HomeMy WebLinkAbout17947 (448) �` CITY OF DIAMOND BAR �—
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�y 21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRESS
�`�%�' BUILDING PERMIT APPLICATION FlRMLY
o DDRIESS Z � N dO� v DATE CATION 2 jj'� NUMB R /7 I""' k!C
� ISSUE TYPE OCC
� APN LOT TRACT DATE CONST. GROUP
p OWNER �/�J�i� _ �h'L.QfJSG
p ADDRESS G� ZONING SETBACKS
Z CITY ZI TE - FRONT RW ❑
g APPLICANT TEL. - REAR p
� SIDE/SIDE STREET RW �
� CONTRACT R SIDE
� ADDR SS Q E y
p PROPOSED USE
CITY ZIP TELj.t�
oARCH/ENG/ � (
�z DESIGNER NO.DWEL NO. NO.
a ADDRESS UNITS STORIES BEDFi00MS
� CITY ZIP TEL.
�
<n DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEFEBY�FFlRM UNDER PENAITY OF PEMIFY 7MAT 1 MI E%EMDT fROM THE CONTRACTORS LI• G3f898/C8fp0A
W CENSEUWfORTMEFOILOWIN6REll50NI5EG7071.58U51NE55MlDVROFES5lON5CODE:ANYCITYOfl (n
U COUNTYNMICHREOUIRESACERMITTOCONSTRUCT,ALiER,MPROYE,DEMOlJSH,ORNEPAIRANYSTRUC• W PetiolDOCk
� NRE.PRIOR TO RS ISSUANCE.A150 REOUIRES TME APVLIGWT FOR SUCH PERMIT TO FILE A SIGNED w
STATEYENT TMAT HE OR SHE IS LICENSED PUii5t/ANT TO THE OROVISIONS OF TME CONTMCTORS LI-
� CENSE UW(dUPTEF Y(COAl1IENdN�YJITM SECTION 7000)OF DIVISION]OF TME BUSINE55 AND P0.0- � POOVSPd
FESSIONS COOE)OR THAT HE OR SHE IS E%Er.IPT iHEREFROM AND iME BASIS iOR 7HE ALLEGED F%EA17-
VTION.ANVVIOLATIONOFSECTION70]1.SBVMIVAPPLIC/WTFORAPERMITSUBJECTSTHEAPPLIGWTTO Z Re-Rool
A UYIL FENALTY OF NOT MORE TWI iNE MINDRED DOLURS�f5oo)�:
O 4A5 O`M�ER Of iHE PROPERTY,OR MY EMPIOYEE3 WITM WACES AS THEIR SOLE COMPENSATION,
Z 0 Commerciat
W�LL DOTME WORK,AND TME STRUCTURE IS NOT IN7EN�ED OR OFFERED FOR ShIE(SEG.7W�,BUSI• J
� NE55 AND GROFESSIONS COOE:THE CONTIIACTOfiS LIGENSE LAW UOES NOT APPL�TO AN OWNEH OF �
VROPERTY VMO BUILDS OR IMPROVES 7HEHEON,ANO YAIOOOES SUdI WORK HIMSELF OR MERSELF OR
2 THROUGNHISORNERONMEM7LOYEES,VPOVIDED7HATSUC/11MPROVEMENTSARENOTWTEN�EDON m
� OFFEREDFORS�LEIF.HOWEVER711EBUIIDINOORIMPROVE/AENTISSOIDWITMINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE TNE BUROEN OF PNOVPJ6 THAi ME OH SHE DID NOT BlJILO OR
= MPROVELORTHEPURPOSEOFSALE�.
