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HomeMy WebLinkAbout13-783 (7) CITY OF DIAMOND BAR ( �' ��", --"---l��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES {��� � � I 21810 Copley Drive,Diamond Bar,CA 91765 V (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��""'. BUQ.DING PERMIT APPLICATION FIRMLY y�, JOBSITE APPLICATION PERMIT e p/� o ADDRESS � 7 3 � �LF,�'l LL�l��� DATE 3 NUMBER ���O� # OCC °� APN LOT ' TRACT D TEE l� ONST. GROUP p OWNER Y�s� o ADDRESS�lF ZONING SETBACKS z CITY ZIP TEL. FRONT q�y � � APPLICANT TEL. REAR p z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE p � ADDRESS � � CIN ZIP��� TEL PROPOSED USE1� C� P w ARCWENG/ -1 � � � z DESIGNER a ADDRESS ry/Q NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION � SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADO/REM O p I HEREBY AFFlRAI UN�ER PENAL7Y OF PE0.AIRV THAT I AM EXEMPT FROM THE CIXJTMCTORS LI- G0t8yB/CBfpOfl W CENSEUWFORhIEFOILOWINOREASON(SEC.70.77.58USINESSANUPqOFESSION5CO0EAHYGTYOR (n U COUMYNTitpiREWIRESAPEFiMIT7000NSTRUC7ALTER�PROVE,DEAlOUSH,ORFE7AIRPNYSTRUG W P8i10/DBCk w TURE,PRIOR TO RS ISSUANCE,AL50 REOUIqES iHE APPIICANT FOR SUCH PERMI7 TO FlLE A SIGNED W � STATEMENT THA7 HE OR SHE IS LICENSED PUFlSUANT TO THE PRONSIONS OF THE CONTMCTORS lF . � CENSE UW(CHAP7ER Y(COMMENCINd WITH SECTION 7000)Of DIVISION�OF THE BUSINE55 ANO PfiO- � PDOUS Q FESSqNS COO�OH THAT HE OR SHE IS E%EMPThIEREFROM AND 7HE BA515 FOR THEALLEGED E%EMP• C7 � V TION.ANV VIOLqT10N OF SECTiON 7031.5 BYANY APPLICANT FOR A PERMIT SUAIECTS 7HE APPLICANT T0 Rg-ROOf ACIVIL PENALTY OF NOT MORE TNAN FNE HUNDRED DOIUHS(i500).): 0 �I,ASOWNEROFTHEPROPERiV,ORMYEMPLOVEESWITHWAGE5�l5THEIfiSOLECOMPENSATION, 0 COffIRIBfCtal � Z N7LL DO THE WORK�D THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SALE(SEC.7oM,BU51- J � NE55 ANO VROFESSIONS COOE THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � . 7ROPEHTY WFp BUILOS OR IMPROVES TiEREON,M10 WHO DOES SUCH WORK HI/ASELF OR HERSELF OR wTHiIOUGHHISORHEROWNEMPLOYEES,PROVIDEDh1A75UCHIMPROVEMENTSAfiENOTINTENDEDOF m 0 OFFEREDPDRSALEIF,HOWEVER7HEBUItDINGORIMPROVEMENTI550LDWfTT11NONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDER NALL HAVE h1E BURDEN OF GROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE WRPOSE OF SALE). w OI.ASONRIEROF7HEPROPERTY,AAIEXCLUSNELYCANTRAC7W[iWRHIICENSEDCOMMCfORS - Q TO CONSTRUCT THE PRQIECT(SEC.)01�,BUSINESS AND PROFESSIONS COOE:THE CONTRACTORS LI- V0IU8IlOf1 ADJ.AREA W LENSE UW DOES NO7APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON.AND = NTIOCANTRACTSFOHSUCHPR0.IECTSWITHACONTRACTOR(5)LICFNSE�PURSUAHTTOTHECONTfUG FEE . ~ 70qSLJCENSELAW.). OUANTITY DESCRIPTION . Y � � ❑I AA1 IXEMVT UNDER SEG 8.8 P.C.FOR hflS REASON Q ?i ` U LL DA7E OWNER F- Z U �� LICENSED CONTFACTORS DECLARATION w �,�,(e,,�� �.... ,", �0, 1 ':IUIJ�i.'J 1 HEREBYAFFlRM UNDER PENALTY OF PERIUHV THAT IMI LICENSED.UNDER PROVtSIONS Of CHAPTER � O" � Y(COMMENCINO WfTH