HomeMy WebLinkAboutPR 12-1576 (4)+ CTI77 OF DIAMOND BAR cl3C 4 b'
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21010 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION
JOBSITE X S ` Q �
ADDRESS i
APN V164 LOT D 1 1 TRACT Z .
OWNER F 1 t� T 1't iN1QG
ADDRESS a+D Q
CITY O ZIP 1 TEL
APPLICANT 0R TEL.e4cl Z014
CONTRACTOR-( fi�[aF1G 1a1GST CLMt-t. fpuc-
ADDRESS SOD NS LAIIST[�tE ST.
CITY SAka ZIP TEL b26 831- y9�lg
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DESIGNER]( f-w4k
ADDRESS f'iPQ�A.J[Ar
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OWNEWBUILDER DECLARATION
I HFAEBY AFFM UNDER PENALTY OF PIFFULM THAT 1 AM EXEMPT FROM THE CONTRACTORS u -
CENSE AW FORTHE FOLLOWING REASON (SEG.7mlA BIISNESSAND PROFESSIONS CODE AIR'CRY OR
COUNTY WHICH- NE m+ SAPEIANTTOCONLS hU(:t,AIJUL WPFKMOBIOYSK OR RERVRANY STRUC
TURF. PRIOR TO Rs ISSUANCE. ALSO REOU 3 THE APPLICANT FOR SUCH PENNANT TO FILE A SKINGD
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PRDVSRONS bF. THE'CONTRACIR" LL
CENSE LAW (C/WTER (OO\Yi1BICYlO YRni SECTION -m OF DIVISION 7 OF THE sIISNES11 ANDPLR�O
FESSIONS COOS) ORTHATHE OR AME IS ER4IPTREPEFROM AND THE BASIS FOR THEALLEOED VrtMP-
TION. ANY VOLATIDN OF atCftW 7" A NY ANY APPLICANT FORA PERMIT SUMEC76 THE APPLICANT To
ACML PENALTY OF NOT MORE THAN FRE NUINDRED DOLLARS asb4r
O LAS OWNER OFTH r PROPERTY. 09 MY EMPLOYEES VMVIAOESAS THEIR SOLE COMPO/SATION.
WILLOO THE MCMC AND jTH1EE STRUCTURE IS NOT MENDED.OR OFFERED FOR SALE (SEC. TON, tlILTF
NESS AND PROFESSIONS COCE THE CONTRACTORS lSCE/S, LAW GOES HOT APPLY TO AN OWNFA OF
PROPERTY W/q BUk*S OR MPROVES THEREOK /IND WINO DOES SIAHMA7fIK=YELI:M /ERSBFOR
TTINOUGH HIS OR HER OWN EMPLOYEES. PROVIDED TWAT SUON WROVEJBNTSARE NOT MELOID OR
04-MMFOR SALE IF. HOWEYM 7W DULOM OR NAPOVEIBN 13 SOLOVIMMONE YFMOFCMtK.C-
iION, THE OWNEIFBIALDEi T HOVE THE WROE/ OF PROVNO T1UT HE OR SHE ISD NOT BUaD OR
MPROV, FOR THE =DISPOSE of sALEk
D L AS OWNER OF THE PROPERTY.AM EXCLUSNELY CONTRACtM WITH ucEISED OONNIUCMAS
TO CONSTRUCT THE PRCIECT (SEC. 70U. SUSMS3 AND PROFESSIONS COOK THE CONTRACTORS U -
CUM LAW DOES NOTAPPLY TOAN OWNER OFA PROPER,' THIO BUILDS OR WROVES 1TRTIEON, AND
TWIG CONTRACTS FOR SUPROJECTSWITIIACCNTRJbCTOR(S)UCB6ED PURQUANTIOTHECbNIRAC
0I
TORS UCENs, LAK).
❑ 1 AM EXEMPT UNDER SEC. S. A P.C. FCR THIS REASON
DATE OWNER_
LICENSEO CONTRACTORS DECLARATION
1 H EREBYAFnM UNDER PEWILTY OF PERJURY THAT (AAI LICENSED UNDER PRONSIONS OF OWPITER
UCOLMIG ICING WITH SECTION 70M OF DIVISION 3 OF THE BUNNESS AND PROFESSIONS DOM AND
LICENSE M N FULL FORCE AND EFF&CY.
' LICENSE CLASS A LIC. No.
DATE.. --]22--,1L5 I z.0Com_ CCNr"CTDA cL�C JA PPrt-TV/-3 et
C WORKERS' COMPENSATION DECLARATION
/
I 1 MMI AMM UNDER PENALTY OF MUIRY
1 019 OF THE FOLLOWING DEOJIRATKINS:
_I HAVE ANO WILL MAN" A CE TFMATE OF CONSENT To say-wsum FOR WoweRr
COAIMMTION. AS PAQVDW SY SECTION 3700 OF THE LABOR CODGj fOR THE PERFORMANCE
OF THE WORK FOR WHPOI THIS PEMST ISISSUED.
j
1 HAVE AND VYSI YAIMAN WORKER. OOMPEISAMN NSURANQE N REQUIRED AY SL.CNON
3700 OF THE LARCH COOS. FDR THE PE VORMANCE OF THE WORK I& WN CH Tws PERIM H
' ISDII®. MY wowu r CC7MPEmfm MSURANCB C pmv; AND POLICY NUMBER ARE:
I
CARRIER_Ot-L?U 1kF3,]S&L
POLNCY NUMSER K- ICJW • °MISS 2,51.3 -0-1.