W ❑LASOWNEROFhIEPROPERfV,11ME%CLUSIVELYCONTMMWOWITILICENSEOCONTMCTORS
� TO WNSTRVCT THE GRQIECT(SEC.7Wl BUSM[SS AND PROiES510N5 CODE:THE CONTRALTORS LI- V2IU2S�Of1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANONMEROFAGROFERTYWNOBUILDSORWPROYESTHEREON,AND
� W110LONTMCTSFORSUCMPHO.lECTSWITHACONTMCTOR�3)UCENSEDVURSUMITTOTMECONTMP QUANTITY DESCRIPTION FEE
Y TORS UCENSE Uw 1. J
� OIAME%EAIPTUNDERSEC. B.6V.C.FORTHISREASON Q
� U
Lt. �
DATE OWNER V
Z W
� LICENSED CONTRACTORS DECLP.RATION W
�d \\ .
I HEREBYAFFIRM UNOER PENALTY OF PERIURYTMAT I AM LICENSED UNOER YROVISIONS OF�MAPTER �
d f(COMMENqNC3VATHSECTION7000)OFDNISION70FTNEBUSINESSMlDPROFE5510N5CODE.MlO Z
MY tICENSE IS H fULL FORCE AND EFFECL m
� LICENSE CUSS � ^ �L1C.NO. V�Q..1�� J
V OATE Z CONTMCTOR� � d
W
� WORKERS'COMPENSATION DECLARATION Q
y IHEREBYAFFIRAIUNDERPENALTYOFPERIURVONEOFTHEFOLLOWIN00ECLMATIONS. Z
� �IHAVEANDWILLIAAINTAINACERTIFICATEOFCONSENTTOSELFJNSUR[FORWORICERS' _ ,
COMPENSATqN,A4PROYIDED8Y5ECilONSi000FTHElABORCODE,FORTIEPERFORMAHCE �U
�WORK FOR WHICH TMIS iERM1T IS ISSUED. �
0
IHAVEMIDWILL4AINTAINWOPI(ERS'COMPENSATIDNMSURANCE.ASREOUIPEDBYSECTION / J ,� ��^
d 07000F TIIE WBOR E.FORTHE DERFORMANCE OF iHE WORK FOR WNICNTHIS VEPI/IT IS � /�/ . �
� ISSUED.MY W'ORI(ER COMPENSATq NSURANCE CMRIER AND PO ICY NUMOER ARE: CONSTRUCTION � l0"1'
� GRRIER V PLAN REVIEW �—
� iOLICYNUMeER liV �-Z �.� � ELECTRIC
0 (11iS5ECTItt�NEmNOTBE(1�1.tPL.EfIDOFTEPERMTISPoRONE1MDfiEDDOIUftS(ftOqORLFSS� PLUMBING _ _
W
Z I CERTINTHAT IN TiE iEFFORMANCE OF THE WORK FOR WHICH iHlS PERMIT�S ISSUED,1 MECHANICAL �� � �-�� ��� , �
V' SNALLNOiEMPLOYAN'lPERSONWMffMPNNER50A5TO8ECOMESUBJECTTOTME "
(n WOW(ERS'COMPENSATIONUWSOFGLLIFORNI/�,MlOAGREETM�TIFISHOULDBECOME INSPECTIONFEE I
S SU&IECT TO THE WORKERS'COMPENSATION PRONSIONS OF SECTqN�7aa OF THE UBOR '
CODE,I SHALL FOR7M'ATH LOMOLY WITM THOSE PRONSiONS. ISSUANCE I �P� �
��� .
p DATE: APPLICANT: SMIP � �
� ENEfiGY P/C �
J WIIRNIN6:FAILURETOSELUREWORKERS'C01dPEN5�T10NCOYEMGEISUNUWFUL.ANDSMIILBE
� SU3JECTANEMPLOYERTOCNIMPJALVEN/LLTIESANOCIYILFMESUPTOONEHUNDRED111JUSAND j.-�.L._ ___
DOLLARS�f100.OW),MADOITIONTOiMECOSTOFfAMPENSATICN,DAMACE5A5PROVI0E0FORIN ENERGYPERMIT f---'
¢ SECTION]7oeOfTNELABORCODE.NTEREST,ANDATfORNEY5FEE5. RETENTIONFEE: � • ��
pw_, CONSTRUCTION LENDING AGENCY PflE-ALT FEE:
O
� 1 NEREBV AFFlRM UNDER PENALTV OF PERNRY THATTHERE IS A CONSTRUCTION LENOING AGENCY
FOR TME PERFORMANCE OF THE WORN FOR WMICH TMIS FERMiT IS ISSV ED(SCC.Jov�,CIV.C.�.
