HomeMy WebLinkAbout13749 (647) �� CITY OF DIAMOND BAR O
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.CoplcyDrive Suitc 190
(909)860-3195 Fax(909)8b 1-3117 PRESS
'�^` BUILDING PERMIT APPLICATION FIRMLY
vi /J ' �J
Q DD ESSS�f r�/'"S� �" /"�, APPLICATION �J� PERMfT � P/C
p DATE � NUMBE !1
� PN LOT, TRACT ISSUE TYPE OCC
°C OWNER G�C/ L�C✓ DATE CONST. GROUP
ADDRESS SS/ 7op,5" ' � . ZOPJING SETE3ACKS
W ITY.Q����+-✓�• ZIQ TEL. ° �IS���Z FRONT RW p
� A LICANT �"" �"-«� TELf�' j' -Y�� REAR p
� SIDE/SIDE STREET RW O
CONTRACTOR c ! OL C o SIDE ❑
� ADDRESS ��/f+^�w F /c �
CITIf,Sc.µ �.•+-e�-S'
ZIP ti TEL ��5� PROPOSED USE
� ARCWENG/ ,,,_ �<`�CIC�//r`�1
DESIGNER W�G� f!
ADDRESS L L" .�f'�' . NO.DWEL. NO. NO.
� CITY S�"" �'"`'" 21P��z TE �( UNfTS STORIES E3EDROOMS
�
�n OESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
Q ONMER�BUILDER DECUIRATION SFfilADD.TiEM
O
p I MEREBY AFFIRY UNDER VENALTY Of OERAIRY T1uT I IW EX£uPT fRpA TH[CONTRACTORS U• G8f8A0/CtfpOR
LL CENSEUWFORTF1EFOlLOWiNGRFASON(SEC.7071.6BVSMESSMlJPROFESSIONSCO�E:AN'/CITVOR (f�
CJ COUHTYM'HId1RE0UIRE5A7ERMRTOCONSTAUCT,/1TER�PROV[,DEMOLISH,ORREPAIRAN'/STAUC• W
u� TURE,YR101t TO ff3 IS9UANCE.ILSO 11EOUIR[S 71iE AVVLICANT FOR SVCH VERYIT 70 FlLE A SIGNED W Patiolpeek
� 8TI1TEr/EM THAT ME OR SHE LS LILEHSED 7URSUANT TO 7HE PROVi510N5 OF TNE CONTRACTOHS LI•
CENSEUW(QU➢TEH��COMMENCWOYA7HSECTqN7o00)OFDIVISVN�OFTHEBUS:NESSANDPH0. � POOUSpa
FESSqN5C00[)ORTIUTMEORSMEISE%CYPTTHEREFROAI►NJTMEBASISF011THEALLEGEDEMEYD• (�
TIOH.ANYV10LAilONOFSECT10N70.71.6BYANYAVPLICAHTFOflAVERMITSUBIECTSTHEMPLM.MITTO Z Re•Roof
� A CMl VENAL7Y OF NDT MOpE THMI iNE HUNORCO DOLLARS�f So0)}
� 04�SOMMEROFTMEPROPERTY.ORMYE�PLOYEESWITMWA�ESASTNEIRSOIECOMPENSATqN, � COmfIlOfCidl -
Y/�LL DO TNE WORK AND THE STRUCTURC IS NOT INTEND[0 OH OFFEREO iOR SALE(SfG 7a�,BUSb J
� NE55�ND PROFESSqNS LODE:h1E CONTMCTORS LICENSE Uw pOCS NOT AViLY TO AN OWNER OF �
PROVERiY MMO BU4D5 OR IIAPROVES 7MEREON,/�ND Nn10 DOES SUG1 WOHK M:MSELF OR MERSELF OR
Q THAOlKY/Hi50FiNER014NEM7LDYEES,PROVDEDTl1ATSlKIIWPPOVEYENTSMENOTNTENOEDOR m
� OfFEAEDFORSAlE1f,M0YlEVERTME&1IlDINOORM7ROVEMFM�SSOIDWRHiNONEYEAROFCOMPIE•
� TION,iHE OWNER�UIIDER WILL HAVE TNE BUfiDEN OF VROVNO THAT ME ON SME DIO NOT BUItD OR
MVROVE FOR THE R1RP05[O�SALE).
