HomeMy WebLinkAbout12-945 �;�_ CITY OF DIAMOND BAR ' ��
���
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _r�
21825 Copley Drive,Diamond Bar,CA 91765
I (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS
"��' BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE APPLICATI PERMIT '/�� C� p/C
� ADDRESS � DATE .S �c+�. NUMBER !/� / # ��.
o ISSUE TYPE OCC
^° APN � LOT TFjACT DATE g�, I �a"' CONST. GROUP
p OWNER OS� G/I�f]rI��
ADDRESS I� ZONING SETBACKS
� FRONT q�y p
Z CITY ZIP TEL. �
p APPLICANT TEL. S DE/SIDE STREET RW ❑
z
� CONTRACTOR i � �' G//f/ SIDE ❑
� ADDRESS PROPOSED USE P /� G�'/ .
� CITY �.�f Q ZIP L. �
o ARCH/ENG/ OOf�
z DESIGNER �` .
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENAL7V OF PERIURV THAT I MI E%EMPT FROM THE CONTRACTORS LI� G8f8JB/C8fj10fl
W CENSEUWFOR7HEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCINOR (n
U COUNTyWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w NRE,PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STA7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAN7RAC70F5 LI- �
� CENSE LAW(CHAPTER D(COMMENCING WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PRO� POOUSpO
� FESSIONS CADE)OR THAT HE OR SHE IS ExEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� . .
V TION.ANVVIOLATIONOFSECTION7031.5BYANVAPPLICANTFORAPERMI75U&IECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
0 ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIHSOLECOMPENSATION, � Commercial
Z WIIL DO THE WORK,AND THE STRUC7URE IS NOT INTENDED OH OFFERED FOR SALE(SEC.701�,BUSI- J
� NESS AND PROFESSIONS CADE:THE CANTRACTOfiSIICENSE LAW DOES NOT AFPLV TO AN OWNER OF � �
7ROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CC 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NO7INTENDED OR m
Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCqMPLE�
z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
�y,� OI,ASOWNEROFTHEPROPEHTV,AMEXCLUSIVEIYCON7RAC71NGWITHIICENSEDCANTRAC70R5
� TO CANSTRUCT THE 7RQIECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CON7qACTORS�LI- V81U8�iOn ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONTJER OF A PROPER7Y WHO BUILOS OH IMPROVES THEREON,AND
� MM1iOCON7RACTSFORSUCHPRQIECTSWITHACONTRAC70R�5�LICENSEDPURSUANTTOTHECAN7RAG . QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.). -
� ❑I AM EXEMPT UNDER SEC. B.8 F.C.FOR TFIIS REASON Q
� „ U
� �
DATE OWNER �
Z W .
� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENPLTY OF PERJUPV 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � '
d e(COMMENCING WITH SECTION 7000)OF DIVISION J Of THE BUSINE55 AND PROFESSIONS CODE.AND Z
MY LICENSE IS IN FULL FORCE AND EFFECT.
B� m
� LICENSE CLASS LIC.NO. /// j ,
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DE LARATION Q �
� I HEREBV AFfIRM UNDER PENALTV OF PEiiJURV ONE OF THE FOLLOWING DECURATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CANSEN7 TO SELF�INSURE FOR WORKERS' _
CAMPENSATION,AS PROVI�E�BY SECTION 3700 OF THE LABOR CODE,FOH THE PERFORMANCE U
Q THE WORK FOfi WHICH THIS PERMIT IS ISSUED. � _
� �AVEANDWILLMAINTAINWORKERS'CAMPENSATIONINSURANCE,ASRE�UIREDBVSECTION
Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��
ISSUED.MV WORKERS'C PENSATION INSURA �CARRIERiN�ICV NUMBERARE: CONSTRUCTION
¢ ���e ��
�j , CARRIER /y �B PLAN REVIEW
Z POLICV NUMBER % v � ELECTRIC
Q ,/'_
� (i}iISSECIIONNE�NOTBECOMR.EfEDOF7HEPEW�VTISFORONEFNPDREDDOLLARS(S10D)ORLESS). PLUMBING �p
W
Z I CER7IFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,rJ SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE "
Uj . WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME � INSPECTION FEE
? , SU&IECT TO THE WOR RS'COMPENSA710N PROVISIONS OF SEC710N 3700 OF THE LABOR ''''/�7
CODE.I S LL FORT TH COMPLY WITH T�HQ SE PROVISIONSy. � ISSUANCE • ( /
p DATE: � LICANT: l_Ji �!/L� �/�/(/ �'�' SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS 11NLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT �
DOLURS(1100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ^
� SECTION 37oB OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: .CJ�
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERF-0(iMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.�.
Z
W
� LENDER'S NAME �
F– LENDER'SADDRE55
� O
. w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES � �
� I AGREE TO COMPLV WITH A�L CITV AND COUNTV ORDINANCES AND STATE UWS REIATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7NIS COUNTV TO ENTER UPON THE �
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PUAPOSES. COMMENTS '
� V . f GI � �+
�
m PERMITTEE NAME(PRINT � ' �
� � ��
� SIGNATURE ITTEE DA7E � �
= RECPT.NO. l���P� PAIDBY a1�E�'o'�g�/ALIDATION
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanCs Copy
CI�Y OI� DBA►6Vdf)�� ��►R
INS�IEC�BOi� RI�CORD
„, �� f>9, . „ ,
(�C�I`��O{�� � ' ° � ' � e ' ° •
e .
� - � - ��
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
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 FENCING
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
t 7i..�..
`�.. � y� �rY {r `i� .
f-
COMMENTS ��L�__�3.—'�
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�{k -- - - -
� �- �,�� =�
��� .,��
��� ��� - -- -
r� �,� ,f'.
�;�,,�
z ,, �
:�,�
t� � .����
�
N= 4 �' � x,2�
�jPf� 4µi` ` {�/�4
�iicY.
�'`.:� � i �s�� .
,, �,k;E