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HomeMy WebLinkAbout13-641 � . � ' � '�- 'Ft,� �+ ,=� ��.�..1 � '� -�� �� c9.���� � , �` CTTY OF DIAMOND BAR .!i • � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES t ' 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Notline(909)839-7027 PRESS ' �����'� BUII..DING PERMIT APPLICATION F{RMLY � JOBSITE APPLiCATION � j 3 PERMIT I�Z�I P/C o ADDRESS . � C ��� DATE � NUMBER�7 � o� ISSUE TYPE OCC APN LOT TRACT DATE CONST.��, GROUP p OWNER o ADD ZONING SETBACKS z C{ ,rirB�, ZIP TEL. D• � � FRONT RW ❑ � APPLICANT 1 �Et TEI. �/ D REAR ❑ Z SIDElSIDE STREET RW O m CONTFACTO 0/T L• SIDE ❑ Q ADDRES �/�T.QGC �i5� J. � � CITY �/Y1 , Z�P � TEL�1�/•�73°I dva PROPOSED USE �EC/� �/Cc` w ARCH/ENG! z DESIGNER NO.DWEL. NO. N � ADDAESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION rn � OWNER-BUILDER DECLARATION SFR/AD�/REM O p 1 HEPFBY AFFlRM UNOER FENILTY OF PEA.7JRY THAT 1 AM EJtEMPT FROM THE CONTMCS00.5 L]- Garage/Carport W CF?75EUWFORTHEFOILOWINOREA50N(SEC.7oJI.S8U51NE55AND7ROFE5510N5CO0EANYCRYOR (n . U COl1HfYwHFCNREOUtRESAVERMITTOCONSTiiUCT,ALTEAU/PROVEOEMOU4iOflREPAiRANYSTRUG W PatiolDeck wNHE,PRIOR TD RS ISSUMICE,ALSO REOUIRES 7HE APVLIGWf FOR SUtl1 PERMiI'TO FlLE A St�NED w � STATEMEHT 7HAT HE OR SHE IS UCENSED PURSUINf TO 7HE PROVISIONS OF THE CONfMCTORS lF - � CENSE UW(4iAFTER Y{COMMENCWO MrtTH SECT1oN 70001 OF OIVISION 7 OF THE B1151N£55 ANO PRb u- PaoVSpa . FESSqNS COO�OR iHAT HE OR SHE IS EXEMVT THEREFAOM AND THE BA515 FOR THE ALLEOED ExEMP• � 7pN.,WY VIOIATiq1 OF SECTION 7071.6 BY AN1'APPLICAHf FOii A PENMIT SUBJECTS 1HE MVLICANT TO Z Ro-Rool � A CMl VEIULTY OF tbT A10RE hWJ FNE HUNDRED DOlUAS(isoo).}. � ❑1�30WNEROfTMEVROPERTY.ORMYEMPIOYEE9N!ITHX'AGESASTHEIRSOLECOMPENSATION, 0 Commercial � Z WILL 00 TNE WORK�D TNE STRIICNNE IS NOT INTETl�ED Oi1 OFFERED FOR�ILE(SEC.7aK 8U51� J NE55 ANO PROFESSIONS CODE:7HE COflTRAC70R5 LICENSE UW OOES NOT AGPLY TO AN OYMER oF � PROPERfYNM1iOBUR0.40RIMPROVESTHEREON,ANONMODOE55UCNYKIFKHIMSELFOHHERSELFOR � [[ THHOUCFiHISORHEROWNEMttOYEES,PpOVlOEDiNAT5UU1{MPROVEMENTSARENOTRJTENDEDOR m W OFFEREDFDRSALEIF,HOWEVER�1iE8UILDIN00RIMPROVEMENtI550lDWfTHINONEYEAROFCOM7LE• � � TqN,TNE OWNERAULLDER VALL NAVE THE BURDEN OF.VqOVMG 7W1T HE Oq SHE�ID NO7 BUILD OR Z IM�ROVE fOR iHE PURPOSE OF SAL�: � = O�ASOWNEHOFTHEPROPERTY,AMEJ(CLUSNEIYCONTMCTPIaVrtIHIICENSEDCOf1iRACTORS � W �[ TD CDNS7RUGT THE PRGIECT(SEC.7oal,BUS1NE55 AND PROFESStONS CODE THE CONTTUCTORS LJ- V81U8IIOf1 ADJ.AREA W CENSEU�MOOES�NOTMVLYTOANONTIEROFAPHOPERriWH08UILD50RU1VROYE57HEREON./JN . Z yyrqCpMpACTSGOA5UG17R0.1ECTSWfTHACONfMCfOR(S)UCFNSED7URSUAHTTOTHECOHiMG � QUANTITY DESCRfPT10fJ FEE - ~ TORS UCENSE U�N.1. Y ,J � ❑I AN E%EM�T UNDER SEC. B.