HomeMy WebLinkAbout16930 (37) �� CITY OF DIAMOND BAR �
DEPARTMENT OF COIvIIv1UNITY 8c DEVELOPMENT SERVICES
\\'� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
� BUILDING PERMITAPPLICATION FIR Y
Q ADDRIESS W I /LUE APPLICATIO �p•D� PERMIT P/C
p � � . �—�� DATE NUMBER�I�(�Z�p
� APN LOT TRACT ISSUE TYPE OCC
� DATE D U CONST. GROUP
p OWNER
p ADDRESS � IL ROI�C ZONING SETBACKS
Z CITY � IP�_ TEL. REART RW p
g APPLICA T ,Bqf D �L+j��. TEL. ��� SIDE/SIDE STREET RW p
� CONTRACTO � � SIDE ❑
ADDRE ' �
� CITY ZIP . TEL / .�• :-lS-y PROPOSED USE d . (H3
�
w ARCH/ENG/ � �
z DESIGNEFi �
w NO.DWEL. NO. S, ' , •NO.
a ADDRESS
= CITY ZIP TEL UNITS STORIES BEDROOMS
�
cn DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER�BUILD[R DECLARATION SFR/A�D/REM
O
1 NEREBY AFFlPIA UNDER FENILLT/OF PEM:RY T/UT 1 AM E%EMPT FROM THE CONiMCTORS l4 G3f0A0/CB�pOR
W CENSEUWiOHTHEFOILOWWOREASON(SEC.7071.SBUS:NESSANODilOFE5510N5CO0E:ANYCITyOR (�
U COUN7yWryIp7REWIRESAVEM�ITTOCONSTAUCT.ALTER,MPROyE,pEMOLISM,ORREPAIRA1rY5TRVG w
W TURE PRqR TO ITS ISSIJANCE�LSO REOUIit[S THE�PDLM.AM FOR SUCH PERMiT TO fllE A SICNFO W PatiO/DCCk
� STATEMENT iHAT HE OR SHE IS UCENSED FViiSUANT 70 TM[PROVISIONS OF TNE WNTMC70R5 LI� �
C CENSEUW�qNVTERi�CDMMENCINCWITHSELTION7oo0)OFOIVISiON]OFTMEBUSINESSIW'JPRO� POOUSPO
V FESSIONSCOOE)ORTHATMEORSHEISEXEA/nTTNERCFPOMANDTHEBASiSFORTHEA��ECFOE%EMv. C7
.0 TION.ANYVKKATIONOFSECTION7071.lBY/uaYA7PLICANTFORAPERMIT5U61ECT5TME�PPUGWTN Z R8-ROOI
ALML PENJILTY OF Iq7 MORE T1UN FNE HUNORED DOLURS(f5oo�.p
0 4 AS ONRIER OF THE PROPE RTY,OR MV EMPLOVEES W�TH v1AGE 5 AS THEIF SOIE COMPENSATiDN,
Z VALL DO 7NE WORK Ml�THE STRUCTURE IS NO7 IN7ENDE0 ON OFfERED FOR SA:E ISEG.70��,9U51• � COmrtlOfCial
N NESS INO PRO�ESSIONS COOE:TME CONTMCTOi75 LICENSE UW DOES NOT AV7LY i0 AN OWNER Of j
PRDPERTY Yhq BUI(DS OR IMPROVES iH[REON.NN�1M��O DOES SUCH VJORK HIMSELF OR NERSELF OR
2 7NROUGHHISORNEROYMEMPLOYEES.VROYIDEDTHATSUCMIMPROVEIAENTSMENOTINTENDEOOH CO
w OFFEREDWRSKEIF,MOWEVERTMEBULDINCO(IIMPRpVEIAFNTI550LDW:7NNONEYEAROFCOMP�E-
0 TION,TME OWNER�BUqDEfl WILL FUYE TME BUflOEN OF PflOVINp THAT NE Ofl SHE D�NOT BUI�OR
Z IMPROVEfORTMEPURv0.5EOFSALE). �
Q= OIASOWNEROFTNEVROPERiY,AME%CLUSNELYCAMMCTINQWITHLICENSEOCONTMCTORS
TO WM'TRUCT 7HE PpOJCCT(SEC.701�.BUSINC55 ANO PROFESSIONS GODE:THE CONTqACTOf15 Lt� V31U0tiOn ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANONTlEROFAPROPEATVN4�OBNtD50RMVROVE5711EREON,AND , ••
� 1MiOCOMMCT5FOR5UL}1FRO.JECTSYA7HACONTMLiOR(5)LICENSEDVURSUANTTOTHELONTMG QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW�.
