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Home My WebLink About1050 GRAND AV (5) \ " ^- ��`_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES y 21825 Copley Drive,Diamond Bar,CA 91765 PRESS '� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 4��»'��W BUILDING PERMIT APPLICATION • FIRMLY � JOBSITE �v S b �AG��.�� .�r, uP�I�� S'{�Z I DATE CATIO�N �+O I o8 NUMBER �,�. ��!C �1 G o ADDRESS r� � ISSUE �a TYPE OCC APN LOT � TRA�T DATE I �v (vt$ CONST. GROUP p OWNER ` '` � ZONING SETBACKS o ADDRESS ' y FRONT RW ❑ w CITY ZIP J�L�Q TEL.' �5' REAR ❑ � APPLICANT /II TEL. � �! SIDE/SIDE STREET RW ❑ � CONTRACTOR 1T�M0 NG SIDE ❑ o ADDRESS PROPOSED USE W D �Q L�/J/ CITY ZIP TEL. w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES � BEDROOMS � � C�7y ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENALTY OF PERIURV TFUT I AM EXEMPT FPOM THE CONTRACTORS LI� G82A6/C6fPOR W CENSEUWFORT1iEFOlLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCIiYOR (� . ZCOUNTYWHICHREOU�RESAPERMRTOCON57RUCT.AL7ERIMPROVE,DEMOLISH,OAREPAIRANVSTRUC- W patfo/Deck W TURE,PpIOR TO ITS ISSUANCE,ALSO NEOUIRES THE APFLICANT FOR SUCH PERMIT 70 FILE A SIGNED w g STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L6 LL, POOUS 8 � CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION�OF THE BUSINE55 AND PRO� � P � FESSIONSCODE)ORiHATHEORSHE15E%EMPTTHEREFHOMAN�THEBASISFORTHEALLEOEDE%EMP- T10N.ANYYIOLATqNOFSECT10N7031.68YANYAPPIICANTFORAPERMITSU&lECTSTNEAVPUCANTTO Z Re-Root � A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5o0).): � OI.ASOWNEROFTHEPROPERTV,ORMYEMPL��EESWITNWAOESA57HEIRSOLECOMPENSATION, Q CORIfIIBfCI81 WILL�O THE WORK,AND THE S7RUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7M�,BU51- J N NESS M1D PFOFESSIONS GODE THE CONTMCTORS LICENSE IAW OOES NOT APPLV TO AN OWNER OF � Pii07ERTV NR40 BUILDS OR IMPROVES THEREON.AND NhiO DOES SUCH WONK HIMSELF OR HERSELF Oq � 7HqOlN3H MIS OR HER ON7J EMPLOVEES,PHOVIDED THAT SUCH IMPROVEMEMS ARE NOT WTENDED OR � � OFFEREOFORS/�LEIF,IIOWEVER.THEBUILDINGORIMPROVEMFM�SSOLDVJITMNONEVFJ�ROFCOMPIE� Z TION.TFIE OWNER$UILDEP WfLL 71AVE THE BURDEN OF VROVIt16 THAT HE�R SHE DID NOT BUILO OR � IMPROVEFORTHEWRPOSEOFSALE). �},AS ONMER OF THE PROPEHfV.AA1 EXCLUSIVELV CONTPACTIN6 WRH LICENSED COMRACTORS Ii � TO EONSTRUCT 7HE PR0.IECT(SEC.70u,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U8t1011 ADJ.AREA � CENSE IA�M OOES NOTAPPLV TOAN OWNER OF A PROPEHTV WHO BUILDS Oii IMPHOVES THEREON,IND N?qCONTRACTSFORSUd1PR0.1ECT9WITHACqf7MCTOR(S�LICENSE�PURSU�W7TOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE V.WJ. � O 1 AM EXEMPT UNDER SEC. B.d P.G.FOR THIS REASON � ��G! T S 3 �� 5ul I T 4-a . '�a �±- rc i7 owNeg v z w � LICENSED CONTRACTORS D�CLARATION -� ¢ w , � 1 HEREBY AFFIfUA UNOER PENPLTY OF PERIURY THAT 1 AM LICENSE�UNOER PROVISIONS�F CNAPTER � "s C,��VL d Y(COMMENCIN�WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PROFESSIONS COOE,AND Z �' � �� X AIV LICENSE IS IN FULL FORCE AND EFFECT. �� m � 1 Q lLl u/. � 1 � LICENSE CLASS UC.NO. Vr�� ✓ G� /�.