HomeMy WebLinkAbout14785 (1099) " �� ���_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEYELOPMENT SERVICES
� , 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)B61-3117 PRESS
'�^' � BUILDING PERMIT AFPLICATION FIRMLY
r JOBSITE 0 APPLICATION PERMIT /�(J�-,L�= P/C
o ADDRESS ���— �Ga �t,l i✓rd 1c/uOc-A_ DATE_ NUMBER k
� APN �OT TRACT pp� �/-� o p a TMPE OCC
/ ��� CONST. GROUP
� OWNER d�.. .� .l - -�--
8 ADDRESS�g'(,��"+—I a�.-,h��� /V�__ ZONING SE'TBACKS
� C�TY ,ZIP TEL.a�b—�Y�/y�tl FRONT qyy p
APPUCANT TEL. REAR ❑
z�. � SIDE/SIDE STREET RW p
� CONTRACTOR � • SIDE p
¢ ADDRESS
� CITY� ZIP�[[ TEL._.�"� PROPOSED USE r -
o ARCH/EN '
� DESIGNEFi NO.DWEL. Np. Np,
ADDRESS
UNITS_� STORIES '��BEDROOMS
� CITY ZIP TEL.
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
¢ OWN[R-BUILDER DECLARATION
p SFR/ADDfREM
p I HEREBY�FFlRM UNDER PENALTY OF PERIUM 7HAT�AM EXEMP7 FRou 7NE CaN7RACioR5 LI- GBfSgB/CelpOrt
LLl CENSEIAWFONTHEFOLLDN'INGREA50N�SEC.7o31_6BUSINESSANDPROFESSIDNSCODE.ANVCIiVOa (n
C7 �qJl�'yMICNRE0U1qE5APERMITTOCONSTRUCT,ALTER161PROVE,UEMOL15H2ORREMIqANYSTRUC- w Petp/�BCI(
Z tUHE,PRIOR TO ITB 166UAHCE,ALSO REOUIRES THE�PPLICANT f-0R SVCH PERMiT TO FIIE A BMaNED W
� STATEMENf THAT HE OR SHE IS LICENSFD PURSUANT TO THE GRqVIgIDNS OF TNE CONTRAGipHS LI• �
� CQISE LAW(ClU1PTER Y�CqMMENCING NATN SECTION 7000�OF DIYISION 9 OF THE BUSINE55 AN�PHO- POOUSpB
FESSpN5000E�DRTHATMEOHSHEISE%EMPTTHEREFROMANOTi7F.6A515FORTHEhLLEGEDE%EMP- (�
iqN.IWYVI0LAT10NOFSECT10N70.11.6BYANYAPPLICANTFORAPERMITSU&lECf57HEAPPIIf.AN7T0 z Ra-Roof (�
F, ACIVILPENJLLTYOFNOTMORETHANFNENUN�REU�OLLARS(f6pplJ'�
� ❑4ASOWNEROFiNEGROPERTV,ORMYEMPI.OVEESWITHWSGE5h5THEIR50LECOMPEN6ATION, COfI1ffIB�CiBI -
NIILL 00 THE WORK�TNE STRUCTUHE IS NOT INTENOEO OR OFFEREO FOR SALE(SEC 70��,B1151- Q
� NE85AND VROFESSIONS COOE:THE CONTRACTOqS LICENS[LAW DOES NOTAPPLY TO AN 01NNER OF
PROPEHfYMMO8UILDSORW�ROVESiHEREON,ANOriHO�0E95UGiWORKHIMSLLFOflHERSFLFOR �
WTNiWIWHMSORHEROWNEMPLOYEES,PROV10ED7HA75l1CHIMPROVEMENiSARENOTINTENDE00R m
� OFFEHEDFOFSKEFFqWEVER.7NE8ULOMCORIMPfiOVEMENTISSIXDWITHI.NONEYEAROFCOMRE-
TIDN,TNE OWNEq-0UILDER W�LL HAVE THE 9UROEN OF PROVING TFUT ME OR SN�DID NDT BUIL�OH
� IMPROYE FOH 1HE PURP0.SE OF SALE).
