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HomeMy WebLinkAbout11781 (5) P1a.�� J ��-- CITY OF DIAMOND BAR � � � COMMUNITY DEVELOPMENT DEPARTMENT � 21660 E.Coplcy Drive Suitc 190 (909)860-3195 Fax{9D9)861-3117 PRESS '�""� BUILDINGPERMITAPPLICATION � .. � ° � . .FIRMLY o� JOBSITE �� .�",'� L� i.��;i C��� APPLICATION � � PERMIT p/C � ,.,A ADDRESS ��'� � DATE NUMBER I�� # 'G� � ISSUE ��TYpE OCC APN LOT TRACT DATE ,CONST., GROUP p OWNER 1 C.�7M1_� p ADDRESS �W� M.1� �T�.. �y� ZONING SETBACKS ` � CITY �4 ZIP TEL���jw FRONT RVy "_I APPIICANT TEL. REAR r z 'SIQE/SIDE STREET RW ❑ ¢ CONTRACTOR�Q� SIDE' ' �_ ADDRESS � CITY ZIP TEL, FROPOSED USE o ARCH/ENG/ z DESIGNER � w NO.DWEL. NO. � NO. n. ADDRESS � CITY ZIP TEL. UNITS �•STORIES BEDROOMS ca — cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BI:ILDER DECLARATION SFRr'ADDlREM ' O � 1 HEREBY AFFIRM UNOER PENALN OF PERJURY THA7 I AM E%EMPT FFOM THE CONTRACTORS LI� Gyfa99lC8fpOR Q� W CENSELAWFOqTNEFOLLOWINGREA50N(SEC.7o31.58U5ME55AN�PflOFESSION5Cq0E:ANVCITYOR (n U COUNiYWHICHREOUIRESAPEflMITTOCONSiRUCT,AL7ER,IMPROVE.DEMOUSH,ORHEPAIRANYSTRUC� �� w TVRE,PHIOR TO IT<ISSUIWCE,AL50 REOUIRES TNE APPLICANT FOR SUCH VERMI7 TO FILE p SIGNED w Patio/Deck � STATEMENr THAT HE OR SHE IS LICENSEO R1R5UANT TO THE PROVIS!ONS OF THE CONTHA�DRS LI- � CENSE UW�CHAPTER 9�C0IAIAENCING WITH SECTION 700D)OF OIVISION 7 OF iHE BUSINESS ANU Pi30- � POOYSp3 . y FESSIONSCODE)ORiHATHEORSHEISEXEMPTTNEREFROMAND7HEBASISFOR7HEALLEaEOF%EMP- (� � TpN.ANYVIOUITIONOFSECT10N70315BVANYA7PLICANTFORAPERMIT5UH,IECTST4FAPPlN:ANiTO Z Re-Roo1 � A CIVIL PENALTV OF NOT MORe'THAN FIYE HIXJORE�DOLLARS(SSao).�: Q f.71,A50WNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfTIR1BfC18I Z WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE�SeC.7oa�,PUSI� � ' � NESS ANO PNOFESSIONS CODE�.THE CONTRACTOqS IILENSE UW OOES NOT APPLY TO AN OWNFR OF � � PROPEHTY WHO BV ILDS OR IMPROVES THEHEON,PNo WHO OOES SUCIi WORK HIMSELF OR HERSE:F OR Q THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHFTSUCHIMPROVEMENTSARENOTINTEN�EUOF m � OFFERE�FORSALE.IFHOWEVER.THEBUILDINCOFIMPROVEMENTISSOL�w;iHINONEYEAROFCAMP�E- Z TION.T1E OWNER�BIJIIDER WILL NAVE THE BUR�EN OF PHOVING THAT HE OR SHE OiD NUT B!11LD OR = IMPROVEFOR7HEPURPOSEOFSALE;. , , w 61,ASOWNEROFTHEPROPERTV,AAAEXCWSNELVCONTRACTINGWiTHLIGENSEDCON7RACTORS � TO CONSTRUCT THE Pfi0.1ECT�SEC.7os�,BUSINE55 AND VqOFE5510N5 CODE:TNE CONTR�CTORS LI- VaW8110f1 _ _ _ADJ.AREA W CENSEIAWDOE9NOTAPPLYI'OANOWNEROFAPPOPERTYWH09UILDSORIMVROVESTFiEREON,RND --'—' = WHOCAN7RRCTSFORSUCHPR0.IECTSWITHRCONTRACTOR(S�LICENSEOPURSUANTTOTHECONTRAC- FEE ~ roqsucEr�sEuw.