HomeMy WebLinkAbout12653 (13) J� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT S VICES
�� 21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 ��� PRESS
�•��� BUQ.DING PERMIT APPLICATION FIRMLY
� JOBSfTE �/2� APPLICATION � ERMIT /C
o ADDRES `yw, Su.t!N�JC.�,�ST G�T. DATE � ✓ � NUMBER�.� A
$ ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER I�UA �'D�T'�Z
ADDRESS S ZONING SETBACKS
$ CITY ZIP � � TEL. R�R RW �p
Q APPLICANT TEL.
� SIDElSIDE STREET RW ❑
CONTRACT � SIDE p
o ADDRESS , PROPOSED USE � C
CITY � L. ZIP TEL.
o ARCH/ENG/
� DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BUILDER DECLARATION SFR/ADDIREM �
O
p I HEREBYAFi7RM UNOER PENA�iY OF FEMIRII TMAT I AM E%EMPT fR04 THE OONiFUCTORS LF Garape/Caiport
W GENSEUwFOq7NEiqlOWwOREASd�(SEC.70�1.60USWESSANDFROFESSIONSODDEANYCRYOH (n
U �qMiYM4�q1RE0UIRESAPEFMRiOCONSTpUCT,ALlE{�MPROVE,DEA10115H2OFREFAIq/WVSTRUG W paliolpeck
� NRE.VNIOR i0 RS ISSUANCE.AL90 REOU�RES THE APPLILAN7 iOfi SULM PERMIT TO FILE A SIGNCD w
_, STATENEPlT 71uT NE OR SHE t5 110ENSED R10.5UAHT TO TME VROVISIONS OF iHE CONTMCTORS LL
� CEN5E1Aw(CIWTEHO�CpAMENqNOWfTMSECTION7o0o)OfDMSqNlOFiHEBU5iNE55M1'JPRO- � POOVSpB
FESS�ONS WDE7 OR lw1T HE ON SME IS E%EMPT iNEREFRorA/iND 7HE BA515 FOR TME PLIEOED E%EMP-
TION.ANYVIOLAT1f7NOF5ECT10N7D]1.6BYANYAD0.1GNTiORAVERYlTSl161ECT5iHEAPVLK',ANTTO Z Re-Roof
� ACML PENALTY OF NOT MOflE ttwr iNE MUNDnED OOlLMS(fsoo).��
� 04ASOMMEROFTHEPfqVENTI;OF►1YEUP�0YEE5NA7MWM,ESl�STNEIP50lEGOMPEN5A710N, O COTmerdal '
VALL DO iHE WORK,AND iHE STRUCTURE IS NOT�HTENDED OR OFCERED FOR SAIE(SEG)0��.BU51. J
NESS APD FROFE5510N4 COOE:7ME CONTMC'fOiL4 LKEHSE UW DOES NOT APPLY TO AN OYYNER OF
N VROOERTYWFqBUqD90flMCROVESTHEREON.ANOW/10DOE55UCHYNJRKMiMSFIFORMERSELFOR �
Q T}YiOUGHN5011HERONTIFLIGLOYCES.PPONDEDiHATSUCJ11MoqOVEMEMSARENOTPlTENDEDOR CI�
. � OFiE�DFORSKEF.MOWEVE0.�BVLDIN00RMPf10VEMEHTISSqDWfTMNONEYEAROFC�0AIPLE-
� �TON.711E OwNER-&11tDEN WILL NAVE TME BURDEN OF VROVWG THAT HE OR 6NE DiD NO7 BUI�D O�i
�.IPRWE FOR 7ME PURP06E OF S/LE7.