W 01/LiOVMEROFiHGPROPERT`/,AAIE%CLUSNELYCONTMCTPJGWITMIICENSEDCONiMCfORS
� TO CONStRVCT THE iRO.IECT(SEG 70N,BUSIhCSS AND PROiE55ION5 COUL TN[CONiMCT0115 U- V�IU�IIpI ADJ.AREA
CENSE UW DOES NOT APPLY TO AN OWNER OF A PROVEIIT'Yllp BUlDS OR 1�1Vf+WE3 TNERCON.AND
� WHOCONiMCT5FOR5VCNYROJECTSWIiNACONTMCfOfyS�LICENSEDPURSUANTiOTMEWHTMG OUANTITY DESCRIPTI04 FEE
� iOfii L/CFNSE UN��.
� OIAME%EYPTUNCENSEC. B,tP.GFORTHISREA:AN Q
U �
� �
DATE OVMER U � .
�4 LICENSED CONTHACTORS DECLHAATION W
2 IHEACBYAFFIRIIUNOERPEWLLTYOFFERAIHYTHATIAA1lICENSEDUN7CRPFlONSiONSOFCk1APTEA V.
� O�Ci'71Y�EN('.INOYATHSECT10N70o0)OFONISqN70FTNEBUSINE55Ml�PROFESSIONSCOCE,AND
E(Y(10ENSE IS H NLL iORCE ANO EfFECT.
� LICENS^E�CLA S "'�`'� LIC.N0. L � �7`� J
V pATE f6 � CONTMCTCR �
W
� WORKERS'COMPENSATION DECLARATIOY ���t' � U o�, �� Q�„C e ,- .
� INERCBYIIFFIRMUNOERPENALTYOFiEM1MONcOFTMC�OLLOYANdDECURATqNS. � Z 'o-t G C/v�i dp(j , �
a
� _IMAVEAN�NnLLNAMTAiNACERTIFIGTEOFCONSENTTOSELFaNSUREFOfiWOfiNERS' S 'Z(SG UC (µ
CpAPENSATqN,AS PROVIDED BV SECTION 7]0o OF TME L/30R CODE,FOR 7NE PCRFORY�NCE �U w
OFTHEYV9RKFORNM1IICNTHISiERMITISISSUCD. � E���„sl- �a,,�,� J�
� 2
1 NAVE AND N"LL 1M7M�u1 WON(ERS'COMPENSATION INSURANCE,AS RCOUIRCD 8V SCCTION
Q ]700 OF TME L�DCXi OOOC.F0�1 TME DENFORUANCE OF 1HE WORK FOH WMiL11 THIS PEfUAIT IS
�SUED.MYND E 'C04PENSATpNINSURANCEGRRiERF1.'DPOLICYNUMAENAAE. CONSTRUCTION
� uwRIER '�'� PLAN REVIEW
� pakrM»"°ER!U C� a �"' ` EIECTRIC
� �nss[cror;Nceornre[nx�Ermacnccca�.+rs�oaor:EMror��mU,uR�ro�oa�ssl PLUMDING
Z 1 CERTIFI'TMAT IN iHE PERFORMANCE OF iHE NfORK FOR WHICH THIS PEiW1T 1 i ISSVED,1 M HANICA
(,'J SMALIfqTEMPLOYMlYVER'.a0NP1ANYMN�NER50A5TOBECpAiSVBJECTTOTME i/� �
(,/) N9Po(ERS'CDMPENSATIONUWSOFCALRORNIA,IV1�11GftEE7MATIfI5//OVIDBCCOMF I� FEE � f������
SUBIECTTOTMEWOfiKERS'COAIPENSATqNPRON5qH50F LTpt17T000FTHElABOR �.
coo��FORTM'ITNCOMPIVNtTHTiDSEPROVIS s ISSUANCE
O DATE: e AP%.ICANi. � SMIP •' •^n�
� ENERGY P/C `I� . V t� t�_��
WARNINO:iALUR[TO=ECURE WORKERS COM�ENSATION COVEMGE IS U�UwF�.AND SYULL BE
� SIAIECTANEYI+�OVENiOCRl1.1?U:VENALTIESMOCMLFWESUPTOONENUNORCDTFK7USAN� ENERGYPERMR� � T, "�
DOILARS�7100,000�,W I�DOITION TO TNE C0.5TOF�pN0EN5AT10N.DAIMGES AS PROVIDEO FOR W �.,_ „ ��. ,� � ���•
JSECilON77oeOfTHEIABOROWE,NTEREST,ANDATTORNEY5FEE5. - � ' ' ` � ��
� RETENTION FEE: '
a CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
O
� IHEFCBVAFFIPIJUNDERVENI�IT/OFPfR1URYTHATTHCqEL51CON5TRUCTIONLENOWGAGENCY
� FOR TME PERFORMANCE OF THE WORK fOR MMItl1 TMIS VERM:T IS ISSUEO(SEG A»i,CIY.C-�.