�P.C.fOR TWS RERSpJ Q � d �'e� •- 0 � � •_ ��,JL,:.:ll��'��n � lr�.,.,.R.,�. � OATE � a�ER . w O J P i� 0 0 � 0 � 0 ��✓ � LICENSED CONTRACTORS DECIARATION �j q_ . „ 0 � „ qo_ �, o , � J= ,` CC I HEREBY AFFlRN UNDER PEW�17'�OF 7ERIUpY 7HAT I AM LICEHSEO UNDER GROVISIONS OF CHAVTER d i(COMMENC7H3 WITH SECT�ON T000)OF DIVISION�OF THE BUSINE55 N10 PROFESSIONS CODE.FND Z � n.. - � � - /dY IICENSE lSIN FUIl FORCE/JJO EFFECT. m � UCENSE� C �39 . ���.No. l00l0/ � r�%'. • ...�; . V OATE_TZS ��� .__. COMRACTO / a , � � ti.t � WORKERS'COMPENSATI DECL4RATION Q . �`� . ' �t _ � r � I HEREBY�FFIRM UNDER PENAL7Y OF PERNiIY ONE OF TNE FOI.IOWING OEQ�JWATIONS: � . � "—' a 0 _I HAVE AND WILL�1AINTNN A CEpfIFiCATE Of CqNSENf TO SELF-WSUflE FOR WORKERS = '�d- COMPENSATqN.AS DROVI��BY SECTION 77o00F 7HE UBON COO�FOFl THE PERFORMMlCE w OF THE WORK FOR WHltli iH15 FEHAl1T IS ISSUED. � � � �II�VEANDYAILAUIMrMY10Rl(EAS'COMVEN5�710NINSURANCE,ASHEOUIREDBYSECTION J�7 �f O 77ao OF THE L/�BOR CODE.FOR THE FER W PMMlCE OF THE WOfiK FOq WHIOI THIS GERMR IS �C.� �S./,� {SSUEO_MY MKIRKEAS CdAVEN��INSUiWJCE CMRlER MA POIICY NU{ABER ARE: CONSTRUCTION ✓ � �� j CARfiIEA S�7�T�/�D PUW REVIE4V ZPQICY NuueER ELECTRIC ¢ � �sEcnonr�IDwreE�ns��rIDOFnE�rsFoqar�EM�oatu�R�m�oatFss� PLUMBING Z I CEP7IFY THAT IX iNE 7ERFOPMAfJCE OF THE WORK FOR N711CH iHIS PERIAIT IS LSSUED,1 MECHANICAL � LJ SHILLNO7EMVLOYMIYPEASONWIHYM/WNERSOASTOBECOMESUBJECTTOTHE � WORKER5 C04(PENSATION UM/5 OF C!�IiFORNIti Al10 AGPEE TNA7 IF I S}I(%1LD 0£CAME INSPECTION FEE �'}�7 � � SU9IECTTOhIEYWiIXERSCOMPENSATpNPRO ISIONSOFSECTION]7aoOF�p • / / O 1 SHALL RfM1N7M COUP�Y WIiH �SE� VIS�ONS. � ISSUANCE � Y , � DATE �--- . . . .SMIP . Q • LS �3 APPLICA C � ' w ENERGY P1C � --� WAiV11NU:iA4LRE iD SECURE NIORKE 'COMPENSATqN COVEMGE IS UNUWFUI,AND SHALL BE J SUBJECT AH EMPIOYER TO CqIMWIl PENALTIES ANO CML FlNES UP 70 ONE MINORED iYKK15AN� � DOLURS(SI OD,Doo�,IN ADDIl10N TO THE CO51 OF COMPENSATION,DAMAGES AS PROVIDED FDR IN ENERGY PERMIT •a� ¢ SECTbN 37aE OF THE LABOF7 COOE.�NTERESY./J!O ATTOFWEYS FEES. - R�ENTION FEE: w CONSTFiUCT10N LENDING AGENCY PgE•ALT FE�; O lf.C' n�/i �� � I HERE6Y AFFlRM UNDER PENALTY OF GERIURY iHAT 7HERE tS ACANSTAUCTION LENDINO AOENCY ��,�tT�C �� d FOH TME PERWHMANCE OF hIE wORK WR VhilCi/THIS FERMfi IS ISSUED(SEC.]oV7,CN.C.j. W � LENDERS MAME F— LENDEi1'SADDRE55 Q I CERTIFY TIAT I HAVE REM THIS APPIJCATION ANO STATE iHAT iHE ABOVE PlFOAMATION IS CORqECT. TOTAL FE ES �g� �R w IAGREETOCOM7LYWfTHALLCiTY1J3000UNfYOPOtNMlCE5ANO5TATEUNSPEUtiNGT08U7DtN0 � CONSTRUCfION,ANDHEREBYAU�HORIZEREPHESENTATNE50FTHI5COUHfYTOEMERUPONTHE ZA80'VE#IEHTqNED VROPEAT'f FOF INSPECf10N VURDOSES. COMMEMS 0 C �� � J / � QPER � E E(GNHT) ^ " I� , � . . . . tn Y� � IGNATUREDFPERMITTEE D E RECPi.NO. PAID BY VALIDATION ~ YJHI7E-0eparlment Copy.YELLOW--Finance Copy,PINK-Assessor Copy,GOIDENRO�-Flle Copy,GREFN—ApplkanYs Copy �y3'a'l/ 4.1u :I_�i i';a�':�',;�?