Z
W
� IENOERSNAME
H LEN�ERSADDFESS
� TOTAL FEES 1 2 .O�
� ICERTIFYTHATINAVEREADTHISAPPLICATqNANDSTATETMATMEABOVEINFORMATqNISCARRECT.
w IAGREETOCOMGLYN7THILLlCfTYANDCOUN7YORDINANCE5ANO5TATEUWSREUiWGTO8U0.DIN0
� CONSTfiUCT10N,1WOHEREBYAUTHOfiIZEREPRES N7ATIVESOF7HISCOUN7YTOENTERUVONTNE
Z ABOVE�MENTIONEDPROVERTYFORINSPECT P RPOSES� COMMENTS
O
m
¢ PENMIT7EENAAAE(PRIM)
� SIGNA��PEMM7Kw� D�7E�� � /'
� RECPT.NO. ��`7 PAID BV � VALIDATION
WHITE-0epaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENFiO�File Copy,GREEN—AppliaanCs Copy
. . � - �e . . . . , . ,. • . , .� . �,:St ,. , . J.: .��. - '" - ..�. _ . ... ..� . � . .. ' .. . ,. .., . '
c���' QF D!�'�Tf�f�i�3 E3�'�[3
IT�1��EC i iOf�! �3��a�6�
(►�E-��a��`'tl L���►�I �._._....��-�i._.. _,..�I:I►'E=�.�1=c�i C n)a ti_.._._,_.�..��I��E-�i;�-14:'�I�l c`!�p ______�.�._.__m y��[I� I►'E..`i.�?E�'K�a� �
.__.._..�.._�_._.__.. _._____y_---- . ..._ ..�._..,.---.__..._.... ...---..._..� -- ----.---- -.__�.___._.... ___. ..- .-----._._.�__._.__..--.�___.__._...___.�_
SET BACK � — 1--- --- � I FLOOR JOIST , ---
FTGS/FORP�IS/STEEL ' ' FHA REQMTS �
ELECTRIC GAOUND i i I UNDER FLOOR DUCT I •
GROUND PLUMBING � i UP�DER FLOOR CUf�!DUIT
�--- --- —
SLAB GRADE I _t FIREPLACE_FOUNUATION
TEMP POWER I I i FIREPLACE BOPJD BEAP�1
WATER SERVICE _ �`__ i MID HT. �OND BEAP.4
ROOF SHEATHING ,'����_'y__�� � � , F3 FT. BO�D BEAM _ i
FRAMINGNENTILIATION � ; FINAL BOfJD BEA�JI � �
ROOF COVER ''�I ri ��� � PRE-GRADING
�.--✓�<<._. -�f�,.
ROUGH HEATING BENCHING
ROUGH ELECTRIC I ROUGH GRADING
ROUGH PLUMBING l � FINISH GRADING
SHOWER/TUB TEST � � POOL ELECTRIC
EXT.LATH/SIDING � I POOL FENCING
WALL INSULATION � POOL FINAL
CEILING INBULATION OFF SITE IMPS.
pRYWALL NAILING DEDICATIONS
SEWER FIP�AL EtJG. �
SEPTIC TANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. ' ON SITE ItJ!PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FIP�A!
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING � ENERGY �
I -- -- — l
— �.�`'"`' ;�` n��.{� R.___..._..— ---1-- -----
COMMEhJTS
SEPTIC.TANK SIZE
SEEP PIT/U SIZE
�_���__�_
�,�r� - -
� .
��