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HomeMy WebLinkAbout12629 (35) � _ CITY OF DIAMOND BAR DEPARTMENT OF COMM[1NITY d�DEVELOPMENT SERVICES � , 21660 E.Copley Ihive Suite 190 , (909)86Q3193 Fax(909)861-3117 PRESS ��'�"�. BiJILDING PERMIT APPLICATION FlRMLY � JOBSITE C� –� Q ADDRESS Z$ ! S U��� 1. APPLICATI ,,. � / PERMIT � `L P/C o DATE NUMBER K g ISSUE TyPE p�C APN LOT Z CT DATE CONST. GROUP � OWNER � ADDRE 2 ZONiNG SETBACKS � CITY�j(YO�HC.� ZIP�TEL FRONT RW ❑ APPLICAM' TEL_„T_ REAR ❑ � SI�E/SIQE STREET RVy ❑ CONTRACTOR �.. � SIDE p � CnDRESS ZIP��� TEL PROPOSED USE � ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. � CODRESS Z�P TEL UNITS STORIES BEDROOMS v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OVYNER-BUIIDER DECLARATION $FR/ADD/REM O I MEREBY AFFlRAI UNDER PENALTY OF PEiWRY THAT�A1A EI(EMPT FAOM iHE CONfRACTORS LI- �e�� rt CENSELANfFOR7HEFd10WINOREA40N�SEC.7m1.eBU5MEeSANOPROFE55qNSCODE:ANYCITYOR (n 9 ery0 OOUMYYAtlCMREOIHRESAPERYRIOCONSTRUCT,ALTER�PFIOVE,DEMOLISH,ORREMIRANVSTRUC- W p9�10/�6Ck riNiE PRqR 10 RS 16SUANCE,AL80 RECUIRE9 THEl�PPLICAHf FOR SUCN PERMIT TO FILE A&ONED 6TATEMENT 7HAT HE OP 8HE IS LICENSEO PURSUANT TO THE PROVISbNS OF THE OONTRACfORS LI� CENSE UN'(GIA%ER�(COMMENCINC�YlRH SECTqN 7000)OF DMSION 7 OF TiE BUSINESS AND PHO� ' � VOOVSp81 FESSqN5000qp{TFYITXEORSMEISEXEMPTTHEREFHOMANOTNEBASISFOR7HEAI.IEQEDEXENP• : (� iql7.MJYV�OLATIONOFbECTION7W7b8YANYMPLICANiFORAPERMIT6U&IECT57HEAPPLICANTTO . +� pe_p� � 11 CML PENALTY OF NDT MORE THAN FNE MINDHED DOLUAS(l900).): ' OLASO'MIEROFTMEPROPENTY.ORMYEMPLOVEESWI7MWAOESAS7HEIN80LECOMPENSATION, � CommBfCi01 MALL DO 7HE WON(.AND THE STRUCTURE IS NOT INTENDED OR OFFFRE�FOq ShLE�6EC.7oM,BUSI- �J � NESS M1D PROFFSSPONS CODE:TME OOHfMCTORS LICEN6E LA4f DOES NOT APPLY TO AN OYYNER OF ? PIpGERTY WIiO BU0.D90R IMPROVE9 THERE-0N,AND N7/0 DOES SUqi WORK MIMSELFOR HERSELF OH � iMiIOUGH NIS OR YIER OMM BJPLOYEES.PiWYIDED iFU1?SUCH MPqOVEMBQT&ME NOT NTENDED OR � m OFFEHED POR&4E IF,lIOWEYER 7HE BUILD�N�OR N1PipVEMQJT IS SOLD WIiMN IXJE YEAR OF COMPLE TION,TNE OWNER�6URDER WILL WIVE 7FIE BUR�EN OF VROVINO 7HAT HE OR SXE DID NOT BUIID OR MAPROVE POi17HE RIRPOEE