\I._'� ._];�-1;i•. „ . �����G"..�'i,�„ ,��J~>� . �_...� ,.i �J li��'��i . �,-, � �� �..i I .���� �� �.i� +' �.�a � I �:; .1���� I .�i �l � � �.�� �. . .'ll� =1-`�.ti �I �F(��� ���i n _i JJ� � �i� �:{tl*�J i��.� lit�� � r� �y' ._ . . ._.... ._._...�..,- 'I-_"3'c--`-•_ --= � ...��.-----__.. _. '� _ .:..-'•.-...�._.:.�.4..�...v...�_�..__ .__..,.._.._�. _ _.._.._. .--'-�--�(--�-'---'-=-���. ,_ .,� .-�.;.. . . : . ,,. . . '-._._. _._. ", � .. SET EA:K I FLOOR IOIST I I------ . _ _.. _ , . . FTGS%�nRivlS/iT,i=L '-- � .FH�RFnivIT� -- - . _ -j - - - ----- _...._. . . _. _ _...... . .__ ._ .. _ ._ _ ---- ...__ _ _-- --. .._ ._..--- --�-----r __ _- --..._I -- ELKTI;IC r,:'OUt�JD ' ! ; t_iNpFR�I.00R DIICT ----...-------- - - --=� --------------------------- -- -i �-------------------...----- -- - ._ . � C��ROUI�!D PU.!i,�i.P,IhfC � ; �UI�If�cR FLGOR COMDUIT j -----�--------..---...---�------' -I--- �----�---------� r-_---------�------- - SLAB GR�C.� � � _----.-� ,FIR�PLACE FOUt�D�1T10�1 �--------- TENIPPO�VER -----------------------�---�---------�----- ----� 'FIREPLACEBONDBEANI-----(�-------_. I ��/ATER SERVICE '�ti110 HT.20ND EEAPA I ROOF SHEATHIfJG • 2 FT.BOiVD BEAM � �----- --- ----�- -- -- FRAMI�IG/VEN1lLATIOM � _ _ j FIfdA.L BOND BEAM_ __ _ _ R00_FCOVER_� ---_ --_ -,- -_---_—_-� ----- ;PRE-GRADING -- -• • -------- ----------. ---..____..—_._.. ROUGH HcATI�lG �F.cf�I��iING --------- ---...-----....---- ---- - - ----- ---- ------------------------ -_---- -----------�- --,..-�--------..-- ROUGH ELECfP�IC � i ROUGH GRADING ROUGH PLUMBI�IG �FINISH GRADING SHOWER/TU6TEST _� I p00LELECTP,IC _ EXT.LATH;SIOING I POOL FENCING bVALI I�ISUI_ATION � j POOL FINAL CEILING I��.ISIJLATION �OFF SITE IMPS. DR'(b�/ALL f•I;aILIPJG i DEDICATIONS -•--------...------�--- ----------------�---- --- -- ' -- -------- - ;E�A/ER �FINAL ENG. ---------�-----�-----�-- -- ---------- ------------------ ------------ --- -.._.._.___ SEPTICTANK I LANDSCAPE!IRRIG. ---- ---- ----- —L--------- _._.----------- h ------------------------ . SEEP PIT!L.L. i OfJ SITE IiViPS. GAS AIR TES I ,FINAL ZONIiVG FINAL E6td5�T. l0 �FIRE DEPT.FINAL . FINAL rIEA�I�JG � � �HEALTH DEPT.FiNAL - FINAL ELECTRIC' �' � ' " - � �DEV.FEES PAID fINAL PIIJPABING ' ' �" I EI�IERGY FINAL PLANING . FINAL E�IGI�ItERI�I� ------ ------ ---�- - `� i��:_� - ' �;._"�:;�-.`;� . �' _�= :5� ���. .: COMMENTS � � • SEPTIC TANK 51ZE SEEP PIT/U SIZE :2 _ _ - � I J _ � +�`b� 4 l� ' � ^e-.,�„3 y " . . � . 1��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' � 21810 Copley Drive,Diamond Bar,CA 91765 I (909)839-7020 Fax(909)861-3117 Building Inspection Notline(909)839-7027 PIRESS ' �"'^', BUILDING PERNIIT APPLICATION FIRMLY ` o� JOBSITE . APPLICATIOt� PERMIT� �q I P/C ADDRESS � r' DATE / NUMBE � # � ISSUE TyPE ,�y�� pCC APN LOT ACT DATE. CONST.���b�-- GROUP y� p OWNER � ADD SS � ZONING SETBACKS 0 Z CITY � ZIP TEL. - .� 6 FRONT q�/y p • � APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ z � CONTRACTOR �` SIDE p ' ADDRESS , � CITY ZIP TEL. PROPOSED USE � w ARCH/ENG/ z DESIGNER � ' w NO.DWEL NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � �n DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV APFIRM UN�ER PENALTY OF PERIURY THAT�AM EXEMPT FROA1 THE CONTMCT00.5 LI- GefHJB/CefPOR. W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSAND7ROFESSIONSCODE:ANYCI7YOR (n C-) CIXIHTYNMICHREWIRESAPERMITTOCONSTRUC7.AL7ER,IM7ROVE,DEMOtJSH,ORREPAIRANYSTRUC - � w NRE,VRIOR TO RS ISSUANCE.AL50 REOUIRES TFiE APPLICAN�FOR SUCH PERMIT TO FILE A SIGNED w PatiWDeck � S7A7EMENT THAT HE OR SHE IS UCENSED PURSUANT TO 7HE PROVISIONS OF THE CONTfiAC70RS ll- � � CENSE LAW(CHAPTER o(COMMENCiNG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRa . POOVSp3 � PESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFPOMANDTHEBASISFORTHEALLEGEDE%EM7- (� . . V TION.ANYYIOLATIONOFSECTION7o31.5BYANVAPPUCANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z� qe.Roof � A CIVIL,�ENALTY OF NOT MORE TNAN FNE HUNDRED DOLURS(5500�.): 0 �QI,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSATION, 0 COrt1RIBfCi81 �� - Z VALL DO THE WORK,AND THE STAUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70ai,BU51• J � NESS AND PfiOFE5510N5 CODE:THE CONTRACTORS LICENSE UW DOES NOT A7PLY TO AN OWNER OF � i� PROFEHTY NM1iO BUILDS OR IMPROVES THEREON,M1D WHO DOES SUG1 WORK HIMSELF OR HERSELF OR Q 1HROUGHHISORHEROWNEMPLOVEES,7ROVIDED7HATSUCHIMPROVEMENTSARENOTINTENDEDOR m � / . � OFFERmFORSALEIF,IiOWEVERIMEBUILDINGORIMPROVEMENTIS" �WfTHINONEYEAROFCOMPLE- � Z TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING iHAT HE OR SHE DID NOT BUILD OR / � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,ASONTlEROF7HEPROPEHTI;AMEXCLUSNELYCONTRACTINOWrtHUCENSEDCp1TMCTORS . _ [[ TO CONSTRUCT THE PRQIECT(SEC.7as1,BUSINESS AND PROFESSIOHS CODE:THE CONTRACTORS ll- V01U0I1Of1 ADJ.AREA � W CENSELAWDOESNO7MVLY70ANONMEROFAPROPERiVWHOBUILD50RIMPROVESTHEREON,AND � � � NMOCOMfUCT5FOR5UGiPR0.1ECT5WITHACONTRACTOP(5)LICENSEDPURSUANTTOTHECONTRAG ouANnrr DESCRIPTION FEE . Y TORS IJCENSE UW.). 