HomeMy WebLinkAbout11765 (5) CITY OF DIAMOND BAR •
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�� . 21660 E.Caplcy Drive Suitc 190 ---- �� �
(909)860-3195 Faa(909)861-3117 PRESS
BUII.DING PERMIT APPLICATION. FIRMLY
� JOBSffE c . `1{� /� � APPLICATION PERMIT � p/C
a ADDRESS 2�� I � �lh�C`{' `���� pATE � � NUMBER R
c� ISSUE 7YPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER � �
o ZONING SETBACKS
W CITY S� � ZIP TEL. , FRONT RW ❑
� APPLICANT ti TEL. — REAR ❑
� SI�E/51DE STREEf RW ❑
CONTRACT L SI�E ❑
� ADDH 5S � _
PROPOSED USE
CfTY �` ZI TEL. �
0 ARCH/ENG/
DESIGNER NO.DWEL. NO. NO.
ADDRESS UN ITS STORI ES BEDROOMS
� CITY ZIP TEL
� DESCFIIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER•BUILDER DECV�RATION 5FR/AD�/REM
O
Q I NEREBY AFi1NM UNDER VENALTY OF PER.AIRY T/IAT 1 NA E%EMPY iROM h1E COMMCiOqS Ll- G8f9Q0/C81j101S
Cil CE115ELAWFOfIT11EFOl10WINOREASON(SEC.70.77.68USINESSANOCROFESSqNSWDE:MIYLITYOR (n
� CWNiYNR11LHREONRESAVEAAIRTOCONSTRUCT,I1TEi�MPROVE.DEY0U5N,OfiNECAIRANVSTRUC. W patiaJDock
7UP.E,VRqN i0 ff3 ISbUANCE,PL50 REOUIHES iNE ACPl1CANi FOR SUCM PEFMIT TO FILE A S�GNED W
� STA7FYENT THAT HE OR SME IS LICENSEO M10.5UMfT TO THE PROVISIONS OF iHE CONTMCTOFiS U-
� CENSE UW(CHAPTEfl��COMMENLWO M'ITH SCCTION 7000)OF DIVISION f OF iME B��NESS ANO PRO- � PoaVSpa
fE55qN5COUE)ORi1NTNEOflSHE15E%EYVTiMERCFROIAAN�THEBA515iOR7HEALLEGEDE%ENP. ('
710N.MfYV10UT10NOFSECTICN7071.6BYANVMDIN'JJdiFd1A0ERYITSUBIECTSTMEIIPGLK'J�NTTO Z Ro•Roof
�,,,� A CML VENFLTY OF NOT NORE Tf VN FNE/MARED DOILAiG(f500)Y
� 04�OM'NEROFTFIEFROPERTY.ORMYEMROYEESMn7Hw�GE5A5THEUi50LECOAIPENSATqN, � CpmmBrCi�l �
MAI.L DO THE WORK.IWD THE STAt1C1URE IS NOT MEN�ED OF O�FERCD FOR SALE(SEC.7a1.BUSI• J
y NESS AND VROFE5510NS OOOE:7HE WNTRACTONS UCENSE UW DOES NOTAGPLY TO AN OWNER OF ?
►ROVEHTYlN�O8UlA50RIYPRdVE5T1CRLON.AtAWIqDOE55UP1VAr7KHIMSELFOflME115ELFpq m
Q TfIROUdIHISORNEPOWNEMPLOYEES,PROV�EOiHAT6UCHMPROVEMENTSARENOTlREh9EDOR
LJ� pFFEAmfOR5ILE1F.IpWEVER7NEBUILDWGORMPROVEMENfI5501DWIT1eNONLYEMOFCOMPLE• .
