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HomeMy WebLinkAbout10-1090 _ _ _ _ _ _ — � ��'{.J _�f�_ CITY OF DIAMOND BAR ���j �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERV U 21825 Copley Drive,Diamond Bar,CA 91765 ������� '� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 4%9��W BUILDING PERMIT APPLICATION Y � JOBSITE Z � �j�p ��R C HI L(„ �•�, DATE'CATION NUMB T �� O�/C o ADDRESS ISSUE /�>'7 G�/f� TYPE OCC � APN LOT TRACT DATE / �a � CONST. GROUP o AODDR SS T� C S � ^ ZONING SETBACKS 0 2{ / C 7 Z CITY �/ ZIP ���,� -S - ( REART RW Q o APPLICANT���.�L[� TE SIDE/SIDESTREET RW ❑ Z SG�✓f SIDE ❑ � CONTRACTOR � ADDRESS PROPOSED USE � CITY ZIP L. � w AFiCH/ENG/ �� DESIGNER NO.DWEL. NO. NO. ADDRESS UNI7S STORIES BEDROOMS � C�7y 21P TEL. N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 1 HEREBY AFFIRM UNDER PENALTY OF GERIURV THAT I AM EXEIAPT FAOM 7HE CONiRACTORS LI- G8f8QB/CB�Oh W CENSEUWf-0HTHEFOILOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCOOE:ANYCITVOR (n U COUNTYWHICHRE-0IJIRESAPEHIAITTOCANSTHUCT.AITEA.1A1PftOVE,DEMOLISH,ORREPAIFANYSTRUC- W patlo/Deck ' Z NFE,PRqR TO RS ISSUANCE,IL50 HEQUIRES THE APPIICANT F-0R SUCH PERMIT TO FILE A SIGNED w Iw STATEMENT THAT NE OR SHE IS LICENSED VURSUANT TO THE�ROVISIONS OF THE CONTRACTORS LI- ' � CENSE LAW(CNAPTER B�CAMMENCiNO WITH SECTION 7000)OF DIYISION 3 OF THE BUSINESS AND PRO- � POOVSPB � FESSIONS COD�OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLE6ED EXEMP� � � TION.ANY VIOLATION OF SECTION 7o3t.5 BY ANV APPLICANT FOR A PERMIT 5U&IECTS THE APPL�CANT TO Z qe-Roof � A CML PENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLURS(f500).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITNWAGESASTHEIR50LECOMPEN5A710N, � ComrtlBfCi81 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT IMEN�ED OH OFFERED FOR SALE(5£C.7W i.BU51- J � NESS AND PROFESSIONS CODE:TNE CANTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV NRIO BUILOS OR IMPROVES THEREON,AND Nh10 DOES SUCH WORN HIMSELF OR HERSELF OR m Q TF/ROUGH HISOR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR W OFFEREDFORSALEIF,HOWEVERTMEBUI�DINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMRE- � TqN,THE OWNER�BUILDEH N�LL HAVE 7HE BURDEN OF PROVINO THAT HE OR SME DIO NOT BUILD OR Z IMpROVE FOR THE VURPoSE OF SALE). _ ❑I,AS OWNER OF THE PROPERTY,AA/EXQUSIVELV CONTRACTINO WITH LICENSED CONTMCTORS � TO CANSTRUCT THE 9ROJECT(SEC.7oa�.BUSINESS AND PROFESSIONS COOE:THE CONTMCTORS LI- V0IU8tWn ADJ.AAEA � CENSELAWDOESNOTAP7LYTOANOWNEROFAPROPERTVWHOBUILOSORIMPROVESTHEREON,AND . WFIOCONTRACTSFOFSUCHPROJECTSWIhIACONTRACTOR(S)LICENSEDPURSUANTTOTHEGONTRAC� �IUANTITY DESCRIPTION FEE 70R5 LILENSE L+�W.}. 0 O I/JA E7(EMPT UNDEF SEC. B.8 P.C.FOR THIS REASON � � � LL DATE OWNER V Z W � LICENSED CONTRACTORS DECLARATION � � W I HEREBV AFFIRM UNOER PENALTV OF PERJUFV THAT I AM LICENSED UNDEF PROVISIONS OF CHAPTEA Vr d D�COMMENCIN(I WITH SECTIOh!7000)OF DIVISbN 3 OF TME BUS�NESS ANO PROFESSIONS CODE,AND z X MV UCENSE IS W FULI FORCE AND EFFECT, m lLl ,A � LICENSE CLASS� –"� LIG NO. � �� � ' � V DATE�O � ���_ CONTRACTOR � a W � WORKERS'COMPENSATION DECLARATION U f�C �, N 1 HEHEBv AFFIRM UNDER