SECfION 70oD)OF DIVISION]OF THE BUSINESS AND PROFESSIONS COOE,AND Z _ Y �p o X� MY LICENSE U^IN NI.L FORCE AND EFFECT. m �u� � LICENSE CLASS �• LIC.NO. � V� e wDATE � CONTRACTOR d e� � WORKERS'COMPENSATION DECIARATION Q �-'.: �_ . � I HEHEBY AFFIqM UNOER PENALTY OF PERJUflY ONE OF THE FOLLOWING OECLARATIONS: U � z O _I HAVE AND WILL MAIMAIN A CERTIFICATE OF CANSENT TO SELF-INSUPE FOR WOfUCERS' _ Q COMPENSATION,AS PROVIDFD BV SECTION 37000F 7HE LABOR CODE FOR 7HE PERFOqMANCE U Q OF THE WORK FOR WHICH THIS PEflM1T IS ISSUED. � - � QW �1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUMNCE.AS HEOUIRED BY SECTION 77oa OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOH WFIId1 THIS PERMIT IS . �f��, �� ISSUED.MY WORKERS'COMPENSATION INSURMICE CARRIER M!D POLICY NUMBER AfiE: CONSTRUCTION J J j LAfiRIER �'�T�� FCS-AItD PLAN REVIEW . . Z aoucrNUMeEa ELECTRIC ¢ 0 (INI95ECfIDNNE�NOTBECOhTLEfIDOFTHFPFAMR6FpqONEHUPDfimOCUJ�fLS(5100)ORLE551 PLUMBING W Z I CERTIFY i/iAT IN THE PERFORMANCE OF 7HE WORI(FOR WHICH THIS PERAIIT IS ISSUED,1 MECHANICAL C�S .SHALL NOT EMPLOY ANY VERSON IN ANY MANNER SO AS TO BECAME SU&IECT 70 7NE (/) WORNERS'COMFENSA710N UWS oF GLLI ORNIA AND AGREE THA7 IF I SHOULD BECAME INSPECTION FEE = SUBIECTTO7HEWOitKERS'COMPEN 10 ROVISbNSOFSECTION370oOFTHEUBOR ,/ ^� CODE, SHALLFOFiTHWITHCOMP�V THTHO PRO ISSUANCE �/- / � p DATE: 3 APPLICANT: � �SMIP _ � � W J WARNINa:FNLURE TO SECURE WOiU(ERS'CAMPENSATION CAVEMGE IS UNUWFUI,ANO SHALL BE ENERGY P/C ' J � SUBJECT AN EMPLOVER TO CRIMINAL PENPL71E5 AND CIVIL FINES UP TO ONE HUNDRED iit0U5AND ENERGY PERMIT DOLLARS(5700.000�,IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FDR IN J SECTION 370E OF THE LABOR CODE.INTEREST,NID ATfORNEYS FEES. � � -�7 w RETENTION FEE: (��D O CONSTRUCTION IENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHATTHEREISACANSTRUCTIONLENDWOAGENCY �as� 1 �O d FOR THE PERFORAIANCE OF THE WORN FOR WHICH THIS VERMIT IS ISSUED(SEC.3os1,CIV.G.). W J'�/f ^ � LENDER'S NAAIE r 'f/1 . I— LENDER'S ADDRE55 W1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE 7HATTHE ABOVE INFORMATION IS CARqECT. TOTAL FEES �K/.� � 1 AGREE TO COMPLY WI7H ALL CITV AND CIXINTY ORDINANCES M1D STATE UWS PELATING TO BUIIDiNG � CANS7RUCTION,ANDMEREBYAUT}IORREREPRESENTATNESOFTHISCWNiYTOEtRERUPON7HE Z ABOVE-MEMIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � � L m VERMtTTEE AME(PRt � � 3 � , � S�GNATUR E DATE , = RECPT.NO. PAID BY VALIDATION ~ WHITE-Department Copy,YELLOW—Finance Capy,PINK—Assessor Ca GOLDENROD--File Co GREEN— / PY� py, AppllcanYs Copy � �6°�'`� ��f� ���E;�'���'� ��� " ` 96��:����A u 9y.��,4'�4 6�ti�:���� ��.�a .. __'_'""` ,.,,; w a . ..��,.�T"-i?���"'•,��'.� t,� .. �.'� a_.�t�----�--r,�._ fi i���' .. 'm �� �''�� -- s���� Fj5-�,� �-�r-��u"�`Y-�-fr�c:f � _.k� v�. �`�=t {� _,� ,,. -� �:'g'� � kt •"'� �t.�.�� '��": �o ,,,� �: f�,:-a.,JJ.i.��.:?¢�t(u. €���i F���"j,�T�F ���-�t. -k`"�?-k,w a.. .!�4.��°,,.�i-��z. 