HomeMy WebLinkAbout16852 (25)�- -
��� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suitc 190
� (909)86Q3195 Fax(909)861-3117 , PRESS
� '�' BUII.DING PERMIT APPLICATION �, �C'S ( C 2 G FIRMLY
o ADDRESS W Z` V f�V1 I I � 1 V �`��� DATE CATION �'� � NUMB R �0���#/�` �
� m ISSUE TYPE OCC
APN OT T�iACT ���2,�r�- DATE �� �'CONST. GROUP
¢ OWNER �
� ZONING SETBACKS ' '
ADDRESS
� CITY � ZIP TEL. REART . RW �❑
APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
q� ADDRESS PROPOSED USE ` �
� CITY ZIP EL. .
8 ARCH/ENG/ . .
� OESIGNER NO.DWEL. NO. NO.
ADDRE S UNITS STORIES BEDROOMS
� CITY ZIP TEL
�
cn DESCRIPTION^ , SQ.FT. F CTOR PSF ADJ.AREANALUATION
O OWNER-BUILDER�DECLARATION SFR/ADD/REM - Q
� I HEREBV AFFlRM UNDER PENALTV OF VERNRY THAT I AM E%EMPT FROM THE CONTRACTORS L4 Q8f9QB/CBfPOfI '
CENSEUWFORTHEFOILOWMOREh90N(SEC.70J7.6BUSINESSANDPROFESSIONSCODEANVGTVOR (n �
COUJTYNTi1p1HEOlARESAPEAMffTOCONSTRUCT,ALTER�P��.OEMOLISH,ORREPAIRANI'STAUC- W p81b/DBCk
TURE,VRpfl TO ITS 19SUANCE,AL50 REW IRES iHE MPLlCANT FOR SUCH PERMIT TO FILE A SIONED W
STATEMENT 71iA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI�
� CENSE UW(CHAPTER Y(COMMENCWO WITH SECTION 7000)OF DIVISqN J OF THE BUSINESS AND PR0. � POOVSPB � � . -
FESSIONSOODE)ORTMATMEORSHEISIXEMPTTHEREFHOMMlDTHEBASISFOR7HEALLEOEDEXEMP� C7
TION.ANYVIOLATIONOFSECTION70J7.6BYANVAPPLIGNTFORAPERMITSUBJECTSTiEAPPLICANTTO Z Re-Roo1
� AGVIL PENALTV OF HOT MORE hIAN FIVE HUNDRED DOLlARS(i500).):
� OI,ASOWNEROFTHEPROPER7Y,ORMVEMPLOVEESWI7HWAOESASTNEIRSOLECOMPENSA710N, � Cq�mBfCiel � • � �
WILL DO TME WORI(MA THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704I,BU51� J
� /iESS MID VROfE5310N3 ODDE THE CONTRACTORS UCENSE Uw DOES NO7 A7PLV 70 AN OWNER OF � .. , . �
PqOPEHTV NRiO BU0.DS OR IMPROVES THEREON,AND WFIO DOES SUCF1 WOfiK HIMSELF OR HERSELF OR �
� iHA0U0H WS OR HER ON7J EMPLOYEES,PROVIDED THAT SUC/I IMPROVEMEMS ARE NOT INTENDED OR m .
OFFHiEDFOR3ALEIF,HOWEYER��ILDINOORWPROVEMEHT1350LDWITHINONEVEAROFCOMPLE B � C
Z 'TqN,THE OWNERAUILOER WILL HAVE THE BURDEN OF PqOVINO THAT HE OR SHE DID HOT BUILD OR
� IMPROVE FOR THE PUR➢0.5E OF SALE} �
W OI.ASOWNEHOFTIEPROPEHTY,AA1IXClUSNELVCONTRAC71NONrtTHUCENSEDCOMMCTORJ
� TO CONSTRUCT THE PR0.IECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI- VelU0li011 ADJ.AREA
CEN9E UW DOES NOTMPLY TO AN OY/NER OFA PROPERTV WHO BUILDS OH INPROVES THEREON,AND �
� WFqCONTRACTSFORSUp/PROJECTSWITIACOMMCTOR(5)UCENSEDPURSUMlTTOTHECONTRAG ou,aNnTv DESCRIPTION FEE �
TORS UCENSE UWJ.