�. OUANTITY DESCRIPTION Y Qi]I qM EMEMGT UNDER SEC. B.8 7.C.FOH THIS REASON ¢ ' � � U LL DATE OWNER �F Z U • � LICENSED CONTRACTORS DECLARATION w I a � I HEREBY AFFIRM UN�ER PENALTV OF PERJURY THA7I AM LICENSED UNDER PROVISKKJS OF CHAP7ER �� �, 9(COMMENCING W1TH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,RND Z ' X MV LICENSE IS IIJ FULL FORCEANO EFFECT. ♦� m Q UCENSE CLASS�J��� � LIC.NO._�/F�yJ�/ j� . . V DATE 7/3 a�CONTRACTOR�'—._�� a W --'i . � WOFKEFS'COMPENSATION DECLARATION ¢ � I NEREBV AFFIRM UNDER PENALTY OF PEPJURY ONE OF THE FOLLOWING DECLARATIONS. V � Z O IFIAVEIINOWIILMAINTAINACERTIFICATEOFCANSENTTOSELF-INSJREFORWORN[RS' a Q COMPEN5ATION,ASOflOVIDEDBYSECTION37000FTHEU�BORCODE.FORTHEPERFORMANCE U Q OFTHEWORKFORWHICHTHISPERMITIS195UED. � W �1 HAVE AN�WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOIIIRED BV SEC710N Q 3700 OF THE LABOR CO�E,FOR 7HE VERFORAIANCE OF THE WORK FOR WHICH iHIS PERMIT IS f ISSUEO.MV WORK/E1RS'COMPEN ATION INSURANCE CARRiER AND POLiCY NUMBERARE: CONSTRUCTION /��Q �� jCARRIER �%L��� _ PLAN REVIEW I!33e�S zvoLICYNUMeEa -- ELECTRIC ¢ 0 (IFIISSECTIONNEmNOTBECCY�LEfEDOF7HEPERMfT6FORCNEHINMiED�OLLAR5�t10%ORLESS� PLUMBING LL1 Z 1 CEFTIFY TF417 IN THE PERFORMA�CE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALLNOTEMPLOYANYPERSONI�ANYIdANNERSO0.5TOBECOMESUBJECiTOTHE (/J WORKERS'COMPENSATION LAWS OF CALIFORNIA,qND AGREE THAT IF ISHOULD BECOME INSPECTION FEE SU&IECTTOTHEWORKERS'CAMPENSATKKJPROVISIONSOFSECTION3)OOOFiHELA00R /� MM ,: O CADE I �ORTHWIiHCOMPLYWITHT EP OVIS N5. ISSUANCE �(!(J p DATE: , APPLICANT. SMIP _, �f � q Q W ENEHGY P/C � WARNING:FAILURETOSECUREWORKEHS'COMPErySATIDNCAVERAGEISUNUWFUL.ANDSHAILBE � SV&IECTANEMPLOYERiOCRIMINALPENALTIESANDCIVILiINESl1PTOONEHUNDRE�THWSAND ENERGYPERMIT ��_.,. k ,� '+.'_ ��S � } DOLLARS(f100.�aa�,M ADOITION TO THE COST OF COMPENSATqN,DAMAGES AS PqOVIDED FOR IN ` J SECTION37080FTHELA00RCODE,IMEREST,pNDATTORNEY'SFEES. ,/�`O ` Q HETENTION FEE: O CONSTRUC710N LENDING AGENCY _____ _ � (� PRE-ALT FEE: � I HEREBY AFFIRM UNOER PENAL7V OF PERJURM THAT TNERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE Or TME WO K F R WHICH THIS PERMIT IS ISSUED(SEC.30B],CIV.C.