HomeMy WebLinkAbout17019 (1110) .�� CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
,��y 21625 E.Copley Drive I
(909)860-3195 Fax(909)861-3117 PRESS
��-�� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSITE �13 S O W I L L U C Y �U D DATE CATION C/ ���_�'NU B R�� �fJC
¢ ADDRESS ti
� APN LOT TRACT I ISSUE TYPE OCC
DATE CONST. GFOUP
� OWNER VI U�
0
0
ADDRESS ZONING SEfBACKS
z CITY ZIP 41���5 TEL. FRONT RW ❑
g APPLICANT TEL. REAR p
� SIDE/SIDE STREET RW O
mQ CONTRACTO . (• � SIDE ❑
� ADDRESS � T PROPOSED USE
p CITY ZIP 1 TEL'
oARCWENG/
w DESIGNER NO.DWEL. NO. N0.
a. ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn , DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p OWNER-BUILDER DECLARATION I SFR/ADD�'REM
p I HEREBY AFFlPAI UNOER CENALTY OF PE0.NRY THAT 1 AM E%EMVT FRDM TME O�NTMGTORS l4 Garege/Carpon
W CENSEUWFOHTHEFOLLOWINGREASON�SEC.7C316BUSINESSANODROFESSION9000E:ANVdTVOR (n
U COUNTYWHIdiREWIRESAFERMITTOCONSTRUCT,A.TER.I/APROVE.DEMOlISH,ORREPAIRANYSTRUC W PyIl0ID0CI(
NRE,pP10R N ITS ISSt1M10E.ALSO REWIRES THE APFIICANT fOR 5l1CH DERAIIt TO FILE A SICNED
� STATEMENi hiAT HE OR SME IS UCENSEO PURSUANT TO THE iROV1510NS OF TH:CONTMCTORS ll• �
� CENSE UW(CHAPTER 0(COA�MENtlNO WITH SECTON 7000)OF DIVISION 70F THE BUSINE55 AND 7R0. PooUSpa
FESSqNSGODE)ORTHATHEORSHE�SEXEMPTTHERE�POMFNOTHEBASISFOHTNEALLECEOEXEMP-
TbN.M7YVIOLATIONOFSECTION70��.69YANYAPPLICMlTFORAPERMITSUBJEGTSTMEAPPLIWNTTO z Re-Roo1
ACMLPENILTVOFNOTMORETWWFNEHUNDRED�D�LAqS(fSWl.k '
0 01.11SOWNEROFTHEPROVERTY.OFMYEMPLO�EESWITHWAGESASTNEIflSOLECAMPENSATqN, ❑ COrtIRIBfCIdI
� MlILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OF OFfEFEO iOR SA:E(SEC.701�.BU51- J
N NESSANDVROFESSIpN50D0E:iHELONTMCTOFSULENSEUWDOESNOTAPPLYTOANOWNEqOF �
VR07ERTY YMO DUILDS OR 11.17ROVE5 TNEREON,ANO WHO DOES SUCH WORK HIIdSELF Oq HERSELF OR
� THROUGHHISOflNERONNEMP�OYEES,PROYtDEDTNAT5Up11MPflOVEMENTSAAENOTWTENOEDOR m
QOiFEIiEDFORSALE6,HOWEVERTHEBUILDINGDRWPROVEAIENTLS50lDW1TMINONEYEAROFCOAIPLE-
� TKKJ,T}1E OWNERAUILDER WILL HAVE THE BUfL7EN OF PROl/iN0 THAT HE OR SHE DID NOT BUILD pR
= IMPROVEFORTMEPURPOSEOFSALE� '
�y,� OI.ASONMEROFTHEPROPERTY,AME%CLUSNELYCONTMCT:NOWITIILICENGE�CONTMCTORS
� TO CONSTRUCT iME PRQIECT(SEC.70u,BUSINE55�flD PPOFESSIONS COO[:TME COHTqACTOflS LI• V21U8SiOff ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROLAPROPERTYWF109VILDSORp.1VROVESTHEREON,MlD
� WFI0GON7RACTSFORSUCMPRO.lECTSWIMACONTRACTOR(5)IICEN5E0PUR5UNRNTHECONTM(� QUANTITY DESCRIPTION FEE
� TORSUCENSELAW). '
� 01�E%EA1PT UNDER SEC. B1 RC.FOR TMIS REASON Q
� U
¢
u" DATE OWNER � U
� UCENSED CONTRACTORS DECIARATION ' w
� IXEREBYAFFIRAIUNDERPENALTYOFPERIURVTMAYlA4LiCENSEDUNDERPROY15qN50FtMAPTEq � � !t —'h