� O I AM IXEMPT UNDER SEC. B.i P.C.FOR 7HIS REASON J � �,(i � �
Q
3 � •
�
� DA7E OWNEH (Hj �" ,- ���.. � � O
� UCENSED CONTRACTORS DECLARATION W •
J Z Lnl•
� W
I HEREBYAFFIfUI UNDER PENAL7Y OF PERIURV 7HA71 AM LICENSED UNOER PROVISIONS OF CHAPTER � ` �� .
� i(COMMENCWO WITN SECTION 7000)OF DMSION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z � • '
"� W IICFNSE IS w FULL FO CE ANO EFFECT. m
� � � 0.
� LICENSE CLASS LIC.NO. ' �
~ DATE CONTRACTOR � d �
i � ev 1
� � WORKERS'COMPENSATION DECLARATION Q vy ,.Y �
� I HER AFFlRM UNDER PEN�LTY OF PERIUPY ONE OF TME FOLIOWINO DECLAHATIONS: Z 1 �
�� I���lIAVEANDWILLMAIHTAWACERi1FICATEOFCONSENTTOSELF-INSUREFORWORKERS' a
2 1 � /
� CONPENSATqN,AS PROVIDED BY SECTION 37o00F THE LABOR COOE,FOR THE PERFORMANCE w Y �V
Q THE WORK FOR NMICH THIS PERMIT IS ISSUED. �
� I HAVE/V�/D WILLM/JNiAPI WORKERS'COMPENSATION INSURANCE.AS REWIRED BV SECTION
4Q 3�0a OF THE LABOR CODE.FOR THE PERPoRMANCE OF THE WORK FOR NMICH THIS PERMR IS
ISSUED.MY�vc ERS'COMPENSATION INSU CE CARRIER AND � CY NUMB R ARE CONSTRUCTION
� c�wRiER � 1 �U S• o PLAN REVIEW
�Z pp�V�!1�Q^y�M�l€''P) ELECTRIC •�/
¢ ` �
0 (IFOSSC-��IONMEID ENI.vLEiIDOF71fPERAff6FOf7oDlEFAFDiiEODoILPitS(ftao)aaLEss} PLUMBING I� •1JJ �,,�
W �+^� � �
Z I CERTIFY THAT W 7HE PERFORMANCE OF THE NVRK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL V �
U'� SHKL NOT EMPLOY ANV PEFiSON W ANY MANNER SO AS 70 BECOME SU&IECT TO 7HE
'(/J WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE TMAT IF I SMOVLD BECOME INSPECTION FEE
SUBJECT TO THE WORI(ERS'COMPENSATqN GROVISIONS OF SECTqN 3�0o OF THE L�Boq „�``.�
s �"�o E,�I fSH�ALL�FORhRYITH CAMPLY WITH TFqSE PROVISIONS. ISSUANCE �
p DATE:�l/1 APPLICANT: ����Q��� SMIP S
J WARNINO:FAIWRE TO SECURE W'ORKERS'COMPENSATqN COVERAOE IS UNUWFUL,MJD SMALL BE ENEROY P/C O i��[�
�y SUBJECT/W EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED T}KK15AND ENERGY PERMIT //1'
DOLURS(t100.000),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF THE LABOR COOE.INTEREST,AND ATTORNEV'S FEES. �'Q']� �
p� RETENTION FEE: � v
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFlflM UNDER PENALTV OF PERIURV THAT 7HERE IS A CONSTRUCTION LENDWO AGENCV �
FOR THE PEFFORMANCE OF THE WOR/K-FOR H?iICH THIS PERMI7 IS ISSUED(SEC,30G\7,CIV.C.).
� LENDERSNAME �,Io{ Ilv���,ITV\ 1 1 \ol�/S / � • � .
1— LENOER'SADDRESS
� TOTAL FEES " ��
� I CERTIFY THAT I HAVE RF1D THIS MPLICATION AND STATE THAT THE ABOVE INFORA/ATqN IS CARRECT.