¢ O I AM E%EYPTUNDER SEC. B.d P.G FOfi THIS RE1�SbN Q
� U
LL ¢
OATE OWNER U
Z W
_ ¢ LICENSED CONTRACTORS DECLARATION W
OC IHENEB'l4FFIRMUNOERPENAL7YOFGEiiJUHYTHATIAM�ICENSEDUkDER7ROVI5KKJSOF�HAPTER Vr
� C(COMMENCW6 WITN SERION)000)OF DiV15lON 7 0F THE BU51NE55 AND PROfE55�Or:S CODE,AND Z
X MYLICCNSEISINFUL�FONCEIWDEFFECT.
� �� �Q �_�� �
u, UCENSECLASS_S__e.Z—`/ UC.NO. �„�� m
V DATE T T COMRAC70R a
W
� WORKERS'COMPENSATION DECLARATION 4
NINEREBVAFFIRMUNDERiEN.LLTYDFGEiWRYdJEOFTHEFOLIAK:N��ECURAT10N5. Z
G �I NAVE AND WILLMAINTAIN�CERTIi1CATE OF CONSENT TO SELHNSURC FOR VIqiKERS' _ —�'
� GIMAPENSA71pN,A50ROV10EDBY5ECTKKJnooOFTMELA[30RLODE,FORTNEOE0.FORIAANCE U � '�'r "S�'-'_'�
OFMEWORKFOfiWMipITHiSGERMIT19155UE0. � � --�r-_ . - �. -� --�-
0
�IH�VEANOWILLMAIMA�NWORKERS'COMPENSAiqNINSURANCE,ASREWIREOBYSECTION � � ��^� 1�T
Q 77000F iNE UBOR CODE,FOR THE DERFOWJANCE OF TME WORK FOR WNiCMTH15 PER4:T IS n 1�(` �� � Dq , �
ISSUED.MVWORKERS'CAMVENSATIONIN��n y�ECARAICR/V�POIICYNUMBERARE: CONSTRU TIONf.j� I7 � � V
� CARRIER_,;S�AT� � ,���n- PLAN REVI VJ �
Z POLICVMIMOER_l-Et ELECTRIC ��r, �
¢ ,_r=�._.__�---
� (I}tSSECIIONNCmNDTBE00NPLEIEDOFTIEPERM'6W{i0nE4111�O11ED00LL�ViSI[�Oo)piL6S1 PLUM6ING -""--'"�
Z ICER7IFYTWR W THE PEAFORMANCE OF iHE WORN LORNMICHTHIS PERMIT IS ISSUED,1 MECHANICAL '
('J SNALLNOTEMPLOYNlYPENSONNANVMANNERSOASTOBCCAM[SUBJECTTOTHE
(n WORNERS'COMPENSATqNlAN50FCAlIFOpNV�ANOAGREETMATIFISHOULDBECOR�E INSPECTIONFEE
S SUBlECTTO7HEWORKERS'CqAPEu5A7iONiROVI5iON50F5Ett N7)OOOFTMEIABOP
caoe.-`�nnnTn caer�r vnrn nroce rrro�sar+s. I SSUANCE
� ' SMIP �
p DATE: � APPLICANT:�.
J WARNINO:FA URE TO SECURE WORKERS'COMPENSATiON COVERAGE IS UNUwFUI,AND SHALLBE ENERGY P!C
�y SUBJECTANEUP�OYERTOCR:MINALPENALTIESANDCINLFWESIJPTOON[Nt1NDRE0THOU5M10 ENERGYPERMIT
OOLLARS(f I0o,000),IN I�DDITION TO THE COST OF COMPENSATqN,CAMAGES AS PROV:OED FOR IN
� SECTION770lOFh1EUBOflCODE.IN7EqE5T.�YD�TTORNEY'SfEES. RETENTIONFEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I NEREBY AFFIPM UNDER PENALT/OF 7ERIURV 7HI1T THEAE IS A CON57RUCTION LENOINC AGENCY
FOR TNE PEfiFORMANCE OF THE WORK FORwHiCH TMIS PEAMR IS ISSUED�SEG]OD1,CIV.G).
