HomeMy WebLinkAbout17870 �` CITY OF DIAMOND BAR /�� '�
DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES (� (.; /
21825 E.Copley Drive ��
(909)860-3195 Fax(909)861-3117 PRESS
�`%� BUILDING PERMTT APPLICATION FIRMLY
o DDRIESS���d � �TTT� �i.L�T DATE'CATIO � O . �y. NUMBER �/ P!C �
K �� I�
� ISSUE �a a2 TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER __�o S h,t1.c� '�S u
" ADD ESS b'f- S ' ZONING SETBACKS
Z CITY� ZIP �(7 b�TEL �3 q� Shc�$ FflONT RW O
g APPLICANT ��'�'Z CO.M.t TEL. � REAR p
� � SIDE/SIDE STREET RW O
� CONTRACTOR ��� �' �?y SIDE ❑
Q ADDRES ' � • �
o CITY ►2 e1✓ ZIP ZSr3-�TEL�/ PROPOSED USE c o c�
wo ARCH/ENG! �� �
z DESIGNER NO.DWEL NO. NO.
oW. ADDRESS UNITS , STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBY AFFIRM UNDER VENALTY OF VEiWRY THAT 1�M E%[MPT FROM THE COtiTMCTORS L4 8/pOR /
W CENSEUWfORTNEFOLIOWIN6REA50N�5EG70.71.68U5ME5511NDVROFE55�ON5CODE:ANVCIT`/OR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSiRUCT,ALTER,MPROVE,DEMOUSH,ONNEGAIRANYSTRUC• �J,J jjp/pgCk 1
� TURE.VRIOR TO RS ISSUANCE./�150 PEOUIRES TNE APPLICIUdT FOR SUCH iERMIT TO fILE A SIGNED W
STATEIAENT T1uT HE OR SHE LS LICENSED DlliiSllANT TO THE PROVISIONS OF TME CONTMCTORS U•
� CENSE UW(pUPTER i(C01.1MENdNa N7M SECTION 7000)OF DIVISION 70F TNE BUSINESS Ml�PRO- � POOVSPB
fES510NS CODE�OR THA7 HE OR SHE IS EXEAIPT 7HENEFROM AND TME BAS�S iOR TIE ALLEGED F%EMP-
VTION.ANYVKKATqNOFSECTION7071.bBYANYAPPLICANTFORAPE1iMITSVOJECTSTNEAPPIICANTTO Z Re-Roal
A pVIL PENILNOF NOT MORE THAN LNE HUNOREO DOlUfiS�f5oo).�:
Z ❑I,ASONTJEROFMEPFOPERTY,ORMYEMFLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COff1R10fC131 �
YALL 00 TME WOHK�ND THE STRUCTURE IS NOT IN7END[D OR OFFEFE�FOR 5lLLE(SEC.7M�,BU51- J
� NESS AND VROFESSIONS COOE:THE CONTMCTORS LICENSE lAW DOES f:OT AGPLY TO AN OWNER OF j
FROPERTYVA108U0.DSORIM7HOVESTHEREON,ANOYAIODOESSUp1WOfiKHIMSELFORMERSEIFOR
[C THROUGMHISOfiHERONMEM7lOYEES.VROVDE�7FL1T5UCHIMPROVEMENTSARENOTMTEN�EDON m
QOFFEiIEDPoRSALEIF,HOWEVERTME8UIL01NGORU.IPROVEUENTLS50LDMATHiNONEYEAHOfCOA1PLE•
Z TION,TFIE OwNER-BUItDER WILL HAVE 711E BURDEN OF 7ROVw6 TNAi HE OR SNE DID NOT BUILD OR
= MPROVE FOR TNE PURPOSE OF SALE4 �
w OL��N'NEROFTIEPROPERTV,IIME%0.USIVELYCOMMCTINOWITHLICENSEDCONTRACTOH3