Z �TqM,TNE OWNE{LBUILDER WILL FU.VE iHE BUROEN OF VROVINO iMAT HE OR SH[DIO NOT 9UILD qi
= MPRO'VE FOii TNE CURPOSE OF SALE}
W ❑1A50NNEROFTHEVROPEfif7.IlMEJ(QUSNELYCONTMCTWUWfTHLICCNSEDCONTMCTDiiS
� 70 CONSTi1UCT iNE FHOJECT(SEC.�ON.BUSINESS/WD PRDFESSIONS COOE:THE CONTRACTORS L4 �/e�U81iIX1 ��./1RE.4
GENSE UW DOES NOTMPIY i0 AM OM/NER OF A PROPERTY WMO BUILDS OR MGRD'JES TIEREON,IWU
z yN1000HTNACTSFORSUWpRDJECTSNATHALONTMCTOR(S)IICENSEDVURSUANTTOTME00flfRAG OUANTI7Y DESCRIPTION FEE
� TOhSUCENSEUw.�. J
� O I IW EXEMVi WOER SEG B�PC.FOR iMIS NEASON Q
3 "
�
� OA7E ON'NER ~
� W
LICENSED COPfTR/ICTORS DECLARATION �
� W
�HERCBYAiFIW.IUNDER0ENILLTVOFPE0.AIHVTMAT1AYlICENSEDUNOERVROYISi01:SDFLMA7TER V. l n
� �(CpA1ICNCM6 VrtT115ECT10N 7000)OF OMSqN]OF TNE BUSINESS AN'�DROFE5510N5 CODE.ANO Z
x W LICEHSE R N fULL fORCE AND EFFECL m
W /
0 IICENS[CU1SS �� LIC.NO.____��3Jb �
v o�� — corrtrucroa h a
w
� WORKERS'COMPENSATION DECLARATION G���7S ¢
� IHEREBYIIFiIRMUNDERFENA1TYOfGERJURYON[OFTIEFOLLOW1NCDfttAM710N5: � U
y Z
Q
� ��MAVEANDM/ILIWMTAINACERTiFICA1EOFCONSENTTOSELFJNSUREFORWOi1KFR5' S
� COUPEN5ATION,/ISVRDV�DED8Y5EC710N77000FTHEU13qiG�DE.F01iTMEVERFDRMM'C� w
OF TNE WOp1C FOR WMiCM iNIS PERMIi IS ISSUEO. �.- �
� ' '
1 FIAVE AND YfLLMA�MAW WOfUCERS Cp.�PEN5AT10N INSUqiW CE.AS REOUIRED BY SEC7iON,
O l7ooOFTHEU80ROO�EiORTHEFERFORMMICEOFTHEWORKPoFlWNiCMTM�SiENJITIS �
ISSUED.WWORKERS'COAIPENSATIONINSUMNCEGV7RIER/NDPQIIGYNUUBERME CONSTFiUCTION
� CMRIER S ��'�- PUW HEVIEW _ _
Z va�cvr�u�BER � . — ELECTRIC
d �.
� (ft65ECR?!N[�r+o7BCCOH�EfIDOFMPfAMt6PonONEHl�DRm�dU�tSR�oo)OriLESS? MBING
Z IGERTIFYTMATWTHEPERF0�1MiWCEOFiNEWOnNiORWHICNTH15VEiWI715155uED,l ICAL
(�} S/ULLNOTE4PLOY/JJYiER50NNANYMANNER50ASTOBECp.�ESUBJEGTTOTME
N NpRKERS'CO�APENSATqNU�OFCALIFOFtJV�ANDACRFETNAT615MOULDBECOME WSPECTIONFEE
S SUOJECTTOiNEWOfIXEHS'G9�A7ENSATqNPROV15�ON50F5ECT�ONT000FTFIEUBOR . ; �� 1
cooE.isiwiFpm�mn�ca.�v�rrwn�ni � ao��si jNs� ISSUANCE � ��'�' L�, �—
� �/�(� �-}�j�/ SMiP ��^ ��_�
p W7E.����vRJcaNi: �' i �' — ' . .
� ENERGY P/C
WARMNa:FA0.URE TO SECURE M/OnRERS'COUPENSAT�ON COVEIUGE IS UNtANTUL AND SHALLBE
� S�ECTANEMPLOVERTOCROAWALiENALTIESANDCMLiINESUPTOONENUNDREOTNOVSAND ENEFGYPERMIT
DOLU0.5(f I00.000).Nl AODIiION 70 iME CAST OF COMPENSATqN.OAM�GES AS PFOV'OED iOR IN
¢ SECf10N7/0lOFTHEUbORCOOE.MTFRESiANDATTORNEYSFFES. RETENTIONFEE:
a CONSTRUCTION LENOING AGENCY PR6AlT FEE:
O
� IHERCBYA�FIRAIUNDERPENALiVOFP[PJURYTUTTNCREIS�CONSTRUCTIONLEN�iN�AGENCY
Z FORiHC VERFOW.MNCE OF TME WORK FOR WHiCH THIS YEIiY�T IS ISSUED(SEG]oY1.GY.G).
