HomeMy WebLinkAbout16051 (1109) �\ CITY OF DIAMOND BAR �
_ - � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drivc Suitc 190
(909)860-3195 Fax(909)861-3117 PRESS
��'y��� BUII.DING PERMTT APPLICATION . FIRMLY
o ADDRESS � + �("'V � � DATE CATION i � 6 NUMBER I "0 � ' N,C
� ISSUE 1C TYPE OCC
APN LOT TRACT DATE U CONS7 GROUP
� OWNER SA�� �
LL ADORESS ZONING SETBACKS
� CITY ZIP TEL - R�RT RW ❑�
APPLICANT TEL. SIDE/SIDESTREET RW O
� CONTAACTOR a�y SIDE ❑
ADDRESS C � ��L PROPOSED USE � I N DV
� CITY �' k ZIP TEL � /v
� ARCH/ENG/ • • - . _ ,
DESIGNER NO.DWEL � N .. NO.
ADDRESS UNITS STORIES BEOROOMS
a CITY ZIP TEL
y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AFiEANALUATION
�
Q OWNER-BUILDER DECLAHATION SFFVADDIREM
O
p 1 NEREBV AFiIiW UNDEH OENALTY OF VERA/RV THAT 1 AM EXEMPT FROM THE CONfMC7DR5 L4 Garage/Carport �
� iL GENSEIAWfOR1HEfOLLOWNOREA50H(SEG7W�.eBU5WE53ANDPROFE5510NSCODEM7YpTY0R (�
C� COUNTYMAOCHREOUIRESACERMRTOCONSTRUC4ILLTE�LN�PHOYE.OEAtOUSN.ORfiEPAIRANYSTRUC• W PgSIO/DBCIC
� TURE p����SUANCE ALfA REWIRES TNE MPIICANT FOIi SUCH PER/AIT TO FILE A SIGNED w
STATEMEM THl1T ME OR SME IS 11GEN5ED PURSUMl�TO THE PROYISIONS OF TME CONTMCTORS L4
CENSEUw�G1APTEPi1COMUENCNOWI7M5ECT�ON7000)OFDMSIONJORTMEBUSMESSAA�PRD� � PooVSPe
FESSqNS COOE)OR iNAT ME Ofi SME IS E%EMPT iHEREFROM MIO TNE BtiS�3 FOH 7HEALLEOED EXEMP•
TqH,ANYV10LA1qNOFSECfIOH7D71.68YAHVA7VlICAP(TGORACERMITSUB.IECTSTHE�VPLICIINTTO Z �{�g•Rppf Z
r ACML�MkTYDFNOTMORETWIFNEIUNDREODOlUFS(fs0o).):
- � OI�W+NEROFIMEPRODERTV.OiiYYE1APLOYEESWIiHWAGL5A5THEIRSOIECOMPENSAiICN, ❑ (`,pmm0fCl81
MALL DO THE W�DiYC,/WD THE STRUCTURE IS NOT IMENOED OR OFFEREO FOR SALE�SfC 7oa�,BU56 J
NESS/N�GROFESSIONS CODE 7HE CONiMC70R5 LILENSE UN�DOES NOT APPLY TO AN DWNER OF
N ipOFEHfYYFpBUtD50RIMP1i0yESTMEREqJ.INDWNO00E55UpINqRKN11ASELFORNERSELFOR =
� TMIi0UC�1MI50RHEHOWNEMPLOYEES,ViqV10EDTNATSUGI�APROYEMENTSIIRENOTINTEN0E00R m
OFTER�FOR S�LLE.�F,IIOM'EVER7HE BULdN�OR IYPROVEMINTIS SOLD MnMN ONE VEAR OFCOMME
�TqM,TME OWNERBURDER YnLL INVE THE BUHDEN OF PROVWO TNAT HE M1 SHE OD NOT WIID OR
IAIpqpVE FOq 7HE pUPPOSE OF SALE}
� 04/�4OwNEROFTHEP110PEHTY.M�EXCLVSNELYCONiEACTMOVA7Ml�CENSEDCdffMCTORS
TO LONSTRUCT iME PRO.IECT(SEC.70H.BUSINE55 MA PROFESS�ONS OODE:THE CONfFUCTOR5l4 VelU8tbf1 ADJ.AiiEA
CENSE UW OOE9 NOT MPIY TO MJ OVR�ER OF A YROPE0.7Y Y/HO BULDS OR IMDROVES 7HEREON.ANO
N}1DCONTMCTSFORSUQ/PROJECiSWfTMA�NTMCTOR(S)LICENSEOPURSUMlTTOTHECOMMG OUANTITY DESCRIPTION FEE
� TOnS UCENSE LAW.�
O��E%EMPTUNOERSEC. 0-��.GFORTHISNEASON U ��
3 ¢
LL' OATE OWNEH V
� UCENSED CONTRACTORS DECLAAATION W
� I NEREBYIIFFWM UNDER YENALTV OF PERnIRv TN�T IAM LICENSED UNDER GROv�5�CN50F GUo7Eq V.