� y�.�,� j ^Z. -�� a S V DATE �_ CONTRACTOR C(�G ✓��1'� � ��1(aL a 'T� W � � WORKEAS'COMPENSATION DECLARATION � � � ..j'''y�J �'0 , � I HER B�AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLAAATIONS: Q �� - �� s � � � �1 HAVE�ND MlILL MAINTAIN ACERTIFICATE OF CANSENT TO SEIF�INSURE FOR WORKERS' _ � C0IAPENSATION,AS 7ROVIDED BV SECTION 37o00F THE LABOR CODE.FOR THE PERFORMANCE w OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � W _I HAVE AND WILI MAINTAIN WOFKERS'CAMPENSATbN INSURANCE,AS REQUIRED BY SECTION Q 370o OF THE LABOA COOE,FOR THE PERFORMANCE OF THE WORK FOP WHtCH THIS PERMIT�S �� `� ISSUED.MV WORICERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMOER AAE CONSTRUCTION � CARqIER PLAN REVIEW d,� 0 POLICV NUMBER ELECTRIC T-� •SO 2 ^ Q �'f. �� Q (t}{ISSECiIONNE�NO7BE0.Y.IR.EfFDOFTHEPERI.T�ISFORONEFAIHJ�EDDaLARSR100)ORLESS} PLUMBING s�� w MECHANICAL "'� • S� Z I CERTIFV THAT IN THE PERFORMANGE OF TNE WOH7(FOR WHICH 7HI5 PE W.�IT IS ISSUED.I �J SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE � WORKERS'COMPENSATION IAWS OF CALIFORNIA AND��REE THAT IF I SHOULD BECOME INSPECTION FEE S SU&IECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION37000FTHELABOF (SSUANCE 1� � —v CODE,I SHALL RTHWITMCOMP�V WVTH T1111 E�P OVISIONS. /f B � O /� 'i�dSeL�-[f' yr.Y//l.�L!/`^� SMIP � �S� p DATE:_�z� APPLICANT. � w � ENERGY p/C --� WARNINO:FAILURE 70 SECURE WOflKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE J � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDAEDTHOUSAND ENERGYPERMIT pOLLAqS(f tao.000).M ADDI7ION TO 7HE COST OF COMPENSAiION,DAMAQES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,PND ATTORNEV'S FEES. A�E{.JTION FEE: '' UD � � w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a O � 1 HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CQNSTRUCTION IENDING AOENCV � FOR THE PER(-0RMANCE OF TiE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.9081,CIV.C.). Z W � LENDER'SNAME H LENDER'SADDRE55 ��J'��V� � I CERTIFV TNAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES " � W 1 A6REE TO COMPIY WITH All CITY ANO COUNTY ORDINMlCES�NO STATE UWS REUTINa T�W ILOIN� � CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTV TO EMER UPON THE � ZABOVE�MENTIONED PROG TV FOR INSPECTION PURPOSES. COMMENTS � � ,� ��n� � m PE /JAE(PR1Nn � � � f0 �8 � SIO ATUFE OF PER � E D TE RECPT.NO. PAtD BY VALIDATION Y �' , WHITE—DepaAment Copy,YELLOW��ence Copy,PINK—Assessor Copy.(iOLDENROD—File Copy,GREEN—Applicant's Copy L _ CITY OIF Di,�NiOND �AFi ` - I�SPEC1'IOi� RECORD ��1�[�. ` � � . � • - e . � • ` .� SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR C,ONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC �,� � � ROUGH GRADING ROUGH PLUMBING � FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCI(JG WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK � LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY • A COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE ` � -sT�� ,. ��. . � : Y;�.�� - ,� � ..'