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HomeMy WebLinkAboutNo Permit Number (12) 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;��+ - -. - - - . . . 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