•�COMMENCINOYIfT/13ECTION70o�10FDM5lON]OFTMEBUSIHESSMID7ROFE5510NSCOOEFNU Z
�j MYLIGENSEISWFULLFORCE�NDEfFECT. m
0 LICENSE CUSS LIC.NO. 1`��O � `� �
7
� p�7E � �CONTRACTOR d
w `+1�J1 ��
� WORKERS'COMPENSATION DECLARATION —�
¢
� IHEREBI'A�i61MUNDERVENN.ttOFPE0.JURVONEOFTNEFOLLOY/iNODECUF1nT10NS.+ �
� Z
� _IHAVEANDWILLMWN7AINACERT�FlCATEOFCONSENTTOSELFiNSUAEFONIMDRI(ERS' S �
COMPQlSATIDN.ASGROVIDEDBYSECTIONTOeOFTMEUBORC07E.FORTNEVENFORMANCE W
OFT/E WORK FOR WHld/THIS VERMR IS ISSUEO. �
0
��1 HAVEMID WILL WIMMI WORKERS'Cd�DENSATION INSUMNCE.AS REIXIIRE�BY SEGfqN J A� 2 �'. �O O 1
Q 970oOFTNELABOROODE,FORTIEVERiORMANCLOFTHEWORKFORVIHICHTHISFERAIRIS ` '
ISSVED.IIYWOPJ(ERS'CONPENSATqIJINSUiUNCECARRI[RANDi0l1CYNUMOERARE: CONSTRUCTION �
� CARPoER • fYr • � PLAN REVIEW �',�T^'�Tr"'TDi7�'i��ip�T?h t) _
� voucr� AFR�� ��(�`rt'�', �� fn ELECTRIC
0 (RiSSECICNPEmNOTBEWFRE7EDOF7FEPEfMT6fOqONEM1�DRLDbotiWtS�xpi�� PLUMBING
� ICEiiTIF`ITHATRlTHEVEHFORMANCEOGTHENORKFORWNiq/TH15PEFWiTI51S5VED,1 MECHANICAL
() 511ALLNOTEMPLOYMlYVER+ONRIAN'/A/ANNERSOAST08ECOUE5LB1EttTOTNE
N YlOHKERSCOMPENSATqNUWSOFCAUFORNI�,ANDAGREETMATIF151KK.lDBECAME INSPECTIONFEE
5 SUBJECTTOTNEIWRKEFS'COMVENSATIONOROVISIONSOFSECTION]7000FTHEUBOR _
cooE s�w.�co n�canv�rNnn�nroserno�nsar+s. ISSUANCE
� (�'�) SMIP
p DATE: D�APPLICANT. _�� ��- i .
