HomeMy WebLinkAboutNo Permit Number CITY OF DIAMOND BAR - " � ��
-- " — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES -
21660 E.Copley Drive Suite 190
(909)860-3195 Faa(909)861-3117 PRESS
�'+�'��� BUII.DING PERMIT APPLICi►TION FIRMLY
� JOBSITE APPLICA710N I'� I �J��-7
o ADORESS ��;��Y ['4I.LI�.T� DATE (✓�l�� NUMBER "'" ✓ M�
� ISSUE TYPE OCC
�- APN�,_, LOT T C DATE CONST. GROUP
g OWNER
� ADD SS ZONING SETBACI(S
� C � ZI �, FRONT RW ❑
� APPLICANT � REAR ❑
� SIDFJSIDE STREET RW ❑
CONTRAC R 51DE ❑
g ADD S � �
PROPOSED USE I
CITY ZI j�,� TEL. -
8 ARCWENG/ ����
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CfTY ZIP TEL.
DESCRIPTION SQ.Fi: .. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFRIADD/REM
O
1 HER�Y AFFlRM WJOER PENALTY OF PERNRY THAT I AM EXEMPT FqdA TMF CON�MCTORS LI- Gfi�8Q9�CafpOR
CENSEWYFOHTHEFOLLOWINOREASON�SEG7091.60USINESSANDPROFESSpNSCODE:ANYCT'OH (n
OOIM(TYNT9GHREOUIRESAPERMRTDOONSTRUCT,ALTER,pAPROVEDEMOLI3H2ORREMIpM1YSTRUG. W Pg�iO/DBCk
TURE,YRIDR TO ITB IBSUMICE.ALSO REOUIRES TFIE MPLICANf FOP 811CH PERIMr TO FILE�BIONED�
BTATEMENT 7HAT ME OR 8HE IS IJCENSED PUfiSUMlT 70 THE VROVISIONS OF 7NE CONTRACiORS LI•
CENSE lAW(p1�PTER 0(OOMMENCWO YATH SECTION 70W1 OF DIN&ION 9 OF TNE W61NE55 M!0 PRO-. u' POOYSpO
fES5qN5CO0E)ORTfATHE0ii8HE18DfEA1PTTHEREFROMMOTNEB0.41SFORTYIEALLEOEDEXFMP• (�
TION.ANYNOUTIONOFBECTION7QH.lBVANYMPLICANfFOR�PERMR5U81ECSSTHEAPPLILANTTO Z {�B-Rpp}
� ACMLVENAL7YOFNOTMOREl11M1FNEHUNDREDDOLWi3(is001.): � .
� 04���EROFTHEPROPEIITY,ORNVEMPWYEESWIhIWACiESA6THEIPSOLECAMPEN6ATIDN, � Commerclal -�
YALI DO THE WON(,MD THE STRUCiLRE IS NOT NfTENDE�OR OFFEREO FOR SALE(SE0.7oa�.BUSI- J
NF55 M!D PFqFESSIONS fADE:T11E CONTRACTORS LICENSE LAw OOES NOT APPLY TO AN OINNER OF' _
� ►ROPEHTYYMl108U4DSORYPROVESiWEREON,ANDW110DOE55UCNWORKHINSELFORHERSELFOR
� TNROUOI�i950RHEflONMEMPIAYEES,PROYI�ED7HAT8UCMIMPROVEMENTSMENOfttiTENOE�OR m
OFFEI1m FOR8JILE.IF.IION�EVERTME BUILDINOOR IMPHOYEMEN713 SOL�WITHN ONE YEAROF CdY1PLE
TION,iNE 01M1EM1BU0.DEFi MfILL Fi�VE 7VIE BURDEN OF PROVWO THAT NE OR SNE DIO NO7 BUILD OR
MAPiqYE WR TME VURPOSE OF 6ALE�
O I,AS ONMER OF THE PRDPERTV,MI El(CLUSNELYCONiMCTINO VlRH 1IC915E�CCMMCTORS
� TO CON6TRUCT THE PRQIECT(SEC.7DH.BU61NE56 AND Pf10FES810NS CODE:�HE COMMCTORS U- Ve1U9110� ADJ.AREA
CENSE LAW OOES lpTAPPLY TO M/OWNEH OF A GROGERTV NTID BUILOS OR MPROVE9 TiEREON,ANO
WHOCONTRACTSFOR9Up1VRQ1EGT8YATNA00NTMCTOR(5)LiCENSEDPURSUANTTOTMECONTPA6� QUANTITY DESCRIPTION FEE
� lOR3 UCENSE L11WJ.