p� 0(COMMENCINO WITH SECiqN 7000�OF ONISIpN]OF iHE BUSINESS M1D DROFESSIONS COOE,M1D Z � V U
W UCENSE IS N Ml fORCE AND EFFECT. m
� LICENSE S LIC.NO.�� ��� �
J
V OA7E � CONTRAGTOR .I• a
W
� YlORKEFS'COMPENSATION DECLAHATION � �
¢
� U
� IHEREBVAFFIRUUNDERGENALIYOFFE0.NHVONEOFTHEFOLLOWINGDECIAMTqNS: Z
Q
Q _�HAVEANOWILLMAINlAINACERTIFICATEOFCONSEMTOSELF-INSUREFORWORKERS' _
� CDMPENSATqN,ASVROV10EDBYSECTIONJ�D00FT1+ELABORCODE,FO�iHEPERFORMANCE W
pFTHEWORKFORNMICHiHISPEAMITISI55UE0. i �
Q I
W _IHAYEANDYJILLMAINTAINWORI(ERS'COMPENSATIONINSUMNCE,ASREOUIREOBYSECTION
Q 77000FTHELABORCOOE,fOATHEGERiORUANCEOFTHEWORNFORWHICHiNISFERMITIS
t55UED.MY KERS'CQMP NSATIONI SURANCECARRIERANDPOUCYNL'A�CERARE: CONSTRUCTION
Q GARRIER ��I�7�'�� �' PLAN REVIEW
�
z oa�crNur.�oEa Y� C (IDS . ELECTRIC
Q
0 �n+ssEcnonNEmr+oTeEa�.stErmcFnEa[�nrt�ra�anruormoal.vu�+m�oatFssa PLUMBING ,.���
Z I CERTIFY THAT N THE PERFORMANCE OF THE N'OAK PoH WHICH iMIS PEAMIT IS ISSUE�.1 MECHANICAL �
(,�} SMnLLNOTEA�PLOYANVDERSONWANYAAANNERSOASTOOECOMESUeJECTTOTM[
� WJRKERS'COMPENSATIONUWSOFCALIfOR41qANpACRCETMATIFI5110VlDBECAME INSPECTIONFEE
5�1fiJECTTOTHEWORKERS'COMGENSA710NJ ROVISIONSOFSECTION77000FiHEUBOR ,\
O �._�:
E,I SHA:L F RT11WiTH COMP�Y WIR1JY1�1 PRONSIO/NS. ' ISSUANCE �v
p OATE:
�/�2�o I ppPLICAN7; _��'��•'✓`^� SMIP
� � ENERGY P!C
� WARNING FAiLURE TO SEWRE WORKERS'COIdPENSATION COVERAGE IS VM1UWFUL.ANO SHALL BE
�y SUBJECTANEAIPLOYERTOCRIMINALVENALTIESANDCMLFINESUPTODNEHUNOR[DT/IOUSAND ENERGYPERMIT
OOlURS{f10o,000),IN ADDITION TO THE COST OF�OMPENSATqN,DAMACES AS 7ROYIOED FOR IN �y
� SECTqN77080F7HEUBORCODE,MTEREST,AND�TTOpNEYSFEES. � RETENTIONFEE: ��,�`�-
a CONS7iiUCTION LENDING AGENCY PRE-ALT FEE:
O
� IMEREBVIIFFIRMUNDEAPENALTYOFPERIURYTHAYTHEREISACONSTRUCTIONLENDINCACENCY
d FOR TNE FERFORMANCE OFTHE WORK FOR WHICN TM�S VERMIT IS ISSUED(SEC.�091.CIV.C.). ,
Z
W
� LENDEHSNAME
� LEN�ER'SADDRESS
� ICERTIFYTHA71/wVEREADTHISAPPLICATIONANDSTATfT1UTTNE�eOVEWFO�ATiONISCONRECi TOTAL FEES �� `S�
W 111GREETDWMP�YWIMALLCRYANDCOUNTYORDu4ANLE5AND5TATELAWSRELATING?OBURDING �
� CONSTRUCTIDN,ANDHEREBYAUTNOPIIERE7RESENTATNESOFTNISCOUNTVTOE4TERUPONTHE
ZPBOV�MENTIONED VROPERTY FOR INSPEC7 �N 7URPOSES� ' COMMENYS
� ell '
m OE TiEE NAM- RINn
Q
�
Vj 5� NA7UREOFPERMITfEE D � � '
� I RECPT.N0. � PAIO BY VALIDATION
WHI7E-0epartment Copy.YELLOW—Finance CoDY•PINK—Assessor Copy,GOLDENROD—File Coq,GFiEEN—Applicant's Copy
, �.. . .. .. � ... ...� �..i-. i,,�..n: . .. ..� . . .,�-.. 1 _� . . . _
"��i��. r,� ,+:1'.i...;i 'i� i_rF;�'=
��'��:. ,�{.. , i. �� . ..�41... . .._
�"".__�_. . -..`5_ ._. _ . . .,`1L.' ^... ...... ... ..!. . .. ..... ... . y�. .. . .II{. . _ "' '"_ .. _ .,�. ' "' �f�
�� ,' i. �: . t�.. .� .F ._ ..- .:m`i t v ... - 1• .._" .�..__.....