0 O 1 AM EXEMPT UNDEH SEC. . B.8 F.C.FOR THIS REASAN Q � U � ¢ DATE L� ��J/ OWNER F- Z W � UCENSED CONTRACTORS DECLARATION W � � 1 HEREBYAFFIRM UNDER BENALN OF VERIURV TNAT I AMlICENSEO UNOER PROVISIONS Of CHAPTER � �� ; � � 9(COMMENCINO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINE55 AND PROFESSIONS ODDE,AND Z Xl� AIY LICENSE IS IN Fl1Ll FORCE AND EFFECT. m llJ � � UCENSE CLASS UC.NO. � , V DATE CONTRACTOR d � � -. . . . W � WORKERS'COMPENSATION DECI.i+RAT10N � Q NI HER�V AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z � � � O _IHAVEANDWILLMAINTAINACEHfIFICATEOFCONSENTTOSELF-INSUREFORVIORNE ' _ � Q COMPENSATION,AS PROVIDED BY SEC710N 370o OF 7HE LABOR CODE,FOR THE PE RMANCE �U� Q OF THE WORK FOR NM1i1CH 7HIS PERMI7IS.ISSUED. � - � � _I HAVE AND WIIL MAINTAIN WORKERS�COMPENSATION INSURANCE,AS RE�UI�i D BV SECTION � Q 370a OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WH THIS 7ERMIT IS �^J�/_ I� ISSUED.MV WORKEAS'COMPENSATION INSURANCE CARRIER�AND POLI UMBER ARE: CONSTRUCTION !/� l0 � ' J j CAARIER PLAN.REVIEW '� 0 70LICVNUMBER Z ELECTRIC ¢ o fn+�ssEcrqr�N�rroreeooMnFrIDOFn��utr�swa�Mxor�ooa�aas�siaolor��Essl PLUMBING Z I CERTIFV THAT IN iHE PERFOfiMANCE Of THE WORK fOR HICH iHIS 7ERMR IS ISSUEO,1 MECHANICAL (.�J SHALL NOT EMPLOY ANY 7ERSON IN ANY MANNER SO AS O BECOME SU&IECT TO THE � WORNERS'CAMPENSATqN LAWS OF CAIIFORNII AND GREE 7HA71F I SHOULD BECAME INSPECTION FEE ? SUBJECT TO THE V10FiKERS'COMPENSATION PROVI S OF SECTION 3700 0F THE LABOR � � CODE,I SHALL FORTHWITH CAMPLY WIiH 7TiOSE P OVISIONS. ISSUANCE � SMIP I`� I � p DATE: APPLICAM: ! J WARNINO:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNUWFUL,ANDSHALLBE ENERGYP/C � SU&lEC7AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT ' DOLURS(5700,000),IN ADDITION TO THE C0.ST OF CAMPENSATION,DAMAGES AS PROVIDED PoR IN ¢ SECTION 37oe OF TiE LABOR CODE,IMERF�T,AND ATfORNE1"5 FEES. - RETENTION FEE: a CONSTRUCTION LENDING AGENCY P E- LT FE • �O ' - Q� 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CANSTRUCTION LENDINO A(3ENCY � FOR 7HE PERFORMANCE OF THE WOFUC WR WHICH THIS PERMIT IS ISSUED(SEC.30o7,CIV.C.). Z W � �� LeNDER'S NAME�' - F- IENDER'SADDRESS w I CERTIFY 7HAT 1 HAVE READ THIS APPLICATION AND STATE iHAT THE ABOVE INPORMATpN IS CORRECL TOTAL FEES �S D� � I AGREE TO COMPIV WITN ALL CITV AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING � CONSTRUCTION.AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTY 70 ENTEH UPON THE � � Z ABOVE-MEMIONEDPROPERTV,FORINSPECTIONGURPOSES. \ COMMENTS � O `=' �4 C/�l.L • _ IN RMITTE N PRI ' � •� / `' � . . � `¢ 2! I �� REO RTEE � DATE� = RECPT.NO. PAID BY VALIDATION ~ WHITE—DepaRment Capy,YELLOW—Fine j py,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplkanPs Copy / � CtYY OF D{AfU1�ND �AR • ,. . INSP�CTION RECORD " ��_..