HomeMy WebLinkAbout13-1930 _�� __ CITY OF DIAMOND BAR
`'—'-•' DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES
I
21810 Copley Drive,Diamond Bar,CA 91765
��`
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
I ""'�,W BUILDING PERMIT APPLICATION �' –. FIRMLY
� JOBSITE
>- 11 APPLICAj10JJ PERMIT "�/9 p/C
o ADDRESS I,S7z ,��v�a l'�'�V\ �O . DATE /O//7I13 NUMBER �/ #
� ISSUE TYPE OCC
°T APN LOT�_�, TRACT DATE ����� CONST. GROUP
p OWNER TOn�I C�TOv
o ADDRESS (S7Z J N1�.► ��� IZp• ZONING SETBACKS
Z CITY�j10.YkcVlO �Gle ZIP 7� TEL. O ' �-�7� FRONT pyy p
� APPLICANT JGNa1 7qr1��25C-� TEL. REAR p
� SIDEJSIDE STREET RW ❑
z
¢ CONTRACTOR Y SIDE p
ADDRESS �
� CITY ZIP TEL 0(,,� PROPOSED USE i
� ARCWENG/
z DESIGNER
w NO.DWEL. NO. NQ,
� ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
rn DESCRIPTION S�.FT. FACTOR PSF ADJ..AREANALUATION
p� OWNER-BUILDER DECIARATtON SFR/ADD/REM
O
0 •1 HER�Y AFFlHAI UNDER PENALiY OF PE0.NRY THAT I AM EXFJAPT FROM THE CONTRACTORS U- G8f8 JBIC8IP0f1
W CENSEUWFORTHEFOLLOWINGPEASON(SEC.>071.SBUSINESSANDPROFESSIONSCODEANYGTYOR (n "
U COUNiYNMICHREWIRESAPERMITTOCONSTRUCT,ALTER,I/APROVE,DEMOIJSH,ORREPAIRANY57qUG �
w TURE,PRqR TD RS ISSUANCE,ALSO REOUIRES 7HE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� S7ATEMEHT THAT HE OR SHE IS LICENSED PURSUAHT TO THE PROVISIONS OF TME COMMCTORS LI-
CENSE UW(C}UPTER v(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF 7HE BUSINE55 AND PRO- � PooVSpa �.
� FE5510N5 COD�OR THAT HE OR SHE IS E%FJ.IPT 7HEREFROIA AND TiE BA515 FOR THE ALIECED EXEMP• C7
U T1ON.ANYVIOUTIONOf5ECT10N7o3t.58YANYAPPLICANTFORAPERMI75U&lECTSTHEAvpLICANTTO Z R�Roof
� ACML PEW�LTY oF NOT MORE THNJ FNE HUNDRED DOLLARS(f500).):
0 OI,ASOWNEROFTHEPROPER7Y,ORNVEMPLOYEESWITHIVAGESASTHEIRSOLECOMPENSATION, � COlfIfilOfCiZ1 -�
Z WILL�O 7HE WORK M1D 7HE STRUCTURE IS NOT INTEN�EO OR OFFERED FOR SPLE(SEC,70��,BU51- J
� NE55 PNO PROFESSIONS CODE:THE COMRACTORS UCENSE LAW OOES NO7 MPLY 70 AN OWNER oF � .
— PROPEFRY VhiO BUILOS OF IMPROVES THEREON,AND WHO DOES SUCH WORK HIA/SELF OR HERSEIF OR
wTHROUGH HIS OR HER ON?!EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR m .
Q OFFEfiEDFOR5ALE1F,F10WEVERTMEBUIIDINGOR4APROVEMENfISSO�DWfTHINONEYEAROFCAMPIE-
Z TqN,THE OWNER-BUILDER WILL HAVE THE BUFOEN OF FROVING 7HA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOR h1E PURPOSE OF SALE).
w .OI,/SONMEROF7HEPROPER�Y,AAIEXCLUSIVELYCAN7MCTINGWITHUCENSEDCOHTMCTOqS
Q 70 CONSfRUCT THE PR0.IECT(SEC.70/�,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI• V81U8f1Of1 ADJ.AREA '
W CENSE UW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHD BUILDS OR IMGROVES TiEREON,ANU
� WHOCAMFUCTSFORSUCHPR0.JECTSWITHACONTRACTOR(5)LICENSEDPUASUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE .
� T00.5 IJCENSE Uw.). -
� ❑1 AM EXEMPT UNDER SEC. 8.d V.C.FOR 7MI5 REASON Q
� U
� �
OATE OWNER F-
Z w
�Q LICENSED CONTRACTORS DECLARATION W
CC I HEREBYAFFIPAI UNDEH PENALTY OF PERIURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � ,
� D(COMMENCINO WI7H SECTION 7000)OF OIVISION]Of THE B1151NE5S AND PROFESSIONS CODE,AND Z
X� NY IICENSE IS IN FULL FORCE ANO EFFECT. m
LL1 ��J
� LICENSE CLAS LIC.NO. /�K j .