+r,� ;�. �''yiir� ��'�� r � ;'4 C��:. �.. a�;�k '�' r�� k4 t � 'Y- �x �� Y * ��.� � ��.�� `� �� K'��§� ; � z'�� ° � � � ..;�- r,'�'�-'� r' ��, ' 1�` CITY OF DIAMOND BAR � , DEPARTM"'�?T OF COMMiJNITY&DEVELOPMENT SER�'"`;ES 21825 Cop. Jrive,Diamond Bar,CA 91765 `W (909)839-7020 Fax(909)861-3117 Buildirg Inspection Hotline(909)839-7027 ��$� :_ _ _ �'�.9�� _ _ .. BUILDING PERMIT APPLICATION ,. �j��Y _—� -JOBSITE—�.v S�_�,`GIZ�� , � 'F� ` APPLICATION PERMIT P/C - . o ADDRESS 1� �G��, u�f� ��Z I y DATE I�'�l 10 I oC'� NUMBER �� - . # �S 1� � ISSUE �� TYPE OCC APN LOT.' � TRA�T y--` DATE I �U (vYv CONST. GROUP _::..o OWNER Z . __' � � i o ADDRESS /77� iLL�LI�C=i Sj(v. I�iG� y ZONING SETBACKS w CITY S � ' '_ - ZIP I Z I'3C..' TEL. •: �3�C"'��; FRONT Ryy p Z REAR : o APPLICANT i1J TEL � ' !.J' � SIDFJSIDE STREET RW p r � CONTRACTOR - r ��'�U ' /�� SIDE p � ADDRESS �� ' PROPOSED USE �D Pi�iftZ/,fif5? S (.r�/I� ��f b(Iv%'/� � CIIY ZIP TEL. 6 � �w ARCH/ENG/ �� DESIGNER NO.DWEI.. NO. NO. ADDRESS UNITS STORIES ' Z BEDROOMS � � CITY ZIP TEL. `n DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION cr� Q OWNER-BUILDER DECLAFATION SFR/ADD/pEM � � � O I HEREBY AFFIPoA IINDER PENALN OF PERNRY THAT I AM EXEMPT FROM TNE LOMRALTORS L4 GflfdgB/CefpOR ' W CENSEUWFORTHEFOLLOWIMGFiEASON(SEG70.7t.5BU51NE55ANDPROFE55qNSCODE:ANVGTYOR (n ` ' U COUNTYYhUpiREWIRESAPERMfTTOCANSTRVCT,ALTEiLWPROVE,DEMOLISH,ORREP/JRMIYSTRUG W PaIID/DBCI( w MiE,PRIOR TO ITS i55UANCE,AL50 REOUIRES iHE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w .. � STATEMENT h1AT HE OR SHE IS LICENSEU PURSUANT TO TNE PROVISIONS OF THE CANTRACTORS LL � , � � CENSE lAW(CH�PTER e(CAMMENCWG N7TH SECTION 7000)OF DMSIDN]OF THE BUSINE55 AND FRO- � PooUSpa �' FESSIDNSCODE�ORhIATHEORSHEISEXEMPTTHEREFRDMANDTHEBA515FORTHEAILEGEDEXEMP- (�J � TON.AN'fVIOlAT1ONOFSECTION7071.5BVANYAPPUCANTFORAPERMITSU&lECTShIEMPIICANTTO Z Re-Roof � A CML VENALT'OF NOT MORE 7TiAN FIVE HUNDRED DOLlARS�fSDD).): Z ❑I,ASOWNE0.0FTHEPROPERT',ORMYEMPLOYEESWITHY�IAOESASTHEIRSOLECOMPENSATION, � ('qTmBfCial WILL DO 7HE WORK�ND THE STRUCNRE IS NOT IMEN�ED OR OFFERFA WR SALE(SEC.7wt,BUSI� J NE55 AND PROFESSIONS CODE TME CANTLiACTORS LICENSE LAW DOES NOT AVPLY TO AN OWNER OF � � PROPERiY WHO BUIIDS OR UAPROVESTHEREON,AND WNO DOES SUCN WORK HI45ELF OR HERSELF OR � � [C THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SW111APROVE/AENTS ARE NOT WTENDED OR m w OFFEREDFOfi5ALE1F,FIDWEVERTHEBULLDWGORIMPROVEMENTI550lDWITHMONEYEAROFCOMPLE � TION,THE OWNERAUILAEA VALL HAVE 7HE BURDEN OF PROVPI�TFUT HE OR SHE DID NOT BUILD OR z IMPROVE FOR 7HE PURPoSE oF SAIE� � _ �A,ASONTlEROFTHEPROPFA7Y,MAE%CLUSNELYCANTMCTINOYrtTHLICENSEDCONTRACTORS WW TO croNSrRUCT THE PRQIECT SEC.7a1,BUSINE55 AND PROFESSIONS CODE THE CONTRACTORS lF �NSEUWDOESNOTMPLYTOANOWNEROFAPROPERIYNRIOBUILDSORIMPROVESTHEREON,AND ValuallOn ApJ,({{�Eq ' � WHOCONTRACTSFORSUCHPROJECTSWfTHACONTMC70R(S)LILENSEDVURSUANTTOTHECOMRAG QUANTITY DESCRIPTION FEE ,., Y TOqSUCENSELAW.). � ❑I hM EXEMPT UNDER SEC. � B.[V.C.FOR THIS REASON � L'G L( I� � � [[ ` st.L'1 r t'� �-.