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HomeMy WebLinkAbout16907 �� CTTY OF DIAMOND BAR EXPI RED ! DEPARTMENT OF CONQvIUN17'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive '� (909)860-3195 Fax(909)861-3117 J U N 191002 PRESS "'�± BUILDING PERMIT APPLICATION FIRMLY } J0851TE �71 • I,, APPUCATION PERMIT � P/C o ADDRESS +�� V 6 �S�• DATE NUMBER p � APN LOT TRAC ISSUE TYPE OCC p OWNER .s f����Q�� DATE CONST. � GROUP o ADD�S� ZONING SETBACKS z anr �1� ZIP TEL. FRONT qyy ❑ g APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ a� CONTRACTOR SIDE ❑ O CID y,V s Z�P^ TE PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL NO. N0. N ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDlFiEM O p 1 HEREBY AFFlRM UNDER PENALTY OF PERIURY 7H�T I AM E%EMPT FROA1 THE CONTMCTORS l4 � Garage/Carport W CENSEUWFORTHEFOILOWMOREASON(SEC.7031.SBUSMESSM707ROFESSIONSCODE:ANYCRYOR V COIMTYWT/ICMREWWESAVERMITTOCONSTRUCT,ALiERA.�PROVE.OEMOLISH.ORREPAIRMlYSTRUG (y� W NRE.GRqR TO ITS ISSW WCE,AL50 REOUINES TME MPIICANT FOR SUCH PERIAIT TO FiLE A SIGNED W Patio/Deck � STATEMENT iHAT HE OR SME IS LICENSEO NitSUANT TO TXE PHOVISIONS OF THE CDNTMCTOHS l4 � .� CENSE UW(d/APTER Y(COMMENCINO WIhI SECTION 70oa)OF DIVISION�OF THE BUSINESS ANO Pq0. PooVSpa Q iES510NSCO0�ORTHATHEORSHEISE%EA�PTTHEREFRpAANDTHEBA5ISFORiHEALLEOEDE%EMP- C7 V TION.ANYVIOIATqNOFSECTION70]1.6BVANVAPPLICMITFORAPERMITSUBJECTSTHEAP�IGWTTO Z Re•Roof A CM�PENKTV OF NOT AIORE TIiAN FIVE HUNORED DOLURS(f5o0).): � 04�.+'ON'NEROFTHEPROPERTY.ORMYEIAPLOYEESWITHWAGESASTNEIRSOLECOMPENSATqN, � COTTB(C�21 Z N�LL DO TME WOHI(AND iNE STRUCTURE IS NOT INiENDED OR OFFEREO FOR SALE�SEC.70��,BU56 J N NE55 AND PROFE5510N5 COOE:THE CONTRACTORS IICENSE UW DOES NOT AVPIY TO AN OWNER OF j iR07ERTY W/i0 BUILOS OR IMPROVES MEREON.AND W/IO DOES SUCM WORK HIMSEIF OR HERSELF OR wTHROUGHHISORHEROWNEMPLOYEES,VROVIDEDTMATSUCHIM7ROVEMENTSMENOTINTENDEDOR m 0 OFFEREDiORSALEIF,HOWEVE0.TNEBU0.01NOORMP{IOVEIAENTISSOLDMATHINONEVEAPOF(b/APLE• Z TION,TME OWNER�B4ILDER WILL HAVE TME BUROEN OF VROV W6 THAT HE OR SHE DID NOT BULA ON = MPROVEiORTMEPURPO5EOF5.U.E). w 04�OWNEROFTNEPROPERTV,AME%CLUSIVE�YCONTHACTINOWITHUCENSEDCOMMCTORS � TO CONSTRUCT THE DH6IECT(SEG)ON,BUSINE55 AND VROfE5510NS CODE THE CONTMCTORS LI• V2II18IIOf1 ADJ.AFEA W �NSEUWDOESNOTAPPLYTO/NOWNEROFAPROPERTVWNOBUKDSORIMPROVESTHEREON.AND � WNOCONTMCTSFOHSUCMPROJECTSWITM�GONTMGTOR(5)LICENSEOPURSUANTTOTMECONTMG OUANTITY DESCRIPTION FEE Y TORS UCENSE UW). 0 OIAMEXEMPTUNDERSEC. 8.6P.C.FORTHISREASDN Q ' � U � � Z OATE OwNER U � LICENSED CONTRACTORS DECLARATION W � �MENEBYAFFIRMUNDERPENiLLTYOFPERIURYTHATIMILICEN5E0UNDEHPROVI510N50FCHAPTER � p„ i(COMMENCP7aYA7M5ECTION70ao)OFDMSION70FTHEBUSINESSANDPROFESSIONSCODE,MlO Z X 4y LICENSE IS IN fUL1 FOHCEANO EFiECT. m �� UCENSE CIAS l. UC.NO.