HomeMy WebLinkAbout15002 (20) • �� CITY OF DIAMOND BAR w
� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES r�
' > 21660 G.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE$$
'�^' BiJII.DING PERMIT APPLICATION • FIRMLY
y JOBSfTE /�+� � APPLICATION �/)� PERMff ��� p/�
o ADDRESS � r7 / I� �wl� �fJCS i!L DATE v v NUMBER �►
� APN LOT TRACT D TEE NPE
OCC
p OWNER __�r CONST. GROUP
p ADD. 55 �^— •'j ZONING SETBACKS
� CITY IP TEL. FflONT RW ❑
APPLICANT TEL. REAR p
� SIDFJSIDE STREET RW p
CONTRACTOR c• t1�t SIDE �
� ADDRES� ' �
� CRy �� � Z�P TE � PROPOSED USE
� ARCH/ENG!
ADDR SS C NO.DWEL NO. NO.
� CITY �- ZIP� TEL!�j . UNITS STORIES BEDROOMS
�
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER OECLARATION SFR/ADD/REM
p 1 HEREBY AFFliM UNDER PENALTY OF CERIURY THAT 1 AM E%C4PT FROM iHE COuiMCTOqS L4 GarapdCarport
� CENSEUWFORiHEFOl10WNOREl50N(SEG70J�.6&15iNES5ANOGROFESSIONSCODE.MIVCRYOR (n
COUHNWMOiREOUIiiESAVERYRTOCONSTRUCT,ALTERMPROVE,DEI.�OLISH.ORREpNRANYSTiIUG W P8lI0/DOCI(
7lNiE.P(Wfi M ITS RSUMlCE.ALSO REOUIRCS THE MPIICANT FOR SIKN PCRMIT TO F0.E A SIGNEO W
STATEMEM iTUT HE OR 9HE IS UCENSCD PVRSUANT TO THE iROVi5iON5 OF ME CONTMCTORS LL
� CENSE UW�CNAPTER Y(CpAMENCINO WIM SECTIDN 70Do)OF DMSION i OF 7ME BVSfNC55 AND Viq � PooVSpa
fE55qNSO00E�0IiTMAiMEOR5MFI5EXE►�PTi1fEqEFROMM1p7NEBAS15FORTHEKIEGEDE%EMP• (7
TON.IV17YqLA7qHOF6ECilOH7071.68YANYAGPLICANTFONApERMITSU&lECTSTHE�PVLIGNiTO Z RB-ROOI
� ACMLGENALTY OF NOT►1DRE T/IAN FIVE HUNJHCD OOLURS(tSDo)k
� OLASOVMEROFTH[PROPERTY.OHYVEUPIDVEESVATHwAGES�STMEIqSOLECp.1PEN5A7qN, CpmmBftldl -
Wtt100 THE WORK ANO 7NE STRUC7URE IS NO7INTENDED OR OFFERED FOR SALE(SEG 7oU,BU51� �
N NE55 MD PiqFE55lON4 COOE:THE COHTMCTORS LICCNS[UW DOES NOT AGPLY TO AN OWNCP OF �
VROPER'fY MA1D BU0.D5 Oq YPf10VE5 TNEREON,AND Nhq DOES SW1 WDRK MIMSEIF OR NERSELF OF
� T/YqUGHW50RMEROWNEMPLdYEEAiNONDEDTHAT5Up11�1PROVEMENTSMENOTMENCEDOR m
� OiFEAEDFOR511EF,MOv/EVEi�1HEBULDNOORMPROVGNCM650lDWITNINONEYFMOFCOMPIE•
Z TION,iME OWNEq�BNIDEN WILL HAVE h1E BUHDEN OF CROYINO 7HA7 NE OR SME DID N0T QUILD OR
MPiqVE FOR THE VURPOSE OF$ALE}
= Ol�OM71EROFTHEVipPEilfV,AMESf1l15RIELYCt7NTR�CTN�riTTML1[ENSEDCOMTMCTGI3
W
� TO CdISTRUCT THE OR0.IECT(SEC,)0��,BUSM[SS AHD VROiES5qN5 COOC:T7E CONTMCTORS L4 VBIUUIi0f1 /1DJ.AREA
CENSE UW DOES NOTAVPLY TOAN OYJNER OF A PROPERTY WFIO BUILDS OR MPNpVES MEREON.NIO
� wr�ocwrrruersr«+suwvAaeerswm��oorrta,�cTon�s�ueer+seovunsuurrron1ecartaw. QUANTITY DESCRIPTION
� lonsuceNseuw�. FEE
O I/W EXE4PT UNDEH SEG B.1 V.C.FORTHIS RCASON J
Q
U
LL' DATE OYmER �
� U
4 LICENSED COPf�FiACTORS DECUIRATION W
[L IHEREBYAFFIPoJUNDERPENALTlOF7ER1UfT'TMA71AA1LICENSEDUNDERVRONSIONSOFCHAVTEq �
� �(COMYENCY�O NnTM SECfION 7000)Of DIVISqN]OF TME BUSMCSSAND CROFESSiONS COOE.ANO Z
�l� W LICEHSE B W FULL FOFCE EFiECt m
� "' � �P,� -�'i /D �
�.,, UCENSE CLASS LIG.NO. �
- V OA7F�-� � C01lTRACTOR d
W ' -
� RKERS'COMPENSATION DECLARATION a
� 1 HEREBVAFFlPoA WDFR PENALTV OF PEM'R'/ONE OFiNE FOLLOYm�G DECLAMTqNS. Z
� _I1u1VEANOWIILMAM7M/�CER7IFICATEO�CONSENTTOSClF�7NSUREiORWURNERS' S
COMPENSATION,ASVROVIDEOBYSEGTIOH7l000FiHELABORCOOE,FORTIIEDERFONaMiCE W
Q OFTNEWORNFO(iNM1UpITMISVER/AITI4155VED. �
1 MAVE ANp WILL WNU W YNqNERS'COM7ENSA1qN INSUW WGE,AS REOUIREO BY SECiION J''J
� J7o00F iHC U�BOR CODE.FOq TNC DERFORA/MlCE OF iHE YVORI(fOR WMICH THIS pERMIT IS � /
155UE0.WwOqK 'COunEH INSURANCE .HANDDOL YNU�IOENAfiE. CONSTRUCTION /• �
� �twEq C.B`'r���e' PIAN REVIEW
� PoLICYM1uBER �����_�o �� � ELECTRIC
0 [n��cNr+[mw7eEoc�£rmaFnfaf�w�rs�anonE 000uilua�ao;or��ss} PLUM6ING
Z 1 CEMIFY THAT W THE PERFORMANCE OF � 'iK fOR WHl i :5['ER 'IS ISSUED,I AIECHANICAL
(y 91ALLNOTEMPIOYAN'IPERSONWIIM/ E.SOASTO _ : UBJE TOTHE � E•; 3,
(/J WOR1(ERS'COMVE 4ATqNUW30fCALIOR '� D G ET ,I� SMIX OBECOME INSPECTIONFEE
SU&IF TMTHE RKEiiS'Cp.IPENSAT V J iS 5 FSEC ]l00 7MElIBOR
s coo.iswutF Hr�+vntrcouv�rw� Ho �o si ISSUANCE ,�/j�
O ' —
p DATE: APPLICANT: �� SMIP r
JENERGYP/C I. Y j LUU �
WARMINC FAI�UftE T ECURE WOfiKERS'COM �NSAT GOVE AGE IS U'UM ,ANO SMALLBE
� SU0.JECf EMROYERTOCRIMINALPENALTIES C 'LFNES TOON HUNDREDT110USAND , • ♦ !l
OOU.MS tao.0oo1.NAD�IitONTOTHEC05T0 LOY NSATKxI, ACE iROV1DEDFORIN ENERGYPERMIT,i..__r_�=✓��A1R/:�^>T�,.�
� SECT1oN 77oe OFME LABOR OOOE.NTEREST,IW �Tt RN[YS FEE RETENTION FE� 1 Z G �`�•TT"�V
u, L3LIfL�?;��=-i� ._,
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IHCREBYAFFIRMLNDERPENALTVOFPERIURYTNATiHERE15ACONSTRUCTqNIEN�WGAGENCY
FOR THC PERFORMANCE OF iHE V10RN FORYMICH TV115 PERAIIT IS ISSUEO(SEC.»Y7,CN.C.).
