HomeMy WebLinkAbout17876 J� CTTY OF DIAMOND BAR
DEPAR'TMENT OF COMMUNITY&DEVELOPMENT SERVICES
21szs E.cop(ey Drivo
'� (909)860-3195 Fax(909)861-3 L 17 PRESS
�`%�� BUILDING PERMIT APPLICATION FIRMLY
o DDRESS_ �0� I!/m0!/ SNe /Y�!' APPLICATION PERMIT ( � P!C�
�Jl DATE �:-- NUMBER #,�i��
� ISSUE 7YPE OCC
APN LOT TRACT DA7E � CONST. GROUP
p OWNER C LL.,C
o ADDRESS 9'dh� k/ S' �� ZONING SETBACKS
FRONT RW O
g CITY ,�{DHO _� IP TEL. qEAR ❑
APPLICANT TEL. SIDE/SIDESTREET RW ❑
� CONTRACTOR � ,l�L1� '�'^SO �1 SIDE ❑
� ADDRESS O i� O.
� CITY C� / ZIP I TELI.K-3 ft.6oy' PROPOSED USE C�
o ARCH/ENG/
z� DESIGNER �'��jEL,�- NO.DWEL. NO. NO.
= CD�DYRESS Z�P TEL. UNITS STORIES BEDROOMS
cn
cn DESCRIPTION SQ.F1: FACTOR PSF ADJ.AREANALUATION
o OWNER-BVILDER DECLARATION SFR/AD�/REM
I MEREBY 11FFlRM UNDER VENALTY OF FERNHY TMA71 AM EXEMVT FROM THE COIJfMC10R5 l4 Garaga/Carport
W GENSEUWFORiNEFOLLOWWOREA50N�5EC.70.71.68U51NES5AN�iROiE55lON5CDDE:ANYGTYOR (n
U COUNTYVMICHREOUIRESAPERMITTOWNSTRUCT,AIiER,RAPROVE,DEMOLISH,ORREPNRANYSTRUG W POtio/DBCk
� 7URE.PRIOR TO RS ISSUANCE.AL50 REOUIRES THE A7FLICMIT FOR SUCH PERMIt TO FILE A SIGNED W
STATEIAEM THAT HE OR SHE l5 UCENSEO�URSUANT TO THE PROVISIONS OF TME CONTMC7ORS t4
� CENSEUW(CHA7TER9(COMAIENCW6IYITNSECTqN7000)OFDNISION70F7HEBUSI�ESSANOGRO� � POOUSPB
FESSIONS COOEJ OR THAT HE OR SHE IS IXEMPTTHEHEFROM AND TME BA515 FOH THEALLEGED E%EMP-
V TION.AHVVKK.ATIONOFSECTION70.71.68Y/VIYAPPLICANTfORAPERMITSUBJECT57HEMPUCAN7T0 Z Re-Roo1 '
A pVIL GENALTY OF NOT MORE 7HAN FNE HUNDRED DOlURS(75ao)):
Z ❑4���EROFTHEPROPERTY,ORMYEMPLOYEESVATHWAGESASiNEIq50LECDMFENSATION, 0 COmmBfCl81 -
WILL DO TiE MIORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7M1,BU51- J
� NESS AND VROFESSIONS OODE:THE CONTMCTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF ?
VR07EHTY WHO fiUdDS OR IIAPROVES THEREON,ANO NMO DOES Slltll WORK HIAISELF OR MERSELF OF
CC 7HROUGHHiSORHEROVMEMPLOVEES,DROViDEDTFIAi5UC11MOpOVEMENTSARENOTPrtENDE00R m
w OFFEqEDFORSILLEIF,FIOWEVER711EBUtDIN60RIMPROVEUEMI550lDWRHINONEYEMOFCOMPLE-
0 710N,TF1E OWNERAUILDER WILL HAYE THE BUROEN OF VRONN6 1HAT HE OR SHE DID NOT BURD OR
Z pAPROVEFORTHEPURPO5EOF3ALE}
= O4�OWNEROFTMEVROPEHTY,/UAE%GlU51VELYCONTMCI1NOWfTHLICENSEDCONTRACTORS
W
[[ TO CONS7RUCT THE PRQIECT(SEC.701�,BUSINE55 AND PROFESSIONS COOE:THE CONTRACiORS LI• VdIU3tiOf1 ADJ.AREA
W CENSEUWOOESNOTAPPLYTOANONTJEROFAPROPERTYWFIOBURDSDRMPROVESTMEREON,AND
t WFfOCONTMCT5FOR5UCHGR0.1ECT5WITHACONTMCTOR(5)UCENSEDPURSUANTTOTHECONTMG QUANTITY SCRIPTION FEE
Y T00.S UCENSE UW�..
¢ O IAM EXEIAPT UNDEH SEC. B.i 7.C.FORTHIS REASON Q
� U
� DATE OWNER �
Z W
F UCENSED CONTRACTORS DECLARATION W
� 1 HEREBYAFFIRM UNDER PENALtt Of PERIURY iHAT IAM LICENSED UNDER PROVISIONS OF CHAPTER U, � r/��
d Y(COMMENCWO WITH SEGTION 7000)OF DMSION]OF h1E BUSMESSAND PROFESSiONS CODE.AND Z t^�'
' X MY LICENSE IS N ML FOFCE AND EFFECT.
lLl /2 [O �
_ � LICENSE`CU'SS Q 4 7 LIC.NO. D�'� j 1
V DATE '7�Y^��L- CONTRACTOR G ! d � � �
W
� WORKERS'COMPENSATION DECLARAT�ON �
� IHEREBVAFFIRMUNDERPENALTVOFPERIURYONEOFTHEFOLLOWIN6DECLARA710N5: Z
� I HAVE AND W'LL MAIMAIN A CERTIFIGTE OC CONSENT TO SEIFINSURE FOR WOPKERS' S
�COMGENSATION,ASPROVIDEOBYSECTION17oaOFTMELABORCOOE,iORiHEVERFORAW�CE W
OF TME WORK FOR WHIq1 THIS PERM�T IS ISSUED. �
0
W ,�IHAVEAN�WiLLtaAttJTAINWORKERS'WA�PENSA710NINSUiLWCE,ASPEOUIREDBVSECTION QQQ��� ///'''►►►
Q 87000FiHEU180RCO0E,FORTHEPERFORIAANCEOFTHEWORKFORWHICHiMISPERMiT15 I��
ISSUEO.MYWORKERS'COMPEN TIONINSURANCECARRIERAN�POLICVNUM9ERARE: CONSTRUCTION �
jCARRIER �GOR� PLAN REVIEW
� POLICYNUMBER_�NQd��K,^��I ��� ELECTRIC •
0 (�rtlSSECroNNEmNoi8E00�.FtErEooFnEGEfMisPoRa�EH1�LAE0Nu.A0.sR+0clORLEss} PLUMBING _
�Z I CEHTIFY 1W�T N THE PERFORMANCE OF TME N'ORK FOR WHICH THIS PEHMiT IS ISSUED,I MECHANICAL
U' SWLLLNOTEMGLOVANYVERSONMANYMANNERSOASTOBECAMESUB1EG770THE �'
� WORNERS'COMPENSATqNUWSOFCALIFORNI�,ANOAGREETMATiFIS110ULD8ECAME INSPECTIONFEE
SU&IECTTOTNEWORKERS'CdAPENSATIONPRON510NSOF5ECTI0NA000FTHEUBOR • ��"
s CODE,ISHALLFORTNVATHCOI.�PLVWITHTMOSE7ROVISIONS. ISSUANCE
� �'�"q'1s'� G J r mOI S SMIP
p OATE: �� � APPLICANT. /��If^'
� ENERGY P/C
� WARNINQ:FAILUNETOSECUREWOPKERS'fAAAPENSATIONCOVEMGEISUMAWFULAHOSHALLBE
�y SUBJECTMIEMPIOYERTOCRiAIINALPENALTIE5MIDCNILiWESUPTOONEHUNDREDTNOUSAND ENERGYPEFMIT
DOLtARS(f 100.0001.IN ADDITqN TO TXE COST OF COMPENSATqN,DAMACES AS VFOVIDED FOR IN T�
..}J SECTqN�70eOFTHELABOfiCODE.INTEREST,AN011TTOiWEY'SFEES. RETENTIONFEE: •V�'
�
a CONSTRUCT�ON LEN�ING AGENCY pRE-ALT FEE:
O
� IHEREBV�FFIRAIUNDERPENALTYOFPE0.NRYTNATTMfRE1SACONSTRUCTIONLENDW(i�CENCV
FOR THE PERFORMANCE OFTHE WORK FOR WMCHTHIS PERIAIT IS ISSUED(SEC.]087,CIV.C.).
�
� LENDER'S NAME
� IENDER'SADDRE55
¢ ICERTIFYTHATIHAVEREhDTMiSADPIICATIONMIDSTATETHATTHEABOVEINFOR1AATqNISCORRFCL TOTAL FEES '
� IAGflEETOCCMPLVWITNALICITYANOCOUNTYOHDINANCE5AND5iATEtAWSFELATINCTOBUILDINC
� GONSiRUCTION,ANOMEREBYAUTNORI2EREPRESENTATIVESOFTHISGOUNTYTOENTERUPONTHE �_
Z ABOVE�MENTIONE�PROPERTYFORMSPECTqNPURPO5E5. COMMEMS � �
0
� :T'� � Gm�o ��.Y
¢ PERMI E NAME(PRitfn �/ /� I �p�
cn ��d-Q7�P"�•� ~I (�l�� �q
� S TUitEOf PERMITTEE DA7E /
� ' �. RECPT.N0. ��PAID BV � VAUDAT�ON
WHITE—Department Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLOENROD—File Copy,GFEEN—ApplicanCs Copy
„ . _ . -_. . ,_._;.,....,,.. , . . . , , __ _ _ - --�- - -- ..
.. .. , .. - .. . � ., . _ , , ��„ , . , ,� . , . , .
�I�'�' {��-• �l�'��:rGt�1� EE�p��
dt�lSi����iQi�d �f�CC��E�
I►�F-'�.a=�.�;i�CIoJ►�! c��_�.-i.W..-�._,(���-'-j:�:.t�;�F'`�)��._�,�...__. I►�E.`iC?=,� 't1Cs�)�''i. T__.----,`j:.k�= ��;1►`�-`iCa=��"C��.� I
_. _ .. � ,_ . . Y _
F1'GSIFORMS/STEEL _....--._. ..._.._. _. __. _._.... ._..__ ......_...._�_.._......._..___..- .. ---� ----.._......._..-•-•.----. ._.......__-- _
SET BACK —�--- --�- - - I ; -- —_-' I I FLOOR JOIST -' ' i . -. --
t���/Z �/ �� ' ` � � FHA REQP�ITS
/--�— ” ,� �-1 }--
ELECTRIC GROJPdD � 6� , gy%��� � I UNDCR FLOOR DUCT
GROUND PLUMBING ��_ _ ; UNDFR FLOOR CUf,�DUIT' � �� _
SLAB GRADE __�_ ~ FIREPLACE FOUPJDATION � �
TEMP POWER I ; FIREPLACE BOND E3EAM
WATER SERVICE I �i t��11D HT. BOND BEAPA� _� �
ROOFSHEATHIPJG 'I � �_I II FT'. B�CJD�E�EAP�1 .. � � � ' � ' .
FRAPJ�INGNENTILIATION ( I FINAL BOND BEA��1 I
ROOF COVER I � PRE-GRADING
ROUGH N�ATING BEt�1CHI��G
ROUGH ELECTRIC ROUGH GRADI�dG
ROUGH PLUMBING �,$/6������ ! FINISH GRADING _ _
SHOWERIfUB TEST � � � POOL ELECTRIC � �
EXT. LATH/SIDING i I POOL FENCING 1
WALL INSULATION I POOL FI�dAL � �,��
CEILING INSULATfON � OFF SITE IhAPS. --� l
DRYWALL NAIUNG � � DEDICATIOfJS �
SEUJER FIrJAL ENG,
' SEPTIC TANh � LANDSCAPE/IRRIG. �
SEEP PIT/L.L. �_ ' ` OU SITE IMPS.
GAS AIR TEST ��/ i��:�� FINAL ZONING
FINAL CONST. �i, �IRE DEPT. FINA!
FINAL HE�TING l j HEALTH DEPT. FINAL
FINAL ELECTRIC � � � DEV. FEES PAID
FINAL PLUMBING � 'I I ENERGY
�� � �Z� �v�� —� I _.�-.
— — � - � � -- ----+=..:�}����_-�__���.;�.:_-__ �__�� _ — --
i
COPJIMENTS
SEPTIC TANK SIZE
SEEP PITIU SIZE
_.�_..��,
��� I
i
�f���' ':�;', r
— �._
i � ' • � ' . ;
' �
� , . .
�r � �