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HomeMy WebLinkAbout12043 (14) CITY OF DIAMOND BAR ����� � ���� � � ��- - DEPARTMENT OF COMMUNITY dc DEYELOPMENT SERVICES 21660 E.Copley Ihive 5uitc 190 (909)860.3195 Fsz(909)861-3117 PRESS ��'��'� BUILDING PERMIT APPLICATION FIRMLY N JOBSITE �S(�8' l�'ttb Cvvu^f" `` APPLICATION � PERM p/C o ADDRESS 1 DATE � �r� NUM6E �N $ ISSUE TYPE OCC APN L T, _ TRACT DATE CONST. GROUP � OWNER f'� ' 'C p ADDRES � L�Y'�' ZONING SEBACKS �W CITY l' ZIP��TEL. — � FRONT pyy p APPLICANT �L. REAR p � SIDElSIDE STREET RW ❑ a� CONTRACTOR q 51DE p g CDDRESS � e,Q Z�P e.TEL. �-p PROPOSED USE � ARCFVENG/ DESIGNER NO.DWEL. N0. NO. ADDRESS UN{TS STORiES BEDROOMS � CITY ZIP TEL � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECI.ARATION SFWADD/REM O 1 NEREBY AFFliW UNDER OENALIY OF PERAIRV TNAT I AIA E%ElAP7 FROM iHE CONTq/,CTppS LF �,arapa�CarpoA CENSf1AMFOR7MEFIXLOWINOREA60N(SEC.709f.68USINESSANOPAOFE5510N5CO0E:AHYCT'OR (n OOtkRYWFACHREONHESAPER►IRTOOOfJSTHUCT,µTER�MPNOYE.DEMOUSM,ORREiAIRANY9TiWG �W Pa�lO/�6C�C IURE,PR�OR TO RB ISSVANCE,ALSO REOUIRES TFIE MPLICANT FOR SUCM PERMIT TO FILE A SIONED w 8TA7EMENT IW�T NE OR 8ME IS LICENSEO PURSUANT TO TNE PROYISIONS OF THE CONfRACTOqS LI. 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Q'�7� / � 1 � �'j DATE CONTRIICTOR�� � . � ��� WORKERS'COMPENSATION DECUIRATION a � I HEREBY IIFFIRAI UNDER PENKTY OF PERIURV ONE OF THE PoLLOVlINO DECLMATIONS: Z � _IMAYEMIDWILLMAIN7AINACERfIFlCATEOFCONSENTTOSElFIN3UREFORN/ORKERS' T OOYPENSATION.AS PROVI�m BY BECTION Slo00F THE LABOR COOE.iOR THE PERFON1dMICE W Q OF 7HE WORN FOp WHIq1 TNIS PENAl1T IB ISSUED. � �t MAVE AN�VYILL UAINTAIN YYOPo�RS'COAAPENSATION INSURANCE.AS RE�UIREU BY SECfION Q 9700 OF TNE LABOR ODDE.FOR THE PERPORMANCE OF THE WORK FOR WMlpi 7HI5 PERMIT IS ISSIIC-0.W WD/g•�cERIS' PENSATrpN_INSURANCE CTARRIER MD POLICV NUMBERME: CONSTRUCTION � CARRIER [7r71��fn G�(4I G l�LS. PLANREVIEW � POLICYMIMBEN_N`�1IC� ,- -�.O—�oU �LECTRIC � (fHsBEC�ONr��p7eEooMFLE�OFT1EaEaMrsFORONE�A1�ORm0oli/Rs(S�m1oRLE5s1 PLUM�ING � Z 1 CERTIFYTHAT N TNE PERFORMANCE OF TiE WORK FOR WHICH TNIS PERMIT IS 1 SUED,1 MECHANICAL 6HAI.l NOT EMPLOV MIV PERSON IN ANY M/JINER 60 AS TO BECOME SUBJECT HE (q YVORI(ERS'COMPEN9�TqNLAW9DFCNIFORMIA,AND110HEETHATtF18FpUl ECAME INSPECTIONFEE � SUB.IECTTOTHEriOfiNERS'COMPENS�TqNPROVI5IONSOF3ECT10N]Ivo HEUBOR