�
� LEADERS Wu�E
C IENOER'SADDNE55
� TOTAL FEES
' w ICEiR�FY7HATIHAVER[ADTHISAPPtJCATqNANDSTATETMATTNEA00VE1NFORMAiqNISCORRCCT. �
� IAGREETOCOMFLYWITHALLLTlAHDCOUNTYORDININCESHJDST�TEUNSREUTWOTOBURDINO
CONSTRUCTpN.IWO MEREBY�UTIqR11E REFRESENTATIv[5 DF TWS COUNTY TO EMERUPON THE
ZABOYE�MENTIONED7ROPER FpRINSV�:T10N RaosEs. COMIAENTS
� ,/(/� �G..(./��!�J
_
m P�RM'TT F N�uE IPRINn J(�
¢ � � ` .
� �7 � �1 -� � fv � �
� S NAiVHEOFVERMITTEE 0 �E J�]
� RECPT.N�I , PAID BY VALIDATION
WHITE-0opartment Copy,YELLOW—Finence Copy,PINK—Assessa Copy,GOIDENROD—File Copy,GREEtJ—ApD����'s Copy
, r .... . ..-�, - .. . ,. . .. . . . :*' .,.'' - ...T.o. .'}. .:��. .,,+.,i` '"z_+..4'• :�<.�;. . .!,'v�.�..;,'.:.... ` . ;�:. ,�• .� r•• .
; � CITY OF DIA��iOND BAR
� . If�SP�CTiON RE�d7RQ
�.1����X�e��ajc�rf , -, ;���j�� -il����.`��,�r. 1►f-y=�=�;'�.1.�'J���a���i'_ _'---f►��:y�-�=r''!'�'i�i"'_ _...
�SET BACK.__.._.� _. _a.____ti..�.__�._ . -,-'FLOOR J015T _.,_,.�......�....�_.'.I. ._....._�._._. ,�.........____.-.,_. - .- --
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GR�UND PLUMBING I I UNDER FLOOR CUi•IDUIT �
SLA�3 GRADE ; FIREPL'AGE FOU�vDATION � � � ' � ^
TEh1P POWER I FIREPf:ACE�OND BEkh1 � � ' ' I � � '
'WATEfl SERVICE I MID HT. BOND BEAM ' � �
ROOF SHEATHIPJG I 8 FT. BOND BF�M . .- • I ___ _l
FRAD.�INGNENTItIATION I FINAL F30ND BEAM : � I _ _ I
RO�F COVER I I PRE-GqADING j
,
ROUGH HGATIPJG BENCH1t�G.� ��,�'.< ' •
'ROUGH ELEC i RIC I ROUGH GRADING
RO;JGH PLUP�IBING � I FiPJISH GRADING I
SHOVVEF.ri'UB TEST POOL ELECTRIC
EXT. LATH.�SIDING � POOL FENCING I I
1'VALL tNSULATiON POOL FINAL _)
CE(LifJG INS�JL.ATtON OFF SiTE IDfPS. I� ___ _ ___I
DRYI�"JALL NAILI�JG DEDICATIONS __ ____ I
SEl"IER FINAL ENa.
ScPTiC TANK LAPJDSCAPE/IRRIG. � I
SEEP PIT/L.L. ON SITE IP,1�S. i �
G�,S t,l�:TEST � FINAL ZONIPJG � �
F!N�.L COidST. FIRE D�PT. FINAL �
F1'dl�L HEATI^JG ;$��� - -- _L HEP.LTH DEPT. FINFIL. � � ---------
F';;�A.i.ELECTRIC � ; � DEV. FEES P��ID
i :=��.'/;�PLU�l,BI�dG � ENERGY � ----------�
'-_�_ �— � � � f-- i ----------�---- I
' I � ����'�'at r.5�-u;: ._._�.��.._.. '. - -----I
� - . . _' . . _. 3' -_� -. . � ,� . , , ,
� � �
Fcor�;r�nENTs- . . . � � .�. _ � �- � -- {
- . , :�- , . . . .. , . , �
. , . , -- --------------;
-'� .- --- �, - _L
-- `,-- -----
. � �. '�
------------ --�-�
----...-------I
- - - . . - --�-�
SEPTIC TANK SIZE _ ____�
SEEP PIT/U SIZE _ �
_. . .... �
-. . �y��:� . . �"; --- ------�------- ---i
. . � - ---------1
��� . . _; I
��� � -
. . . . , . ----.�.-----.--.---
. . :; --.----- -----
• '4 ' � ,� � " � .
.' . .�a A � � i � � ' �