HomeMy WebLinkAbout15635 (48) � _ - , . /,
� CITY OF DIAMOND BAR
� " � DEPARTMENT O�COMMUNITY&DEVELOPMENT SERVICES '
21 fib0 E.Coplcy ihiv'e Suite 190
(409)860-3195 Faz(909)861-3117 PRESS
'�'�� BUILDtNG PERMIT APPLICATION _ , ; FIRMLY
y, J08SITE !� ^ � �- 1 �... , APPLICATION'"'� ^�' �; �) PERMIT J f
o ADDRESS 1-r��� 'f ��r�t � ��Y�' DATE ���° , ' NUMBER i��-�`,;;f�� �!C (��`�_f�/y.
1
� DA EE ��-` � '"`-' CONST. GROUP
APN LOT TRACT � ';
c�j OWNER f%. `"/�� .� �� { �
"" " � ZONING SETBACKS
p ADDRESS `� { r^' ,;� S�•t^'r t r.
� CITY �`•'r f�:...,< <r•• ZIP �:;'�:,'" TEL.��-:. ^.:':.wr«t.. FRONT RW ❑
APPLICANT �r� TEL. SIDFJSIDESTAEET RW ❑
� CONTRACTOR SIDE . p�_
ADDRESS t-. � . •' 1.r,!' � r. .
g CfTY ZIP TEL. ' PROPOSED USE _ � 1 : ,F..._ .,
w ARCHlENG/ � � ' ��
�� DESIGNER N0.DVJEL. ✓NO. r NO. ~
ADDRESS UNITS STORIES I BEDROOMS
CtTY ZIP TEL
�
• rn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDEA DECLARATION . •
SFR/ADD/REM -�,!- � ;
Q I HERE6V AFFlRM UNDER PEN�LTY OF P[RURY THAT�AM EXCMCT fROAI TME CDMftACTORS LI� GdfBQB/CBfpOf2 �
W CLf15[UWFORTHEFdlOWMIOREA50N(SEC.70J1.50USM[SSAPrJ7FlOFESSIONSfADE:ANYGTYOR (n
COIMTYNHICHREOUIRESAPERMRTOCDNSTRUC'T,AITER,�MPftOVE.�CMO�15M,OfiREPA:RANYSTftUC• w
W NRE.GfiiOR TD ITS ISSUhNCE,K50 REWIRES TfE 11PPlICM7 FOR EUCH VER�11T TO FIIE A SIGNEO w P8ti0/DOCk �
� STATEAIENT THAT HE OR SHE IS UCENSED PURSUANT TO 1NE PROVISIONS OF THE COrQRACTORS LI- �
� CENSEUW(CN/�PTERY(C�OMMENCINO WITH SECTION 70001 OFOIVISION]OF TNC B115'NESSAN�DRD- POOVSp3 �
FES� /iSCOOE�ORTTIATMEORSHEISE%EUPTTH[REFR01.1�1JOTNEBASiSFORTNEIILEGEDE%EMP- �
TION.ANVVIOL4TIONOFSECTION70]1.58YANVADPLICANTFORAPCP4��TSU9JCCTSTHEAPPlICM1TT0 � Re-Roof
F ACIVILPENAiTYOFNOTMOfiEhWlFNEMUNDREOOOlURS(f5�o).): �
Q ,i�4�OWNEROFTHEPROPEPTY,ORMYEMP�DYEESWITMWAGE5A5T/1[IRSOLECOA�PENSAnqJ, CammafCial -
Z WFLLDO THE YNRK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFEP E�FOR SALE(SEC.T0�l.6U51• �
� NE55 MA VROFESSIONS WOE:TME CONTRACTOR9 LICENS[UW DO[>NOI AP('lV TO AN OWNER OF ?
