HomeMy WebLinkAbout16963 (447) ��� CITY OF DIAMOND BAR - .
� DEPARTMENT OF COMMUNITY�DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)864-3195 Fax(909)861-3117 PRE$$
�'�^ BUII.DINC PERMIT APPLICATION FIRMLY
JOBSITE APPLICATION PERMff I. P/C
o ADDRESS �'2�� VAI.P�C� DATE �I�s��( NUMBER I V �F
$ ISSUE TYPE OCC
APN �FOT TRACT DATE CONST. GROUP
p OWNER ��.1+t�{ Sk'S ��)
ADDRESS ZZ30Q� VA(.pIC.O ZONING SETBACKS
� CITY DIA�IDN� 'Chi� ZIP TEL. REART RW ❑❑
APPLICANT TEL SIDFJSIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� CnDRESS Z�P TEL. PROPOSED USE " : C•� '' G�
� ARCH/ENG/ _
DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS � STORIES � BEDROOMS�
� CITY ZIP TEL
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWN[R•BUILDER DECLARATION SFR/ADD/REM
OQ I XEREB'!AFFIHM UNDER PEN/LTI OF YERAIPY TMAT 1 AM ExEMPT iROM 111L CONTMCTORS lb Gdf8g0/Ca�pOfi
W CENSEUWFORTHEi0LL0YlINOREASON(SEC.70.71.SBUSRI[SSMl�7ROFE55lON5CODf:AYYCITYOF (n
S� WUNTYWHICHR[OUIRESAFEWAIiTOCONSTRUCT.AITEqIIAPROVE,OCMOLISH.ORREPNRANYSTRUG W PO;iOIDOCk
u� TURE o�TO RS 65U�NCE.ILL50 REWIRES 7HE APPIICMlT FOR SUp1 VERMIT TO F0.E A SIGNEO W
� STATE4ENT TUT HE 01i SME IS UCENSED PUR.UIfR TO iME GRONSIONS OF 1HE CONTRACTORS Ll•
� CENSEUM�(CHAPTERO(CddMENCW01NiHSECilON7000�OFDIVISION3O�111EBUS�NESSANDDR? �- PooVSpa
FESSKKIS CODE)OR THAT HE OR SH[IS EXEMP7 TNEREFROM ANO THE BASiS FOR TM[ILLEGED E%E/.iP�
TION.ANYYIOL�TqNOF5EGT10NT0.71.3BYAMlAPPLK.ANTFORAPERMITSV&IECTSTH[APPLIGANTTO Z RO•R001 Qv
F ACI�(�LiENALTY OF NO7 MJRE iww FrvE MUNDRED OOLlARS(tsoa).1:
� �R�ASOWNEROFTHEPRDPERTY.ORMYEMPLOYEESYATNWAGESASTNEIRSOIFCOMPErvS�TpN, ❑ COmmefGial �
WiLL DO THE WOFiK,AND 7HE SiRUCTURE LS NOT IHTENDCD OR OiFERED FOR SALE(SEG 70N,&15L J
NE55 MID DROFESSqN3 C170E:TNE CIXtTMCTOiL^IICENSE UW�OES NOT APPLY i0 hN OWNER OF
� PROPEHTYYN�DBUlD90RMPROVESTMERCON.IU+OWIqDOE55UCNWOfiNN1Y5ClFONHERSELFOR �
Q TYWIMHWSORNERONMEMVLOYEES,ORO1nDEDTSUTSUCHMVROVEMEMSARENOTPITENDE�OR m
OOFFERmFORSILEF,/qWEYE1tTHEBVILdNCOR1uPROVEMCMI5501DN77HNONEYEAROFCOMRE�
z TION,iME OW�IER�BURDER IMLL NAVE TNE BUROEN OF PROYWO 7NAT HE OR SHE DID NOT BURD OR
= MFRD`/E FOR il1E PURP0.5E OF SALEF
W ❑II�SOWN[pOFT1[PIIO�CfiTY.AIAE%0.USNEL7WMMCTINaM^.THIICEN5E000NiMCTORs
� TO CONSTRUGT iHE FRWECT(SEC,701�.BUSiNC55lW7 PROFESSIONS COUl.THE CANTRACTORS U� y81t18110� ADJ.AREA
CEHSE Uw DOES HOTAPVLY TO AY OWN[R OF 11 PROPEH7Y W/p BUttDS Oft MPROVES TMCREdI,AND
� 1MqCOHTRACT5iOR5Ud1PROJECTSNn7NACONTRACTOR(5)lKENSEDVUR^, AN+TOTHECONTMG QUANTITY ESCRIPTION FEE
� TORS IICQISE Uw.).
