HomeMy WebLinkAbout16945 (23) CITY OF DIAMOND BAR ����5�'� ���
�� � DEPARTMEM OF CONIIvIUN1TY&DEVELOPMENT SERVICES �
21 B25 E.Copley Drive
(909)860-3L95 Falc(909)861•3117 PRESS
"%�' BUILDING PERMIT APPLICATION FIRMLY
y JODSITE � ' APPLICATION - I u v1PERMIT P/C
o ADDRESS DATE 1 NUMBER #
c� ISSUE TYPE OCC
APN L T TRACy DATE CONST. GROUP
p OWNER U `V
" AODRESS ZONING SETBACKS
SCITY�.y��/�v�-� ZIP TE . � O REAR RW ❑
APPLICAf�T TEL. SIDE/SIDESTREET RW O
� CONTRACTOR SIDE ❑
Q ADDRESS
� CITY ZIP TEL PROPOSED USE
o ARCH/ENG/
z� DESIGNER NO.DWEL NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCFiIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFlPoA UNOER VENALiY OF FEiL1URV THAT I AM EXEMPT iROAI THE CONfMCTORS lF Garage/Carport
W CENSEUWWRTNEFOLLOVnNGREA50N�5EC.7m1.68U51NES5ANDDHOFE5510N5CO0E:ANYCITVOR (n
U CpUNTYWHICNREONRESAPERMiiTOCONSTRUCT.l�1TER,IMPROVE,OEA�OLISN,ORREGAIRANVSTRUG W Patio/Deck
W TURE,PRIOR TO RS ISSUANCE,A150 RE�UIRES THE APPLICANT FOR SUCM PERMIT TO FllE A SIGNED W
� STATEMENT TW�T ME OR SME IS UCENSED PUHSUMlT TO TME PROVISIONS OF THE CONTMCTOfiS Lt•
� CENSE UW(CHAPTEH Y(COMMENGINO WITN SECTION)000)OF DIYISION D OF THE BUSINESSAND PRD• � PooVSpa
FESSIONS COOE)OH THl1T HE OR SME IS E%EMPT TMEREFROM IWO TME BA515 FORTNE ALLEGED EXEMP•
� TION.IM'VIOLATIONOFSECTION7071.6BYANYAPPLICANTFORA7ERMITSU&lECTSTHEAPPLICANTTO Z Re-Root
� ACMLVENALTYOFNOTMORETHANFNEHUNDREDOOLURS(f5D0).):
� OI.ASOWNEROFTHEPROPERTY.ORAIVEAIVLOVEESYATNWAGESASiHEIRSOLECOMPENSATION, O COrtImBfGi81 �
Z VALL DO iME WORI(ANO THE STRUCTURE IS NOT IN7ENOED OR OFFERED FOR SALE(SEG 70��.BUSL
NESS AND OROFESSIONS COOE:TNE CONTRAMORS UCENSE UW OOES NOT APVLV TO AN OWNER OF
N PROPERTVWIiOBUILD50RIMPROVESTMEREON.M7DW11000ES5VGIWONKH�AISELFORHERSELFOR �
K THROI/6HHISORHERDWNEMROYEESVROVIDEDTHATSUq/1MPROVEAlEMSARENOTWTENDEDOR m
W OFFEREOFORSALEF,1qY/EYERTMEBU0.DPlOORpA7ROYEMENTISSOIDNnTHINONEYEAfiOFCOM7LE�
� TION.TME OWNER�BUILDER WILL MAVE TNE BURDEN OF PFOVINO h1AT ME OR SHE DID NOT BUIID OR ,
= IMPROVEFORTHEPURPOSEOFSALEy
O l AS OVMER OF iME PROPERTY.AAA E%CLUSNEIY CONTMC7W O WI7H UCENSEO CONTMCTORS
� TO fANSTRUCT iHE PR0.IECT(SEG 7011.BUSINE55 AND PROFESSIONS LODE:TME CONiMCTORS LI� Va1U8110f1 ADJ.AREA
W CENSEUwDOE3NOTAPPLYTOANOHMEROFAiROVERTYW1108ULD50RIMPpOVE57HEREON.ANO
� VAqCONTMCTSfORSUCHORO.IECTSNn7HACONTMCTOR(SjLICEN5E0pUR5UANTTOTHECONTMG QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW). ,.J
� OIMIEXEMPTUNDERSEC. B.LF.4FORTHISREASON a
� U
�
LL" DATE OMMER V
Z W
� LICENSED CONTRACTORS DECLARATION W
� IHEREBVAFFIRAIUNDERPENALTVOFPEiL1URVTHATIAMLICENSEDUNDERVROVISiONSOFCMAPTER V,
d i(COMMENpNOK'I7NSECTION70oalOFOM5lON70FTHEBU5INESSNJDPROFE5510NSCODE,AND Z
X MY LICENSE IS IN iULL FOHCE AND EFFECi. m
LL �
� UCENSE CUSS LIC.NO. J
V DATE CONTRACTOR a
W
� WORKERS'COMPENSATION OECLARATION a
= U
� IHEREBYAFFIRMUNDERVENALTYOFVERIURYONEOFTNEFOLL0IMNGDECLAM110N9.