OF BALEI. W ❑I.ABqM1EROFTHEPROPEHfY,AYEIICLU51YEiYC11MR11CTWAWIhIUCEN9E�00MiiACTOR3 � TO CONSTRIICf 1f1E PqO,1ECT�BEC.76tt,BU81NE53 AND PROGESSIONS OODE:THE CONTqACTORS LI- Va111811Of1 qp,J,pFj� CENSE lAW ODEB NOT APPLY 70 AN OWNEH OF A 7ROVERTY VYF10 BUMAS ON MPilOVE9 TNEREON,MW � MM1WCONiRACTSFORBUCXPqO.IECTSWfTFiACONfMCTOR(S)LICEN6EDMIR6UANTTOTNEOON�MC pUANTITY DESCRIPTION � ronsucd+sEwar.�. FEE O I AM EXEMPT UNDEfl SEC. 8.\P.C.FOR TMIS REASON � � �y � DATE OWNER . aC OI(�v� A I� � LICENSED CONTAACTORS DECIARATION W � 1HERE8YAFFIRAIUWDERGENAITYOFPEiWRYTFIATIIJAUCENSEDUNDERPROVISqNSOFCNMTER � � i�COMMENCMNiW1iTiSECT10N70W)OFDIVISION70FTMEBU6MESSIWOPROFESSIONSCOOE,AND Z �� MT LICENSE IS R/Fl1LL FOHCE ANO EFFECL � uc�sE G� � uc.rio.�ZZ—�� � U w,�� corrrancroR�'LR—�lC`fY[C. 3' � = WORKERS'COMPENSATION DECLARATION � NI HEREBY 11FFIRY 1/NOER PENALTV OF PERIURY ONEOFTHE PoILOWINO OECLARATqNS: � � _IHAVEMlDWILLWIMTAINACERTIFlCATEOFCONSENT708ELFINSUREFORWONKER5 = G04PENSATqN,A9 PROVIUm BY SEC710N d700 OF THE IABOR COOE.FOfl TNE VERFORMANCE C� O pF 7HE YVORN PoR NMICH TNIS PENMIT IS ISSUE�. � � •/ V IHAVENIDWILLMAIMAINWORKER&'CqAPENSATKKJINSURANCE,ASRE�UIREDBYSECTpN Q i7oo OFTHE IABOR CODE,FON TNE PERFORMAN���EEE OF 7NE WORK FOfl WXIp17/115 PERMIT IS � 163UE�.MYNORK 5'CO IPENSA71yp�INSU�CARRIERANDPOLICYNUMBEHARE: CONSTRUCTION �.• �j CARRIER � V PLAN REVIEW � POLICYNUMBEH� � CTRIC � 0 fMSS2CIqNN�NO7eEoo6KEimOFnEPEaM1RI6FDRONEHUK]REODouN�a(s+wloqtEssE PWM8ING Z �CER7IFYTHAT W THE PERFORMl1NCE OF THE NqRK FOR WFiICH TNIS PERMIT IS ISSUE0,1 MECHANICAL �3' SHAIl NOT EMPLOY ANV PERSON IN ANY M/WNER SO AS TO BECOME BUBJEC7 TO THE (p WORNERS'COMGENSATIONLAWSOFCALI�ORNIA,ANDAGREETHAiIFISHOUIDBECOME INSPECTIONFEE 5 SUB.IECTTOTHEWORNERS'COM7ENSATqNPqOVISIONSOFSECTKKJf700OFTHEUBOR caoE,�sw�u wannnn�caav�v xnni nrose onowswNs. ISSUANCE .� O p DAlE: APRICANT: SMIP � WARNINO�FAILUqET08ECUREWORKERS'COMPENSATIONCOVERAGEISUNUWFUL,ANDSMALLBE ENERGYPlC �n.�(�'__�_�/�/�/� �y SVBJECTANEMPLOYERTOCRIMQJKPENPLTIESANUCNILFINESUPTOONEHUNDREDTFWUSANO tJ 1 1 �� ����� D011AF1..