� .�� DATE r�Z- ��F�_ OWNE ��• F � Z V W , � . LICENSED CONTRACTORS DECLARATION w .Z � � •' � � I HEREBY AFFIRM UNDER PENALTY OF PERIURY THA7 I AM UCENSED UNDEH PROVISIONS OF GiAPTER �. � C�r�� d Y(COMMENqN(i WfTH SECTION 7000)OF DNISqN�OF THE BUSINE55 AND PROFESSqNS CODE,AND Z � ` „X MY LIGENSE IS W FULL FORCE AND EFFECT. --� ` m . � � � LICENSE CLASS LIC.NO. ��r�L.�,y`7�-� n � I C�, . , U. DATE�_ L7 _ CONTRACTOR��L' ✓/I71� C�'J�//�I�l d Z � �� . � WORKERS'COMPENSATION DECLARATION ¢ � _ Y � 3� ,� �� 1 HER BY AFFIRM UNDER PENALTY OF PERIUHY ONE OF THE FOLLOWINC DEGtARAT10N5: Z � � '�'... �2-. i=,�"5 � �IHAVEANOWILLMP.INTAIN�CERTIFICATEOFCONSEMTOSELF�INSUREFORWORKERS' _ ' Q ��COMPENSATIOIJ,AS PHOVIDED BY SECTION Jloo OF THE LABOR COOE,FOR THE PERWRNANCE �U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � , . � w _IHAVEMJDWILLMAINTAINWORI(ERS'CAMPENSATIONINSURANCE.ASFEOUIREDBYSECTION � 370o OF THE UBOR GODE,FOR THE PEFFORMANCE OF THE WORI(FOR wHICt17H15 PERMIT IS � LSSUED.MY WORKERS'CAA/PENSATqN INSURANCE CAHRIER ANO POLICY MIMBER ARE: CONSTRUCTION � ��„� _C'��' J " � CARRIER PLAN REVIEW � � � POIICYNUMBER ELECTRIC ' ' � .SC3 � (R16sEctnNrlEmIJo79EmMRErEooFn�PEw�mswaa+ElM�DfiEoOcu.nitSR�roloaLEss}� PLUMBING 1C��'7 t.°C� . W Z I CERTIFY T}1AT M THE PERFORMANCE OF THE MVRK FOR WHILH THIS PEfUlll IS ISSUED,I MECHANICAL �, �J (.'} SHALL NOT EMPIOY ANY PERSON IN ANY MANNEH 50 AS TO BECAME SUBJECT TO THE � Uj WORKERS'COMPENSATION LAWS OF CALIFORNIq ANDACREE THA7IF I SHOUID BECAME INSPECTION FEE � ' SUBJECT TO THE WORKERS'COMPENSA710N VROVISqNS 0F SECTION]70o OF THE LABOR , � .�r� � CODE.I SFiAL1 FORTHWITH COIAPLY WITHTyyy�pp E P ONSIONS. �SSUANCE �-I�JLJ . � f /� ��7 SMIP �S� . p' DATE Z �+ APPIICANT. ��, f9 • ..f�17i�� " J WARNIN(3:FAILURE TO SECURE WORNERS'CAMPENSATION COVERAGE IS UNLAWFVL,AND SHALL BE ENERGY P/C � SU&IECTANEAIPLOYERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUIJ�HEDTHOUSAND ENERGYPERMIT OOLURS(5100,00D),W ADDITION TO THE COST OF CAMPENSATION.�AMAGES AS PROVIDED FOR IN { � , � SECTpN37olOF7HEUBORCADE.WTEREST,ANDATTORNEYSFEES. RETENTIONFEE: � 1. �} ` ' d CONSTFUCTION LENDWG AGENCY ' PFE-ALT FEE: O � 1 HEREBY AFFlRM UNDER PENALIY OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY � � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERIAIT IS ISSUED(SEC.3ov],GIV.CJ. Z " W � �LENDERS NAME f— LENDERSADDRE55 >", � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA710N IS GORiiECT. TOTAL FE ES v `� '� w I AGREE TO COMPLV VAhI ALL CRY M!D COUNTY ORDWANCES AND STATE LAWS REUTING TO BVILDIN� � � CONSTRUCTION,AND HEREBV AUTIIORRE REPRESENTATNES OF TH15 COUNTY TO ENTER U70N 7HE Z ABOVE-MENTqNEO 7ROP n Foa wsaECTwr+�unvosEs � COMMENTS � ' ,� �'��- � � m PE AME IPHINT) Q ¢ �Z /C O(> � �• SIG NRE OF PEFA1 E D TE -� / V� � RECPT.NO. ' PAID BY \�✓ VALIDATION WHITE—DepaAment Copy.YELLOW—Finence Copy,PINK—Assessor Copy,GOIDENROo--File Copy,GREEN—Applicant's Copy . �/: �i ':* : ! ;1i :. 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