w 01�SOwNEROFTMEiiqPEHI'/,AMEXLLUSIVEIYCd+fMCTNOWrtHL10EN5EDC011TRACTOAS
(C TO�iSTRUCf THE PNOJECT(SEG 70u,BU511:[SS AND PI10fE551ON5 CODE:iHE C�OIfTfUC70R5 U� V81U8IIOf1 /1DJ.AREA
L11 CENSEUWDOE4NDTAPPLYTOIWO�N�EROFAPqOPERTYWI/OBUMSORIAIPROVESTMEREpLNA
� M11000N�MCTSiOHSUQ1iRWECT5W17MACOMiMCTOP(S�LICENSEOPURSUANTTOTMECONTMG pUANTITY DESCRIPTION FEE
� TORSLICENSEU�N.)-
O 1 AM EXEYfR UNDER SEC. B.i P.C.FOA TMiS REASON Q
� U
�
u' pATE OWNER �
� W
F LICENSED CONTRACTORS DECLAAATION W
� INEREBYAFipWUNOERPENALTYOFVE1U11TYTHATIAMLILEN3EDUNDEHiROV1510N50FG1A➢TER � �./ �
p, •(Cd�ENCWOWfTHSECTION70001�OM510N]OFTHF9USINESSANDPAOFESSIONSCOOE,ANO z «�
LL� W LICENSE IS N Ml FORCE AND EFFECT.
o _ G��i936 m
�
F LICENSEIX1lSS LIC.NO. J
� D�rE /!-/ b�`� carnucron ��_� a
w
� WORKERS'COMPENSATION DECLAFlATION Q
N INCRFBYAFi7W1UNDERVENALTYOFGEliM11RYDNEOFTNEFOLLDWINGDELtAM7lON5: U
� Z
Q
O �_IHAVEANOWILLMARlTAMACEHTIFlGTEOFCONSEMTOSELHNSUFEfOF1WORKERS' _
� COMPENSATION,ASPfLDViDfDBV5fC710N77WOFTHEUBORCWE,FORTHEDERFORGUJCE U
Q OFTHFVJONKFOqWHICMTNISYENMITISISSUED. W
Q 2
�1 HAVE/ND W�LLMAMAM WOfiKERS'COG7ENSATiON RISUHIWCF.�5 REOV6IED BY SECTION
Q 97000FTFIELABOACODE,FOHTNEDEAFOR4ANCEOFTNEWORKFORYn1Ip17HI5VENAITIS
� 155UEO.MYM•OW�CEnRS'COE,I7ENSATqNMSUFINCECARRiERMlOPOLICYNUM�:RARE: CONSTRUCTION
� c�AweA v-T•-L � _ PLAN REVIEW
� POLICYM!IINFA R/1 ��� / �Q (� ELECTRIC
Q
o �sEerc.,r�r,ors�cc�.�,oanc�a,.rrsx�,ar+eM,ron�noaLucsa�m�on�ss? M61NG
Z ILERT�FYT�UTNTHEVEFlFORMANCEOFTMEWOfiKFORWMICMTH15VEHM1iI5155UE0,1 MEC NICAL ��
(J SMILLLNOTEUPLOV/JJYVERSONNANYII+WN[RSOASTOBECOMESUOJECTTOTHE �
� N'OPo(ERS'CDMPENSATiDNLAW50FGA1.IFORNIAANDAGREE7MATIFISHOIhDBEC011E INSPECTIONFEE n� ���
S SWJECTTOTHEMIORKEA5COYPENSATIONPROV�S�ONSOFSEC710N]1o00FiHElABOft �SSUANCE `
CODE,I6FNLL FOqTM'ATN CdAo�y W11N T1105E VROVISIONS.