�. ' '- - �W � — LENDER'SNAAIE _ _ _ f- LENDER'S1IDORE55 W ICEiiTIFVTNATIHAVEREADTMISAPPUCATIDNANOSTATETMATTHEABOVEWFORMATONISCORqECT. TOTAL FEES I��� ` � ��� � IAGREETOCOMPLYWITHALLCIryANDCOUNTYOFIDINANCESANDSTATEUWSRELATiNGTOBUIl.OING - . � CONSTRUCTION,ANDHEREBYAUTHORIZEREARESENTAf!VESOFiH15COUNTYTOENTERUPONTHE _, � Z RBOVE-MENTIONEO PROPER'h'FOR INSPEGTION PURPOSES. COMMENTS_ � R��c�� -- J � . m _" '�__�""� ¢ PERMITTEE NAME PqW ___ . . � � � �'��--�� �y -- � SIGNAT EO�MITiEE DATE —�--�-' '—�i�-�-�— � RECPT.N�. _ � Q_ PAID BY V�� VALIDATION___,_ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—ApplicanCs Copy , , . . , CITY OF DI/AfV6C)I'�!D BAf� INSPECTION RECORD �- a � � . �.. � . . ; � . . ` . SET BACK � `• . _`� � FLOOR J015T, , ; • -.� . ^I ---^ - � `----� __.. �_.��_ . FfGS/FORMS/STEE� �20�$i FHA REQMTS � �,, •, ; r�� , ELECTRIC GROUkVD ?►Zp�� � UNDER FLOOR�qUCT�• ..�: � . GNQUND PLUMBING � - UN�ER'FLbO'R CE�NDUIT "� �� '� ' �<l•'?_v_ . SLAB GRADE�_ �-Zo-9q ��� ; FIAEPLACE FOUNDATtON � TEMP POWER I FIREPLACE BOND BEAM ' ` a • WATER SERVICE � r0 3 � � MID HT.BOND BEAM i RC)OF SNEATHWG L� Ig; 8 Fi.BOND BEAM FRAMiNGNENTlLIATION �� i i FINAL BOiVD BEAM . ROOF COVER PRE-GRADING �� F�OUGH HEATING L , BENCHING RDUGH ELECTRIC ` , RaUGH GRADING ROUGH PLUMBfNG � � FINISH GRADING SHOWER�T"UB TEST L �� POOL ELECTRIC . EXT.LATN/SIDING I � POOL FENCtNG WALL INSUII�TION i � POQL FINAL � ' __ ----- CEILING INSULATION ; �; OFF SITE IMPS. DRYWALL NAILING ' ' DEDICATIONS � �— SEWER � FINAL ENG. � SEPTfC 7ANK � +' � ` LANDSCAPE/IRRIG. ' SEEP PITlL.L. � I ON SITE IMPS. ; J___ GA5 AIR TEST I j ; FINAL ZONING FINAL CONST. i FlRE DEPT. FINAL i � FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC �j DEV. FEES PAID ; F1NAL PLUMBING I I ENERGY ; c��lC� E/p _� i "-_ . �• �,e � - �— 3 t � � � .?\� . COMMENTS � . , ' . '� . . ; , � , . ,,.. . , .. , — ---- '���. . ,.�r � � , s , , ;. . � . . �. ;`— . , ,5 ; __-- ....R..� . . _ _. SEPTIC TANK SIZE #� ���' �' ^ ....,�.,...�,....------_.._ _..._,._.( SEEP PIT/U SIZE —`� — --- f �� -- �, . --- ,� r� -------- .�a , �= . . ; ;,�., 1 4 .� i`: ���� 1'! ' °! "� ` . \'