(RM8EC11aHH®FATrEOD1i'LETIDOF71#PEMMT GFOROMHU D EDO4LRBM110MORLIN%
I CERRFY THAT N THE PowoRMANCIE OF THE woo Fol YnIHdI Tft PERLKT IS =MD.1
i SHALLNOT EMPLOY ANY PERSON N ANY MANNCR BOAS TO BEOCME S B1ECT TOM .
j YproNERs CWNPENSATIOII LwYYS OFCALIFOF-A.AND AGREE THAT i19110ULD BEOOM,
SUBDECTM THE YPDNCERS CONPEISi T.1 PRONSIONg OF RECTION A000F THE LABOR
CODE.1 sNALL FORTHRYIm COMPLY wrrH Y"m PnamoNB.
DATE APPUCANf:
WAFNNo: FALURE TO SECURE WOIOCERB' CCUPENSATM COVERAGE 13 U AA*IA., AND.&LILL BE
SULIECT AN EUPLOYER TO CRMNAL PENALTIES AND CML FINES LIP To ONE HUNDRED TIIDUgAID
DOUAAS M110o,000).1N AOORION 10 THE COST OF COMPS SMICH. DAMAOES AS PHOADED FOR K
J. SECTION i7oP tIF,HIE 1A8011 CODE, PFI—ES7; ANO ATTORNM FEES
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERUIRY,IAT THERE tl A CWMTWCRON LENDM AGENCY
FOR THE PERFORMANCE tY THE VTN FOR VAtl K!X PEFWT IS tSSUED ISM 301.OV. b}
LENDER'S RAW
LEDER'SAODRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE TNATTNEABOVE SPOMIATON IS OORREOE
L IAGREI TO COMPLY VAT" ALLCRY AHO C0LWTY ORWWM3 AND STATE LAWS R9.ATM1 TO BUIUMI
COMtRUCTIOK AND "EIESYAURpRRE R,PRESE TOWS OF THIS COUNTY TO ENTER UPON THE
ABOVVAIENIICNrD PRWffR'Y FOR NSPEC'RW PURPOStS.
PEronTTEE NAM, 1Rwn
2 J2 1q 2013
7j SONATURE OF PEAWrTEE DATE
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PRESS
FIRMLY
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ISSUE " \ ' \ - TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW p
REAR ❑
SIDE/SIDE STREET RW ❑
I:]— SIDE 0 -
PROPOSED USE i SS CA^ (►1iJAll C n�PIt I L
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAPVALUATION
SFR/ADDVREM
Gam. gate1por(
CCD
LU
POWDM*
POOAISPS
C7
Z
Re -Root
coInn-CIN
m
Valundon I ` ADJ.AREA
OUANTTTY .'DESCRIPTION FEE
m
a�
_U
CONSTRUCTION a8'7 c
PLAN REVIEW a..
ELECTRIC
PLUMBING
INEC11AMCAL
INSPECTION FEE
ISSUANCE
.SM1P
ENERGY PIC
ENERGY PERMIT
RETENTION FEE--
EEPRE-ALT FEE
PRE-ALT
TOTAL FEES X441 11
COMMENTS
1371
RECUT -ND, �'� ala]-"�. PAID BY \ Vu MTTON h
YNR 1 t--VBPBTDTISTHI %.q T euV� I.OPJ N'( Sia C Co GRED--�r'B Copy
• City of Diamond Bar SyC�Q1�
Building & Safety Division
21810 Copley Drive
Diamond Bar, CA 91765
Building Division (909) 839-7020 / Inspection Request Hotline (909) 839-7027
PERMIT # �� ` � - \ S"l (s DATE ISSUED: a Igg I N S
ADDRESS: g (moi grY�r� �DESCRIPTION:
POST IN SAFE, CONSPICUOUS PLACE AT FRONT OF JOB. PROVIDE PERMIT NUMBER WHEN CALLING FOR INSPECTION. HAVE APPROVED PLANS
ON JOBSITE AT TIME OF INSPECTION. INSPECTION REQUESTS SHALL BE MADE 24 HOURS IN
ADVANCE. YOU MAY CALL US THE DAY OF YOUR INSPECTION AT 9 -nn AM AT (Qn01 RRo_7mn Tn nRTAiN Au Aoo0nv1AAA7c TUACCOAAAC
INSPECTION
DATE: SIGN:
INSPECTION DATE: SIGN:
SETBACK /LETTER ..
TRACT AND LEDGER
FOOTINGS�FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG-. PLUMBING,
T -BAR
UG. ELEtMCAL -
INTERCEPTER
LIFER GROUND:. ..
HOT MOP/SHOWERPAN
SEWER LATERAL
SEPTIC/CESSPOOL
SEWER CLEANOUT
HERS REPORT RECEIVED
MAIN WATER LINE
IDEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
P90L/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING: :.
FRAMING/VENTING
ROUGH ELECTRICAL .
RO. MECHANICAL
ROUGH•MECHANICAL
RO.: ELECTRICAL W(') C O
GAS TEST
RO. PLUMBING
PRE GUNITIE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P TRAP ,
DRYWALL
FENCE j-GATE'/.ALARM
LATH (PRE)
FINAL POOL.::-
LATH EXTERIOR
WALLS.-
ALLS.LATH
LATHINTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 1ST( ) 2ND( ) LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN / SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO. FRAMING' PLANNING.APPROVAL
FINAL.BUILDING
ROUGH FIRE -APPROVAL
F7/VAL,M5PYANIG4L..
.. .
FINAL_FIRE
FINAL ELEC7RIC4L
PLANNING
RNA L`PLUMBING
RNAL`ENG7NEERING/ PW
, C `of OCCUPANCY
FINAL COMMUNITYSER VICES
CERT.OF OCCUPANY
FINAL` HEALTH.DEPT
INDUSTRIAL WASTE FINAL