� 1 AOREE 70 COMPLV WITH ALl CtTV AND COUNTV ORDWMICES ANO STATE UWS REUTING 70 BUILDING y�
•� CONSTRUCTION,AND HEREBV AUT}IORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON iHE ' � -
Z ABOVE-MENTIONED PROPER7Y FOR INSPECTqN PURPOSES. COMMENTS � '�\
�
J
�
� PERMITTEE NAME(PR1 '
UJ 9 ���D
� sio REOF7E EE DATE RECPT.NO. ' PAIDBY � VALIDATION
� WHITE—DepaRment Copy.YELLOW�Inance Copy,PINK—Assessor Copy,GOIDENROD—Flie Copy,GREEN—ApplicanCs Copy
CI'�'Y O� V���1i1N�Jf�� �B�aR
� !9�lSPEC�'i01�! REC�9��
'a � . ���.C"`�t � D � . .� ��' s � n�2S �,'�"•''` :Wv`:-N;4.i�.i.d�u�+�" � � I � ��o (} o
SET ElACK FLOOR JOIST •
FTGSiFORMS/STEEL FHA REQMTS '
ELECTRIC GROUND •� UNDER FLOOR•DUCT �
GROUND PLUM8ING 2.-�X ' • UNDER FLOOR CU�IDUIT '
SLABGRAQE I FIREPLACE.F(aUNDATION . �
TEMP POWER FIREPLACE BONQ BEAM
WATER SERVICE MID HT. BOND BEAM .
RO�F SHEATHfNG •-a:• : -�� • `� 8 F7: BOND BEAM
FRAMINGNEIVTILIATiON -� -U/ FINAL BOND BEAM
ROOF COVF_R PRE-GRADlNG
ROUGH HEA7ING ' BENCHING • �
ROUGH EL CTRIC � • ROUGH GRADING
`��������_ M.����J ' " �'�.�1� FINISH GRADING
�`F!O �TUBITE�ST ' POOL ELECTRIC �
EXT. IATH/StDING• �j— POOL FENCING
WALL INSULATiOId ,0� POOL FINAI. .
�EILING INSULATION ' OFF SITE IMPS.
i3R��'1NA41.{di�1LtNG 30 � �EDICF�TIONS �
SE�ER,�� ,,��=`, , • � �� _ FINAL ENG, � �
S PTIC 7AfVK' LANDSCAPE/!RRlG. ,
SEEP P1T/LL. �_±�:,,' �;.L� � �t -:`_ ON SITE IMPS.
GA�f A!R TEST FINAL ZONING
f�IM1J�I'�lC%�M�`r. � - FIRE dEPT. FINAL
FI^6 �.}-lFA�ING � i , - HEALTH DEPT. FtNAL
�S�V�t •t! GTRIC - � � -' a • DEV. FEES PAID
r �=i'd�.L PLUNiSING� , . ENERGY
. . \ ,
� ' ' � p .fl O �a .
f ���� `� . .. - P ^br — __ _
�`��S , -- `" ' -
r.1': .
:�i . .
� nh .
� ', r,
- i � .„F -�a ` < .., i � ' �
'`..' ,J.f:.•C;4 ',�+.'.L!'i:i..�i. --_
. ';:, . �_. ; �.J�.i.C- ,
i��-..1..% ,
y------ •
SER.TI���K SiZE _ T
SE�P PIT/U SIZE ---
� t � ��� �
FI�! 5;. 1 ""�'�.� �'tl. �.�� . � , ' . � ' � , �
�. �t F
'W � �d Yti. f�� �y�'p �� � .
`'�'i_ ,4�.. .
�n� ,- �.�r' � � �}`� .'. .
UU �`�� �" �� '
6- � . � 5
$� �6 ,p"�� '"�.. ;�.� w� - _
. , �q
I�}+lx'�� ��'�`' �., ,q:'m ',��.
s .s ;°. : : . .
-�c ,i�4 r .,•,�r,�3 �e� }�;« R::a � .
r�, �.,r° �'��,'.'f�" 5+':`f':�r� \ ' J , ' ' � .
, � ' _.���__ ___ _ �,