W
� �EHDER'S NAME
• � LENDER'SADDRE55 ,
WICERTIFYTUTIHAVEREADTHi5A7PLK.ATIONANDSTATETMATTIEABOVENFOiU1AT10NI5COHRECT. TOTAL FEES ���
� IAGRCETOLOMVLYYAMALLCfTYM�DCOIMTYORDPIANCFSAN�ST�TEUWSREUTNaTOBUM1WNa
CONSTRUCTION.IWD NE0.EBY11UTIqfi1ZE REVRESENT�TNFS OF MIS COUNfY TO CNTER UPON iNE
S� �BWE�MENTI�NED PROPERTY fOfl WSPECTION WRPO`+ES. COMMENTS
� .�� !-
� �
m VEf711fTT AIAE(PWHT)
N �_____�_�`r` � J�-Z-�,�?Fj i �
� 6tiwUUH F iR E �
D�TE L
� R[CPT.NO. . PAI�8Y VALIDATION
WHITE—Depertment Copy.YELLOW—fnence Copy,PINK—AseassorCopy,GOLDENROD--File Copy,GREEN—AppieanCa Copy
, � • . � , .. , . . '�•• �. r;r'. , . . . .. . . � ..� . ,, . •. . .,, ,, . . .. . e �r . . � , . . . .. ,
CITY OF DIAMOND BAR � .
�� ' � �INSPECTION RECORD, ', . . '. �
_ , • � � . , � i �
SET BACK ' � ' :� • ` ' ,-.' FLOOR,JOI,ST': .; _ ',• ;. , r' ' i • ; .
FTGS/FORMS/STEEL � ' FHA REQMTS � '
ELECTRIC GROUND - - UNDER FLOOR DUCT , •_; ; � J '�� ?
GROUNDPLUMBING ' �UNDER,F�QOfiCQ�IDUIT'�.': � :. '
SLAB GRADE � FIREPLACE FO�INDATION •'� � �- � � '1 '• ' ' �
TEMP POWER - - - FIREPLACE B�OND BEAM = - ' ' ..
�NATER SERVICE -- - - ' MID HL 80ND BEAM'� ' ' - • = �'_- - -
ROOF SHEATHING ',-i r. , , � ( . 8 Ff:�pND BEAM'';;', � •� -� �� -- -� . �. ;�.� ,.! 's�•
FRAMINGNENTILIATION � FINAL BOND BEAM '
ROOF COVER PRE-GRADING
ROUGH HEATING - - � • BENCHING - -
ROUGH ELECTRIC � ROUGH GRADING -
ROUGH PLU��ABING � � ' FINISH GRADING
SHOWEHlTUBTEST - PDOL ELECTRlC • '
EXT.LATH/SIDING POOL FENCING '
WALL INSUTATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER. • ' FINAL ENG.
SEPTIC TANK . -.: ' LANDSCAPE/IRRIG.
SEEP P!TlL.L. - ON 51TE IMPS.
GAS AIR TEST � FINAL ZONING
�FINAL CONST. - - FIRE DEPT. FINAL
FINAL HEATING - - HEALTH DEPT. FINAL
-FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING , ;i • ��� !,; : r, l ENERGY .
i�.A.��ir.e1�,�.i �_ •
:r_ :s`.
l � . I •-� —• . � . .� _ .-. ,_,
COMMENTS � �'�, � ' _ �� .
.
�
� �
• ;,`� 1 _ , . .f
.,
� , , '
_._. _
.
_ . ' . _ �
SEPTIC TANK SIZE �
SEEP PIT/U SIZE . .
��' "
� ,
.,�� _ � _ .
� . t . -
,.�',` ; , .'>>��, ��� • - ' . ��� ;�, _ -