C1� Q
� _IH�VEANDWILLNAINTAINACERTIFICATEOFCONSENTTOSELF•INSUREFORWORNER5 S
� COMPENSATION.AS PROVIDED BY SECTION]70o OF TME IABOq CODE,FORTHE OERFORMANCE U
Q OFTNEWORKFORWNICHTHISPERAlITI5155UE0. �
G
_I HAVE ANO WILL MA�MAIN WORKERS'CAMPENSATION INSURANCE,AS RE W IRE�BV SECTION
Q ]7o00F7HELABORCOOEFORTHEPERFORAIANCEOFTHEWORKf-0fiWHIp1THISPERMITIS
0 ISSUED.MVWORKERS'COMPENSI.TIONINSUMNCECARRIERANDVCIICYNUMBEHME CONSTRUCTION
j CARRIER PLAN REVIEW
� POIICV NUMBER ELECTRIC
d
�
(IHISSECRYINEmNDTBECn.RF�mOFTfPERMT6WROhElAN7fiEDDOl1AFt5(StW10RlE5S1 PLUMBING � -- —
Z 1 CERTIFYTHAT N THE PERFORMANCE OF iHE WORK FOR WHld/TNIS PERA.IIT IS ISSUED,I MECHANICAL
C7 SHAILNOTEMPIOYANYVERSONINANYMANNERSOASTOBEC0�1E5UBJECTTOTHE
� WOR1cER5'COMPENSATqNUW50FCAUFORNIA,AN��GREETHAi1FIP.H0ULD8ECOME INSP�CTIONFEE
S SU&IECiTOTHEWORKERS'GOMPENSATIONPf10V1510NSOFSECTION�7000FTNElABOR �SSUANCE �
COOE,1 S WLLL FORTHVATH COMPLY WITH THOSE PROVISIONS. �
0 SMIP
p DATE: APPLICAN7:
J ENERGY P/C
W�RfJIN�:FAILURE TO SEWRE WOFiKERS'COMPENSATION LOVEIUGE IS UNLAN'FUL AND SHALL BE
� SN37ECiANEMPLOYEHTOCRiMWAIGENALTIESANDCMLFINESUPTOONEHUNOFEDTIqUSAHD ENERGYPERMIT
DOILARS(SIOO,OW),IN ADDIiION TO THE COST OF COMPENSATqN,OAMAGES AS GROY�OEO FOR IN
� SECTIDNJ7DlOFiHEUBORCODE,MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
� CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
O
CC IXEREBYAiFIRMUNOERPENALT'OFPERNRYMATTHEREISACONSTRUCTION�ENOWaACENCV
�- FORiHEPERFORMUICEOFTMEM/ORKFORYJ111CMTMISPERMRI3155UE0(SEC.709�,pV.CJ.
Z
W
� IENOERS NM1E
� LENDEfCSADORE55 /�,_
W IGERTIFYTL1TIfUVEREADTHI4MPLICATIONANOSTATET/UTTHEA80VEWFORMAT10NI5fARRECT. TOTALFEES � !�1`�
� IACREETOCDMC�YN7TMALLLT'ANDCWNTYORDINANCESANUSTATEUWSREU71N6TOBVILDIN6 ��
CONSTRUCTIDN,M7O HEHEBYAUTHORIZE EPRESENTATIVES OF iH15 CWNTV TO ENTER U70N THE
ZI180VE�MENTIONEOVROPERTYFOflMS� Twr+vunvoses. COMMENTS
� � �
�
¢ PERMITTEE NAA1E ryNNTJ �/ r/�I/
� /� V
/ /
N SI E FPEMAI DATE
� RECPT.NO. _PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicant's Copy
.. ...._.. ,. ._...._..._ ._, _. _ __ -- - --- - . ..
.. . , . ., , , . . ._ . . . . - - . .,.:�,:. . „ . .. . r . , .., .., .. . .- ,- �. . .,� , .. . . ... , ,.. _ .,;,
" C1 i�a O� 1�f�4PViOF�l� Ef�R
ff�lSF`EC i IOf� f�ECO�D
1����'���;_� c�,rI� ._�__.__�7+'����fi= � f►��-`i.��¢����___..._.�. ��- �: ��`l 'I �?�V'�'= ,�����;���r`�dc��'8 '
r � �M r i+�i �R �:-�� :�'� 1 . �' �
-____._____..__.__-._..______._.__... , .. .._____ _.--"----- --`---.._._--'--.-'- .._.�_.__..._.:-'- ._._...__._ .._-_.,..�.`-`--._._.:._�.."-'_.--'__.W_.._.._._
SET BACK , � � � I FLaOR JDIST �
FTGS,�FORP�15/STEEL r � � FHA REQhr1TS
ELECTRIC GROUND � � UNDER FL�OR DUGT
GRDUND PLUMBING U�JDER FLOOR CU(�IDUIT I
SLAB GRADE I FIREPLACE FOUNDATION I I
TEMP POWER I FIREPLACE BOND BEAM
1�lATER SERVICE I MID HT. �OND BEAM
ROQF SHEATHING 8 FT. BOND BEAM I
FRAMINGNENTILIATION FINAL BOND BEAPd �
AOOF COVER I PRE-GRADING �
AOUGH HEATING I BEtJCHI��G
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING � � FI�diSH GRADING
SHOWER/TUB TEST � POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
VJALL INSULATION POOL FINAL
CEILING INSULATION ' OFF SITE IMPS.
DRYVUALL NAILING DEDICATIONS i
SEWER 1 L�3-�� � FINAL ENG.
SEPTIC TANK �� LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE Ih4PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FIPJAL
FIPJAL HEATING HEALTH DEPT. FIP�AL
FINAL ELECTRIC � �� DEV. FEES PAID
FINAL PLUMBING � (�'a2 ENERGY
6.�. .?4.S1, (.�iCiF_ .,_,_
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
,,�p - i
� I
t�1( i_'�I
_ 'I
