HomeMy WebLinkAbout17665 �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)8603195 Fax(909)861-3117 �` PRE$S BUILD[NG PERMiT APPLICATION FIRMLY JODSITE r� Q' APPLICATION �4,, PERMIT ( '�P/C o AD�RESS Gu D9 a e�C�rse ��, DATE_���NUMBER�W M � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER " ADDRESS ZONING SETBACKS 0 Z CITY IP TEL. FRONT RW ❑ � APPLICANT ' tX�O UN� AK TEL � � / REAR ❑ � SIDE/SIDE STREET RW O � CONTRACTOR r �l ,O rc.S • P�t S. SIDE O p� ADDRESS - ' � CITY___[��cC1i(w� . ZIP TEt( � ' PROPOSED USE w ARCH/Eh1�/ � �� DESIGNER ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � ONMER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBY AFFlRM UNDER PENALTY OF PER7JRY THAT I AM EXEMPT FROM THE CONTMCTOFS L4 Garege/CarpoR � W CENSEUWiORTHEFOILOWPI6REA50N(SEC.70JI.68USINESSANDPROFESSIONSCOOE:ANVqTYOR (n U COUNTVNMItlIREWIRESAGEHAIITTOCONSTRUCT,ALTER.IMPROVE,DElAOL15H.OHREPAIPANYSTRUG W PBIIOIDBCk �LTURE VRqR TO ITS ISSUANCE,AL50 REWIRES TNE A7FLICANT FOR SUCN VERMIT TO FILE A SICNED w � STA7EMENT THAT HE OR SHE IS t10ENSED PURSUANT TO 7NE VROVISIONS OF THE CONTMCTORS L6 � CENSE tAW(CHAPTER Y(COMM[NCINO W17N SECTqN 70D0)OF DIVISION�OF THE BUSINESS AND PRO � PooVSpa fE5510N5 COOE)OR iHATME OH SHE IS E%EMPT THEREFROM ANU iHE 8A515 FOF THE ALlEOED E%EMP� V TION.ANYVqUTqNOFSECilON70.71.SBYMlYAPP�ICANTfORAPERMITSUBJECT3iHEAPPLIGANTTO Z Re-Roat � AGVILVENAL7YOFNOTMORETHANFIVENUNDREDDOlURS(f5o0).�: � OL��NEROFiHEPROPERTY,ORIAVEMCLOVEESMATHWAGESASTHEIq50LECOMPEN5AT10N,. ❑ COmm9fC181 � Z WILL OOTHE WORK,AND iHE SiHUCTURE IS NOT INTENDED OR OFFERED FOR SILE(SEC.7W�,BUSM J NESS AND VROFESSIONS COOE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER DF � VROPERTYVA108UILDSORIMPROVESTHEREDN,/WOWMODOESSl1p/WORKNIMSELFORHERSELFOR � [= THROUCHHISORHEROWNEMPIOYEES,PROVIDEOTHATSUCNqA7ROVElAENTSAFENOTMRENOE�OR m W OFFEREDFORS/�LEIF,iIOWEVERTMEBUILDINCORIMPROVEMENTI55dDWITHiNONEYEAROFCOMPLE- 0 iION,TFIE OWNER-BUItDER WILL HAYE TME BURDEN OF PROVIN6 iHAT H[OR SHE DID NOT BUILD Ofl Z MPROVE FOR711E PURPOSE OF SALE�. = OI�ON'NEROFTMEPfWPENT�:NAE7(CLUSIVELYCONTMCiWOWiTMIICENSEDtONTMC70R5 � TO LONSTRUCTTHE PRQIECT(SEC.70U.BUSINE55 MID PROFESSIONS CO�E:lHE CONTMC70fl5 LI• V81U8SI0/1 ADJ.AREA Lli CENSEUWOOESNOTAPPLYTOANONMEROFAiROPERTVWIqBURDSORIMPROVESTMEREON,AND � W11000NTMCTSFOqSUCMPRQIECTSWITHACONTMCTOR�S)UCENSEDiURSUAHiTOTHECONTMG QUANTITY DESCRIPTION FEE TORS UCENSE lAW). � O�lWEI(EMPTUNDERSEC. B.6P.C.FORTNISREASDN Q 1 I�� h� TQW pYQY d C � U � LL' DATE ONR:ER V Z W QUCENSED CONTRACTORS DECLARATION w ¢ IHEREBYAFFIRMUN�ERGENALTYOFVE0.IUMTHATIAMUCENSEDUNDERif10VIS10N50FCHAPTER d f(COAIIIENCINUWRHSECTION7000)OFDIVISqN30FTHEBUSINE55ANOPPOFE5510N5LODE,AN� Z X A/Y IICENSE IS IN FULL FORCE NJD EFFECT. � � llJ ��� I � � LICENSE CLASS G t O ��NQ j V DATE ?