►+� ENEFiGY P/C
WAHNINa FAILURE TO SE WRE YA]itl(ERS'COMPENSATION COVERAG[IS UIMWNL./�N�SW�LL BE
� SUBJECfANEMPLOYERTOCPoM:NALPENAlTESMIDCIViLFNESUPTOONEHUNDREDTHOUSAND ENERGYPEflM1T
DOLLIINS If 100.D001.W��pT10N i0 T/1E COST OF COMPENSATION.DAAIAGES h5 PROVIDED FDR IN
� SEC710N]7oeOFTHELA80RCO0E,iNTEREST,ANDATTORNEY5FEE5. RETENTIONFEE:
CONSTFUCTION LENDING AGENCY PRE-ALT FEE:
O
� IMEREBYAiFIRMUNOERVENKTYOFPERJURYiW�TTHEREISACONSTRVtt�ONLENDINOA�ENCY
2 FOfI THE PERWRMANCE OF THE WORK iOR WMIp1 THIS GERMIT IS ISSVED(SEC.]Oal,dV.0.).
V1
� LE��ERSNiuIE �
� IEN�ER'SAD00E55 . I
� i��EtomATi.iivmRm�iMcmum�rr�o�iruTric�stw�"osr�uw`s°p�u woroeCOi1unoi a TOTAL FEES 1 , I �
CONSTRUCTION.ANO HEHEOVALITHORIZE REVRESENTATNES OF TMIS COUNiYTO ENTER UPON TME
Z /10WE�MEMqNEOVFiOPERTYFOR�NSPECTIONVURVOSES. COMMENTS
J .
�
¢ VERMITTEE NA41E(P /
� ,
� s�crwtun F e o�t pECPT.NO. • PPJO BY VAUDA110N
� WHITE--Department Copy�YELLOW—Finenee Copy.PINK—Asiessor Copy,GOLDENROD--File Copy.GREEN—Applicanl's Copy ,
, CITY OF DIANiOND BAR
� lNSPECTION REC�RD � ' � _
� ��� ��,,•: ,D ,^....�, __ • � �-'�� ..���"'�r��i�4rl���� ....Il'�C�r��Cr14a,�r�._...,.�II
;SET BACK � � �� FLOOR JOIST ,
. ;FTGS/FORMS/STEEL � � ' � FHA REQMTS �
� ;EIECTRIC GROUND __i i UNDER FLOOR DUCT •
� GROUND PLUMBING UNDER FLOOR CO�IDUIT '
SLAB GRADE FIREPLACE�OUNDATION �
TEMP POWER FIREPLACE BOND BEAPA � -
WATER SERVICE MID HT.'BOND BEAM
'ROOF SHEATHING , ' I�� • 8 Ff.BOND.BEAti1 -
FRAMINGNENTILIATION � ' � FINAL BOND BEAM �
!ROUFCOVER L-OZ-aL � PRE-GRADING
ROUGH HEATING - BENCHING .
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING - FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT:LATH/SIDING - POOL FENCING i
WALLINSULATION - POOL FINAL
CEIUNG INSULATION � OFF SITE IMPS.
DRYWALL NAIUNG DEDICATIONS "�
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. -
SEEP P1T/l..L. � - �-� ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATlNG HEALTH DEPT. FINAL �
FINAL ELECTRIC - DEV. FEES PAID
�FINAL PLUMBING ENERGY �
_ ;�: ��' � . ^'`t'c`"...'.�.-�.,.._"_' :i
.:,�-,�_...,M. ��:.��: .
_ ..,. ,:
- -�,,� .:.i _ . _
COMMENTS _�'�.:������;•(� ,. •
. . � ,I , � -- �. � • -
. . ... �� i ,i -- , . , . _ _ —
� —
. . . l � - ._ . , , . .
SEPTIC TANK SIZE
�SEEP PIT/U SIZE —
� �.�..;.,..,.,
�.'s-•'�fk
� t
._l
4 ' .'�� ' , _ ,
t q ;
�' � _ _ i
� ...___. . .� , . ._ - � � �� < � . - -