VROPERTY VF10 BUM1DS OR MPROVEShI[REON,AND N1�0 DOES SUCH wOR'.f HiNSELF OR HERSEIi OR
Q T/IROUGHHISORHEROWNEAIPIOVEES.GROVI�EOTHA'SUCHIMPROV'eAIE�lTS�RENOTMTENOFDOq LA
W OFFEAE�FOHS/LEG,lqV/EVER7HF.RUILDMGOH1410ROVEUENTIS50LDYnTHINONEYEAROFCOAIP�E-
� TIDN,TNE OWNERbUILDER W'LL M�VE THE BURDEN O�VROVING iHAT HE OR 511E DID NOT BU0.�OR � �,
= WPROVEFORTNEPURPOSEOFSALE� i J I � . %�l'' ���
O I,0.5 OWNER OF TiE PROPEHTI:AM E%CLUStYELY COMRACT'�NQ K1TM LIGE NSED CONTRAGTOftS
Q TO CANSTPL'Ci THE PRO.IECT(SEC.)ou,BUSiNESS ANO PROFESS�Ofi;CO[;[:THC COf11RACTOflS LI• V3�Ua�lOf1 r �� � � • ADJ.AREA
W CENSEUWDOESNOTAPPL'ITOANONTIEROFAPROPERTYKTA9Utt.OSORIM�ROVE5IHER[ON,AND
� W11000NTfUCTSFOFiSUCHCR0.1ECT5YnTHACONTRACTOR(51LICENSEDPUASUM1VTTOTNECONTMG OUaNTITY DESCR9PTION �E
� TpiS LKENSE UW). '� I�'
❑I AM E7(EAIPTUNDER SEG B,a PC.FOR TMIS REASON Q j � � ^ `� f
u"' DATE "r i j��� OYMER � � `_. ¢ . .. , ' .� . - .
z f .� . .� ,. W -; ,�:�;:�: .___
� UCENSEDCONTRACTORSDECIARATIOY I w
� IHEi�BVAFiIR11UN0ERPEN,LLNpFPER1URYTHATIAAIUCENSEDUN�Ef7VROV:510NSOFGHACTER �
S Y(COA/MENCINQYIfTM5ECT1DN70oo�OFDMSqNeOFiHE8U51NFSSANDP�O(ESSIOnSCAD[,AN� Z
X IAY UCENSE IS N ML FORCE AND EF�ECT. � - , m
lL I
� 110ENSECLA55 LIC.NO. ' �
V DATE CONTRACTOR � d
W
� WORKERS'COMPENSATION DECLAR.4TION ', Q
NIHEREBYAFiIRMIIM�ENPENIITlOFVERAIRYONEOFTHEFOLLOWIIJCO[CU'aATqNS. Z
� �IHAVE�NON'ILLIAAINTAINACERTIFlCATEOFCQVSFNTTOSELf�INSL'REFORWORKENS' 4 ,
_
COMPENSATqN,ASVROVIDE0BY5ECT10N11ooCFTHEU�80RCO0C,F0'iTHEPERfORMANCE U
Q OFTME WORK GOR WMIp1TM15 VERMIT IS ISiULO. '� �
_I HAYE M�O VALL 11AIMAM WORI(ERi'C01.1PfN5AT1[k�IhSURANf'E,A'.REGUIRED BV SECTION
�C J7000FTMEL/DORCOOE,FORTHEPERfORMµ�EOFTF'[WO'�KFURYn1�CHTHISPFRMITtS • �< � ,�; �
� ISSUEO.MYV.'ORKEPS'COAIFENSATIONINSU�n4CECARFI[RMIDPCIICYN�IMPERME: CONSTRUCTION 7 � �I %��� �` �
juAwEa ' PLANREVIEW: L� +'� �• F 1�Q T-`�.