�y ❑4ASOMMEROFiHEPROPERiY,AME%CLIISNELYODNTRACTINGWITNLICENSEDCOMFACTORS
� TO CONSTHUCf THE PpOJECT(SEC.7W�,BUSINESS ANO VROFESSIONS COOE.TNE CON7RAC.TpRS LI- V81U8f1Of1 _ADJ.AREA
W CENSEUW�OEBNOTAPPLYTOANOWNEROFAPROPERTVWHbBUILO50RIMPROVESTH£REON.AND
� N?qCOM1UCT8FONBUCHPRQIECTSMATHACONTRACTOR�S)LICFNSE�PURSl1FNTrOh1ECONTRAF QUANTITY DESCRIPTION
ioAs ucErasE uw.p FEE
� ❑IM/E%EMMUNUERSEG B.iPC.FOPTHI,REASON � � �
3 �[�-'
� OATE OWNER F'
� ___'- ___ W
� LICENSED CONTRACTORS DECLARATION �
� I MEREBY�FFIRM UNOER PENALTY OF GERIVM THRT I�M UCENSi:�UNDEH VFOVifliONS OF CHAPTER �
� Y�QOMMENCNIOWIT?ISECTqN7000�OFDIVI5lON30fTHE9U51NE55ANDPROFESSIONSCADE,AND Z
NY LICENSE IS IN FULL FORCE AND EFFECT.
LV /� rS� m
� LICENSECLASS �^•^�� LIG NO. J �S� �
�j DATE y� Dl�� GONTFACTOH��iy_ �
W
� WORKERS'COMPENSATION DECIARATION Q
� I HEREBY�FFIHM UNOER PENALTY OF PERIURV ONEOF THE FOL[OWING DECLARATIONS: Z
� _IMAYEMAYYILLMAINT�MACEfifIFICATEOFOONSENTTOSELFINSIJREFqqWOqKERS' a
2�
COMPFNSA7N)N,ASPROVIDEDBYSECTION37ooOFTHELABORCOL7F.,F4RTHEPERFOAMANCE U
�EMpHN FOR WHIp1 THIS PERMIT IS ISSUF.�. W:
�i
I HAYE AND MflLL MAIMAIN WOflKERS'COMPF.NSATION INSURANCE.AS RF.OUIRED BY s[CTIOY �'y���''''']]J /�n
Q 9�00 OF TME UDOP CODE,FOR TNE PERWPMANCF OF THE WORK FDfi WHICH 7H15 PFPMIT l$ � 7( / v
� ISSUE�.MY WORKERS' P NSA ON INS NCE CARPIE ND Ppl ICY NUMBER ARF. CONSTRUCTION _ �, /
j c�aaiEa ___ __ � pLAN qEVIEW __
� POIICYNUMBER I C^/!/1 / _ ____ � ; ELEG7RIC __
b
� (IHlSSECfICNDE�FpTBE00MR.ElFDOF7/¢PEFMT6FOAONFHNl7F`EDDq1PR5({tpp�pq�E55} I PLIJMBING
Z I CER7IFV THAT IN 7HE PEFFORMANCE OF THE WORN FOR WHICH 7HIS GEHMIT IS ISSUk 0,I I MECHANICAL �' � •
� SFULL NOT EMPIOY ANV PERSON IN ANV MANNFR SO AS TO BCCAMF SUOJF_C7 TO TNE �'i=
(p WORNERS'COMPENSATIONLAWSOFCM.IFORPIIA,RNOAf:qEETHATIFISFK)ULDBECOMF. � INSPECTIONFEE
SUBJECT TO THE WORNERS'COMPENSATON PRONSIONG OF SEGTqN 310o OF TNE UROR
s CODE,I SHAIl FOWfHWY7NCOMPLY WITH TFKJSE PRnVI517NS. I ISSUANCE � /� �
� � V 4
p DATE: APPLICANL __ � SMIP ♦ �
� WARNIN(i:FALIIRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWRX,AND SHI!L 9E ENERGY P/C �yy�,�' _A��A�$�
r�a s va iu�F
�y SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINFSUGTOONENl1NOREDTNOUSAND ENERGYPERMIT 7f]T�TT TTAT/"� ART C �
� DOLLAflS(t10o.o00),IN ADOITION TOTHE COSTOF COMPENSP1qN.DAMA�'c5 AS PROYIDED FOR IN —���I.���`�_��.,�_� �
J SECTION970BOFTHELAffORO�OE,MTEREST,ANDATTORMFYSfEF.S.
