HomeMy WebLinkAbout12412 J,4,�__ CITY OF DIAMOND BAR ��y /
� DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES
21b60 E.Copley Drive Suiu 190
(909)860-3195 Fex(909)861-3117 PRESS
�';°�''' BUQ.DING PERMIT APPLICATLON FIRMLY
` DD ESS �.. APPLICATION f O_7�� PERMR � ')�
o DATE l NUMBER � �f
� APN LOT TRACT SZZ� �SSUE TYPE pCC
�ATE CONST. GROUP
g OWNER �,� Gt C..
LL' ADDpESS � ZONING SETBACKS
CITY ZIP 7EL.'Z-�ti�!� ' i FRONT RW ❑
APPLICANT' �E�. /JU� REAR p
SIDFJSIDE STREET RW ❑
CONTRACTOR SIDE p
ADDR 5
g CITY���__ ZIP�TEL. - j PROPOSED USE
8 ARCH/ENG/
� DESIGNER NO.DWEL. NO. NO.
ADOHESS UNITS STORIES BEDROpMS
� CITY ZIP TEL.
� DESCRIPTIQN 5a.FT. FACTOR PSF AW.ApEANALUATION-
¢ OWNEF-BUIL�ER DECLARATION SFq/ADD/REM
O
I HERE6Y 11FFlRY IMDER VENKTY OF PERJUFY TMAi 1 AM E%EMPT FqOM THE CONTpACTpRS U�
CENSEUIWFOqTMEfOLLOWINCiREA90N�8EC.7091.68USINESSANDPROFESSIONBCO�E:pM�CITYOR � GefBgBJCdryOR
OOUMYWHIGIREOUIRESAVFAMRTOCONSTRUCT.ALTEF.IMPROVE,DEMOLISH.ORREWVRAN787RUG W Pa�lO/DBCk
71RIE,PRIOR TO RS ISSUANCE.11�90 REOUqE6 TME APPUCAM WR BUCN PERMI�TO FlLE A 61ONE0 W
STATEYENf TUT NE OR SHE 19 IICENSED PUIiSUANT TO THE PROVISqN3 OF lHE OOHTMCTORS U�
CENSE UW(CHMTER�(COMMENCINO WITH SECTION 700Dj OF CMSION]pF TIE BVSINE55 AND PRO� u- PooVSpa �
FEeSqNSCOD�OqTF1ATHEOq9HE1SEXEMPTTNEREFHOMNiDTT1EBASISFORTIIEALLEOEDEXENP� (� :
TqN.ANYVqLA71ONOF8ECT10NYWt.69YANYAVRICMI7FORAPEPM176U9JECT8T7EMPLIGNT7O �! Re-Roof
� ACML PEfULTY OF NDT MORE 1T1AN FNE NUNDRED OOLURS(t600�.�:
OlASdNNEROFriIEPROPERT'/,ORMVEMPLOYEEBYNTHWAGESASh1EIR90LECOMPENB►7iON, C,pmmBroipl
WRL DO iHE YIIOAK M1D THE STRUCTl1AE lS NOT INTENOED ON OFFEREO FOR SALE(SEC.701A,BU51� �
� NES.AND PROFESS10N5 CODE:TYIE CONTMCTOIiS UCENSE LAW DOES NOT MPLY TO AN OWNER OF �
PIIOFERTV YYVq BULUS OR NAPRDVES iXEREOµAND NhlO OOES 6UCH N/DRK HMSELF OR HER9ELF OR
flSiOUGHWSORHERONME1APlAYEES,PFpVIDE�711AT8UCHIMPROVEMENTSMENOTMITEN�EDOq m
GFFEREO FOR BALE IF,NOYVEVER 1ME EIRDINOOR MPi10VEMEM ISSOID WRHIN ONE YFAqOFGUMPL�-
TION.TNE OYYNER�UIIDER WILL NAVE TME BURDEN Of PROVNO iHAT 71E OR 6NE DID!qT BUILD Oq
IMPFIOVE FOH 7ME PURPOSEOF 8lLLE). �
