HomeMy WebLinkAbout17694 (889) . - -- � _ ..__ .__ __. . .---:-.:._..�—_._-------- � . .-----.__.'_.. -- -. .._....,----�------ ------_ _.. ._
f,� CTTY OF DIAMOND BAR
DEPARTMENT OF COIvIIvIi]NITY&DEVELOPMENT SERVICES
21825 E.Coptey Drivt
�'�` (909)860.3195Fax(909)861-3ii� PRESS
��'-:�»'� BUILDINGPERMITAPPLICATION FIRMLY
y JOBSITE '+� �°!O� (�la Ge•4 �l r4:� ICD APPLICATION � ���ERMIT � l- P/C
o ADDRESS �] DATE UMBER l9 �
� APN LOT TRACT ISSUE TYPE OCC
�— DATE CONST. GROUP
p OWNER,11�z�'fd.�d [�d��frD
o ADDRE^SS" Z�LD� � � 60A 7ICR1 I Q ZONING SETBACKS
z CITY l�f�►'HOM /�IwI ZIP TEL�/1�2-5�,�/ REAR RW ❑
g APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR �lFrr�t O�%��f SIDE ❑ �
� ADDRESS q � 'T
� CITY �Id !/eY►It f14 ZIP 7a0 TEL9 SJ�•'/�� PROPOSED USE �
o ARCH/ENG/
z� DESIGNER NO.DWEL. NO. NO.
N ADDRESS UNITS STORIES BEDROOMS
� CIN ZIP TEL.
�
cn DESCRIPTION S0.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 NEREBY AFFIRM UNOER PENALTY OF FERJURY THAT I AM E%EMPT FRqA THE LONTMCfOHS L4 � Garage/Carport
W CENSEUWfORTHEFOILOwRIaREA50N(SEC7WI.SBUSWESSANDOiIOFESSqNSCODE:ANYCRYOR
U COUNTYWNIdIREOUIRESAPERMITTOODNSTRUCf.KTER�PR�E,DEMOUSM,ORREGA�RJINYSTRUG W PdtiO/DBLk
� TLIHE,VRqR 10 RS ISSUANCE,ILLSO REOUIRES THE APPIICANT fOR SUCH PE{UAIT TO FILE A S�GNEO W
� STATEMENT THAT NE OR SHE IS UCENSED PUNSUANT TO THE PROVISIONS OF THE CONTRAC70i19 L4
CENSEUW(CFUPTER/(COMMENCWUWITMSECTION1000)OFDIVISION30FTHEBUSINESSANDPRO- LL' POOVSpB
FESSqN5CO0E�ORiHA7HEOR5HEI5E%EMPTTMEREFROMANDTHEBASISFORTHEALLE6E�EXEMP• C7
� TIDN.ANYVIOUTDNOFSECTION7071.68YANYAPPLICANTFORAVERMITSU&IECTSTHEMPIICANTTO Z Re•Root
A CML PENALTY OF NOT/AOFE THAN FNE HUNDREO DOLURS(SSoo�.):
� OlA50W��EROFTHEPROPERTY.ORMYEMPLOYEESWI7HWACESASTHEIqSpLECOMPENSATION, � �mmercial --
z VALL DO 1HE WORKµ0 THE STRUCTUNE IS NOT IMENDED OR OFFERED FOR SILLE(SEC.701I,BU51� J
N NESS AND PIiOFE5510NS OOOE:THE CANTRACTORS 4CENSE LAW OOES NOi MPU'TO AN OWNER OF �
VROPEH7YN0�0 BUILOS OR IMPROVES MEREdJ.AN�WHO DOES SUd/WORK HI45ELF OR HERSEIF OR
Q THHOU6HNISORHEROWNEMPLOYEES,PHOVIOEDTHATSUCHIMPROVEMENTSMENOTMENDEDOR m
� OFFENEOFORSAlE1F,HOVYEVERINEBULDINGOR1YPqOVE1AENTISSOlD1NR1iiNONEVEAROfCdAPLE•
Z TION,THE OWNER-BUILDER N'ILL HAVE THE BURDEN OF VROYINO TMAT HE OR 6HE D�D NOT BU1LD OR
= MVROVEFORTHEPURP0.5EOFSALE).
W OIti+OWNEROFTHEPqpPERTY,/ME%CLUSNEIYCOMMCTN6MATHLICENSEDCOHTMCTORS
¢ TO CONSTRUC'T T1E PRO.IECT(SEC.7a�,BUSiNESS MID PROFESSIONS CODE:THE LONTMCTORS LI� V21Ueti0� ADJ.AREA
W CENSELAWOOE3NOTAVPLYTOMIOWNEROFAVROPER7YVn108URD5 ��THEREON.AND
Z wr+000rrtru sFonsud+vroo.�crsvnr� Kwe� s4�nTTo7MECONiMG OUANTITY DESCRIPTION FEE
� mac ucer+ uw.�.
