HomeMy WebLinkAbout16-0009I-
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CITY OF DIAMOND BAR 1/a714
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityoldiamondbarcom budding@diamondbarcagov
JOB SITE ADDRESS E� C
APN LOT TRACT
OWNERT(���%
ADDRESS
CITY ZIP TEL
APPLICANT TEL
CONTRACTOR
ADDRESS
CI-21P9/>/_yE
ARCH/EN
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-BLULD R DECLARATION
I hereby affirm under penalty of perjury that I em mempt from me Commodore Sate Ucersa Law for me reasons)
Indmame below IN ms tlsckmmk(s), I lure placed neA to the applieaae Ilerna) iseabn 703115, Rutlrm and
Pedsom Pada Mry my a uom" Dui ropmes a pemN m ®ubuN, ether, I*mw, dmdkON w mp*, nary
structure, proof to his Issuance. else requires are applwmf for to permN to file a signed statement foul he m do
is ImdrnsW pmmmrmm the p wis me of to OmbuYafs Stale home Law (Cnepmr B) Co m craft with Seem
7000 of Dr.bw Sb to Bmhmaa am Pdmebm Oodal or Met he a she Is exempt from llormm and me ball for
the BIILged exemption Any violation at Section 70315 by any applimrd for a permit subjects M applicant m ecIW1 pemmy
of not more men five hundred dorms 000)
UI moworottheproperly.mmywVWf mwedwagesaudrsaeompernsmm,willdoUMoaUpwmom
of the work, and the ehuMne Is not Intended or offered for sale (Section 7044, Business and Profession Code The
Camreaas' Slate Lomas, law does net way m an owner W property wbe Mao employees or permna effori, Mlm
aImprwestmpmmdy providedmel Ila ImV"Twbore Mimagedmomee0forsale plaintiffs Ilemllpeqa
Improremenl a mid within one year of omplemon, me Owner Bulmer will have me burden of proving mat It wear not beam
a martinet la the purpose at safe)
U I As owner of me property, Am mnmhety ter hear with III CarboMe to construct me project (Secmn
7044 Business and PMBSsbm Cade me Comecmrs' Smm UUM law doe pet appy to an owner of pmpedy who
beDodalmpmres diaeon as wtmmnmecmfor the pole[mwlm a lhemal CaNazlm proms m the Cadre[Ms Sure,
LLmne Law)
U I Am exempt from Ilttreaoe muter me Contractor's Sims License law far me following reafena)
By my signature below I acknowledge mat modal for my personal resideno In which I must Imre resIded for at least one
year prior to mmpdmn of Ile Improvements mvaed M lab pamRl to not legally sell a structure met I lure OWI a an
owner MMer 11 it IW not bear CommLLted m Its entirety by IcnmeG mnbata9 I understand mat a Copy Of me
appik2ble law SeLbknl 7044 Of me Business and Profesabna Cade Is evallabla upon reOuesl when Ire appllcellon is
submitted Or at the Ialisi Wed she hllywmr mplMp mgm/maw Mml
LICENSED CONTRACTOR'S DECIARAnON
I hereby ahem under penalty of Wary mat I am licensed under mmtvlmv of Chapter 9 (oanmenong with Section 7000)
of Osman 3 of the Busedas and Professions Code and my Worse R In pep Imo and effect
tExsE uc NO
ATE CONTRACTOR
WORKER'S COMPENSAnOM DECL MTION
I AF TY OF PERNIR'I ONE OF INE FOLLOWING DECAAA NS Yom•'
I have, and will maintain a CeNecele Of Consent to Sell Insure len Worker's Compensation a proMed by
Section 3700 of be Labor Code, for me pedama oe of the wmic for which this permit R aimed