O I,AS ONMER OF THE Vf10PEATY,AM E7(CLUSIVELY CONTRACTMO WRH IJCEN5E0 CONTMC70qS
TO OOFATRUCT THE PRO.IECT(8EC.70M.BU91NE53 AND VROFESSIONS COOE�TME CONrMCTORS U• V01U9tbR p,p,�,qqEp
CENSE LAN!OOEB NOTAGPLY TOAN OWNER OF A VROPERTV WIID&1NDS OR IAIPqO'VES THEREON,IJt1
��m�creFOR6UCFIiAQ1ECT6MATNA00HTRACfOR�S�UCENBEDPUR6UANTTO�HECONTRAG qUANTTiY DESCRIPTION FEE
� �
O i AM D�AIVf UNDER SEC. B.8 P.G FOR TMIS REA5ON a
U
�= DATE OWNER �
� LICENSED CONTRACTORS DECLARATION �
� I HEREBYIIFFIHM UNDER PENALTY OF VERJUF7Y T1AT I AM LICENSEO UNDER PpOVI5lON5 0F CFNPTER �
��COIIMENCWON7TliSECTIONT000�OFOIVISION]OFTHEBUSINESSANDVROFESSqNSCODE,NV� Z
K MY LIGENSE IS W FULL FORCE AND EFFEC?.
o �:°-�� `��( Z� �
�LICEN7SE C S LIC.NO.
� �9��.a� ' -��_corrrnncTOR f�5d A�72.. a
WORKERS'COMPENSATION OECLARATION � a_v ��
� I XEREBY i1FFIRY UNDER PENALTY OF VERJUFiY ONE OF THE FOLLOWINO DECUMTIONS: Z I) �,
6v /�
� �I YNVE AND NALL GAINTAM A CERTIFlCATE OF OONSENT TO BELF-IN9URE FON 1MORKER3' J��`� /�
COMPEN$ATIOH.h$PRDVIDEDBY9ECTION370oOFTMEIABORCOOE,FORTMEPERFORMANCE U �"� {d� '
OF THE MpRK FOR WHICH TF119 PEIMUT IS 19SUED. W �
� � � � Z�. ���
1 HAVE MD N9LL MAIMAIN WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BV BECiION
� 97000FTHElABOFCODE,FDA7HEPERFORMANCEOFTFIEWORKFORWMI�MTHISPERMITIS
ISSUED.MYVMDRKERS'COMPEN5ATqq INSUlWICE CARHIER AND YOLICYNUMBER AqE: CONSTRUCTION
j CMRIER PLAN REVIEW
� POIIGV NUMBEX " ELECTRIC
Q f�+ss[t.�mnr��noreeaowst�ooFn+evew.rrsroaorver�r�ooaur�s�sioola+�ss� PLUMBING
�u
� 1 CERTIFYlT1AT N 7ME PERFOFMANCE OF THE WORN FOR WHICH 1HIS PERMIT IS ISSUED,I MECHANICAL �
SNhLI NOT QAPLOY ANY PERSON W ANY MANNER SO AS TO BE ME BU&IECT TO THE
(n WORNERS'COMPENS�iIONUWSOFdLLIFOqNItiMI UTIF18NDUL�8E001AE INSPECTIONFEE
SU&IECTTOTHEWOHKER' a00F LABOq
•
rj coo�, sH�u w COM FqSE iR � ��� � ISSUANCE
O Q,�
� w7e:�[� pUc r. SMIP
WMNINO:FAILUR[TO SECURE WORKE OM SATI COVERAOE IS UNLAVIFUL,AND SHALL BE ENERGY P/C
�y SUBJECfANEMPIAYERTOCRIMWALPE D ILFINESUPTOONEHUNDREDTHOUBAND ENERGYPEFtM1T
DOU.ARS 1�1 a0,oao�,IN ADDITION TO tHE COS70 PENSATION.OAMAGES AS PHOVIDED PoR IN
� 9ECTION a7W OF iHE LABOfl CODE,MTEREST,AND ATTORNEY'S FEES. RETENTION FEE:
