Copy.GOLDENROD—Fila Copy,GFEEN-1lpplieant's Copy
CITY OF DIAMOND BAR :. , �
'�� ''"� � INSPECTION RECORD�
' �. � e � � ' • � � e � '
SET BACK ' � � i�, ;. FLOOR JOIST
FTGS/FORF�IS/STEEL � • FHA REQMTS
ELECTRIC GROUND � ' � UNDER FLOOR DUCT �
GROUND PLUPJIBING UNDER FLOOR CU�!DUIT •
SLAB GRADE FIREPLACE FOUNDATI�N � �
�TEMP POWER ' FIREPLACE BOND BEAM _
WATER SERVICE - PJIID HT.BOND BEAM - ' • • - �
ROOF SHEATHING ' '� • • • • � 8 FL'BOND BEAM ' , � -
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING �
RaUGH HEATING BENCHIPJG
ROUGH ELECTRIC : ROUGH GRADING
RaUGH PLUMBING ��� �_ FINISH GRADING
SHOWER/TUB TEST � - - POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING '
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS. -
DRYWALL NAILING DEDICATIONS
SEWER. . .... . . . _ ; FINAL ENG.
SEPTIC TANK _.. LANDSCAPE/IRRIG.
SEEP PITlL.L, - ' ON SITE IMPS.
GAS AIR TEST• - - FIPJAL ZONING
F1NAL CONST. - - FIRE DEPT. FINAL �
FINAL HEATING � HEALTH DEPT. FINAL ,
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING . c t�4 . .� �: . ENERGY
,� ,
`• � � �� -.t � �: `,=�=r��,�'�p1� ; -
':� • , ' _ � . . . ,- � .. . _. . --•- - _ . : . .- . ,, . ';
cor,nr�nErv-rs
. , ,,-. .
..,� .:,�,
_ .,�,;,_�: ,:
._ ,:
SEPTIC TANK SIZE '
SEEP PIT/U SIZE
��. � •
��1. � - ., ... _ ,. , :
. .. . • - . . . . , ,
� � . �
��
_ �__.. _.. � .