___���� � V DATE CONTRACTOR_�" � _ W � WORKERS'COMPENSATION DECLARATION Q NIHEREBYAFFIHAIUNDENGEN�LLTYOFPERJUf1YONEOFTHEFOLIOWiNGOELLARAT10N5: Z � �I/UVEANDWILLMNNTAINACERT�FlCA7EOFCANSENTTOSEIF-INSUFEFORWORKEFS' _ � COMPENSATION,AS PROVIOED BY SECTiON]�oo OF iME LABOH CODE,FORTME 7ERFORMANCE `U O OF THE MlORK FOR WHICH THIS VER1.11T IS ISSUEO. � Qw �IHAVEANDWILLidA1MAINWORKERS'C-0AIFENSATIONINSUiUNCE.ASREOUIRFOBVSECTION AOOOFTHELABORCOOE,FORTMEPERFORMANCEOFTHEWOHKFORVMICHTHISPERMITIS � ISSUED.MYYlORKERS'COMPENSATIONINSU C C RIERANOPOIICYNUMBERME: CONSTRUCTION � GIRRIEN PLAN REVIEW � POLIGYNUMBEH � ELECTRIC p (iH55ECiqNNEmNOTBE00MFLE7EDOFTEOfiMTSiORONEH1rDREDDCtUiL.Kfm)Of1LESS} PLUMBING � Z ICERTIFYTHATWTHEPERFORMMlCEOFTMEWORKFORWMILHTHISPEPMRRISSUED,1 MECHANICAL U' SwLLLNOT EMVLOYANY VERSON IN ANY MANNER 50A5 TO BECOME 5U&IECT TOIME (n Y/ORKERS'COMPENSATIONUWSOFCAUFOflNIA,ANOACREEiHATIFISH0ULD8ECOlAE INSPECTIONFEE S SUB1ECiTOTHEWORKERS'COMPENSATIONCROVISqNSOFSECTION170oOFTHEIABOR , COOE.I HALL ORTHWITHCOMPLY OS ROVISIONS. ISSUANCE ! � p DATE: APPLICAP7T� SMIP J WMNIN6:F�M1URETOSECUREWORKERS'COMPENSl1TIONCOVERAGEISl1NUWNL,IWDSHAILBE ENERGYP/C � SUBIECTANEMPLOYERTOCRIIAINALPENAlTIES►NOCIVI�FWESUPTOONEMUNOREOTFqUSMlD ENERGYPERMIT DOIUfiS(t100.000).W ADD1T70N TO THE LOST OF LOAIPENSATION.DAMAGES AS PROVIDED FOR IN J SECTIDN77oeOFTMEIABORCOOE,WTEFEST.ANDATTORNEY'SFEES. I � p� RETENTION FEE: t oCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNOERGENAITYOFPERIURVTHATTHEREISACONSTRUCTIONLEN0IN�AGENCY FOft THE GERfORMANCE OF THE WORK FOR WHICH TMIS VERMiT IS ISSUED(SEC.9o9).CIV.C.). Z w � ��r+oEasr�e � IENDER'S1IDDRE55 W 1 CEH71FY THAT I HAVE READ TiISAGPUCATION AND STATE TMAT iME ABOYE MFORMATION IS CAqRECT. TOTAL FE ES � v � IAGHEETOCOMPLYWRHALLCITYANOCOUN7YORDINANCESANDS7ATEUWSREUTWGTOBUILDINO V, CONSTRUCTION.ANDMEPEBYAUT1iOR2EREPRESENTATIVESOFTH15tOVNTYTOEMERUPoNTIIE Z l�BOVE-MENTqNED7ROPEHTYFORINSPECTIONPURPOSES. COMMENTS O � � � m iTTEEN ryRiNn � j1[_ � (n S�OIIATURE riMITiEE 7 '�( � RECPT.NO. � ��PAID BY � VALIDATION WHITE—Depanmenl Copy.YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENROD—File Capy,GREEN—ApplicanCs Capy .,.tF'� 7.,rh�n �._..-_... .� : � � _, .. . . � ' ' " �... - - .� - , .. �.. ��::��.��[����_. -a..�:.s..,��7",. - .- .. .� . ....�ui�-..T.,Y�,a.�F•: , :y�rtr. r; . . ... . • , . ... �.a ... .r.. :4"i,r�Z�ii��e'�iYy 'rrS",A� '�._ . ciz�' (JF D1AfJIOP�3D E3d�R lf��SraE�9 IOid �EGU�'D '��►�E-'����1`rC�►�� ��y'_'�E?=� I►��`1:���r�;�)�1� I►"�-'i�a�,i:;f'loli'k �c�;,��C�:� (►�����c�;i�s�j=; - ------�----------- --_ .-- __-- ---- - ._ .-----------�- ---- ---- -------- -----=---------= . SET BACY. ( � � FLOOR JOIST —�—� FTGS/FORMS/STEEL � , � FHA REQMTS � — -- � ELECTRIC GROUND � UNDER FLOOR DUCT � GROUND PLUMBING UNDER FLOOR CU�IDUIT � SLAB GRADE FIREP�ACE FOUNDATION I TEMP POWER I � FIREPLACE BOND E3EAh1 WATER SERVICE I MID HT. BOND BEAM ROOF SHEATHING S FT.BOND BEA�A FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING I FI�dISH GRADING SHOWER/TUB TEST � POOL ELECTRIC EXT. LATH/SIDWG I POOL FENCING WALL INSULATION POOL FINAL � CEILING INSULATION OFF SITE IMPS. DRYWALL NAILIP�G DEDICATIONS SEWER FINAL ENG. SEPTIC TANK � LANDSCAPE/IRRIG. SEEP PITIL.L. � ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUM9ING � ENERGY �'�'=a_',c'1:_'C'lsts`,______�__ � COMMENTS ' - � , , - SEPTIC TANK SIZE SEEP P1T/U SIZE I►�� I � I�r�+ a �� � � • , . ..�-� --- -_'�--__�_.__.� • ' ' I