Z
W
� LENDEi#SPUME
F— LENDEf7SADDNE55 -�
¢ ILERTIFYTMATIHAVERUDiNISAPPLICATIONANDSTATE7MATh1EABOVEINFORAIATqNISfAii17EC2 TOTAL FEES . � V
W I AGREE TO COb1PLY WITH ALL GiTY ANO COVNT'ORpINANCES ANO ST�TE UwS PCLAT:NO TO BVLLDMO
� fANSTRlKT10N,ANDMEREBVAIRHORIZER[PFESENTATIVESOFTl1ISCWNTYTOENTERUPON7ME
z AOOVE�MENTIONEDOROPERTYFORINSPELTIONPURPOSCS. COMMENTS
� , �
J
_
m VEN . [IPRINT) �
Q
N �
� SIGN .uRLOFPERMITTE DATE
� RECPT.NO. � PND OY VALIDATION
WHITE—Depar,ment Copy.YELLOW—Fnence Copy,PINK—Assessor Copy.GOLDENROD—File CoOy.GREEN—ApDlican['s Copy
. - ....:,.,-:..:.....:...:...._.,......� .. .. .. ._ . -, ,_ _..- .. . .. - •.,... -. _,,..., ... .
� !:,li'� Ot= L�l,��.[���t�(: E�r'-.Ii
?i�!�[=:=r i�iOP,.! �:��:�GTG
_...�____.__._.__.....__... — - --..�._....__...._--•-- - .-• -- •--___._�____�___...T__ ___.__ _ _
I►�F:j,aat;[[��►�E �'1�':f= li'E�i'�=;L 'F:EJ�� li`ti�E���c��r'lcla! �t:t:['- ;IJ(�`i�!_,e�.:i`c'].{
'�--.:..----..._.. ...: . . .... . ........_......... .. .
--- ---- --- ..... . . .. _ _. . . _ ..--- ------....... _...-----_._..._--
SET BF,CY. I i ___ `__ � I FLOO�JOIS i ' i •.
FTGS;FORP�IS;S i EEL �------� ' i FH;, REQ„TS ----- ----I - �--
--�-; !� i
ELECTRIC GAOUND � ; � i I UhJDER FLOOR DUCT � �
1 —
GROUND PLUi�1BIfJG � � � � Ut1D:� FLOOr3 CCidDUIT ;�
SLAB GRliDE I I I � �If��PLF,CE FOUtJDr"�TIO"J � �
TEP.9P POVJER � — � — -----i � FIREPLACE f7"JD �E-.��P.1 I-- —� --
�"JATER SEFiVICE � -- i � ------�1 �.91D fll. �30"�:D F��Fr�----1------� -
RdOFSHEATHING 19 ! v(—T�� ��� i � 8FT-. E37;dQ.9��,':^, ------_-�- -__i ----
FRA"�11PdGNENTILII,TiOP1 I j� I , I FI�dAL�OPJD E3EA�.1 j
A --�—�------ ----�— ----
ROOFCOVER ��0�/(�O( I/Y_/�� I � FRE-GFil,DItJG ___ I__ I __
ROUGH HEATING I � ___1 6ct•1�f-11�J�a _ � �
ROUGH ELECTRIC � � � ROUGtI Gr^,ADiP�G __ _ —�
ROUGH PLUt�1�ING � iJ _! � FIP;ISH GRADI?JG _ � --
SHO�"JCR,�TU3 TEST I ; � POOL ELECTiiIC _
—�---- - -
EXT. LATH/SIDIfJG � _� ___ I � �'C�L FEh.CIt1G � I __
�"JALL RJSULATION � J � f'OOL FI�•;AL �
CEILIN3 IfJSULATION � � � I Orr SITE 1�:1?S. I _.l
DRYV'JALLNAILI�JG I_� ------ ---��_DEDIC�ITIO��S --- �- _�
SE�VER � � FIfJAL EPJ,. �
SEPTIC TANK I _ �� LA�JDSC!'�P�/IRRIG. _ � �
SEEP P!T/L.L. l � i I C�J SITE IP:4PS. I I
GAS AIR TEST �_ � FI?JAL 7_ONI�!G ; �
FINAL CONST. � I , �IRE DCPT FI�Ji,!
FINAL HEF,TING I � I I IicALTH DEPT. FIfJAL �
— -4---
FRJAL ELECTRIC � � I G�V. F�ES PAID _ l ; __
FI�lAL PLUiJiBIiJG I I I EtJ�F�GY I I
.. I I— f-- —t— -
,.
I I
i-p-_.._._..._n�.._...,w..,__.._.._
� --- ----!L•� .,.__,.,�--_�<--- -...^—___..--_.._ � -
CUPJIMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE -�
.�._.._��1� ._._...—.__
rar,r -
�• �
�4 .