I hire and will maintain Workers Co mperpedm imam®, As required by Smem 3700 at the Labor Code for
the perfamumulthe workfor whichmls pernitwesum My Worm's Compensation lmum�no�Card�eerr and
policy Number
PMBE
( ELS�T-
Iormk/fidInmsput r olm0work IwwmmcelepaeanlsI®N Inial notemptryacy permnIn aty manneredam
becomes moats m the Workers CompersOm lam at T WI& And agm fid 4I small pecan sulpei to the Wdkars
Copamlmpp.ffie a Second3700amelacer Cada,IslabIorm omlywlmm pukka
DATE APHICANT
WARNING FNmre to mare Waters Compensation Coverage is mmw/a, all show subject an meomfm to mmbul
persons and dNI fines At m me hundred tlo®nd dere ($100 ODD), In addition m me cost of the cimpmaatlm
damages ns momed for In seam 3708 of the Taber code Interest, and amomey s fees
CONSIINCnON LENDINO AGENCY
I hereby affirm most penalty of permy mal more is a Pammzffin Lending Agency for me performance of me work fur
whim this Penn" is Lsmad (Sm 3097, civ C)
LENDER'S NAME
LENDERS ADDRESS
I tarty, mat I have rem mm applohen and amts Oral the ahare information Is mnecL I agree m comply with all city and
county, aanen Les all male Ism relsmg m building mmmOcllon and Immmy aNpdre repmmmmme of mfr canary m
enter upon me above mentioned property for Inspection purposes
li O
PERM IE K s
SIGNA MI DATE A
712
E
APPLICATION DATE 4 4,, -'II,, I LO
RISSUE DATE ��y/ /6-PERMITK
TYPE CONST VV�
—^P/CN
OCC GROUP
Scope of Work L%
N DWEL UNITS N STORIES
N BEDROOMS
DESCRIPTION SO FT FACTOR PSF
ADJ AREA/VALUATION
SFR/ADDYREM
ci age/Carport
w
PabolDeck
w
w
PooVSpe
Z
Re -Roof
9
Commercial
m
Va/uet/O
Atli Area
QUANTITY D CRIPTION FEE
U
co
so
m
EIEI
U
CONSTRUCTION
PLAN REVIEW
4
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
CJS bLt
SMIP
.Ara
ENERGY P/C
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
• D n
BASF
N
17 Dy
PLOT PLAN
ZONING CLEARANCE
Af-1
TOTAL FEES
COMMENTS
��-• Q V
P/C PAID BY n VAUDAT10N
RECEIPT a -j de2s, - PAID BY 7 VA-iDATION 4
WHITE—DepaMwBnl Copy YELOW—Dnance Copy PINK —AssBmor Copy
OF DIAMOND
INSPECTION RECORD
INSPECTION DATE INSPECTOR
i nn i i
INSPECTION DATE INSPECTOR
SETBAW LETTER
TftAGT AND LEDGER
_
FOOTINGS FORMS
SWITCH GEAR
SLAB ui
COMMERCIAL HOOD
UG PLUMBING
T•BAR
UG ELECTRICAL
INTERCEPTER
LIFER GROUND
HOT MOP/SHOWERPAN
SEWER LATERAL
SEPTICJCESSPOOL
MAIN WATER LINE
_
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOUSPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W I C I
GAS TEST
ROUGH PLUMBING
TYLE GUNITE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P TRAP
DRYWALL
FENCE ! GATE! ALARM
LATH {PRE}
FINAL POOL
LATH SGERIOR tr t►
1 WALLS
LATH INTERIOR
WALL FOOTING/MEL
GAS TEST
WALL STEEL ice{ } 2X0{ }LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE''
''.... WALL FINAL
SPECIAL INSPECTION
RD FPAMBJGPlJWNMGAPPROVAL
FINAL BUILDING
ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT'
FINAL ELECTRICAL
FINAL PLANNING ^_
FINAL PLUMBING
FINAL ENGINEERING/ PW
T C of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT. of OCCUPANCY
FINAL HEALTH DEPT
FINAL INDUSTRIAL WASTE
COMMENTS