PENALTY Of PERIUPV ONE OF THE FOLLOWING DECUAATIONS: Z f c ' � / L�/uj � Q � I HAVE M1D VJiLL MAINTAIN A GEATIFICATE OF CONSENT TO SEIF�INSURE FOR WORKEFS' _ � LOMPENSATION,AS 7ROVIDED BV SECTION 3700 OF THE IABOR CODE,FOR THE PERFORMANCE w OF 7HE WOPK FOR WHICH THIS 7ERMIT IS ISSUED. � � �� w " 1 HAVEAND W�LL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRE�BV SECTION Q 370�OF THE UBOR CODE,FOR THE PERFORM/JIC£OF THE WORK WR WHICH THIS PERMIT IS ISSUE�.MY�WOR�)�(E�RS'CAMPENSATION INSURA7JCE CARRIER AND POLICV NUMBERAAE: CONSTRUCTION jCARRIERYI/C!'�CSI ,�v9T�o�9G INS- Gp . - pLANREVIEW 0 POLICV NU BER f ELECTRIC � Q Q (J}{�SEC1qNNE�NO7BE�EDOF71iEPEW.iTISFORONEFNI�DAF�Od.LFRSlf70o1�LE55A PLUMBING �--,e� w MEC - � v Z I CEHTIFY THAT IN 71-IE PERFORMANCE OF THE WOR7C FOR WHICH iH15 PERMIT IS ISSUED,I � SHAIL NOT EMPLOY ANV PENSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE INSPECTI ON FEE � WORKERS'COMPENSATION U`N3 OF CA�IFORN10.µD AGREE TH T IF I SHOULD BECAME �`��� S SUBJECTTOTHEWORKEAS'COMPENSATIONPROV SOFS IOW7700OFTHELABOR CE ��— CODE.I HALL FOHTM4ITH COMPLV WITH TNOS VISION O SMIP DATE: b � APPLICANT: � w / ENERGY P/C J WARNING:FAILURE O SECURE WORNEAS'CAMP SATION CAVERAG IS UWFUL,AND SHAILBE � SUB.IECT AN EMPIOYER TO CRIMINAL PENA�TIES Ml�CIVII FtNES UP T NE HUNOREO THOUSANO ENERGY PERMIT DOlLARS(f 700,000).IN IDDITION TO THE COST OF COMPENSATION.DM�AGES AS PROVIDED FOR IN , J^� J SECTION 3708 OF THE LA80R CODE,INTEREST,AND ATTORNEYS FEES. RETENTION FEE: ��� � � w CONSTFUCTION LENDING AGENCY PRE-ALT FEE: d � 1 HEREBV AFFIRM UNDER PENAITY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV � FOR THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED(SEC.9ao�,CIV.C.). ' Z W � LENDEF'S NMIE F- LENDER'SADDfiESS • �b � I LERTIFV THAT I HAVE REAO 7HI5 APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CARREGT. TOTAL F E ES a w I AGREE TO CAMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS REUTINO TO BULLDINO � CONSTRUCTION.AND HEREBV AUTNOLI�ZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � ABOVE�MEMpNED PROVEF7Y FOR INSPECTION PURPOSES. . Z COMMENTS � �va �►�,./ L�u s�v�c� ��'/'� . ¢ PEfiMITTEE NAME(PRIPIT) ; � �v� Z� � /� N SI�NATURE OF PERMITT DATE � RECPT.NO. PAID BY ' VALIDATION E—DepaAmerit Copy,YELLOW�inence Capy,PINK—Assessor Copy,GOLDEN OD--FIIe Copy,GREEN—Applicant's Copy �.�,�-,�--,r-�.'�.-� (rr,�;�r-y,�.� CIT'V O� [)I�NiOND �AR - !a t.: : � � . •, , f; � - . ;..� If�SP�CT00i� �i�CORD � . , ; 4 � ,.:... e. �. . � . . "�� ��� ' oGJ'�' ``� 01�I�pC�C��p � ' Oa�3pCC�5�00[� ' DGJ'u� Da�pC�C�G1 ��� SET BACK FLOOR JOIST FTGS/FORMS/STEEL � FHA REQMTS ELECTRIC GROUfVD UNDER FLOOR DUCT GROUND PLUMBiNG UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BONO BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTlLATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHIfJG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlTUB TEST POOL ELECTRIC EXT. LATH/SIDING PQOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION QFF SITE IMPS. DRYWALL NAILING DEDICA7fONS 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 ��o � COIVIMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a. � � ��� o