� pa�crN�eEa ELECTRIC ' � 1 J` .'"; � �
Q �nass[cnwu[mr+oler_m.�oocn[x�,.rrsroHafH�r�cm�s�a,ro�oni�ry. PLUMBiNG
Z ICEFTIFYiHATNTHEFEflFORMANCEO�TNEN'OfiKFCRWHIqITHI:VE11uITi;155UED,l MECHANICAL • I �� � �Iln�
U' :d�+LLLNOTEMPLOVANVPE0.50NN/WYMAVNCRSOA5TO8ECOA�ESU&�ECTTOTHL
� Y/ORKERS'COMFENSATIONlAW50FCALIFCRNIA.MI�IIGP.EET/AiIfISMnULDBECON[ INSPECTIONFEE
S SU6IECTTOTHEWORKEFS'COI.IPENSATIO}17RCNSIONSOFSECTIO'l3�COOFTHEUPOR • i� i/llll.l�J�`y�f ) '
CODE,ISMALLFORTIWITHCOI.IPLYWITNTHOS[PR'JVISIOI:S. i ISSUANCE » • L•� �`
� �� SMIP a". :1V�J f:!`:U�Jii1�'�'j'�r �ti ri,•-'
p OATE: APRICANL
w ENERGYP,C �"'-: I �� f �
� WARN!NQFAILUPETOSECUREWORKERS'COI.�cENS�TqNCAVERAGEISUNUwFUL,ANO5H,ILLB[ „
� SU6IECTANEMPLOYERTOCRI1aiNALVEN,LLTIE5MIDCMLFINESUv700NENUNDREDTHOUSMtD � I%: •
DOLLARS�Sf00.000),NADDITONTOTHEC0.5TOFCOM�ENSA7qM1,0A�1AGE5ASFHOV!OEDFORIN ENERC3YPERA9T �- !�' �"�
� SECT10N71070FT1ELABORCODE,INTEREST,AVDATfOR'�EYSFEES. '� RETENTIONFEE: • '
d CONSTRUCTION LENDING AGENCY . PREALT FEE: � '
O �' !/ .}-," , ,�r' _
� IHCRCBVAFL1fUAUN�ERPENALTYOCPCMIRYTHAiTNER[ISACQYST%ll,'CTIdlI,E4DIN0ACENCY /�� _ -
� FORTNEGERFORMAYCEOFTHEWOFKFORwV1Ip1iH�5FEPMITI5155�ED�EEC.]oB7,CIV.G). �� ��-
W �
� LENOERY Nu.1E �
1-- LENOER'SADDRE55
W ICERTFYtHATIMAVEREADTH15APPLICATIONANOSTA'ETMATTNEMOVEIt+FOPMATKK�ISLORR[CT. TOTAL FEES t'� ��� �'' f�4� (•`�Ir /� `�/.,��
� I AGREE TO COMPIY WITH�LL CRV AN�COUN�Y OfU:NANGES/W D STnTE Uw5 R°LATRIO TO BUILDiNO � .
� CIXiSTRUCTION,ANONERE8YI1UT1/ORIZERe7RF5LNTA�NE50FTM15GUVNIYTOENTEFUPONTHE . _ ' ,
Z ABOVE�I.�EHTIONED7ROPFRTYfORINSPECTIONPU�PO5E5. ,
F— COMMENTS,_;�
� �"; /_'.�;,,�' �r _, , _ � -�.�,<< ��:,,. . � .�,:., , , � ..
m PERIAITTE�E NAIAE IPPoNn • . ' ! �, � �I . � .
!n %�� f'�'', .� '? �%l�7 . . . � .. .. ,
'�i- -�` � � _ .
� S�fNATVftEOFPEfWITTEE OPTE � �
� '�l—� ^' I RECPT.NO. ' t- PAID�Y �:'� � +`� VAlIOATION '
� . WHITE—Aepartment Copy.YELLOW—Fhence Copy,PINK—Aseessa Copy,GOLDENROO—File Copy,GR£EN—ApplicanCs Copy
• CITY OF DIA��OND BI�R
� Ii�SPECTIOtv RECORD
�ti • - _ � o � . - • r . a -
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
EL[CTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR COf�IDUIT
SLA6 GRADE FIREPLACE FOUNDATION
TEMP FOWER FIREPLACE BOND BEAM
WATER SERVICE I MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMINGNENTILIA710N FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING • BENCHICJG
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHO�NER�TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL IPdSUL.ATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPFJIRRIG.
SEEP PIT/L.L. ON SITE 11,1PS.
GAS AIR TEST FINAL ZONI�dG
FINAL CONST. FIRE DEPT. FINAL
FIPdAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUP,�BIPdG ENERGY
�—
��=t� ��- a,��
__.�.___:_ . . ..-.,-- --
COMMENTS
SEPTIC TANI:SIZE
SEEP PIT/U SIZE
�t
4