CC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY pRE-ALT FEE:
� IHEREBYAFFIAMUN�ERPENAITYOFPFAJURYTHATTHERF.ISA('ANSTRVCTIONIENDING�CFNGY I
FOR TME PERFORMANGE OF TME WORK FOR Wh11GH THIS�ERMIT IS ISuUEU�SEC.309],CIV.C.).
Z
W
� LE#IDER'9 NAME __ _ __
I-� IENDER'SADDRE55
W� � TOTAL FEES l .�J(J
IGERTIFYTHATIHAVEREADTHISAPPLIQ1TIpNAN05T11TETH�TTHEIIBOVEINFORM11T10NI5CORHE(:T.
� IAOREETOCdAPLYWITHALlCI7VANOCOUHTYORDINANCE5ANO5TATEUWSFlFIATINGTOBUILDING
� CONSTRUCTION,ANDHEREBYAUIHORIZEflEPRESENTATIVE50F1HISCOUNTYTOENiERUPON7ME
ABOVE-1AEMTqNED PROPERTY FOH INSPECTION PUHP0.SE5. COMMENTS
�
J � �S. /Z
�
m PERMITTEENAIAE .n
� • ����
� SIONATUR EE D0.TE
� RECPT.NO. PAID BY VAI.IDA710N
WHI7E—Department Cooy,YELLOM�--Finance Copy,PINN—Asu�ssa Copy,GOLDENR06--Fils Copy.GREEN—Applicent's Copy
CITY O� DIk14ttOFJD BAR �`Y�' .�
INSPECTiOtd RECORD
c e � � - � s f � • t •
SET BACK �. ,, ; ' ', ' � FLOOR J0,15T . . . -. �• ,
FTGS/FORMSiSTEEL FHA REGIM7S
ELECTRIC GROUND UNDER FLOOR LZUCT , . ;�
GROUND PLUMBING UNDER F1.00RGU�IDUIT .: ,� ,.�'�- _ r. •, ,
SLAB GRADE � FIREPL'AC��UIJNDATION • ' � � -
TEMP P�WER FIREPIACE BOND B'EAM � '-
WATER SERVCCE MID HT. BOND BE�,M ' - ' •
ROOF SHEATHWG '� -d'v 8 FT.�$�1VD BEAM t ' • '
FRRMINGNENTILi'A�FfON � FINAL BOND BEAM �
ROOFCOVER � ' 't�� PRE-GRADING
ROUGN HEATING ' BENCHING
ROUGN ELECTRIC ROUGH GRAD�NG
ROUGH PLUMB[NG I FINISH GRADING
SHDWERIfUB TEST POOL ELECTRIC
EXT. LATH/SIDING � POOL FENGING
WALL INSULATION � 1 �'►;� PODL FINAI
CEILING INSULATION � j OFF SITE IMPS.
DRYWALL NAILING ' DEDICATIONS
SEWER �. , FINAL ENG.
SEPTIC TANK 1 ' • ` _ � LANDSCAPEIIRRIG.
SEEP PIT/L.L. j � � � ' ON 51TE 1MPS.
�AS AIR TEST FINAL Z�NING ,
FINAL CONST. � ; ; FIRE QEPL FtNAL
FlNAL�HEATING � I i HEALTH DEPT. FINAL
,
FINAL E�ECTflIC ; ! DEV. FEES PAID
FINAL PIUMBING ' i ENERGY
� �
�
CONfNSENTS
�. .
� `� ..
. \.
. _ . . . • .,
SEPTIC TAN�C SIZE � �
S��P PiT/U SIZE
��
�; — --
�
.. � . . �.,_ �—
� y
. �'1'; .`` • ; . .. .. .` \, i. . � ` 1 �: 1 _