r lc�,'sn�oRn+vnn+couv�rwm� PROVIS s. ISSUANCE 1_G- p DA7E. � � �� APPLIC�wT: 5MIP � ENERGY P/C WRRNINf3:F/JIUFiE TO SECURE YYORKERS'COIAPENSATION OOVER�CiE IS UNIAWFUI,AND SMALL BE (—y eU8JEC7ANEMPtDYER70CRIMINALPENALTIE3IWOCIVILFINESUPi0011E1WNDREOTHOU8MIU ENERGYPERMIT DOIlAR.SIif 00.000�.IN AOOIiION i0 7HE COS70F COMPENS�TION,DAMAOES A9 PROVIDED FOR IH J fiECTpN�70lOFTHEUIBOROODE.INTEREST.ANDATTOHNEY'SFEE3. RETENTIONFEE: O CONSTRUCTION LENDINO AGENCY ���. ��. ' PRE-ALT FEE: + � 1 FIEfiEHY AFFIWA UN�ER PENALTY OF PERJURY 7HAT iHEHE IS A CONSTRUCTION LENDINQ AUENCY "�•�I } •1 ' FOR THE PERFORMANCE OF THE WOfU(FOH 4VHICH 7NI5 VERMIT IS ISSUED(SEC.70i7.CIV,CJ. � � LENOER'6lMME C LENDER'SADORESS � ICE'RTIFYTNATIHAVEREAUTiISMPLICATpNANUSTAiETHAiTHEABOVENFORMATKINISCORRECT. TOTAL FEES � �(,J � IAfiREE TO C0IAPLY WITN ALL CffYM1D COUNT'ORDIIUNCESMI�9TA7E UWS NELAT4J(i TO BULDING � � CONSTRUCTION,ANO MEREBY AUhIORIZE IIEPRESEM�TIVES OF 7HI5 COUNTY TO EMER UPON THE �eove-uo�rtnnen vwovemv wA wsaEcriav vuavosEs. CpMMENTS � iC,lt.k �� PM � FiRMI AME P ' N � � (/� iKiNATU F P RMIT�EE pA7E � RECPT NO. PAID BY V/WDA710N YVHITE—Depertm6nt Copy.YELLOW--Finence Capy,PINK—Aasassa Copy.GOLDENROD—File Copy,OREEN--AppliuM's Copy , ., . . . . . . . :. .. .. . , . . .. .:. :�... ..� •.�.':•.. .,...�., ,.,.�^.A_ CITY OF Di�►IVIOND BAR , � ' II��PECTtON RECDi�D � � � , . i . . � � � . � . SET BACK - . '� ' . FLOOR JOIST , � . . : � , , FTGS/FQRMSISTEEL FHA REQMTS ELECTRIC GR�UND UNDER FLOOR DUCT ' ' . GROUND P�UMBING UNDER FLDOR CUMDUIT,� :. � . Sl.,4B GRADE FIREpLACE FOUNDATiON� -• • � � TEMP POWER FIREPLA�E�bND BEAM - � ' WATER SERVICE MID NT.BOND B�AM ' • - � , ,'• • � RODF SHEATHING S F?. BONQ B�AM� � � � FRAMINGNENTIUATION FINAL BOND BEAM ROOF COVER ' PRE-GRADING ROUGH HEATING � BENCHING XtOUGH ELECtRfC ROUGH GRADING R�UGH PLUMBING i FINISH GRADING � SHOWER/?'UB TEST � POOL ELEC7AlC EXT. LATH/SIDtNG � PbOL FENCING WALL INSULATION POOL FINAL CEI�ING lNSULATI�N OFF 51TE IMPS. DRYWALL NAILING DEDICATlONS SEWER 9/ FINAL ENG. • SEPTIC TANK f LANDSCAPE/IRRIG. , SEEP PMT/L.L.� ' �N 51TE IMPS. GRS AIR TEST � FINAL ZOIVING r FfNAL CUNST. f. f FIRE DEPT. FINAL ; i FINAL HEATING HEALTH DEPT. FINAL � FINAL:ELECTRIC � � DEV. FEES PAIp FINAL PLUMBING �' � � ENERGY I j , i ` +i 6 � -- GOMMENTS �� _._ . SEPTIC TANK 51ZE SEEP PIT/U SIZE � .. � '�'" . _ �� .� ._ - _ , _ F '