� ..�. . . .�. _ - . � �� � . _ _ �,� . ;� � ��� ¢b � _ z . . -. o � t B � -.i�. ' o � � o�p Y.� - • �. � _ •rL�. ?� .. � , '�.. .. . .e " . 0 � � e yu . r .� . �_.�'a a,;n.0� .. , .:�.�._ �� "y.'� ',•:-'-. �,r� - �' .: s . � , . � � � �� � g �� 5ET BACK _ � . __ __� I FLOORJOIST __ __ _______ ---- - — FTGS/fORMS/STEEL � �FHA REQMTS ---- - ---- -------------- --.._.__.---- ----- ------ ._..__._ _ _._.__ ---__ .._._.___ ----- ------ -..____ ----- ._..----- ------ FLECTRIC GROUND � ;UNDER FLOOR DUCT r GROUND PLUMBING �UNDER FLOOR CONDUIT SLAB GRADE ;FIREPLACE F�UNQATION TEMP POWER �FIREPLACE BOND BEAM WATER SERVICE MID HT.BOND QEAM ROOF SHEATHING I 8 FT.BOND BEAM FRAMING/VENTILATION f j FINAL BOND BEAM ------ -------- --------.------------- --- _.._..--- ----- --__._ _ , _..---- ---_._ _.._.__ _.____ ___- - ---- - -.._.__.-_._.__. ROOF COVER _ �PRE-GRADING __ __ _ __ ROUGH HEATING �BENCHING _____...----._..__...------.-._.._._....---------._. ._...__-._..__._-----.._._-._._.__..__ _ - _.------...---___.-------...._._._.------------- _ _----_----- ROUGH ELECTRIC �ROUGH GRADING ROUGH PLUMBING i FINISH GRAOING SH�WER/TUBTEST I POOL ELECTRIC EXT.LATN/SIDING I POOL FENCING WALL INSULATION j POOL FINAL CEILING INSULATION �OFf SITE IMPS. � DRYWALL NAILING j DEDICATIONS _ -- --____---...._..----._...--------------._._._.__------ ----_ ___._-------------._._.____ _..----- _-_------- - --._._ _.__.._____----._._._..... ........... _._...._.....__. _ SEWER FINAL ENG____ _ _ SEPTICTANK 'LANDSCAPE/IRRIG. _..._.. --------_.-- ------- - ...-- ------ --.__-. __.._._.--------- -......__ _._ -- --....__.-_ ._.__ _._.----...------------._.. SEEP PIT/L.L. ON SITE IMPS. GAS AIRTEST FINAL ZONING FINAL CONST. FIRE DEPT.FINAL FINAL HEATING �HEALTH DEPT.FINAL FINAL ELECTRIC j DEV.FEES PAID FINAL PLUMBING j ENERGY FI NA L PLANI NG i _._.__._--.-------._._----------------.----__ ----------------------- -----------------.-------------- FINAL ENGWEERING ' �o � �'� •�° �� C�MMENTS _G�11� Rc�� �/l6� Po��-�At— S�j���---� _I�� � ;P _ _ _____ _____— o�_,r��+��_�1`_' _____/_�-'z_ _�_____ "__�___ _________- _�*-w�.�.,^c:4a�_d.k_�d�- �'-�_1�-�� 1_� --- - ---------- ---- `�� w�.� � �------------ � �� — - . � � . ; "_ ' ' • • � -----___-----_---=��' ----- —���l, --�a,�-�:-_ �__--- -------__ ��_�_a_ -�_� _ -- -----__.-- , SEPTICTANKSIZE SEEP FIT/U SIZE ---------- -------- --- -------------------....----...----... ` ���� � � .#� $y �.. ---- ----------------------------------------------------------- ''� �;����',`1�r.�' �� � -- — -- — �. � ���� t =°'- ,,� T',�r �' � F� A � ;: '�L ,�`4�•4"F�i' ��}�-+R� i"� _.