OI/iME%E4PTUNDERSEG. ,.BVC.FORIHISREISON a
3 �
u" WTE X 5 OI OWNCH � .
� U
UCENSED CONTRACT0�7S DECLAFATION �
F l:l
Q IMCNCBY/�FFIPoJIMDC11PEwLL7YOFPERIUHYTU71A4lICENSEDUNDERPfioVISWn�SOFCNAPTER �
d �(WIAIACNCOtQ WIiM SECTION 70oC)OF DiVISqN 70F THE BVSME55 ANJ PPOFESS�DN3 COCC.AND Z
X MY LILENSE IS W NLL FOPCEANO EFFECL —�,
LL!
O `
�..,, UCENSE CLASS LIC.t�0. �
J
�j DATE CONTMCTOR d
W
� WOiiKERS'COMPENSATION DECLAAATION Q
� U
� IMEREBYAFFIRAIUNDENPEN�I'TYOFVE0.R1RVONEOFTHEFOLLOW'NGDCCLAMTIONS'. Z
Q
� �INMENNM/illMAiNTA.MACEHTiFlG7EO�CQNSENTTOSELFNSUREFORWORKEPS' _ �
� COMPENSATION,AS PPOVIDED BY SELTION 77000f TNC lAf101i CODE.FOR iME VEAFORNANCE W
O�T+E wnRK FOR WIIiq17HI5 VCRMIT 6 ISSUED c�
0
�I MAYE ANO WILL MAMAIN WORKERS'COAI7ENSAiIDN INSUNU:CE.AS HE WIRE�BV SECTqN �
Q 17000FTME UBOH COCE,FOFi THE GEFFDfiM�NCE OF TNE WO�Uf FOR 1MIIq1 iHl;PENMR�5
ISSUED.MYV�RKERS'COMi'[NSATIONINSURMICECARRIERAhDPOLICYNUMOCRARL CONSTRUCTION
� CARRIER PLAN REVIEY�
z vai�crNuuo[n ELECTRIC
¢
� (fFt55ECTqNKIDrA78ECr6i�E7EDOFT7[aEw.fiC,iORONE14l�D�1ED0011/�'�SR+�)�LESy1 PLUMOING
W IttRTIiYTNATW7}IEOERFOR4iWCEOFTHEWONKFDRNMIp1TN15PE�ITI5155I1ED.1 MECHANICAL
2
(J 511AL1NOTEUPLOVPM'CERSONNAM'AU�NNLNSOASTOBECpA'cSlA1ECTTOTME
� WORNERS'COMPEN5�710NUWSOFCALIFOHNI/�MIDAGREETHATIF151qULDBECWaE INSPECTIONFEE I`
S SU&1CCTTO7MEWOR1fER5'CAMPENSATqNPROVI5AN50F5ECTqN77ooOFTHEIABOR �SSUANCE •v
coo�,�sruu�o��m cor.�Pir mn�n,ose rAo�sar+s. r
0 SMIP •_`�
p DATE: AGFLICANT: .
W�RNiNO:FALURETO£ECUREWOR%ERS'COMPENSATIONCOVERACEISUNUYI�UL.ANDSHALLBE ENERGYP/C
� SV6IECTI�NEMPLO'lEfl70RUMPIALVEtUL71E5MPJCfViLFNESUVTODNEMUNDFCDTMOUSAND ENERGYPERMIT
DOLLAAS(5100.000).N I�DDITION TO TME COST OF GOMPEN5�710N.DAMAGES AS PROVIOED FOf11N �( \
� SECTION]7oeOFTH[IABORWOE.NTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: I • lJv
pw_, CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� IMERCBYAFFIRMUNDERCENKiYDFPERIURYTMA7THEREISACONSiRUCT10NlENDiNaAGCNCY
�z- FOR THE PERFOfY.WICE OF iHE WORK fOH WMiCM THIS PERNIT IS ISSUED(SEG lwl,CfY.G).
