HomeMy WebLinkAbout16603 (1110) J� CITY OF DIAMOND BAR
� ' DEPARTMENT'OF COIvL'v1UNITY&.DEVELOPMENT SERVICES
c � ,�� y�,,� 21825 E.Copley Drive `-�
'�,,..-'�-'�►`,�� (909)860-3195 Fax(909)861-31 l7 PR ESS
�'�� BUILDING PER111IT APPLICATION FIR LY
} JO�SITE �� .�1 APPLICATION ��PERMIT /�
¢ ADDRESS ._���t.{�(TD V -A�- �U R
o DATE NUMBER
� APN LOT TRACT �SSUE TyPE p�C
DATE � Q�CONST. GROUP
p OWNER �� �' RO �;
o ADDRESS - ZOYIP�G SETDACKS
z CITY ZIP TEL. b�y� FRONT RW ❑
o APPLICANT _� _�GS�_ TEL.����_y„� REAR �
SIDElSIDE STREEf RW p
� CONTRACTOR�[.�NtO �J 1 SIDE p
ADDRESS�'�`,'p �, �,�-„�C. ;�cA
� C�TY LsCL-f-S�h�SC�� ZIP TEL. �- �� PROPOSED USE T ) /�t/ � �
o ARCWENG/ —��—'��'� r �
w DESIGNER NO.DWEL. NO. NO.
n. ADDRESS
cn UP�ITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER�BUIIDER DECLARATION
p SFFi/AOD,'REM
0 I HEFEBY AFFIRAI UNOER PEN�LTY OF PER.LFY THAT 1 AM EIfEMCT LfiOM T/IE CONTMCTOAS LI� GafBaC/Cd1pCR
W CENSELAWFOiiTMEiOLLOWINCR[ASON(5EC.703i.58U5M[SSA,\DFROFESSIONSCOD[:ANYpTYOR (n
" "'-'Z COUNTYNTtICHRCOUtRCSAVEiiMRTOCCnS�RVGT,ALTERI�!^ROVE,nCMOLISH,ORHFPAIRANYSTRUG W Pai�o/Dock
w 7URE PRqR TO ITS ISSUANCE,ALA flCWIRES TH[A➢PLICaWT FCR SUCH DEM1.T TO FILE A SIGNED W - -� _ _ ____
Z STATEMGNT Tn�T ME OR SME IS LICENSE7 PURSUANT TO 7ME DRDVi5:Ok5 OF iNC CONTRACTOIIS ll�
� LENSEUW(CHADTERY(COM'AEM1CINGWITHSECTION7W0)OFDIVISION]OFTH[�USINESSANDCqO� u' POOJSp3
0 FESSqNSCODE)ORTMATHEORSNEISE%EAIPTTHCREFROIAIIVDTH[BASi5FOf1THEALLECCDExE�/�- (7
V TqN.ANVV10LA1:ONOFSECTION70]t.SB�ANYAP%,ICAYTFORAVERIAITSI.'0.;CCiSiH[APPJGIHTTO Z Re�Roof
� A CML DEtiALTY OF NOT MORE TMAN FIVE HUNDRED DOW1f15�fsoo)�:
Q 04ASOWYEROFTHEPROPERTY,ORMYEMP�OYEESWITHWAGCSASTMEIqSOLECAMGEnSATqN, O �mmercial
Z W:LL DO TNC WORK,AND TI+E STRUCTUR[IS NOT INTEhAED Op OfF[R��fOR SA_E(SEC.70��.6U51� J
� NESSI�NDPROFESS:ONSCODL:THECANTRACTORSLICENSEUwDO[SNOTAvp,YTOANOW!lEROF �
VROPERTY W1q BUILOS OR IMPROVES THC REON,AND WIIO DO[5 SUCH WOliK HIMSCLF OR H[RSELF OR
WTH(IOUCNHI50RNCRONNEMPLOYEES,VROVIDf.DTNAT5:ICHIMOROVF4CNT5ARENOTMTENDFD�R m
� OFFEREDFORSILE.IF,HON'EVCR7NE9uILDINGORi1APROVE4CN71550LpY.9TMiNO+:EYE�qO�C06��LE-
7, TION.7NE OWNEfi�BJILD[R W'LL HAVE TH[BUfICCN OF PppVINC THAT M[OR SHE DiD NCT 6U�lD OA
� U1PROtlE FORTNE VUP.POSL OF SALE).
w ❑I,ASONTI[ROFTHEPI40PERTV,AMEXCLL'SIVElY00NTRACTINGYTTNLICCNSE'JCONTMCTOqS
¢ TO CANSTRVCTTHE iROJCCT(SEC.70��,BUSINCSSANJ PROFESSIONS WDE:TMC:CO\iRAC70R511• VaIl1�:ICf1 _ � ADJ.AREA
W CENSEUWOOESNOTAPGLYTO�NOri'NEROFAPflOPEFTYWHOBUILO5Cf11MVROVESTH[RCON.AYD
� N'��OGONTRALTSFORSUpIGfq.;ECi5Y11THALONTRACTOfY(S�UCENSe'DPURSUA4TTOiHECONTHAC- QUANTITY DESCRIPTION FEE
� Y 70R5 LIC[NSE Uw�.