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GR�UI�!DPLUib1BInG_._.-----�--------�-----------------I ;,UNDFRf-LQORCONDUIT --' SLAF��RADE I � I ;FIREPLAC( F�JUfvDATION _ T _---- -- _ — TEA�iP P�I�l�ER ------- i--- -�----- __ -_J '•rIRCPLACE d�N[:HEAh1 --i_ — �VAT�R SERVICE i j �'�--� _; �tv11D HT.B0�!D BEANI __� ROOF SHEATi-IIt�G j '�-��- .J !8 F�C BOP1D BEnNi - - ------------- - - ---- ---- � � � � i FIhJl\L BOhJD EEANI FItP,iti1ff:G!VEI�1 fILATIQh,!-----i.----_-------------------- -+ �---------------- ------------------- RGOP COVER � ' 'PRE-GRADING ---------------------------•----------------- =------------- -- ------ ---------------- I?OU v H HEATINu I I i ;B ENCI71 NG--------.------ -------------------------- ----------- __...._.------I---------) - ----------- ROUC:�H ELECTRIC _� I ROUGH GRADII�G __ _ RGUGI-1 PLU(vIEiII�1G _� I _� j FINISI-�GftAGING _ {;HC���lER/TU[3TESl" � -T-- _� i POOL ELECTRIC - ;------ �E'�tT.LATH;SIDifJG ! i j �PGOL FENQNG �b�lALL I�SULF�TION � —�— � �1I LGOL Flf�lAL __ CEILI�dG I�!SULATIQ�J j � I ;OFF SITE I;�APS. .--_ • - GR'f�VALL NAILING � f -----� GEC)ICAllONS------------- - ----- --_------__- ._._ -- ---- � _—�. ------ _ ,FINAI ENG. _ 1 . .---..__ . `- � -- ---- � ----._._.._ _..----- ------. .....-------- ��ti;�F � - �`EI'TICT/aNK I 'LANCSCAPE/InRIG. --------- -1- l �_ ---- ------- ------ ---------- SEEN�fUL.L. j _�__ I �Oi�l SITc IMFS. __ GA.S AIRT[ST -j ;FI�JAL ZOPJif•!G ___ FINE\L�OidST. � —� �FIRE DEPT.R�IAL -- FIfVAL HG4TI(dG _—r 'FIF'r'nLTH DEPT.FINAL I------ — -------III Fln!;\L ELECTRIC i , I ;GEb'.FEES PAID _ -- ' � FINF.�P�UN181NG ---��- � j EM1IERGY ---- i , � - Fllvial FLANiid� � i _ � ' ---- ' ---- - ---- ------ - ---- -- - , -- -- ------ - . __- __. ..--- ------ --- , � FINA,L ENGI�EtRING i I ° �`"� -----�_ .-- --- __--�---= --�- —. __ ._ ----- ---_ __L..�'-� g �'�r`"'"� �' _ _------ �.� � � � CnN1MEN�TS ------- —��. ---- '�:�+.�f � _. _--�-�-L��-�-�-�'-..----------------- � �------- � � ,________________________________ ____________ ____ ____________________ _ _ __________________-__________ ___.____________._________________________ ______ , _ ____________ ___________ SEPTIC TANK SIZE SEEP°IT/U SIZE --- ---- ------------------ ----- ----—------ s' � �-.��� `�-`�� --- - --- ---- -- --- ---- ---- ^����� u ----- ------ '���� '�''��'�� '��''X . ' -- --- -- ��F-��. ,�� -- ------ --- - .------- ---------- - ----- ------- ���.�` ,�;�,� "'s'` .r` . '�'- . �'�C''�. ' - —___. ._.___ __'--__ _"_. _. __. '__—_—'____—__ --'—__--_'—--'_— � ,�,� �,f�,,���� �. �� �y �'st,�� ----'---- -------� ` � - �_� -- ---"--`---------- -----------------'---�------ � � ��ir'� r ',�,,� : �. � � ' , �"•' i.: ' . � � ------ , n " 'qg- ' ---- ---- --------._...----------'-------------------------------"---------`---._. •_..-.. �e 3 - ,. . T _ .. . s. . . :,�-. .;� t� .nH,a.�h�..c i�M?'�.:) _+.. � . _�_—____._—_____—"__.—_—__._.'__—_ ______'_."_—__._— _____.___ . .� �- �� � - �ya �. ,iA' �y . �� �.�i�` - :. �.s: