HomeMy WebLinkAbout16779 �� C1TY OF DIAMOND BAR �'
� DEPARTMENT OF COMMCJNITY&DEVELOPMENT SERVICES ,
��` 21825 E.Copley Drive
(909)860-3I95 Far(909)861•3117 PRESS
���� BUILDINGPERMITAPPLICATION • FI LY
y'�, JOEiSITE 1 � /�/��� �/� APPLICATION �7 PERMIT In p/�
o ADDFESS�`��G���('r �►YC��� l�- DATE � I � I �NUMOEFi `+� p
� APN LC�T TRACT D TEE I O TMPE OCC
p OWNER CONST. GROUP
o ADDRE�S 20NING SETBACKS
g CIT1� FRONT
f���_P� ZIP_��T REAR Rw p
APPLICANT TEL. � SIDE/SIDE STREEi RW ❑
� CONTRACTO SIDE p
ADDRESS
� CIN� ZIP TEL T� rP�RO-PO E�US
w ARCH/ENG/ T'���"�'
iz DESIGNER p, . NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
N CITY ZIP TEL.
N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-OUILDER DECLARATION
p SFR/ADD�M17EM
p 1 HEREBY AFFlRAI UNDER PENILLTV OF CERNRY THAT I AM EXEMPT fROM iHE CArfTMCTORS�I• GOtage/CB�pOR
W LENSEUWFOqTHEFOLLOWMOREA50N(SEC.70]1.SBUSiNE55AN�VROFE5510N5LO0E:ANVCITYOR (n
U COUN7yyy}�ILF7pE0UIRE5AFERMITTOCONSTRUCT,ALTER,IMPROVE,UEMOLJSM,ORREPA1qANY5TRUC- W
W 7URE,VRqN TO I75 ISSUuaGE,ALSO REWIRES TNE APVIiCANT FOA SUCH PERM17 TO FILE A SiGnED W P3ti0/peCk
� S7AiFMENT TNAT HE OR SME IS IICENSEO GUNSUANT TO iNE PiiOV1510N5 OF TNE CONTHACiORS L4
� LENSE UW ICNAPTER Y(COMMENCIN4 WI7H SECTION 7000)OF DIV1510N�OF THE BUSINE55 AND Oq0. u- PooVSpa
fE5510N5�E)ORTHA7HEONSNEISE%EMPTTMERE�ROMAND7HEBASISFOR7HEALLEGEDE%EMP- �
V TqN.ANY1/IOUTIONOFSECTION7071.6BVANVAPPLICMITFORAPERMITSU&IECTSTHEAPPLICIINTTO Z Re-Roo1
A CML FEH�LTY OF NOT Aqf1E T W W FIVE HUNDRED DOlURS(f 500).).
0 04ASOWf�EROFTHEPHOPERTY,ORMYEMPLOYEESMATHWAGE5A5TMEIRSOIECOMPENSATqN, � COmm0�Ci31
Z WILL DO THE WORI(M!D THE STRUCTURE IS NO7 MTENDED OR OFFEREO FOq SA:E(SCC.70��,BUSI� J
N N[55 AND PROFESSIONS COOE:THE CON7fUCTORS IICENSE UW DOES NOT ACPIY TO AN OWN[R OF
iROPERTYVlMOBUILDSORIMPROVE57MEREON,AN�VAqDOE55UCHWORKHIMSEIFORHERSELFOR �
� THROUGNNISORHERONT/EIAFLOYEES.VRONOCD7HATSlItl11YPROVEI/ENTSARENOTINTENDEDOR m
w OFFEREOFOq5ALE1F,HOWEVERTMEBUII.DM�ORUAvppyE4ENTISSqDWITMINQVEVEAROF�pA1P�E
� TION.THE OWNER�BVILDER WILL HAVE TME BURDEN OF PROV:NQ TMAT HE OR SHE DiD NOT BUI�p OR
Z WVROVEFORTMEPUHPOSEOF$ALEF
W
0 4�ONMER OF TME FROPEHTY,MI E7(QUSIVE�Y GONTMCTINC WITM LICENSEO CONTMCTORS
� TO CONSTRUCT T/1E PRO,IECT(SEC.70��.BUSM[55 MIO VROFESSIONS COOE:THE CONTMCTOFlS LI- V31112IiOfl A0.1.AREA
W CENSEUWDOESNOTMPLYiOIWONNEflOFAPROFERTVN?qBUqp50RMPROVESTNEREON,AND -
� NTqCON7MCi5FORSUpIPRO,lECTSVAMACONfMCTOR(5)LICENSEDFURSUAN7TOTHECANTMG OUANTITY DESCRIPTION FEE
Y TORS LICENSE UW�.
