HomeMy WebLinkAbout12-983 CITY OF DIAMOND BAR ���•
� ~ ~----��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �ra^� an
� 21810 Copley Drive,Diamond Bar,CA 91765 �c�ncl��� 5 G �"f`!�n"
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70
��«����� BUILDING PERMIT APPLICATION FIRMLY
' N JOBSITE II S� S• �amOn APPLICATI N PERMIT ���1 P!C �Z
o ADDRESS�,�111� � _ �C�'91��� • DATE �L J I �o� NUMBER a- Q'�r3�
ISSISE . �,o TYPE TT OCC
� A P N O T T R A C 7 D � 1 a' CONST. � --�� GROUP
p OWNER� �S
APDRESS ZONING S ACKS
� Z�P T 5 - 5 FRONT RW ❑
� CITY REAR ❑ �
APPLlrenrt' pI7/.L___MQI'C al S T -� SIDE/SiDESTREET RW ❑
� CONTRACTO SIDE �
QADDRES PROPOSED USE X �raht ��pr�Y��� I
� CITY P � TEL Z �Z- a� ea�i I" �eN�. S
w ARCH/ENG/
z DESIGNER NO.DWEL N�. NO.
� ADDRESS w• c • STORIES BEDROOMS
N CITY • Zl 9fBo3 TE . 2
�
DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� � OWNEF•BUILDER DECIAAATION SFR/ADD/REM
O
0 1 HEREBV AFFlRAI UNPER PENALTY OF PEiLR1RY THAT t AM EXEAIPT FROM THE CONTRACT00.S LL Gerage/Cerport
W CENSEUWFORTHEFd.LOW�N�REASON(SEC.7031.60USWESSANDPROFESSIONSCOOEANYpTVOR (n .
U COI1Ni`fWri1CHRE0U�AE8APEAMi7TOCON87AUCT.ALTERDAPROVE.DFMOUSH.ORRECAIRANYSTRUC W P8t10/DBCk
ZTURE,PPqR TO RS 65UANCE,ALSO REOUIRES THE APPLICAN�WR SUCN PEAMIT TO FlLE A SIONED w
� STATEMENf THAT HE OR SME IS LICENSED PURSUANT TO THE PROYISIONS OF THE CONTMCTOR9 LL � P�US 8
� � CEMSE UW(CHAPTER B(COMMENCwO WITN SECTION 7000)OF DIVISION]OF THE BUSINESS AND PR6 � P
� FESgpNSCOO�OR7HATHEOR5HE15ExFJAPT7MEREFROAIANDTHEBASISFOR7HEALLEOEDEXEMP•
V TqN.ANYVIOUT�ONOF5ECT10N7o3t6BVANYMPIICANTFORAPERMITSU&IECT57HEMPLIGWT70 . Z Fl8-R007
� ACML PENALTV OF NOT MORE 7MAN FIVE HUNDFED DOLLARS(SSoo).): ��
0 ❑I,ASOWNEROFTHEPROPERT'.OAMVEMPLOVEE3WI7H1VAGESASTHEIRSOIECOMPENSATION. � CpmTBfCi21- ��(pO .
Z y,qLL pp 7}{E�µp{�(,�7HE STRUCTUAE IS NO7 INTENDm Ofl OFFERED FOR SALE(SEC.7�,&154 J �
� NESS AND PFiOFE5510N3 CODE TME CONTRACTORS LICENSE LAW DOES NOT APVLY TO AN.OWNER OF � �
PpppEp7yWNDBUp.0.SORIMPqOVESTHEREON.ANDMMODOESSUCHNORKHI/ASELFORHE�ELFOR m . .
� i1fR4U6H HIS OR HEA OWN EMPLOVEES,PHOVIDED 7HAT SUCH IAIPROVEMENTS ARE NOT plTENDED OR
Q OFFEREAFORSALEIF,MOWEVER.7HEBUflDIN00RUA7ROVEMEMiSSOLDN7THwONEYEMOfCOMRE• . .
Z TqN,THE OWNER-BUILDEP WILL HAVE TME BUHDEN OF PROYRxi 7HAT HE OR SHE DID NO7 BU4D OR
= DAPROVE FOR THE PURPOSE OF SALEy . .
O 4�ONMER OF THE PROPERTV.'AM EXCLUSNELY CONTMCTINO WfTN LICENSED CONTRACTORS
Q Tp CONSTfiUCS THE PROJECT(SEC.TON,BUSINES9 M1D PROFESSIONS CODE:THE CONTMCTORS U- V8{U8l{0/1� AQI.AREA' �
W CENSE UW DOES NOTAVVLY TOAN OYMER OFA PROPER7V WMO BU�LDS OR W PROVES hiEfiEON,AND , _
Z M?IOCOMRACTSFORSUCHPR0.IECTSWITIACONTRACfOR(S)LICENSEDPURSUAMTOTHECONTiUC- QUANTITY DESCRIP'fION FEE ,
ioru ucer+sE uw.�. yry
p ❑I A4 E%EMPT UNDER SEC. B.a P.C.FOR TW4 REASON U W ��'� e
� �
� DATE . ONMER . . V,
Z
� LICENSED CONTRACTORS DECLARA710N �J� � �
�
I HEREBYAFFlfUI UNDER PENAIT'OF PERJURY THAT IAM�LICENSm UNDER 7ROVISIONS OF CHAP7ER rU r O G Y `n
a, Y(COI./AIENCMO WITM SECTIDN 7000)OF DMSION 9 OF THE BU5INESS M7D PROFESSIONS OODE,AND Z. . � .