CONSTRUCTION LENDING AGENCY PHE•ALT FEE:
�
I NEHEBV AFFIRIA UNDER PENALTY OF PERIURV T/UTTHERE IS ACONSTAVCTION 1EN01N0 AOENCY
FOR TME PERFORMANCE OF 7HE YYORK FOq ICH TNIS VEFMIT IS ISSUED(5EG 90A,pV.G�. � ,'
� LENDERSNWE
� LENOERS�ODRE39
� ICEqTIFYiNATINAVEHEMT118MPLIGTIONANOSTATETHAThiEA80VEINFORMATIONI500NRECT. TOTAL FEES I SG�
� I MiqEE M COMPLY WfTH ALL CT'M1D COUNT'ORDMANCES ANO BTATE L1VY3 REU7NJ0 TO BUILDINO
� CONSTRULRION,ANDNEREBYMJfFqRIZEREP0.E5ENTATIVE50FTNI5COUNfYTOEMEHIIPONTHE
ABOYEMIENTpNFA iflOPERTY FOq INSPECIION PVRPOSES. COMMENTS
9
� veruarrE �rw �
� `
y &ONATURE E .
� RECPT.NO. PAID BY YALIDATION
WHITE—Oepartmenl Copy,YELLO+M–flnanoe Copy,PINK—Aasasaa Copy,GOLLENROD--File Copy,GREEN�11pplicaM's Copy
. . ..._ ,
... . .. . .�. ,,.
. , . . .. ..
, . . . , ..,. , ,. �.
.. ,,:,. . � , ,..:.. . :.,.,.
�� CITY OF DIAIVIOND BAR
INSPECTION RECOi�O� � �
E � ' ' � ' ' • � � . � .
SET BACK � ' FLOOR JOIST�-: .. '
FTGS/FORMSISTEEL FH REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT "
GROUND PLUMBING UNDER FLOOR CC�[�Rll�T ..:• ._'� ' `,` • , ;.
SLAB GRADE FIREPLACE FOl'JNDATION - .: ---- l • -
TEMP POWEFi _ FIREPLACE BOND BEAM - - -" "
WATER SERVICE MIQ HT. BOND BEAM -� - �- - -
R��F SHEATHIhiG � 8 F?SOIVD�SEAM J � ' ' - ' . '
�RAMINGNENTILIATION ) FINAL BOND BEAM
ROOF COVER PRE-GRADING � ; �.
ROUGH HEATING • BENCHING
RQUGH ELECTRIC ROUGH GRADING �
ROUGH PI.UMBiNG FINISH GRADING
SHOWER/7U6 TEST POOL ELECTR[C ? ,
EXT. LATH/51DtNG POOL FENCING
WALL INSULATION POOL FlNAL
CEILING INSULATION OFF 51TE 1MPS. F :
DRYWAL.L NAILlNG DEDICATI�NS
SEWER � I � ,
FINAL ENG.
SEPTfC TANK i LANDSCAPE/IRRIG. � , ,
SEEP PITJL.L. � ON SITE 1MPS. � �
GAS AIR TEST ( I FINAL ZONING � �
�
FINAL CONS'f. � � FIRE DEPT. FINAL F �
FINRL HEATfNG � : HEALTH DEPT. FINAL `-
FINAL ELECTRIC " � ` DEV. FEES PAID
FINAL PLUMBING I j � ; ENERGY
i E
' j � i � � -
� _
CC.�MM�NTS .. - �
. .. --�� � �
� . . , . _ __
�
iI
_ �`
. . � . .. . . ..H ,'\`. - ' i. _.._ �'.
• . . . \; ...,t_..'... ....� �-�-��t
SEPTIC TANrC SIZE �
SEEP PIT/U SIZE � -
{ �� ,
'' � r ,
_..__ _. ... ... . �
,......,.... .,... ..._..,_...,. � � , , '
. . " '. r,� .. . . .