HomeMy WebLinkAbout18322 (663) J� CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES t
��w 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
�`-���� BUILDING PERMITAPPLICATION 1� � �FIRM Y
Q DD ESS ��b",� //�N��� !/l e ll�I1� APPLICATION PERMIT '1 �P/C
o / DATE � � �Zi NUMBER f'� a �7—I l 1
� ISSUE �, TYPE OCC
APN •M � ACT � DATE � CONST. GROUP
p OWNER � -
p ADDRESS ' � L/{� ZONING SETBACKS
z CITY ZIP � TEL. FRONT qN/ p
g APPLICANT TEL.' R�R ❑
zd SIDFJSIDE STREET RW O
r� CONTRACTOR `' /i SIDE p
� CITY S <�IP 2 E�,� 7 PROPOSED USE_ ( �'� � � `� �Q ��
o ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
n. ADDRESS
� CITY ZIP TEL UNITS STORIES BEDROOMS
N
� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� ONRJER•BUILDER DECLARATION SFRJADO�AEM
O
p I MERE AFFIRN UNDEN PENALTY OF PERIURY THAT I/JA EJ(EAIVT FROM �CANTRACTOFS LI- G8199B/CAfPOR
[L CENSEUWF THEFOLLOWINOREASON(SEC.70.71.6BUSINESSANDPROFES NSCODE:ANYCI7YOR (n
U �yW�11 EOU�RESAPERMRTOCONSTRl1CT,ALTER,IMPHOVE.DE ORREPAIqANYSTRUC• W ati Ck
� TURE.VRqR TO'S ISSUANCE,AL50 iIEW IRES TNE�CPUCANT FOR N PERMIT TO FILE A SIGNE� W
� STATEMEM THAT �OR SHE IS IICENSED WRSUANT TO TNE PRO iONS OF THE CONTMCTORS LI- �
CENSE UW(CHAPT (COMMENCIN6 N'ITH SECTION 7000)OF SiON 70F THE BUSINESS/ND Pfl0• POOVSP2
FESStONSCODE�OF MEORSHEISEXEAIPTTHEREFROM THEBASISFORiMEAUEGEDE%EMP• (�
TION.ANYYqIAiqNOFS TION70]I.6BYMlYAPPLI qAPERMITSU&IECTSTMEMPLIGWTTO Z Re•Roof
AGYILVEN�LiYOFNOT 1UWFIVEHUNOREDD (fSDo)�:
Z ❑I.ASWMEROFTHEPRO RTY,ORMVEM7L ESWITHWAGESASTHEIRSOLECOMPENSATION. 0 COmmBfCial �
NALLDO THE WORK,AN�THE STR RE IS NO TENDFD OR OFFERED FOR SALE ISEC.70��,Bt1Sl- J
� NESS AND GROFESSIONS COOE:iHE M RS UCENSE LAW DOES NOT ACFLV TO AN OWNER OF ? � �
VFOPERiYVAIOBUROSORIAAPqOVEST ON,ANONM1/ODOESSUCHWORKHIMSELFORHERSEIFON
Ct 7HROUGNHISORHERONNEIADLOYEE VIOEDTIATSIKHIMVROVEMENTSARENOTWTENOEDOR m
w OFFERECFOqS�LEIF,HOYfEVERTH RD�N qIMPROVEM[NTISSOL�WITFIINONEYEAROFCOMPLE•
Z TION.THE OWNER-BUIL.DER WILL iHE BU �N OF pqOYIN6 THAT HE OR SHE DID NOT BUILD Oq
= MGROYEFORTHEPURPOSE E}
�yJ ❑4�"OWNEROFTH PERTY,MIE%CLUSIV CONTMC7INOWfTMLICEN5E000NTMCTORS
Q i0 WNSTi1UCT THE P CT(SEG 7Mt,BUSINESS pROFES510NS CADE:7HE CONTRACTORS LI• V21u3ti0n AQI.ARE/1
W CENSEUWDOES 7PLYTOANOWNEROFAPPOPER NTIOBUILDSORAAPROVESTMEREON.AND
� WHOCONTMCTS PSUpIPRQ1EC7SMATHA00NTMCTO 7LICENSEDFURSUANTTDiHECONTiUC• QUANTITY DESCRIPTION �E
TORS IICENSE .).
0 ❑1 ExEMPT UNOER SEC. B.t F.C.FOfi THIS REASON Q .� � � �
� U
ZTE OWNER � ,
�Q UCENSED CONTRACTORS DECLARATION W
¢ IHEREBYAFFIRMUNDERPENALTYOFPE0.NRVTHATIMIItCENSEDUNDER7ROVI510NSOFCHAPTER �
d i(COMMENCINQWITHSECT�ON7000)OFDINSION30FiHEBU51NE5SANDOROFE55lON5CODE,AND Z
X MYLICENSEISINFULLF RCEANOEFFEC7. m
LL �
0 LICENSECUSS � � LIC.NO. ��� �
V DATE COMRACTOR�.��� d .
W -
� WOFKERS'COMPENSATION DECLARATION � , S��
� IHEqEBYAFFlFiMUNDERPENALTVOFPE0.IUMONEOFTHEfO�IOWINGDECIARATIONS: Z
� �,,,,�INAVEANDWILLMAINTNNACERTIFIC�TEOFCONSENTTOSELFdNSUREFORWORIfERS' S
COMPENSAiION,ASGROVIDEDBVSEC710NT/ooOFTMEUBORCODE,FORTHEDERFORAIANCE W
Q OFTHEWORKFORWHICHTHISGERIAiTIS�S5UE0. �
�IMAYEANOWILLMAINTA�NWORKERSCOMPENSATpNINSURANCE,ASNEWIREOBY5ECT10N � O
� ]7000FTHEUBORCOOE,FORTHEPERFORMMICEOFTNEWORKFORWHId/TH15DERMITIS
� ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIERANO POLICY NUABERARE: CONSTRUCTION
� GARIER PLAN REVIEW �-h _
� PoLICYNUMBER ELECTRIC l�J
� �f�+ssecfn�nemr�oreeoor.Rt�IDaFnFrew,trsr�a+�M.rormoaius{siao�oatEss� PLUMBING 's
Z ICERT�FYTHATNTHEPERFORAAANCEOFTHEWORKFORWHILHTHISPEN.IIT6155UE0.1 MECHANICAL �'7 �
(.�} SHALLNOT E1�PLOVANY DERSON W ANY MMINEF SOAS TO BEfAME SU&IECT TO ME p�
N WORKERS'COMFENSATIDN UWS OF CALIiORNI�,M10 AQREE iHAT IF I SHOIAD BECOME INSPECTION FEE � , F�
S SUBJEGTiOTMEWORKERS'C0IAPENSATIONPROVISqN50FSECTION�7000FTNEUBOR �
CODE.1 SHALL fORTIVIITN COMPLY WIM T1105E PROYISIONS. ISSUANCE
�
p OATE: APPLICAM: SMIP \
�, WARNiNO;FARURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNUWFUL,ANDSHALLBE ENERGYP/C
�y SUBJECTANEMPIAYERTOCRIMiNALPENALtIESANDCMLFMESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOILM..�f10D.000),N PDDIiION TOTHE C0.5TOF COMPENSATpN,DAMAOES AS PROVIDEO FOR IN
� SECTtONa7oeOF7HELA80IiCO0E,INTEREST,ANDATfORNEY5iEE5. RETEMIONFEE'
oCONSTRUCTION LENDINGAGENCV PRE-ALT FEE:
� �HEREB'�AFCIRM�ypERVENALTYOF {WR�THATTHEREIS�CONSTAVCT�ONIEND�NC�CENCY
FORTHE PELIFORMANCE OF TNE WO FOR WHlpl iF115 PERAIIT IS ISSVED(SE0.70Y�,CIV.C.).