II�E:j:�:.! E'1�1 i ` �. „ .I li f �'E ' _ L f C',I�t
-- —
SET EACf: , I ; FL00�'�JOIS i '
—- _ ----- — ----_ --------- — ---—- -- --�__ -—- ---
FTGS�FaR',15:5TEEL ---- -----•_., FH_^:_REQ?�1TS^- J ---i --- !
ELECTR�C GR�I!iJD - {----------- U�:DrvR f�OOn DUr'T �- � -- - -
--- --- - - --- --- --- =---- �
GROU'JD PLU'�l?I�dG I i � Ui:QER FLOOr;CO�•IDUII �-- �-- -
-------,- -- -- ---�-•- •----..�------=- =----------
SLABGRl,D� ' I FIREf'L;�C�` rGU��D�.TIO'•:
1-------------t-1- -- -- - ---
- ----_ . � —
-!_I_FIR�PLF,C� 60'�.'D �EAi:�----I
1 a c ;! � ,------- ---
• -- -------
TE�,4. POWr_R I I
�^JATER„ER.ICE I i 1 �aID i iT. E'0.'dD BEi�'"
FiOQF SHEATHIt�1G----i--- I-- ---------------I-�-;.i f-1 L�O!JD EE/�'.! --- - ------- ----- -
r �__ __-'_'__._ __-___. .-___
_"
------ ---, � _f_IfJ:�L GOi1D EEl,L"
e - '" � --------
FAA,.11t�G,'4EiJTILIATIO�d �
ROOr COVER � I --- � � PR�-G�'sF.D!_:G__ --- -----i- - -
ROUGH HEATR�G � � � j BEi�!CHIFJG � �
f70UGH ELECTR!C -�-- -� - ; ; ROU�H GR:,C?I�J�, -- � � --
- � '----- - --------------�--
---
ROUGH PLU?�AE31iJG I� -__---' —_--' � FI��:IS'r1 GRP,DIfJG �
•-- � --
SHOVJERIi�UBTEST _j � ___— ----�-,_F'OOL ELECTRI„ � - - -- -----
EXT. Lf,T-H;SIDIi�1G I I I � POOL FE(�:CI��:(=� �
_ _ - ____- -- - --- --------
_ __
'::ALL IfdSULATl���1 , � I POOL Fli�.�,l_ _ _ i _
CEILI�IG INSU���TION 1_ � i OFF SITF Ih.iPS _ _ '
-� — -.�_,
DRYV'JALL NFtILING � � � DEDI�P,TIJiJS �
SE�VER -- �------------f ! FIiJAL EP��. —C---- 1 -
- - - --` ----
SEPTIC TAP:}: ; � � LA�JDSCF,�EIIftRIG. I I
SEEP PIUL.L. ; � OPJ 51TE I'"PS. I I
1 - --------- -��------- -- -
GAS AIR TEST �_�_ � ; FINAL ZOrJitJu � �
FI�!AL CONSi. � ! ! ! FIRE ��FT. FIPdA'__ `�
FINAL HEl',TING i � � 'IEALTH DEPT. FIf�AL � ��
-�----
Fli�r;t ELECTRIC � �_ I �EV. FEES Pr,ID I
f�lidAL PLU�.1�1^JG �(�- �-U� � E��ERG.`r' �
I {-�---- —�- . . - -- -�--
; -_
- � -�-� - ' ---
� � _. :-- �. _ . . ._. __.�__.�,
�• i. .. . . i. , ,
, . ., . ,
- ----------L- --------- -__ _.. ---- ---_
CC)i�2,�ENTS
S�PTIC TAtJ;: SIZ� ^�
S�EP PIT/U SIZE ——--� --
�,; — --- -- __ _
,��a�
' � , : .�, -- --- --
�,, , ,