� ❑IA1A EXEIA�7 UNDER SEC. B 8 P.C.FO�TH�S REASON Q '
j U
� DATE ONMER f-��
Z U
�Q LICENSED CONTRACTORS D[CLAFiATION W
CL IHEREBYAFFIRMUN�ERPENII�TYOFPERNRVT�:A71AAlLICENSCDUNCER7ROVISKKlSOFCHAPTER V.
p_, Y(CpAMCNCINCN'1TNSECTION7000�Of'DIVISqN]OFTHCBVSInESSAh�PROfE55'�ONSCODC,AYD Z
L`� IAYLICENSEISWMLFORCEANDEFFECT. Q
0 L�CENSE C SS�9 LiC.NO.��Q�� �
V o�tE�� O � corJraacron_��_�L(r�_ a
w
� WORKERS'C061PE-PlSATIOU D[CLARATION Q
� IMEREBYAFFIHMUMJERVENALTYOFGE0.IL'RVONFOF7HEFOlLOWIYGDECLAMfIONS. Z
� _INAVEMIDWILl1AA14TAINACERTIfI�ATEOFCANSENTTOSELF�INSUREFOHK'ORNCRS' _
CqaPENSRTqN,AS PRONOED BY S[CTION 7T00 OF TME LA�CIi CODE,FOR THE FCRFpqUANCE U
OF TME WORK FOR WNICH iM15 GERMITIS ISSUED. W
O z
W _IHAV[AN�WILLMAINTAI4W0{L(ERS'COMPENSATIONIhSUM.':CE,ASREOUIREDBVSECTiON
Q 71000FiHEUBORCOOE,F01iTHEPEAFORMANCEO�TH[WOFKFORWHiCHTH15PEiiNIT15
J ISSUED.MY WORKEf15'COMPENSATION II:iURANCE CARR�CRMlD iCIiCY NUM�ERAR[: CONSTRUCTION �� � 2�
- � ' CAHRiER �TA�L� �.l n�� -� PLAN flEVIENJ
o vaicrr:uMoea�� ELECTRIC
¢ 3�33(�
� (f1LS5[CTqNN[mNOTBEOp.�REfE�OFiI[P[R�.R6Fi�flpr�EFiU�DllEDOCUA{iSK�aC;O(1LE55} PLUMBING
W
Z ICERTIFYTHATNTHEPERFORMAYGEOFTM[WORKFORVhI!piTHISPERVAITI5155UCD,l MECHANIC
(�' SMALLNOTEMPLOYANY�ERSONIN�HYIAAYNLRSOASTOBECCNE51:[L'CCTTOTHE �� —
(n WORNERS'COMPENSATIONUWSO�CAUFORtiIR,ANDAGREE7HAiliISHbJLDBECOME INS�ECTIO '
S SU[31EGT70TH[WOFNEPS'CLIAPENSATIONGHOVISIONSOFSECTiON]lOOOGTMFU30R _
COOE.1 SNAL ORTMWITH CONCLV WITHTHOS[PIlON5qN5. ISSUANCC �
0 1 ///yyy,,... ��,
p DATE:�(��._ PPFtICAM: _y���J■ ��E�J SNIP _�
� WARNINO:FAhURLTOSECUR[RI�RKERS'COMPENSACIOYCOV[RAGC�SUNUwFl1L,AN�SHALLBC ENERGYP,'
�y SU&IECTANEUP�OYERTOCRIM:NALPGNALTiESM'DCMLFW[SUPTOONFMVNDf1COif!OUSAND ENERGYP�tdJ.`_
DOIUfL�S 100.000�.W ApDIT10N TO THF COST OF�OAIPENSA'ION,DAMAGCS AS PROVICED iOR IN
¢ SECTION])OeOFTMELA80RCODE,INTENEST,ANDATiORYEY'SFEES. �E7ENTIO ' E"'�
oCONSTFlUCTION LENDING AGENCY PRE-ALT FEE:
� IM[RCBYAFFIRMUNDERPENALTYOFPEiUURVTHA7TNEREISACONSTRUC710NLENDINGAGCNCV
FOR THE PER�ORMFNGE OF TME WORK iOfl KTnGH THIS GCRMIT I5155 VED(SEC.9C91,LIV.C,).