� TO CONSTRUCT THE VHQIECT(SEC.701a,BUSINE9S AND Pf�FE5510N5 CODE:THE CONTMCTORS LI� Vdl{18tlOfl ADJ.AREA
W CENSEUWDOESNOTAPVIYTOANOWNENOFAFROPERTVI`rtWBUILD50RIMPROVESTMEREON.AND
� W11000NTR�CTSFORSUCNGRO.lECT5W17HACONTMCTOR�S)ULENSEDVURSU�N7TOTNECONTRAG QUANTITY OESCRIPTION F
Y TORS UCENSE UW). h
� OIAME%EMPTUNDERSEC. B.BP.C.FORTHISREASDN U CJ �
�
U. �
Z DATE OWnER w �7 /� •y `
� LICENSED CONTRACTORS DECLARATION W
� INEREBYAFFIRMUNOERPENALTYOF7ERNRVTHATIAMLICENSEDUNDENFROVISIONSOFC1u�PTER Vr
p. 9(COMMENpNOYATHSECT10N7000)OFONISION70FTNEBUSINESSANDPROFESSiONSOODE,ANO Z
u� L(Y UCENSE IS N FULI FORCE ANO EFFECT. m
� UCENSE CU55 �O J���7� UC.NO. y� �
V DATE �'�U^��— CONTRACTOR C��4+�S�LL 'L�. d
W
� WORKERS'COMPENSATION DECLARATION Q
NIHEREBVAGFI{UAUNOERCENALTVOFPE0.1UilYONEOFTMEWLLONANIiDECLMATIONS: Z
� �IHAYEANDWILLMNNTNNACEFTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
COYVENSATION,ASPROVIDEOBYSECTONTo00FTHEUBORCOOE,FOR7HEPERFORMANCE U
Q OF iME WORK FOR WHICH iH13 VERAIIT IS ISSUED. �
�
�I HAVE AND WILL MNMAIH WOPI(ER5 COMVENSATION INSUfLWCE,AS RE WIRED BV SECTqN /
Q 97ooOFTMELABORCODE,FORTMEPERFORMANCEOFTHEWORK(ORWHICHTHISPERMITIS , /J�
ISSUED.MYIMDRNERS'COAIPENSA7qNIN5URMICECARRIERANDPOLICYNUMBERARE: CONSTRUCTION
jc,�RwER PLA VIEW
� aoucrnuueEn �EZ:TRIC
� (iHSSECTIdaNEmNO'TBE071.1fLE7IDCFTIEGEWA'TSiORONE�MDqEDDOLU1351S�[a)ORLESS�. C�
z I CERTIFV TNAT IN THE PERFORMANCE OF THE WORK FOR WMIqV TMIS PERMITIS ISSUED.I MECHANICAL
(•J SHN.L NOT EMPLOY ANY PERSON W ANY MANNER SOAS TO BECOIdE SUBJECTTO iME
(/� WORNERS'COMPENSATIONUWSOFGLLIFORNItiANDAGREETMATIFISHOULABECOME I E
SU&1ECT TO THE WORKERS'G0IAPENSATION PRONSIONS OF SECTION 3700 OF iHE UBOR
c/o�oE,isw�ucoarHvnn�coua�rvnn� s�oNs`.,^ SUANCE �. f� „�_
p DATE: 7'IO�C Z/ APPLICANT: •/�� SMt , �.�
� RGY P/C
J WApNIN6:FAILURE TO SECURE WORKERS'COMPENSATION WVEMGE IS VNUWFUI.AND SIULlBE
� SU[iIECTANEAIPLOYERTOCRIMWALPEN/LLTIESANDCINLFINESUPTOONEHUNDRED7H0USAND ENERGYPERMIT
DOLU0.S(ft o0,000),IN ADOITION TO iHE COST OF COM7ENS�TION.OAMAGES AS PROYIDED FOR IN
J SFCTION]70lOFTHELABORCODE.NTEREST,ANDATTORNEYSFEES. IONFEE:
d CONSTRUCTION LENDING AGENCY � pRE-ALT FEE:
O
� IHCREBVAFFlRMUNOERPENALTYOFPERh1RYTHATTHEREISACONSTRUCTIONIENOWOAGENCY
fOR iNE PERFOf1MANCE OF TME WORK FOR WHICH 7NIS PERMIT IS�SSUED(SEC.]097,qV.C.).