�19 . �2- CONTMCTOR� , ���K�.' a W l " � WORKERS'COMPENSATION DECLARATIO a = U � I HEREBYAFFIRM UNOER FENALTV OF PERAI(3Y IXJE OF 1ME FOILOWINC DECIAMTIONS: [� Q 0 _I HAVE AND WILL MAINTAIN A GERTIFICATE OF CONSEN7 TO SELF-INSURE FOR WORNERS' 2 � COMPENSATION.ASPROVIOEDBYSECTION]7000FTHEU�BORCODE.FOR7HEPERFORMANCE U � OFTHEWORKFORWNId1iHISVEiWITISISSUED. � G W _IHAVEMlD1MllMNINTAINWORKEHS'COMPENSAtIONINSUMNCE,ASREOUIHE08Y5ECTION Q 77000FTHE LABOR CODE,FOFiTME VERFORMANCE OF TME WORK FOR WHip1 TMIS PERMIT IS LSSUED.MYVYORKERS'CAMPENSATIONINSURANLELARRIERANDPOI.IC'/NUMBERME CONSTRUCTION J � CAiiRIER PLAN REVIEW l O DOLICV NUMBER N ELECTRIC ¢ � (f}tSSECIICNNEmNOTBE00hPLETEDOFhEPENAT6PoRONEFILfD(+FDDOl1F1L.(5�001���) PLUMBING Z 1 CERTIGYTHAT W THE PERFORM�NCE OF THE WONK FOR WHICH iH15 PERMIT IS ISSUED.I MECHANICAL (.�} SHALLNOTEAI7LOYANYPERSONINANVAIANNERSOASTOBECOMESU&IECTTOTHE � WORKERS'COMOENSATpNUW50FCAUFORN10.µDACREETNATIFIS/KK1lDBECAME INSPECTIONFEE SU&IECTTOTHEW'OfiKERS'CAMPENS�710NPRONSIONSOFSEC71ON]1000fiHELABOR �SSUANCE COO I S FOFTHN7TH COMPLY WITH�T1�°,S�E,,PROVISIONS. 1 pDAT: � � bL APPLICANT:�a �AN-\' I�t� SMIP W � �/ � I O:FA RE OS,E WORKERS'C0IAPENSATqNCOVEMGEISUNUYIFUL,AN�6NALLBE ENERGYP/C � SUBJE AN EMPLOYER TO CRIMWN.PENALTIESAND dNL FiNES UP TOONE HUNDNEB i1CUSANO ENERGY PERMIT DOlURS�3100,000),IN ADOITON TO THE COST OF COMPENSA110N.DAMAGES AS MONEEO FOR W � SECTION7�OeOFTHEIABORCODE,NTEREST.ANDATTORNEY5FEE3. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY pRE•ALT FEE: CC IHEREBVAFflRMUJDERVENKTVOFPfRJURYTMATTHEREISACONSTRUCTIONLENDRlGAGENCY n- FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS DERMiT IS ISSUED(SEC.]001,CIY.C.). Z W � LENDERSNMAE � IEN�ERSADDRESS wICENTIFYTUTIHAVEREADTNISMPL�CATIONANDSiATETHATTNEABOVEINFORMATIONISCARRECT. TOTAL FEES { ^S.S� � IAGREETOCOMPLYN7TNALLCITYANDCOUNTYORDINANCESANOSTATEUWSRELATWOTOBUIlDiN6 \y CONSTRUCTION,AND HEREBY AUTHONI2E REPRESEN7ATNE5 OF THIS COUNTY TO ENTER UPON THE �� ZABOVE�MENTIONEDPROVERTYFORINSPECTWNPVRPOSES. COMMENTS � �U J S ✓l �� _ � PEfW1TT E (PRl � 'z !4 �L y SIG TU �O RA�I EE �A7E � �� RECPT.�O. PAID BY VALIDATION WHITE—Department Copy.YELLOW�inance Copy,PINK—Assessa Copy,GOLDENR D—FlleCopy,GREEN—ApplicanYs opy - . . . . � , �.�; .., ,.�•�v.. .,-::.... ,.; ,.-..�., �. ..:�� ".;,,. .._ .,�., . „ _ ;t5r1..v��...r.i. . , _C.r.:: rid .tC' .. . . , , . . . ,. ..' . .. . .�. .-,- �.-�,.. . . .. �.. ..' � .. . .... .... . .ei . .., ., . .:�-- ...... .��. :n�. .. .. , .. �•r�:,w�,..,.. , ._. 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EOND BEAh1 FAAMINGNENTIUFlTION � � FINAL E30ND BEAh4 ROOF COVER I PRE-GRADING , ROUGH HEATING BENCHINU ROUGH ELECTRIC I ROUGH GRADING � ROUGH PLU�JBING � FINISH GRADING � SHOWER/TUB TEST POOL ELECTRIC � EXT.LATH/SIDING POOL FEPJCIN� WALL INSULATION POOL FINAL j CEILING INBULATiON OFF SITE IMPS. � DRYVVALL NAILIPJG � �EDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PITlL.L. OfJ SITE It�1P5. G.AS AIR TEST �• , FINAL ZONIPJG FINAL CONST. �!RE DEPT. FINA'_ FINAL HEATING HEALTH DEPT. FINAL FItJAL ELECTRIC ? � ---��---- DEV. FEES PAID FINAL PLUP�1E31NG ENERGY � c:l:;�s r r 1.^-�iic(c'.-_.__�.�_,.. _..�._____.___.�:.:�_._.__._ _._�__� COMMENTS SEPTIC TANK SIZE � SEEP PIT/U SIZE �4'r ___. , , 1�t�' ��� _ � � � � �;; � , . , � ►� � - —..---...__ _._..__ ._.__._..._..._._� . �