� SMIP _�������
p DATE:.,/��2�APPLICAM: l
►+� ENERGY P/C
WMNiNO:FARURE TO SE W RE MKMKERS'COMPENSATION CAVEMCE IS UNU'NfUL AN�SHAL�BE
(�y SUOJECTANEMP�OYERTOCAIHINALVENALTIESFNDCNILFWESUPTOONENUNDRCDiMOU5AN0 ENERGYPEHMI7 _ _ rDIII�/�«ti'f� ` "�-
DOLUWS(f 100.DOOI.IN AODITION 70 TME CAST OF COMPENS�TiON.OAMAGE5115 PPOVI�ED FDR IN *� ,�
¢ SECTDN77DeOFT�[lABoiiCOOE,MEHEST.ANDATTORNEYSFEES. DJ�yr� ' ' ^ ' �
RETENTION FEE: ��•"�° ,i,'s}�_
a CONS7FUCTION LEhDING AGENCY PRE•ALT FEE:
O
� IHEREBVACFIRAIUNDERVENJLL7YOFVC0.NRYiMATTMEREISACONSiRUCf�ONLENDIN�AGENCY
Z FOR 7HE PER W RMANCE OF iM[WOR1(fOR WMICH THIS PEA��T IS ISSUEO(SEC.�oY1,C�V.G).
W
� LENOER'SwwE
� LENOER'SA'JDRE55 ^
WICEPTIRYTMATIIUVEPEADTNiSAPVL�LA710NAND5UTETIATTHCABOVENGORNAT10NI5CORRECi TOTAL FEES �// �•(J�
p. 1 AGpEE TO COMVLY VATN ALL CRY M1D COUNTY OADPIANCES AND STATE LAwS NEU7W O TO BUM1DINO
CONS7i0.1CT10N./J:O NENE9YAUT110FIIE REGRCSENTATIVES OF TNIS LOUNTY TO ENTEA UPON iHE
Z �9pVE�MEHf10NED��70VERTYFOi11NSCECTIONDURPO5E5. GONMENTS
� d J [G.�
�
m PERMfTTEE A1AE(P{LNT)
� /��6 —Sg a
N gqNATVREOFPERMf1TFE DATE
� , R[CPT.N0. � PAID BY VALIDATION
WHITE-0epartmant Copy,YELLOW�nence Copy.PINK—AsamsorCapy.GOLDENFOD--File Copy.GREEN—AppicanYa Copy
, . . . ... .... � . . .. � - _ � , . , • . �
CITY OF DIAMOND BAR • - �
' INSPECTiON RECORD
��� � e - • � • s -
SET BACK - FLOOR JOIST� �-. �
FfGS/FORMS/STEEL FHA REQMTS - '
ELECTRIC GROUND - - UNDER FLOOR DUCT
GROUND PLUMBING �UNDER FLOOR CO�IDUIT
SLAB GRADE FIREPLACE FOUNDATION - - - - -- -�•� •
TEMP P�WER ' - ' FIREPLACE BOND BEAM .
WATER SERVICE � MID HT.BOND BEAM - • • - •• • -• -
ROOF SHEATHING- •• • � • •• 8 FT. BOND BEAti7' � � � - � .
FRAMINGNENTILIATION � FINAL BOND BEA�Y1
ROOF COVER. PRE-GRADING
ROUGH HGATING BENCHING • .
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUPABING - " FINISH GRADING
SHOWEH/TU8 TEST - POOL ELECTRIC
EXT.L4TH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER. .. FINAL ENG.
SEPTICTANK . .. . . . � LAPdDSCAPE/IRRIG.
SEEP.PIT/L.L. - ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST.. FIRE DEPT. FINAL •
FINAL HEATIhJG- �— HEALTH DEPT. FINAL
FINAL ELECTRIC � �— • DEV.FEES PAID
FINAL PLUFABING � ENERGY
TF,��:��.����I��. .,._ -
COMMENTS --
I-t.��f.
... . .. � ,r.r �• "�)•fi
SEPTIC TANK'SIZF';�` j �t�%;;T 1"�J« '
SEEP PIT/U SIZE � ��� .
���i .. �
,��g . , . .� ,; ; �,—
:
_ . , . , , . .,.: .. . . . .
, _
, . _
� ; . . ... . ..... . _ : ,
� . -- _.�.. ...
�� 1 . _ . . . �. . . ...... ..... . � � .._. ' .. .. ... . . . _. _..-- .. � � .
. R'__`..._ ' •