►ry LICENSE IS W FULL FOPCE AND EFFEC7. m
0 ICENSE CLASS LtC.NO. �I�.-7 D � j� � �� �
a
V p7E Z . CpMRACTOR Y
w
1
� WORKERS'COMPENSATION DECLARATION �
� (�
� I HFAFBV AFFIRM UNDEA PENAL7V OF PERNPY ONE OF THE FOLLOWMHi DECL/�RAT%)N8: �
. � . . .., %N Z
� _I FIAVE�AND WILL AWNTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR MION(ERS' � �
Z �p�p710N,/S PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE W' . . .
Q pF 7�{E WORK FOR WHICH THIS PERMIT IS ISSUED.
�
_1 HAVE�ND N�LL M/UMAW WOPKEfi3'COMPENSA?ION INSURANCE;A9 REOUIRED 9V SECf10N
Q 9Tuo OF THE L'BOR CUDE.FOFi THE PERFO WdMlCE OF THE WORK FOR WHICH 1HIS PE�U/1713 �Q
ISSUEO.MY WOPo(ER5 WkPENSATION INSURANCE CMRIER AND POL�CY MUMOER AAE �CONSTRUCTION. �v�
j PLAN FEVIEW ��a. �-1 r�Q�_,�
`, CAAAIfR S�': �
Z J c voc�cv rxnmEa ELECTRIC
Q (rHssEctor+r�wreE�oFn+eeew.�rswaa+er�noauasls�m)oatFas? PLUMBIN6 `a�• ��
� sy ��� �
w MECHANICAL�
Z I CERTIFV THAT P17HE PERFOFMANCE OF YNE.WOPo(FOR wHIGi TN�S PERMR IS ISSUED,I
�J SHN.LNOTEMPLOYANY7ERSONWANYldM1NEi1SO/ST09ECOME�SU&IECTTOTHE� {NSPECTIONFEE
� WORKERS'GOMPENSATION LAWS OF CAIIGORNIA AND A6REE THAT IF I SHOUTA BECOME . . .
S SUBJEC7 TO7HE WORKERS'COMVEN9A7/0N PROVISIONS OF SECTION a7W OF TNE LABOR `7j� •Q�j
CppE,l FOFRHWITHCOMPLYWITH7HOSEPROVIS10N5. � ISSUANCE �l
� DATE: I D APPLICANT:V � ,�I �V� e �SMIP � • `O
� — aJ3. �O
w ENERGY P/C
J WARMN4�FAIWRETOSEWREWOHKEAS'COMPENSATIONCOVEFIAGEISUNUWFUL.ANDSHALLBE - - �j
J SU&IECfANEMPIOYERTOCRIMWALPENl�LTIESPNUCMLFwE5UPi00NEllUNORED1t10U5M10 �+�� �
� DOU.MS.�StOD.ODO),�W ADDITION 70 THE COS7 OF COMVENSATpN,DAMAQES A9 PROVIDED FOR IN ENEROY PERMIT . (
� 6ECTION 37oe OF TiE LABOR COOE.INTERF�ST,AND ATTORNEV'S FEES. ' RETENTION FEE `� ��� �
W CONSTRUCTION LENDING AGENCY PRE-ALT FEE �
a _
� 1 NEREBYAFFIRM UNDER PENN.TY OF PERIURY THAT THEFE IS A CqNSTRUCTION IENDWO AOENCY �� � -�� �
�FOR THE PERFORMANCE OF.THE wORK FOR WH1CN 7MI3 PERMR IS ISSUED(SEC.7oW.pV.C.}
Z '
w
�� LENDER'S NNAE _ , . .
� LENDER'SADDRESS (���+ �
� �ICERTIFY7FIA'fI�HAVEREAD7HI8APPLIGTIONANDSTATETUTTHEABOVE�NFUNMATN)N�9CORRECT. TOTAL FEES ���1 • C • ���0 •�
w 1 A(iREE TO COMPLV M7TH ALL CITY AND COUNTV ORDINANCES M1D STATE UN5 REUTINO TO BURDWO
� CONSTHUCTION.M1D HEREBV AUTFIORIZE REPRESENTATNES OF 7HIS COUNTV TO EN�EN UPON THE �
Z AgOVE-MENi%7NED PROPERTY GOR INSPECTION VURPOSES. COMMENTS ��
ox e � �
�
m VERMI7TEE NM1E(P NT) . ' . . � . . � . '' .
� r S �� ���, �a�a.�-- �
� sror� vEweme6 ��� RECPT.NO. ��g q�' PAID BY ��Q _ VAUDATfON�.
� WHITE-Department Coryy.YELLOW—Flnanoe CopY.PINK—Assessw Copy.GOLDENfiOD—FIIe Copy�GREEI�ApplkanYs'Copy
CITY QF DIAMOND BAR — '
INSPECTIOIV REGOFiD
��� � • � � �� . �� �' � ,
�� ,�'� � � �� i : �,. o � o . . .
. .� . s . _. .....,.. . .., .
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL • FNA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT �
GRDUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREP�ACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FR,4MING/VENTILATION �FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING � � BENCHIfdG
ROUGH ELECTRK `� ROUGH GRADING ~
ROUGH PLtJMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRlC
EXT.LATH/SIDING POOL FENCIPIG
WALL INSULATION �POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING � '�j t2, DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. Old SITE IMPS.
GAS AIRTEST FINAL ZONING
fINAL CUNST. ;* F(RE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FfNAL
FINAL ELECTRIC DEV.FEES PA10
FINAL PLUMB�NG ENERGY
FINAL PLANING
FINAL ENGINEERING � o
+ 4
COMMENTS��� . " '�.�R. t � . .�,. ' i` � G Gf� d�..
�- � '� � � "
C.liv Ory(�K� �z�d�jl
SEPTICTANKSIZE
SEEP PIT/U SIZE
I,