0 O IAA1 E%EIUPT UNDER SEC. B.8 V.C.FOR 7NI5 REASON Q
� U
LL �
DATE OwNER F-
Z U
F LICENSEO CONTRACTORS DECLARATION W
� 1 HEREBV AFGIR4 UNOER DENALTY OF OE0.JUFV TMAT I/JA UCENSED UNDEH iROVI51qJ5 OF CHAPiER �
d Y(COMMENdNGWITHSECTION70oo)OFDIVISION70FTHEBu51NE55ANDVROFE55iON5CODE,/wD Z
X MY I�CENSE IS IN FULI FORLEAND EFFECi. m
L11
� UCENSE CUSS , LIC.NO.��s(j S j
V DATE��r/��COMMCTOP-�'�. �� a
W
� WORKERS'COMPENSATION DECLARATION Q
� IHEREBYAFFIW.IUNDERDENALTVOFGE0.IURYONEOFTNEfOLLOWINGDfCURAT10N5. Z
� �I/UVEANOWiLLMANiA1NACERTIFICATEOFCONSENTTOSELF�INSUREFOAN'ORNERS' _
CO�.�PENSATION,ASPR01nDEDBY3ELTKKJ�7o00FTHEUBORCODE,FORTMEPERFORMANCE U
Of iHE WORK FOR WHlpl THiS VERMIT IS ISSUED. w
� �
_INIVEAND WIlLMA7lTAIN WORNERS'CO�APENSATqN INSURANCE,AS REW�RfDBV SECTION ('�
Q 77000FiHELA80RCOD[,FORiNEPEHFORMANCEOFTHEWORKFOHWHICHTH14PERM1T15 I 1 J / �� O
ISSUED.MYWORK R'COMPENSATIONINSURANCECARRIERANOPOLICYNUMOERARE: CONSTRUCTION
j uwa:Ea � � PLAN REVIEY!
� POLICYNUMBER��i — ELECTRIC
¢ �T
� (nts5EcrloNN[mwre[WtistErmoFnfvEPo.+rtsFDHa+[1a.wPE�oatAicS(S+a�OntEssy PLUMBING
Z ICENTIFVTHATIN7HEVERFOR/AANCEOFh1EWORKfOIiWHICHTHIS0ERI�ITI5ISSUED.I MECHANICAL �
C7 SWLLLNOTEMPLOVANYPENSONNIINYMANNER50A5TOBfCOMESU&IECTTOiHE
� WOPI(ERS'COMPENSATIONUWSOFfJLLIFORNIA�NOAGREETNATIFISHOl1L�6ECOAAE INSPECTIONFEE
SU0.IECT TO THE WORKERS'COIAPENSATION PROVISiONS OF SECTqN 770a OF TME UDOR
Ocooe,iswuiroanrrnn�cour�vwin+T�aseaaovisior+s. ISSUANCE _ .7��
p DATE: APPLICANT: SMIP � .(J
J WAqNINO:FAILURETOSECUREYJCMKERS'C0IAPENSATqNCOVERAGEISUNUWFUL.ANDSHALLBE ENERGYPlC
�y SIAJECTMlEMPLOYERTOCR:MINALVENAlTIESANDCMLiU:ESUPTOON[HUI.DREDTNOUSAND ENERGYPERMIT
DOlURS(f tOo.Wo�,IN ADDITION 70 THE LOST OF COMGENSATqN.DNAAGES AS PROVaEO FOR IN
� SECTqN]IOeOFTMELA[iORCODE.INTEREST,MlDATTORNEYSfEES. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� IHEREBYAFFIRMUNDERiENALTYOFVERJURYTHATTMEREIS�CONSTRUC710NlENDINGAGENCY
iOR THE GERFOHMpNCE OF THE WORK fOR WMICH 7M15 PENMIT IS ISSVED(SEC.]OY1,LIV.C.�.
Z
W
� LENOER'S NAME
� lENOER'SADDRE55
� TOTAL FEES �3�p, � v
W ICERTIFYTMATIHAVEREADTNI511VPLICATIDNANOSTATEi/U17THEl�BOVENFOFMATpNISCORRECT.
d IAGREE70CAM7LYWRMAlltIiYANDCOUNTYORDiNANCE5AND5TATFUW5REU7WGTOBU�LDiNG
�, CONSiRUCT1ON,AnDHEREOYAUTFpRIZEPE7RE5 N7ATNESOFiHISCOUNTYTOENTERUPON7HE
Z ABOVE��IENTIONEDiROPEFTYFORINSPECf10Nf "POSCS. COMMENTS
� �
m VENA:REE E(PRi
¢ �:'� �I►l'7-/-/�� -
�
(n SIGNATUHLOFFE E V�OAtE
� RECPT.NO. _PAID BY VALIDATION
WHITE—DeDartment Copy.YELLOW—Finance CODY.PINK—Assessor Copy.GOLDENROD--File Copy.GREEN—Applicant's Capy
C[��; C�=. :,IE�;F,rn;•tin ��{€?
13�.��=��.iiGi,� F:�CCiaG
I►�F-'�.a�t'�fl�li`@ •--•:4.1-,._+____ __+,�����=�_'f�16�..._...,._---•--•-I�;f.7:���:E::�r_��•�___.____._.__�,�:.�t'- __._��,1��.I�:c�Ce)C6
. . _ - ... ... . . . -- - - .. .. _. .. - -- --. _ ... ---•-•--
............ ._._.._--. . .. . . . __..._ ... . . . .. . . ---- ---
. _ ._ - •-
.
SET SACK I ' . ' I ' FL00-,JO!ST ' I
-- • ------- -- ---- =1---------
FTGS/FORP�"S;STEEL I ; ' ; I FH�1 RE�","TS '• �
ELECTRIC GROUND � - � --- � ----�-i-lJir'JLR �LQOR D'JCT ----�----� —
GROU�:D PI.U'.1�ING--i---------i------- I ; Ut2DER FLOO,CUN7UIT '---- — -----
SLAB GRC�DE I-----------��_I FIREPL;�CE_FO�`�JDT�TI�?. _ i---- �--- ---`---
TEM1AP PO'vJER I ' � ; FI7Er=�LACE: 60:"JD EE,S:",•1 i i
VdATER SERVICE _�--- -- ' _ -- � I �_'ID i-iT. BO^JD E:EA."," _-- I -- -^-� ---
--- -- -- •—� ....----------- --
ROOF SHF��7HR�G _ .��� __ y � �•F_f--f. F3��J�'iEA'-"-- � ---- � - ----
FF�F.h^ItdGNENTILIATIOPJ I I � i FlidA�E:�i�D v�l��," �
ROOF COVER ----�-l�Lb�'f,l_� i r R�-GRADI^:u --- I -------
ROUGH HEF�i Ii�G —� ! f �,___�_____ � E�''1�;F-�ii`!':a �
—! -�I-� ------- — ,
ROUGH ELECTRIC I ' �?OUGtI GR�,DI�JG I I
- ----- �—�1_=-=-- --- -- - - -�
rOUGH PLU�viair•i�a � � ; FI`JIS�1 GRt;DIPJG � �
1-----------�--•------- --- ---r— -------
SHObVER,�TUB TEST I I I P^vOL�LE_CTR�IC �
�-- - . - _
EXT. LF�TH!SIDING I I I � F'00_F�PJCR1��, � �,
4"dALL INSUL/ITIO�J I i PUOL FIiJF�L �
--� --�-------- -- ---
CEILING INaULF,TION � �_ _� j OrF 5fi E 1F:"PS. _ _ �
DRYb�lALL P�AILIPdG � � � �FDICATIO�vS
--�------------- -
SEbVER � � I I FIPJAL Ef�a.
SEPTIC TANi< ; .�� LAfdDSG�,PE/IRRI;. �
SEEP PIT/L.L. i � --- �_i � CiJ SITE=I�:iI'S. '-- I -
i
GAS AIR TEST � � � � FI�JAL Z�idI�JG _ � _
FIN�L CONST. C �Qi ':��I�E DrPT. FIWt,�
�I�fo«
FINAL HLATING � �_�_HFP,LTH DEPT. FINAL �
FINAL ELECTFiIC __� l_ _ I_I DEV. F�ES PAiD __ � �— -
FINF:L PLUP�1BING � � I I Ef:�RGY
i � � ' I �
I-�_,.-,r.-,_.__...,____ -
.�. .r.,. �.:�_. .,, —.-...�..___.__. �
, .� .
.. . . �.. . .
� . ..
cor,nr,rErvTs
SEPTIC TAP�F:SIZE �
SEEP PIT/U SIZE �- ----
_� '`I��.-----�- — --
ti��� -
�, -------
�, � �