C }�
�I AM IXEMPT UNDEH SEC. B.�V.C.FOR TFH9 HEASON U ► (,,/
� k u
V' DA7E OYYNER
� LICENSED CONTAACTORS DECLARATION �
� W
I XEREBV 11FFUW IN�DER PEWILTY OF PERIUM 1MAT I MI LICENSED UNDEP PROVISIONS OF CHAPTEN �
�(COYYENClKi WIiH SEC?ION 7000)OF DMSION 7 0F THE BUSINESS 11ND PROFE5510NS CODE.MI� Z
� W UCENSE IS IN Fllll E AND EFFEC7. m
0 LICENSE S LIC.NO. J
�j DATE CONTRACTOR` a
SJ
� WORKERS'COMPENSATION DECLARATION �
� IHEREBYAFFlRMUNDERPENALTYOFPERIUIWONEOFTHEFOLLOWIN6DECUHATIONB: Z
� _I NAVE AND WILLMAINTNN A CERfIFICATE OF CONSENT70 SELFdNSUHE FON WOfIKERS' _
OOIAPENSA7ION.AS PHOVI�EO BV SECTION�7000F THE LA60R CODE.FOR THE PEHFORMANCE W
OFTHE WORK FORNMICM TNIS GERMR IS ISSUED. �
�
1 HAVE AND WILL MAMTIUN NlOHKERS'COMPENSFTION ttVSUMNCE,AS REOUIRE�BY SECTION
O 77000F TNE IABOR CODE FOR'IHE GERFONMIWCE OF 1F1E WORK FOR WHICH TNI5 PERMITI9
ISSUED.RIY YYORKERS'CONCENSATpN INSUMi�CE-.C-aARRIER ANO POLICV NUMOER ARE: CONSTRUCTION
� CMNIER�, �� � M�� P IEW
Q POLICV MIMBEN ����� ELECTR
4
� (TY166ECiqNNE�r�D7BE00�PlETEDOFiHEFERMfI5�0apVeMl�i�ED00l1JiRsRt00jaNLESS{. PLUMBING
Z I CERTIFY THAT M 1HE PERFOFM/WCE OF THE WOi1K fOR NMICX 1HI5 PERMIT IS ISSUEO,I MECHANICAL
(�'y SFIALL NOT EMPLOV ANY PERSON IN M!Y MANNER SO AS TO BECOME SUBJECT i0 7HE
y NqRKER3'COMVENSATqNtANlSOFCJIUFORNIqAN�AOREETMATIFIBHOULDBECOME INSP TIONFEE -- -
BUBJECTTOTHEVYORKERS'COMGEN3AT10NPR04ISIONSOFSEGTION77ooOFTHELABOW �� �
rj CODE.1 SF7ALL FO COMPLY YVI OSE PROYISIONS. `� SUANCE ' o�
� �J.�`�'-,��C
� ox�:��arucaHrc• !
� ENERGY P!C
WMW NO:FAILURE TO SEQIHE MK7AKER9'COMPENSATION CqVERAOE 19 UNLAWFUL,ANO 9FihLL BE
� 6UBJECTANEMPLOYEflTOCRIMINALVENALTIESANDCIVILFINESUFTOONEHUNDREDTIpUSAND ENERGVPERMIT
r OOILARS(i100,00D),W ADDITION 70 TXE CDST OF COMPQ15A710N.DNMQES AS PROVIDED FOfl IN
� SECTION770lOF7HEUIBORCADE.INTEREST.ANDATfORNEV'SFEES. RETENTIONFEE:
CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ��
� IMEREBYAFFIRMUNDERPENIL7YOFPERIURYTNAiTHEHEISACONSTqUC710NLENDINGAOENCY
Z FORiHE PER�ORAIANCE OF THE WORK FOR WHICH THIS VERMIT IS ISSUEO(SEC.f0Y7,dV.G�.
W
� �ENDEq'S NAME
� LENDEIYSAU�HESS
� 1 CERTIFY THAT 1 NAVE READ THI9 APPlICA710N AND STATE THAT'RIE ABOVE INFONIAATION IS OORRECT. TOTAL FE ES ���,
I AGREE TO OOMPLY WITH ALL CRY M70 COUHfY OfiDIH�NCES ANO STATE LAWS REUiINO TO BUILDIN�
CdJSTRIICTl7N,AND MEREOY AUTHORIIE REPRESENTATNES OF TW 5 CWNiY TO QJTER UPON THE
� ,IBOVE�MEIlTqNED iROPERTY FOR INSVECTION PURPd4E5.
COMMENTS o
� p� E �
f7� f .'��f ' .
� KiW1NREOFPE J DATE RECPT.NO. v PAID BY VALIOATiON �� �
" NRitTE-0eperanant Copy,YELLOW--Finance Copy,PINK—Jlasessa Copy,GOLDENROD--FYe Capy,GREEN—Applicenl's Copy
, �`, CITY OF DIAIVfOIVQ BA►R
' I(rISPECTIC3N I�ECOf�D-
� � � • � - o E � • -
SET BACK FLOOR JOIS�' -, � . � � '
F-I'GS/FORMSJSTEEL " FHA R�QMTS .� -
ELECTRIC GROUND UNDER FIQQRUUGT"`�` ; t ' , , '
_ _��
GROUND PLUMSING UNDER;FLQC�R CC3�IDUIT .; . .•..;,�. , � '
_ . ..._.._ . .
SLAB GRADE FIREPLX�GE FUl1PiDATION �= -- ` _ • •; �
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOPID-6EA{ut `- --� ----. • , �.•=`- .`. - -
RO�F SHEATHING'�� . , • - - S FL BOND BEAM � -_ - � �•_.: _ • • . y .
FRAMINGNENTlLlATIOfV FINAI.BOND BEAM
ROOF COVER ' PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROU�H GRADING
ROUGH PLUMBING FINI5H GRADING
SHI�WERrT'UB TEST POOL ELECTRIC
EXT.LATN/SfDING POOL FENCING
WA�L INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWEA FINAI.ENG.
SEPTIC TANK LANDSCAPE/1RRIG.
SEEP PIT/L.L. ON SITE IMPS.
C.�AS AIR•TEST -- � , , FINAL Z�NING �
FINAL,CONS�. ----- - -� • � -- - • �� FIRE.DEPT. FINAL
'ftNAL�IEATING -� - '-- � HEALTH DEPT. FINAL �
FINAL ELECTRIC z -� ` DEV. FEES PAID
FlNAL PLUMBING ENERGY
3r O _. .�
CC?MMENTS
. _ . , . ,.
��u� � I T;��+ - -. - - - . . .
SEPTIG TAN��I � � �
SEEP PIT/U SI .,�^"'��(rI�'� vj'r� --
� �' �
':-?_�.�-�--;^!�- '-1.,.i+i:,(T J::
. . ,
, .
. .... - • - -- - - ••- -
, �_...
.. . � . � . ....�+.