HomeMy WebLinkAbout16948 (35) C1TY OF DIAMOND BAR ��SS l^�.S f� DEPARTMENT OF COIvIIv1UMIY&DEVELOPMENT SERVICES ,��� 21825 E.Copley Drive _ (909)864-3195 Fax(909)861-3117 � PRESS "'%�'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSfTE � I I 5 K� �� �-e -�/�'"'• DATEICATION �-1�-� tNU B R I 1�5y tt'C AODRESS 1 � APN LOT 'r'.�U TRACT 5ZZ L� ISSUE TYPE OCC DATE CONST. GROUP p OWNER vv i•f O ADDRESS 1 � d I�Q,rNttl� G1p ZONING SETBACKS g C�y �YV1 N�' ZIp ( II� T � � FRONT RW ❑ APPLICANT TE R�R � SIDFJSIDE STREET RW D � CONTRACTOR SIDE O o ADDRESS PROPOSED USE S�'W�r L�' o CITY ZIP TEL o ARCH/ENG/ z� DESIGNER NO.DWEL NO. NO. . a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SO.FT. 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J V DATE CONTMCTOR 0- W � WORKERS'COMPENSATION DECLARATION d � I HEREBY AFFIRM UNDEH VENALTY OFPEfiNRYONE OFTHE iOILOWINO DECLAMT10N5: U N Q � _IHAVEMIDWILLIAMN7AMACEi1TIFICr1TEOFCDNSEMTOSELF-INSUREFORWORKERS' S COMPENSATqN,AS�ROVIDEDBVSECTION77000FTHELABORCOOE,FORTHEPERFORMANCE U Q OFTIIEWOHKFORWHICNT1715PERMITISISSUED. � � _I HAYE AND N7LLMAINTAIN WORIfEt15'COMPENSATION INSURANCE.AS REOUIRED BY SECTIDN QQ �70oOf 1HELA80R COOE,WRTHE PERFORAIANCE OFTHE WORIc FOF WMd/THIS CERMIT IS i53UED.MYY/ORNER9'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERIIAE CONSTRUCTION J � �qqiEq PUW REVIEW � POLICYNUMBER ELECTR�C � � �nessEcrior�r�mwreEoor.asrcoocnEVEaMrtsionarae�a►�oamorxUrsR�mloAtFssl PLUMBING y I • Z I CERTIFY THIR W TME PERFORMMICE OF TNE WOFK FON YM�CM TMiS VERMIT IS ISSUEO.I MECHANICAL (7 SWLLLNOTEIAPLOVANYVERSIXJINMIYMANNEFSOASTOBECOMESUBJECTTOTHE � WORKERS'COMVENSATIONLAWSOFCALIFORMAANDAOPEETHATIFIS/IOIILUBECOME INSPECTIONFEE S SUBIECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION77000FTHEUBOti CODE.I SHALL FOR7HWRH COMPLV WIM TiqSE VROVISiONS. ISSUANCE S• � SMIP p DATE: APPLIGANT: � ENERGY P/C WARMNO:FAtURE TO SE WRE WORKERS'COMPENS�iqN COVERAGE i5 UNLAWFUL,AND SHAIL BE �J—y SUBJECTANEI.�PLOVERTOCRIMINALVENALTIESANOCMLFNESUPTOONEMUNOREDTHOUSAND ENERGYPERM�T pOlLAR3(f 100,000),IN AODITION TO TME COST OF COMPENSATION,DAMAGES AS PROVIOEO FOR IN J SECT10N77oeOFTMELA80HCOOEJNTEREST,�NDAT70RNEY5FEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: CC IHEflEBYAFFIRMUNOERPEN�LTYOFPERAIRYTMATTNEREISACONSTRUCTIONLENDINOA6ENCV �- FORTMEPERWRAIANCEOFTHEWORKFORVJNICHiMISPERIATISI55UED�SEC709),CIV.C.� � � � LENDER'SWWE � LENDER'SADORESS \ w ICERTIFYTIATIFIAYEREADTHISAPPLICATIONANDSTATETNATTMEABOVENFOiiMAT10NISCORRECT. TOTAL FEES K� `�' � v � IAGREETOCOMPLYWITHALLCITYIW�COUN7YORDINANCES�NOSTATEUWSRELATWOTOBUhDIN6 � CONSTRUCTION,ANOHEREBYAURIORIZEREPRE NTA7NESOFTHISGOVNTYTOENTERUPONTHE •Z ABOVEdAENT10NEDPROPEflTYFOR WSPECTION URPOSES. COMMENTS 0 ��� � m PERMITTEENMIE(VpINn u¢i '"� `�� vj SIONA ERMITTEE O�/E � RECPT.N0. PAID BY VALIDATION WHITE—DepaRment Copy,YELLOW—Finaue Copy,PINK—Assessor Capy,GOLDENFOD—File Copy,GREEN—ApplieanPs Copy . .. ._.. _. ,. ..� .. . , .-t. -ii , ,, ��.�a . ' .. . .�y'r--'.r,'W�:r_,&:.f":r 1' :^y,C2"', ' . ;^^.r-R M N„ .. � .. �... ..... . ... ...... . . . _ . .. . . . . . „ �.:."". F.''e�,fi",:�:�:. ,:. y, •.s: . . .. CITY OF DIAMOI'�!D BAR � IP�ISPECTIQN RECORD .�.. " =a►�.��.���^�° �.� �'��= �'_��������'��n� . I,�A;�-�����4I���.� , l�r��k.� -- - �►��r������ SET BACK � ! -�!" FLOOR JOIST. �i . ' � � , t FTGS/FORMS/STEEL FHA REQMTS �—,� ELECTRIC GROUND UNDER FLOOR DUCT � � GROUND PLUMBING UNDER FLOOR.CU�IQUIT � � '-� �' •' � ` � 5LAB GRADE FIREPLA'CE FO NDA710N ' `� ' ` '� TEMP PaWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING ' 8 FL BOND BEAM � FRAMINGNENTILIATION! FINAL BOND BEAM � ; ROOF COVER I PRE-GRADING ROUGH HEATING BENCHING i ( ROUGH ELECTRIC f ROUGH GRADING ; ROUGH PLUMBING I FINISH GRADING � SHOWERrfUB TEST POOL ELECTRIC EXT. LATH/SIDING � POOL FENCING WALL INSULATION POOL FINAL CEILtNG INSULATION � OFF SITE IMPS. DRYWALL NAILING � DEDICATIONS SEWER ��iZ � FINAL ENG. . SEPTIC TANK � LANDSCAPE/IRRIG. � SEEP PITlL.L. ON SITE IMPS_ GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATWG � HEALTH DEPT. FINAL FINAL ELECTRiC � DEV, FEES PAID - FINAL PLUMBING -- i ENERGY I -- — _ ia�a'14''��r r soj c�: . ; COMMENTS • � �: SEPTIC TANK SIZE SEEP PIT/U SIZE '.�,.� . ;��� .l� , ,. - ��: - -�.J ,-� � , � _