W
� LENDER'S NAME
� IENDElYSIDORE55 � � ^ •^O
WICERTiFY71UTINAVEREADTNiSAPPLICATIONAND57ATETMATTMEABOVEINFORMATqNISCORNECT. TOTAL FEES �j �
� IACRCETOCOAIDLYNATHALLGTVANDCOld7TY0iiDINANCESANOST�TEUN5REUIWOTO0U0.DIN0
CIX:STRUCTION.AN�MEREBY AUT/qf72E RE7RESENTATIVES OF THIS CDUHTY TO EMER UPON THE
ZAOOVE�MEMiqNEC FROPERTY FOR WSPECTiON OURPOSfS. COMMGNTS
� A�,�Y� 1=S���I�
�
QFERMITTEENANE�PR T) � /1S D
N
y SIGNATl1HEOFPEfWIT EE �t
� RECPT.NO. PAID BY VALIDATION
WHI7E—Oopertment Copy.YELLOW—Finente Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GR[EN—Apqicant's Copy
-��., CITY OF DIAfJ10ND BAR
� � IPvSPECZ'IOIL+ RECORD
I
--�-•-----_ ----
��..� � . a ��VI�=�. 1� .�e� c-- ►� `l���`�If.�i �' � `.�`�.. �c�:
1►�_���c�. ���E _�... _ _'.i .�. ;� .�� .�. . _ -����-'.-_�.�..._ �!:�..�_�_ ...-,r.����,.. _'�".��::�_-:��°-�*�_..� �.
SET 6ACK -~W� ; � � .�' , i� FLOO��JOIST M� .•... ..
�FTGS!FORh"SlSTEEL ' ' ' � FNA REQP•ATS
�ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUP�181NG UNDER FLOOR CU�!DUIT I : `
SLAB GRADE. FIREPLACE FOUNDATION I �
TEP�1P POWER I I FIREPLACE BOND BEAh1
VJATER SERVICE _J__ MID HT.BOND BEAF�^ �
ROOF SHEATHING �Z�j-�� _ _ 8 FT.BONJ BEAM
FRAMING./VENTILIATION� i FINAL BOND BEAPA � �
ROOF COVF_R '�,t � I -��"""'-` PRE-GRADING _
ROUGH HEATIPJG �( � BENCHING
ROUGH ELECTRIC I ROUGH GRADING
ROUG}-I PLUi�161NG FINISH GRADING �
SHOWER/TUB TEST POOL ELECTRIC
EXt LF,TN!SIDING POOL FENCING �
�NALL INSULATiQN POOL FINAL �
CEILING INSULATION •�� OFF SITE IMPS. � �
DciYVVAL.L PJAILING � DEDICATfO�JS
�EWCR , FINAL EPJG. �
SEPTIC TANK LAPJDSCAPc/IRRiG. '
I
.SEEP PITlL.L. ' � ON SITE Ih.1PS.
GAS AIFi TEST ( FIi�AL ZQPJING �
FltvAL CONST. FIRE DEPT. FINAL � �
FIi�;�.L HEATII`G � HEr:LTH D�FT. FINAL • � _
I�C.AL ELECTAIC � DEV. FEES FAID �
�---— —T----� —
� �!i•lAL PLUP�19fNG E�•JERGY � ;
`----- � ! .�_. � j --
�1;�_T�� r:l� g:`f"E' --�1 — — ---
� •--s.._.._._._r_�_cs".c�{_.i.�_.c..................... _. —
co���r11EfJTS
,, , .
;
sEP�ic T�r��sizF
SEEP PiT/U SIZE - - ---
. . : ��.'.��, � . -- ---
,
�,�� ;^; -- — — -
. . . .
_.__:...�.___..�,�-_-_�___-�` -' --- - — -