Z
W
� IENDERS NAME
� LENDER'S/DDRE55
W 1 TIFVTMATIMAVER T APPl1CATIONANDSTATETMATiME�BOVEINFORM�TqNISCORNECL TOTAL FEES / �
� IAGR iOCOMDLYWITN L N NOCOUMYORDWANCESANDSTATEUw+REUTklGTOBUCDINC
� ST VCT ,ANOHCRE � UT RRERCPRESENTATNESOFTMISCWNTYTOENTERUPONTHE
Z EDPROVE FO IN ECTIONPURPOSES. COMMENTS
0
J
� �
m EA„ I \E ' (
Q
�� C V
N SI �TUI 'OF EHUITTEE D E
� \ RECPT.NO. PAID BY VAUDATION
ITE�Depertment Copy,Y LLOW—Finance Copy,PINK�Assessa Copy,GOLDENFIOD—FJe Copy,GREEN�ApplicanPs Copy
l
CITY OF DI�MOND [3AR
' :. -- It�:SPEC i l0�` RECORQ
;1►��: :�-�c''I`ty ��� ~ o ��F= lh�E?!�?.���"�`�'7�i � ,� I�`�-y.�'��:Ct�',I►`6�+ ���I� �tCc �► `t:l�c'" �'
_. _.�:..__.�'_._;]:._..__.. .�"...._- ..._.._.... ...�_____._. .,� .,.�. ._. _ __...,._. _.._......... ,..:�".,....,._ ..,�..�':_..._. `:�- ' ._
�SET BF,Cf: �'� ' ' --. ..,n1~FLOOR J01ST �� � .
�FTGS`F�R:"S;STEEL � • -- ; FIiAREQ"�9TS
ELECTRIC GROU�dD � � � � . � � U�JDER FLOOR DUCT
GROUND PLUP�'HING I� U�JUER FLOOR CUf�IDU1T . _ _ ^
SLAB GRAD� FIREPLACE FOUrJDATIOPJ
TEP.1P FO�°JFR I I FIREPLACt BO�dD BEAR1 �
4"JATER SERVICE_� _� P�11D HT. [30ND BER,M �_ �
ROOF SHEr;THIPJG ' ' F f=T. 60"JD'BE71P.1 � �
,FRl1P.'!ItdG�,�ENTILIATION I I FIPJAL BOiJD E3EAP.4� _`�
'r�00r COV�R I I I I PRc-GRADItJG .� � � ' '
ROUGH H�A71tiG }� 6ENCf-fihJG ; , � ' •
R�UG}Y ELECTRIC � I ROUGH GRADIPJG � .
F;JUGfi PLU"�",�If�G � - i FIPJISH uFADI"JG �
•SF!OV'JrR.�TU6 TEST � � POOL ELEGTRIC
,F�T�.U1TH�SIDIiJ� � � � PDOL FEPJCIPdG i �
�Vt'F1LL lNSUU:TIOP; i POOL FIPJAL
CEi�I��G R�JSUL.l;TIOiJ � � OFF SITE IMFS. �
DRl'�"JF�L.L N;,I�1N� � � DE�ICATh�PdS
SEb"JER � l ��' FWAL ENG. �
SrPTIC TAf•1;C 1—T— - i I.ANDSC.APE!IRRIG. � I
S�EP PITIL.L. I � ' _ l CiJ SITE 1^AF'S. �_ I `�
G.AS AIFi TEST I . � ; FI�dAL ZO^:I�JG � j —�
��I'dAL C��dST, y,2 Da J� I I FIRE DGPT. FIN!',L —� '
( i �
Fl^::,L H=ATING �" --1^I �� HEALTH UFf'T. �I�:l1L —i— ^_
FtN.SL EL[CTRIU � � � D�V. FEES Pi�!D ��I
"��i F�� i I - --�-- -
f At_PLU, .3 t�t:a � , I Ei•JERGY -- ---�— —I
___ -1-- .---=� :;-. _;.E,���*�;.,�_.. �__.�.._._� -� _- _
r+'
COP�J;�v1ENTS
. - -- -
SEP i IC TANK SIZE �
SEEP PIT/'J SIZE _ - —
�.,._.._..__-• ,�r}... ..___... _: � ,
� � �
;�;,i,�. . i , .
,� . ' ` -
T , • . . - '_'-_�_