Z
W
� LENDER'S NAME
� IEHOEffSAODRESS �
� TOTAL FEE$
I CERTIFYTHAT I HAVE READ THIS APVUCA7�ONANO STA7ETHAT THEABOVE INFORUATION IS CORRECT. ,
� UGREETOCOMPLYWITNALLCIiYANDCOUNTVOR01NM1LESANDSTATEUN5REUTwGTOBULLDINO i �
CONSTRUCTqN.ANOHERE9YA '2EREPRESENTATIVESOFTHISCOUMYTOENTERUPONTHE
Z ABWE�I.�ENTIONEDO;ODERTYF M Ecrarrwnaos¢s. COMMENTS ,
� c�, � � -�
mPERFA E(�RIN /
¢ -�� e ~ ���
�
y SI E DATE
� RECPT.NO. PAID BY VALIOATION
WHITE—Departmant Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
... �. .. , •'• �r�� ., ..-,�7 .,., .. � ....°i-. � . ...,�. , .�a•., . . � ...,. . . ,.5�'��-� T, �^,. .. �. ,.�- __ .. �� � .r .' . •• ' .'" ' . .. .. � '• . . F�
�i�Tr� Ot� C�l�afJiOf�9D B!'4f-�
it�s���:��or� �Eco��
_ __�_ �..________ _.._ .___�___�.____.__...�. ___�. __.___��
(►��'�.a.�.E Gl�l�l' ��.����=, 'I��f-'����;�`;��`��J:{ I►!.�-?:1 1�.`'G1��;)►� �?1��t1c �►!�`i;�ac�^�`���: �
.__�__._._�.__._._�._. _.__--- _ .._ � --___.._._..___. _ __... __.__...__�.______,_ -- _ ,
___._._ .____.--.------__ .._. _
5ET QACK � � � ,, � � FLOOR J0)Sj , . _..._._ I -�.
FTGS!FORP�ISlSTEEL j 1 ' � � FHA REQPATS �
l--- ---1-_--_—
ELECTRIC GROUND � � � UNDER FLOOR DUCT� �
GROUND PLUMBING I � UNDER FLOOR GU��!DUIT 1
SLAB GRADE I � FIREPLACE FODUDATIO�d j '
TEMP POWER � FIREPLACE BOND BEAP�1_
WATER SEflVICE MID HT. E30ND BEAP,1
ROOF SHEATHlNG ` ___' _} f F�'. BO�JD BEAM ' i _
FRAMINGNENTILIATION I FIPJAL BOND BEAt�I
ROOF COVER I i � PRE-GRADING
ROUGH HEATIhJG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � FI�dISH GRADING �
SHOWER�fUB TEST � POOL ELECTRIC
EXT.LATH/SIDING I I POOL FENCING
WALL INSULATION _-� POOL FINAL
CEILING IN�ULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LFINDSCAPFJIRRIG.
SEEP PIT/L.L. ' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. I�j��vZ- . F!RE DEPT. FINAL
FINAL HEATING-- � HEALTH DEPT. FINAL
FINAL ELECTRIC Z�t � ' DEV. FEES PAID
FINAL PLUMBING ENERGY �
�l--r�: �l:,.�tt i _. . ! I
� ,.._.._._.._ _._.z..�.`_':._____.__._
CUMPJ1EtJTS
t.
t - .
SEPTIC TANK SIZE
SEEP PIT/U SIZE
i Fy� ���
�i
I
I
��y� i n;II'i
� •
; . ,
i .
�k I