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HomeMy WebLinkAbout13035 �� CITY OF DIAMOND BAR � � ' � �� i DEPARTMENT OF COMMUNITY&DEVELOPMENT SER�'[CES 21660 E.Copley Drive Suite 190 � � (909)860-3195 Faz(909)861-3117 PRESS ����� �BUILDING PERMIT APPLICATION ' � FIRMLY o ADD ESS � a QI I✓�L�-`��I�G {��l OATECATION7 �� � NUMBE` v� x,C G. $ ISSUE TYPE OCC � APN� LOT TRACT � DATE CONST. GROUP p aWNER -f-EL/�(�-��fVj}L " a ADDRESS 1��� � Ll 3" �-' C7� ZONING SEfBACKS � CITY c /1�l ZIP�.TEL.SoT �7�f=Tf/, � R�RT RW p� APPLICANT TEL. SIDE/SIDE STREET RW ❑ � � CONTRACTOR -� SIDE - ❑ Q ADDRES� ' � ROPOSEDUSE �� aSY� CC o CITY / ��- ZIP ,Z TEL. �� �„ . , o AflCFUENG/ - _ , DESIGNER ,(�j NO.DWEL. � PJO. - - N . � N ADDRESS UNITS "' STORIES " � ' BEDROOMS � CITY ZIP TEL. � �n DESCRIPTION SQ.FT. FACTOR PSF ' ADJ.AREANAIUATION p� ONMER-BUILDER DECLARATION . 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B.1 D.C.FOR iMIS REASON Q � • � ' ' '" ' 3 � . . .. � ¢ . z DATE OWNER U 4 LICENSED CONTRACTORS DECLARATION W �C IHEREBYAFMIAUHDERPENALttOFVER1URYiNAT1IJdlICENSEDUNOERPROV1510N50FCFU�PTER Vr [L Y�CLMIYENCNOVATNSECTION70oa)OFOMSIDN7DFTHEBlI51NE55ANOVROFE5510NSC0O[ANO Z W LICEMSE i3 N ML iORCE NA EFTECT. m • � UCENSE CUSS��LIC.NO. �'/• j V �ATE Z 17 S CONTMCTOR d - W � WORNERS'COMPENSATION DECLARATION -� , � IMEREBVAFFIRMUHDERPENALTYOFPEM11tYONEOFTNEFOLLOwINGDECUMTId�:O��'. . Z ' , . � �IIUVEMl0YNLL1MIHTAW�CEHfIFlUTEOFCONSEMTOSELFdNSUREFORWOiU(EiiS' _ COMPENSA710N,ti5PROVIDEDBYSECT�ON77o00FTHELA00RCODEFORTHEPERF01iM�VlCE w OF lHE 1vORK FOR Vrtilpl i}n5 PERMIT IS ISSUED. � 1 _I HAVE AND WILL MA1NfAM YIORKER5 COMf`£NSA7qN INSUMNCE,AS REOUIRED BY SECTqN n dQ ]700 OF THE UBOA COOE.Fd17HE PERFORNANCE OFTHE WOnN FOR WHidl THIS PFHMIT IS (J�� � lSSUED.WWORKEHS'CdIPENSATqN1/NHSURANCEGRfUER/UDPOLICYMIY9ERARE: CANSTRUCTION -; J � uaa:¢a ' Z�I'✓/j'�`, � PUW REVIEW.. , z POIICYHUTABER O� Z � ELECTRIC ; d � � (t}USCC1�oNlICFDNoi8E�1.�'LFImaFTEVEix�rsR�Ra�EN1�DRm0oulli.,(t�oo)a+L6S� PLUMDING Z ICERTIFYTHATNiHE7ERFORMANCEOF7HEWORKFORNMICHTHISPEWAITC.I55UED,1 MECHANICAL () SXALLNOTEMPLOv�NVVER50NWANYYANNEHSOitSTOBEC01AE5UEfJECTTOTHE (n WORKENS'COMPENSA7qNU�MSOFULIFORN10.µDAGREETHATIF151ql1lDBCCOME INSPECTtONFEE �1TT SUBJECTTOTXEN+OPofERS'COAIOENSATqNFPONS�ONSOFSECTqN]IOOOFTMEUBOR ' �.,(1l -V - s coo�,isruuFoarmmircoe�r�rwm� aov� ISSUIwCE 1 y^� � 2-/7- ���� -y p DATE: APPLICANT. _��-'a�' SMIP . . � 1 ) � WAANiNafluLUqETOSECUREWOFlKERS'COrAPEN5AT10NCOVFRAGEI6UMAwR1L:ANDSFULLBE ENERGYPIC ���Qj]Q � � S1161CCTANEMPLOYERTOCRIMINILLVEWILTIESMACNILFINESUVTOONEHLNOfiCD7}10USAND JdJ ¢ OOl1AR5(f700.000),INADDITIONTOTHECASTOFWMPEN511TqN,D�ACE5A5PitOVIDEDFORIH ENERGYPERMIT /���+'() -*T T� SECTION770eOFTHELABORCOOE.INTEREST,ANDATTORNEYSiEES. RETENTIONFEE: �lLj �,�FDIt11YlSJ'V"RASi OCONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: BL1�•-DING 'h.i�m'��i�T`� � IHEREHYAFFlMIUNDERPEN�L7YOFPEfiNRYTHIITTHEREISA�ONSTRUCTION�ENDWGAGCNCY ' z fOi7 TME OEA W RMANC[OF iME WONK FOR N'NIp1 TMIS PERM�T IS ISSUE�(SEC.MG7,CN.4). W � LFNDER'S NAME - . � . � � LENOERS/iDDRE55 W ICEATiFYT1UTINAVEFEADTM5A0DLICATION/WDSTATETMATTHEAUOVENFO1WAtqrilStDMECi TOTAL FEES , / � IAOXEETOCd1GLYWITHNLGTY/�NOCOUMYORDINMICE5AND8TATEUwSKEUnFqTOBULDINO ' � CONSTqUCT10N,ANDHEREBYAUi1qP12ERE7RESEMATNE50FTH15CAU1dfYiOEMERUPONTH f �v 3�2� Z /�BOVE�MEHTIONEDPROFEFiYFOqWSPELT10r1PURVO5E5. COMMENTS � 12�G�.� G /�i��F-,. �r. m PEfWI7TEE� �aw � � � Q .. � 2��7� f� cn •Y� � Eq RE OF PE ITTEE DATE ''�� � . _ , RECPT.NO. ,PAIO BY V1ILIDATtON : ? WHITE-Depanment Copy.YELLOW�Inarca Copy.PINK-Aasassor Cocry,GOIDENROD--FiH Copy.GREEtJ-ApqbanYs Copy � • � . . . , . ,.1.._ . .i.�� , � ' r.,a' ,J' . . � •. �S.T�. .. „ ��„� , � �. . �� .�tr • � ,. _.- .. .� .. � . . . ' . . ' . ' CITY OF DIAMOND BAR , �:-.�., � , .. . ..... . ... . . .. . ... .� . , , . .. • � ' � INSPECTION"RECORD • � � � ,.... , � . . ��' ... . . , e o � • ' • � • • - SET BACK ' . • ' � ! • � FLOOR JOIST • ' ' • - ' ' ' � F7GS/FORMS/STEEL .• "FHA REQMTS � � � - - • � -- ELECTRIC GROUND�� � -" � �-- UNDER FLOOR DUCT . ' - , i : GFIOUND PLUMBING ' � � UNDER FLOOR`CO�IDUIT .�. , � �,'_'• � - �LABGRADE - - - FIREPL�A�E`�FOUNDATION •= �` ' - � •• ''== -= �'• � TEMP POWER -- ` - - ' FIREPLACE 80ND BEAM - � WATER SERVICE; �-- �• , - -- - •.-- - � MID HT.BONQ BEAM ' ••� ' ' ' ` ROOF SHEA7HING''�� �� '-/ •�(,4 � ' ` �8 FL'80Nq BEAM � � � � ' ` FRAMINGNENTIL.IATION �'� - FINAL BOND BEAM ' - ROOF COVER �' S �11 PRE-GRADING � � � ROUGH HEATING - � - - BENCHING -- '- � ' �� ' � ROt1GH ELECTRIC- ,- � � ROUGH GRADING ROUGH PLUMBING � - � -- ' FINISH GRADING SHOWER/TUB TEST' - - �- POOL ELECTRlC . . ' EXT:LATH/SIDING POOL FENCING WALL I�iSULf1TION ' �, : .` �: � " C'`,' POOL FINAL CEILING INSULATION �FF SITE IMPS. ' • • DRYWALL NAILING DEDICATIONS � SEWER ____ FINAL ENG. • ' --- - - -- SEPTIC TANK ..__ _ . _ - LANDSCAPE/IRRIG. . SEEP PITIL.L. -. -- -= _ - - � - ON SITE IMPS. ' • i GAS AIR TEST � -- � � -- ,.,, , , ,-, . FINAL ZONING FINAL'CONST. - -- � � ' FIRE DEPT.FINAL � FINAL�HEATING � - HEALTH DEPT. FINAL � • - FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ' � � ��q � Q _ - - ---- -- - ------ - - _-.. ..- • , — - - - COMMENTS ' � �'� � � � , . __ .. �. . . , _ . . :, , . ' _ _ ___ " _ � . . �., . . •• . • .. ' .. . _ . . ' � . i � � . " ' . . _ ' . . � � . . .{ �' ��J' ' , . . . � ' . . , ( . _ I � • . . . _ . , . ` � ` ' � " ^�.i�,. •1'' 1 ! ' . . ' 1 \' � . .. . . .( SEPTIC TANK SIZE. .;,, -, t .;. , , ; ' ' SEEP PIT/U SIZE�-� , , _. ., . , - . , ,._,_� � � � � , - - - -- - - - -� , �1 — � < < , . . ; . . . ',' �„ � . `, ,�. _ . � .. . , • � '�. ._.. 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