� A J
U DATE CJ COMRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q �
� I HEREBV AFFIRAI UNDEF PENALTY OF PERIURV ONE OF h1E FOLLOWING DECLARATIONS: . Z
. Q
� _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' _ �
COM7ENSA710N,/S PROVIDED BY SECTION 3700 OF THE LABOR COOE,FOR 7HE PERFORMANCE `U
Q OF 7NE WORK FOR NM1iICH h115 7ERMIT IS ISSUED. � �
Qw 1 HAVEAND WILL MAINTAIN WOflKERS'COMPENSATION INSUMNCE,AS REOl11RED BY SECTION
�70o OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORN FOp WHICH THIS PERMI715
ISSUED.MY�j R�K��F�iS'COMP SATION INSURANCE CAr NIER A,ND POLICY NUMBER ARE: CONSTRUCTION
�J �W',�,1 ���j �r,`�1�� PLAN AEVIEW
CARRIER
� POLICY NUMBER W��_ e UO !iV `C.�'U ELECTRIC
0 (1HISSECi1DNNE�NOTBEWAPLETmOF71iEPFAhYf6FORCNEM1rDF7�00LIM5(Si00�ORLE551 PLUMBING --•
ZI CERTIFY hIA7 IN TiE PERFORMANCE OF 1HE WORK FOR WHICH 7H15 PERMIT IS ISSUED,1 MECHANICA�
�J' SHALL NOT EAIVLOV ANY PERSON INANY EAPNNER 50 AS TO BECAME SU&IECT TO THE -
Uj WORKERS'COMPENSATIONLAWSOFCALIFORNIAANDAGREEiHA71FI5HOULDBECAME INSPECTIONFEE
_ = SUBlEC7 TO THE WORKERS'COMPENSATION PROViS10N5 OF SECTIOI{ 7o00F THE IABOR ^ ++
CADE,I ALL F iiTFNATH COIAPLY WITH 7HOSE PRo i ^ ISSUANCE >
p DATE:_�J�� AVPLICANL — 1 � I ,_ SMIP .
J WARNINO:FAIWRE TO SECURE WORICERS'CAMPENSATIO CE IS UN UL, SH�U1 BE ENERGY P!C
� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCI INESVPTOONELHII� hi0U5AND ENERGYPERMIT '
DOLLARS(S10o.o00).IN ADDITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FDR IN �J
¢ SECTION 370!OF THE LABOR COD�WTEREST,M1D ATfORNEYS FEES. RETENTION FEE: .�[/�
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFlRM UNDER PENALN OF PERJURY THAT THERE IS A CANSTAUCTION LENDINO AGENCY �
� FOR T1E PERFORMANCE OF THE WORN FOR WHICH iH15 PERMIT IS ISSUED(SEC.3047,GV.CJ.
Z
W., •
��� LENDER'S NAME
F- LENDEFi'S ADDRESS
� TOTAL FEES �9�yJ
¢ I CERTIFY THAT 1 HAVE REA�THIS APPLICATION AND STATE 7HAT 7HE ABOVE INFORMATIDN IS CARRECT.
w I AGHEE TO COlAGIY N7TH ALL CIIY ANO CAUNTY ORDWANCES AND STATE UWS REUTING TO BUILDING
� CANS7RUC�ION,AND HEREBV AIfrHOR12E REPRESENTAT(VES OF h1I5 CIXINTY TO EMER UPON hiE �_�
� ABOVE-MEMIONED PROPERTY FOR:"cocr.ripN PURPOSES.
Z COMMENTS
� ' ^
-� �� ��.� ��.sC�S
�
m PERMITTEENAN�� � �
Q
UJ `
Uj SIGNAiL��vr reHn� DA7E
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De rtment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File �
Pa PY, DY. pY. Copy.GREEN—ApplicanCs Copy
I
?+ly�. �',�*1 !Ja; ;"3 �::� �, _-'
Ma9: 4 2' e I x t�]v�. ..i . r.
� ,-��. rr.s� ^��"'n� ,1
+!LY•..s��I�t..s M1.'J��C�� i���:�..��C.f. 'I F..
.\-.� . - T�'- ..�.T" _ ., .r.— �.. P€ �3 _.—r t+. _'�t--r�i ��� ��
� a�l�-�a.f ,�..:f } � .R.� i 1 1 i-.-.,1 a.::� � ir�. .: t ,r �`�-}—. ���,i �1� �r :Yq '��r.1.�' �Ys� 1 ���v�� o ��'�aP7��'� i
F i k[A � rF � !F� °� �_ �fr � `iY�t r'� .���{w��5,�_ � .e 4��k� £^ i:Kx a t,d t� a -r �u q �-_��,r `,��� E;�
__...,z,�� ;, ;!• •+'� �_..�_z.:s.._._�.�(s-.,._:: ._.-.'.."'v.._,a..�_�...n.a.,_-.:-�„�L,.,...__._....._ � .�=..�.��--..�.�_c'L..�...___�..z.._.�n�-`i.-ei=.