Z
W
� LEkDER'SNAUE
� LENDER'SPDORE55 v
� TOTAL FEES
� I CERTIFY THAT 1 MAVE RE THIS 11iPLICATION MJO STATE T1/ATTNE ABOVE q1FORMATqN IS CORRECL ��
� IAGREETOCOIdPLVM1THALLGTYANOCAUNTYORDINANCESANOSTATEUWSRELATWOTOBNLDING ��y
� CONSTRUC'TION./J�DHEREBYAUT/10RIZEREPRESENTATNESOFTNISCWNNTOEMERUPONTHE
Z ABOVE�MENTIONEDPROPEflTVFORINSGECTIONPVRPO5E5.,• CO MENTS
_ �p� �,,;.�._ ��P fla - ��,r,
m vewaine rd
¢ S I'/ O
(n S�GNATUR F VEHMITT DATE
� RECPT.NQ PAID BY ' VALIDATION
HITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—Fite Copy,GREEN—Appl�cant's Copy
� .. . • . .. , � -� . �f ,i. . . , .. , . .e , , . . .: . J . �x .- � .eJ. ... . . . . . .. , . e. , r. .� ., " ' . � . � .� -� .. .
�!�'�' C�:= �i�-,�:^DR�3 Br�f�
i1�'�:'�G"9'iG�•�! Rt;Ct7t��`.�
I�r�-�l�!�;��CCc�i�� ",�ey;��=r!-__����.-�.�:,.c'�it'a�l;d. �----IiyE-7.1-,,e`'¢il�;l�`! �i:1:Gl: :�i+��,:�.;c�dc��� '
.. �
/ �.. .. . .. .. ._. _.. _.,... _ _...--._._. ..� ....__�____._:. _ _____-----_.. ....__..�___.___.___...___.. - �._.._
`__ _ �_I FLOOR JOIST � �
�.SET BACK_.__.._.____.�--�1
FTGS,FORMS,STEEL j __�,_ FHA REQ'�1T5
ELECTRIC GROUND � � UPJDER FLOOR DUCT . �}� �
GROUND PLUViBING �— I ' � UPdDER FLOOR CU�IDUIT I
SLAB GRADE I FIREPLACE FOUh1DATI�N ! I
TEh9P POWER I � _� FIRcPLACE BOND BEAM
tiNATER SERVICE � i -,—� I ��11D HT. �OND BEA!�1
ROOF SH�ATHING I`�l6/a�/��c� I �3 Ff.BOND E3EAM _
FRAMING,NENTILIATIOPJ I 9.22b'L_ FINAL BOND E3EAh1
ROOF COVER I I I PflE-GRADING
ROUGH HEAi ING � � BEfJCHING
ROUGH ELECTRIC Ir!-1$•oZ �/ I ROUG�-I GF�F,DING
ROUGH PLUMBING _�_ i Fif`dISH GRADINu " _
SHOWER�TUB TEST I � POOL ELECTRIC
EXT. LATH/SIDING � POOL FENCI�Ju �
b'VALL INSULATION �� 7 PDOL FINAL I _
CE�LING INSULATION ���� ' OFF SITE IMPS. _l.
DRYb'VALL NAILING ' �_�'?„�1- _ DEDICATI�NS �_
5E1,VER FINAL EPJG.
S�PTIC TANK LAPJDSCF,PE/IRRIG.
SEEF' PIT/L.L. � ON 51TE IPJIPS.
GAS AIR TEST FIPJAL ZONIfJG
FINAI.CONST. rIRE DEPT. FINF.!
FINAI.HEATING HEALTH DEPT. FIfJAL
FINAI ELECTRIC DEV. FEES PAID ,
FINAL PLUPUIBING ENERG`r
—}-�_. ..�<.,....,,r....�.---'---=.-T...._._.____ � .
I �'�y:?Fi' C1.' £�ert.. .__ _ _.� I
-- - -��-- --�� - - — - ._i
.-- COMMENTS`��tg�o�-- ���- �- ��t�E�toa r�. euil
�,z`�o2 �t-[ac�wckT�o_�5 c�-c4-�2�—r�oy�c�c-�-�.�—D�t�N�ST�L�.__N_�r rQ �r.du: �
g_`1_oz. �(��rc�7�=-1� _F-�vi�—J��_�,
SEPTIC TANK SIZ�
SEEP PIT/U SIZE
I�q� ��..�-�
�f���
` _ .
-