Z
LL1
� LENOCR'S NAM[
S
F= LENDER'SADDRESS
� TOTALFEES
¢ ICERTIFYTHAiIHAVEREADTM15AVPLICATqNIWDSTATETW�7TMEA30VEINfO�3M�T10NI5LOqRCCT.
w IAGREETOCOMP�YWIMALLCITYA/vDCWNT70RO1NaYCE5�ND5T�TEU'MSRFUTINGTOOU0.01NG �
n.
� COfiSTFUC71pJ.Af�DHEREDYAUTMOqIZ[RCPRCSENTATIVESOFTHISCWNTYTOENTERUPONTHE
ABOV[�MCNTqNCD PROOERTY FOfi INSPEC71D4 PURPOSFS.
o COMh7[NTS
=-' �-�Jt.�-�
�
m PERMITTEENAM[(vRINT��
� �- . � G _ �
�
�/j SIGNIITUHEOFPERr 7 ` DATE
� RECPT.�O. _ PAID BY _VALIDATION
WMITE—Depanment Copy,YELLOW—Financo Gopy,PINK—Assessar Copy,GOIDENROD—File Gopy.GREEN—Applicant's opy
�- ....-- �.... ...�_...-...�...... :......•.•:..,o.s•'. � � i' . ,.. ... .. :r-; r �.-�- ,. . � ,r�rr. . .. - . , ... ..... - . .. , ..
�..� I ��i� aE= ���'}�1Qf��l�. C:.iE:
ir�sr-���io��<< r�co�a
_ . _ . .
�_._.______._ ____._�
l�'E:iF��['..CI�J1�! �,i:.�.°F'�--- I►�F-11:.�-i .��,R __----�--�--_,�'�_,:'— . r��;i►`� ii���r- I►��-��►:�c':�rea�t
-- -� - — - —
, _..
_. .._.____..__... ... ... .. . .....: .: . . . . .. .. : . ... :. . .. . . .._.._ ....--------•-------
.. _
SET E3ACY, I � ' � � F�LOOR J�IST• �
— - ------�— - ---- �----
F7GS'FORP�IS;STEEL � _ � __.,--___.__.. I I FHA REQP:'T5 _ I____ i
ELECTRIC GROUPJD � I i ! U�•.D�R FLOOR DUCT � �
GROU��JD PLUi�4BI�JG � UtdD�R FLCOR CUi�!���IT I ;
1.-- ---- .-- - --------
SLAB GRF,DE I �_. _l1 FIREPL.�CE FOU�JDATIOhJ �__ I ____
TEP�1P PO'NER �_ I _�I FIREPLACE E30ND E3Er',P.1 I __ �
WATER S�RVICE I � I I PlID HT. E30�:D BEAt�7 �__ I __
ROOF SHEATHING rj�-(�--0(_� _ I I S FT. 60PdD E3�A"�t _ i __._
FR!'�P.rI�JG,`VENTILIATION; � � I FIN.AL BOI•�D 6EA��" �
ROOF COVER ��—F� I � I �'�E-GR/�DItdG I I __
ROUGH HEATIf�1G � � � � �Eh!CHli�u �
ROUGH ELECTRIC I __� � ROUGH GRADIhJ:� _ i __
ROUGH PLUh^BING � J FI�JiSH GRADI�•dG � I
SHOVVER.rfUB TEST �_l � POOt_ELECTRIC � �
EXT. Lf\TH!SIDING � _� I POOL FEidCli�u �
l"lALL IPJSULATION --� � � POOL FINAL �
CEILING INSULATION � I OFF SITE IPAPS. �—j
pRY1P,'ALL PJAILIPJG � DEDICATIOtJS �—
SEIPJER � FIPJAL EP�G.
SEPTIC TANK �—� LAPJDSCAPE/IRRIG.
SEEP PIT/L.L. —� � ' J O�J SITE I�APS.
GAS AIR TEST � � FIhJAL ZOPJI�dG
FINAL CONST. ��,��_I � FIRE DEPT. FRJP�L �
FINAL HEATING I 1 �J HEALTH DEPT. FIPdAL
FINr>L ELECTRIC �_� 1 DEV. FEES PAID
FINAL PLUP�181NG ENERGI' �
�-------�i �:���..'�.'--!`� ..�....____�� �
cor,nnrENTs
SEPTIC TAPJK SIZE
SEEP PIT/U SIZE
-----',��
•���f -
`