0 E7(EYOT UNOER SEC B.i V.C.FOR THIS REASON Q
� � U
� �
DATE ONMER U
Z �
� LICENSED CONTRACTORS DECU4RATION w
� 1 HEREBYAFFIRAI UNDER PENALTY OF FER1URv 1)7AT I M1 LICENSED UNDEiI OFqVISqNS OF CIIAiTER �
d Y(COMMENpN(3WITMSECT10N10o0)OFpM510NJDFTHEBU5ME55ANOPROFE5510NSCO0EAN0 Z
X MYLICENSEISWFULLFORCElJ1DEFFECT.I��g m
Lll �
0 I�CENSE CUSS�77 ._UC.NO. �
J
V pnTe corrrrucroa a
w
� WORKERS'COMPENSATION OECLARATION 4
� IHEREBYAFFlRAtUNDEROENALTYOf0ER1URYONEOFTMEFOLLOWiN6DECLAM710N5: Z
� �IIUYEMIDWILLMAINTNNACERTIFICATEOFCONSEMTOSELF-INSUPEFORIMDRKERS' _
Q COMPENSATION,ASPROVIOEDBYSECTIONiIooOFTMELABORCODE.FOqTHEPERFORMANCE W
OFTHE YYONK FOR NRIICH THIS VE W.11T IS ISSUED. �
�
W _�IH�VEANDWILLMAIMAWWON(ERS'COAIPENSATIONINSURANCE,ASREWIREDBVSECTION r
� �7o00FTHElABONCODE,FORTHEPERFORMANCEOFTHEWORKFOAYAiICHiHISPERM�T15 \
ISSUED.I.IYWORKERS'COMVENSATIONINSURANCECANNERANDVMICYNUMBERARE: CONSTflUCT1ON � IS�
� GRRIER PLAN REVIEW
� POLICVNUlABER ELECTRIC
p (M55EC1X7NNEEDNOTBECOM1PLEfEDOFhEPEPMTISPoRONEHlA�EOOOlLWS(itpo�OqLE551 PLUMBING
Z I CERTIFYTHAT IN THE PERFORMANCE OF iHE WORK FOR WHICHTH15 PERMIT I515SUED,1 MECHANICAL
(,�} SWLLLNOTEMPLOVANVFERSONINANYMPNNERSOASTOBECOMESUBJECTTOTHE
� WORKERS'COMPENSATIONUWSOFCALIFORNIA,/WDAGREE7IUTIFISNOIADBECOME INSPECTIONFEE
S SUBJECTTOTHEWOHKERS'COMDENS�TIONVROVISqNSOF5ECT10N�7ooOFTHEIABOR
cooe, sw�u,c r+rnyNnr�n con+P�r wirn n+ose vRows ISSUANCE
� DA7E:���O�A SMIP
p PPIICANT. �
� ENERGY P/C
WARNINO:FAILUHE TO SECURE WORKERS COMVENSATION COVEMGE IS UNLAWFUL ANO S WLLL 6E
� 6UBJECTANEMP�OYERTOCRIMiNALPEWLLTIESM'DCNILFWESUPTOONENUNDREDTIOUSANO ENERGYPERMIT
DOLLARS(5100.0001.��OITION 70 TME COST OF COMPENSA710N,DAMAGES AS PROVIDEO FOR IN
� SFCT10N�7oeOf1HEUBORCOOE.NTEREST,/uJDATTORNEYSFEES RETENTIONFEE:
a CONSTRUCTIDN LENDING AGENCY PRE•ALT FEE:
O
� IHEREBYAFFIRMUNDERPENALTYOF7ERJURYTHATTHEREISACONSTRUCTIONLENOWOAOENCY '
Z FOR iHE VERFORMANCE OF iHE WONK FOR WHICII TMIS PERMIT IS ISSUEO(SEC.70W.CIV.C.1.
W
� LENDER'S NMIE
wLEN�Eff51�DDRE55 �• �
� ICERiIF/THATIHAVERE ISAPPL1GTqNANDSTATETUTTHEA80VENFOM1ATqNISLORRECT. TOTAL FEES �
� IAGREETO W GITYANDCOUNTYOROINANCESANDSTATEUWSRELATiNOTOBU0.DING
� CONSTR ON +EREBYMIfMONREREPPESENTAINE OFTMSCOUNiYTOEHTERIIPONTME
Z E - ROPE INSPECTION PV s¢s. COMMENTS
�
J
�
4 C iTTEE N�ME�PRI �
�
SqNATURE OF GERMITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—ApplicanYs Copy
- . r-. - .. ., , . - . , •�.� . .,. " . -Sx.:t... i�!--T�.�.:. . . .. ,:.T:. .. "'R--�-��+�,..� . ...- - ..r .-. -.-. . . ..-. . . ,_......
. , . �r:. . . . � � . . . . • .
CITY OF D1AMO�ED BAf� �
It�ISPEC�"ION REGORD ,
i���!���' � �.i�� ����.��. __I��-�����,�•� :. . ::li��:���'�����:� ..__`- ,�r�� -_ !�R� � a �
SET BACK W4 y� ( u� � � !. � � FLOOR J015T, : ~j ', � � ?
FTGS/FORMS/STEEL FHA RFQ!�1TS I
ELECTRIC GROUND ' UNDER FLOOR DUCT C
GROUND PLUMBING I UNDER FLOOR'CUf�IDUIT , � �
SLAB GRADE FIREPLACE FOUNDATION '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE �_ MID HT. BOND BEAM
ROOF SHEATHING . Z��,'���,��^- 8 F7.BON�BEAM • � �
FRAMINGlVENTILIATI�N / I ' FINAL BOND BEAM
ROOF COVER I/y/�iL I PRE-GRADING
ROUGH HEATING � BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING
SHOWER(fUB TEST '� POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION P�OL FINAL
CEILING INSU�ATION j OFF SITE IMPS.
QRYWALL NAILING � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK , LANDSCAPE/IRRIG.
SEEP PIT/L.L. • � ' ' OPJ SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FIPJA! :
FINAL HEATING � HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID -
FINAL PLUMBING � , ENERGY
� �
� �,1� �..l�.6:��tC�. _
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�v� .
w��� . � ��
. . . , , -
- r� __._.._.�...�� � ; t �,