� _ i .� ...t� . ,
'�.,... �!...._� ..s_..,.,,.,:� _ .:.:.;_ . �._.., �. ._«_ �_I
r Er El�,C I� ' � -!G'�'R IUIST
� � �
f . -. . .___.___: t ---. . _....._ ____ _._ ._ _ _--- � --=- ..__. .. .. -- - ' -- - -} --------- - - ----
_ ' _. .._ � I
F re�i%oh.rv�7isrtr-� , � . i ; ;_Fh�,5�0�,,-�Ts ' -- --- -
-._ _ � _ _-- -- ---------- -
_ ____ _-- ------.. _. _._... �.._ __--..__.._. _ . ----- ,.
����,-nic r,Fo�.�r�.�[7, .� � i �;JND�I fl U�)R��UCT ..-- �--- I '`�...r�
—'__—'—_"__ . ' i __ . _ _..._'__"" .._ ...._._.—_� ____ '..._ ._.__ T .__._i...--_--_——
GRrU�•!DPLiJf�qBIf�G �, -- �-- _------ ---- � FUhdGERfL00n�_01�!UUIT_._._�-------�
------------- --- --- - - -
T--- � i;=1R�PLAC[FOUI�ir,ATIOP.! ;
SL�B GRAUE � � I - - J �------------- -- �-- -
TEN1P POV��ER ----------�.---------r-----------------� i FIREPL�\CE BU�dD HEAtvI --�_-
- ----1----- __��
�f��ATE�SERVIrE --- '- - i -- i !PJ�ID FiT.B01•,(D 6�F�f41 __
ROOF SHEATi-II�•.!G __ �-- ---�--- ---J !8�C BUND BEANi -----I ,
FRP:Il�11NG!�lEfd I ILA.TIOh! ; { �FIIJAL BOhdD BcF��I
-------- ------
------------------------------------ - -----------------------
P,OOF COVER � ! j PRE_GRADI�lG
------ -----
-- ---..--------------,.------------------- — ,
--------- -----------------
ROUGH HEATIfJG ; j _ I +DENCHIPJG ------------- -_^-------- --.--
------------i----- ------------—- ---— —1 �—
ROUGH ELECTRIC i I � :r",OUGf-i GRADING
ROUVH PLUM61h1G L � I i FINISN GRADING
SF104�lER/TUa TEST ' , i PGOL ELEC I RIC __
�----------
-,------- �
EX�C LATH/51DIfJG ; �___ —� !POOL FENCING
4VALL INSULATIOI�J � � �FOOL FI�lAL I
.._ t
-f------;--------
CEILI^JG I�•ISULATION _ i _ __ I _ ;OFF SITE 1�-1P5.
DRYWALL NAILII�G j ;Gf-DICFTIUNS
-----------
------------------- ----___----------- ------ - - -------
, r——- ----—_..-----—
SE�1JER � �FINAL E�lG.
----- ----------------�----------' ---- =--------.._..----- --- ---------
�--------------- --- �
SEPTICTAPdK — ;�A.fdDSCAPE/IRRIG_
SEEP PITiL.L.-------- _-- j----------------- �ON SITE Ii1�P5. -- ------ ---------
GF�S AIRTEST � ` �FINAL ZONING
FINAL CGNST. �� ;FIRE DEPT.FINAL
FI�AL HEATI�JG i • � rl-IEAI_TH DEPT.FINAL
FINAL ELECTRIC -�—i �DFV.FEES PAID �
�
FINP.L PLUM[�ING , i FPdERGY
fl(dAL PLANING ! ' r- — r ------ ------.------
--------- - - --._._ ---------- - ---
FINA,L ENGINEERI�IG ---j _— `'����`����� r�:. : ----- --------—----------
CC�MMENTS ----- ----- ------ --- --- ---'=-
SEPTICTANK SIZE
SEEP PIT/U SIZE ------- -- ---- -- -------- --
��� '+ �l�� -------- -- -------- ------- ----- ----------
�
�;f 4������ .= — ---- . ------- --------- -- - ----
�
� �:�4 .
� :.� .,�Y- - ------------ _------- --- -- -----
_.; _�., - _
:_��- �E - --------- --- -
� �,, � -- ------- ---- -------
_ _'�„� {� -
� �` ------------- ----------- ------- ------ --
_ 4
� �Q:` . --'—"—_--_'___'_— ______ '— -- '—___
�" _ -- �
- '�- . `P":�-.._t; "� ...� --__"—_—_'__ — -- __—'____ "—_ ,