(t1 ao,o0o�,IN ADDITION TO Tff C0.STOF CONPENSIRION,DAMAUES A9 PROVIDEO FOR IN ENERGY PERMIT � SECTIDN970lOF7FIEU�BORCODE,MTEREST.ANOATTORNEV5FEE5. RETENTIONF���77F11��� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:B���p A rn.n.v � �a-iJq'1i s-ia � 1 HEREBY KFINM UNDER PENALTY OF PERIURY TH�T THERE IS A CONSTRUCTION LENDINO AOENCV FOR T7E VERWRMANCE OF THE WORN FOR WHICH 1HI5 PERMIT IS ISSUED(9EC.]oY7,GV.C.�. � � LENDER'S W1ME C LElUEH'SADDRE55 � 1 CERTIFY T1AT I HAVE HEM TNIS MGLMJ�TION AND STAlE THAi TNE ABOVE INFORMATpN IS COqRECT. TOTAL FEES � I AOREE TO COMPLY WfTH Nl CT'IJID COUNTY ORDIHANCES AND STATE UVYS RELATRXI TO BU0.DING '^ COlISTRUCTION,ANp MEREBY MJflqqiZE qEPRESENTJITIYES OF TN45 COUNiY TO EMER UPON THE � /iBOVEdAE11TqNEOPROPERTYPoRINSPEGf10NiURPO5E5. (�,QMMENTS � avv�,�� L o o� m — � PERMITTE E(VRIHn � �o � �, r� ��,n. ✓ � vj BNS TUK OF PERMITTE DA � REGPT.NO. PAID BY _YALIDATION WHITE--Departmenl Copy,YELLOW�inance Copy,PINK—Asaessor Copy,GOLDENROD-file Gopy,6REEN—J1pplicaM's Copy CITY UF Dl//�1td10{i1D BAR � � INSPECTiONt RECC�f�D � ' • � � j • � . . � , , • � - SET BACK ' FLUOR JOIST , _ FTGS/FORMSISTEEL FHFI REQM�$ .; � E�ECTRIC GROUND UNDER FLOOR bUGT ' "� GROUND PLUMBING UNDER FLO()R CUI�IDUIT ' ` � �; SLAB GRADE FIRE LA�E�OE3NDATION ' �_• - " ' � � TEMP POWER FIREPLACE BOND BEAM _ � WA7ER SERVICE Mlp HL BOND BEAM - ROOF SFfEATHING � 8 FT.Bt�IV ',BEAM � �:� . FRAMINGNENTILIATiON FINAL BOND BEAM � ROOF COVER PRE-GRADING _ ROUGH HEATING BENCHING I ROUGH ELECTRIC ROUGH GRADING _ ROUGH PLUMBING FINISH GRADING SHOWERlTUB TEST POOL ELECTRiC : EXT. LATHISIDING POOL FENCING WALL INSULATION � POOL FiNAL ____ CEILING INSULATION ! OFF SITE INtPS. � DRYWALL NAILIhfG ; DEDICATIONS � SEWER ; � FINAL ENG. SEPTIC TANK � � LANDSCAPE/IRRIG. �_ SEEP PIT/l..L. ON SITE 1MP5. _ _ GAS RIR TEST >'' � F{NAL ZONING FlNAL CONST. -- - FIRE DEPL FINAL i 1 �,_ ' - -� —___— _ FtNAL FtEATING ' ' � HEALTH DEPT. FINRL ; FINAL ELECTRIC v ; dEV. FEES PAID �—��- FINAL PLUMBING � ; ENERGY � i . � I rr� - �r �s • . . CO�III6MENTS � � � ' '=—=—�--- .---- � --------- —�---�! r���:,�r --------! I +� y �'' `l ! �i�6'� ---- SEPTIC TANK SfZE, �.1.; ; ,, yi,�,,�ir"��1`r."�'i� --- SEEP PITN SIZE _„�_,,.;��y.. .;',•, ;)�tC.i.;il�'�� r I� i - ------ �� i:