—.._..----------- --�-- �------— --._.._._.... ... ._._.... .._.._...._..—._._...._ _._._...._.__._._....._...___._...._ ...-------...---- +�F � �z� ��� � ----— j �-�� '�'�'k �v' --- --- --- - T _ ,��,� ��� = -�.. � a� ; 1 ���� ;� ------ ----- ----- - . .- ,a �t ,. . �_ �. _._...----.....-------...- ---------._.._._._._._._--._ .._..--- ---- -------...--------------- � `�.- `� a; �"�'R�. -Y:1'r.. �4..;- •escr'iptive Certificate of Compliance: Residentia eroo oject�Address: Climate Zone Permit# . Z!� ,� � � ( OOFING PRODUCTS (COOt ROOFS) §151(�12 'hen fhe area of exferior roof surFace to be replaced exceeds 50%of fhe exisffng roof area, or 1,000 , whichever is less, the new >ofing area must meet the roofng product"Cool RooP'requirements of§152(b)'IHi, 152(b)1Hii, or 152(b)1Hiii. neck applicable alternative or exception below if the roof alteration is exempt from the roofing product"Coo! RooY' requirements:: � Cooi roofs not required in Climates Zones 1-12,14,and 16 with a low sloped roof pitch(less or 2:12 pitch). ] Cool roofis not requiretl in Climates Zones 1-9,and 16 with a steep-sioped roofs(greater pitch tt�an 2:12)and product weight less than 5/Ib/ftZ. lternatives to§152(b)1 Hi and§152(b}Hii,Steep-siope roof(pitch>2:12) O lnsulation with a thermal resistance of ai least 0.85 hr•fi2•°F/Stu or at least a 3/4 inch air-space is added to the roof deck over an attic;or ❑ Existing ducts in the attic are insulated and sealed according to§151(fl10;or ❑ In cfimate zones 10,12 and 13,with 1 ft2 of free ventilation area of attic ventilation for every i 50 ft2 of attic floor area,and where at feast 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or ❑ Building has at least R-30 ceiling insulati�n;or 0 Building has radiant barrier in the attic meeting the requirements of§151(�2;or ' ❑ Building has no ducts in the attic;or ❑ In climate zones 10, 11, 13 and 14,R-3 or greater roof dedc insulation above vented attic. =xception to§152(b)1Hiii,Low-slope roof(pitch <_2:12) ❑ Building has no ducts in the attic. Other Exceptions O Roofing area is covered by building integrated;pliotovoltaic panels and solar theRnal panels are exempt from the Cool Roof criteria. � Roof constructions that have tt�ermal mass over the roof inembrane with at least 25 Ibfft2 are exempt from the Cool Roof criteria. IOTE:If any pne of fhe altemafives or exception is checked fhe Aged Solar Reflecfance and Therme!Emiftance requiremenfs for roofrng �roducts in§118(i)are nof applicable.Do not fill table below. Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number� 5 2:12 >2:12 < 51b/ft2 >_51b/ft2 T eZ f2eflectance3'4 Emitt2�nce SRIS QQ ' 2 ❑ ❑ ;� T� �4 0-�I O�'Z /q ❑ ❑ ❑ ❑ �4 Nofe:If no CRRC-1 label rs available, this compfiance method cannot be used, use fhe Performance Approach to show compliance, 1.The CRRC Product ID Number can be obtained from the GooJ Roof RaGng Council's Rafed Produd Directory at www.coolroofs orv/nroducts/search nho �2.Indicafe the type of product rs being used for the roof fop,r.e.single-ply roof,aspha8 roof,mefa!roof, etc. . !f the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the 9nitial Reflectance value fi�m the same directory and use the equation(0.2+0.7(p;,,,m�—0.2)to o6tain a calcufated aged value. Where p is the Initiaf�olar Reflectance. 4. Check boz if the Aged Reflectance is a calculated value using fhe equation above. 5. Calculate fhe SRI value by using the SRI-Worksheef at htfoJ/www.enenav.ca.Qovlfitfe24/and eMer the resuRing vaJue in fhe SR►Column above and atiach acopy of the SR/-Worksheet to the CF-1R. � o apply Liquid Field Applied Caatings,the caating must be applied across the entire roof surface and meet the dry mil thickness�r coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Seleet the applicable coating: ❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating . ❑ Other NOTE: When a Cool Roof is required, the installing contractor shall complete and submit the CF-6R-ENV-01 for final inspecfion. Declaration Statement • I certify under penalty of perjury,under the laws of the State ot Califomia,the information provided on this form is accurate and complete. • I certify that tlie energy features and performance specifications identified on this Certificate of Compliance confortn to the requirements of Title 24,Parts 1 and 6 of the Califomia Code of Regulations. Name: Signature: � / / lE�- T/LL� - - Company: Date: � � i �. z-� i� Address�,p,�p � ! ��nf �,�jC�� ��� License: l �/// U�v/ / •���M �G� � City/State2ip� � Q�/ PF►one:7/��. 7,�. �j /!'7 � For asslstance or questions regarding the Energy Sfandards, confact the Energy Hotline af: 1-500-772-3300. �\ � ' CITY OF DIAMOND BAR � �-"---��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I . , � 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PIRESS '��"'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE k �a � � 3 �/r'O.S' �YC /; APPLICATIQN PERMIT � �'� p/C �_ o ADORESS DATE ��'I a� (�1 NUMBER��� # `r APN LOT T CT D TEE ��al�.�\\ ONST. GROUP p OWNER 0� � r ' o ADDR SS � ZONING SETBACKS Z CITY � IP�S7EL. �.O 6 FRONT Ryy p p APPLICANT TEL. SIDE/SIDE STREET RW ❑ z � CONTRACTOR /� i G/^ " SIDE p � ADDRESS PROPOSED USE , � CITY ZIP TEL. o ARCH/ENG/ z DESIGNER � w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � u� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDIREM O p I HEREBV AFFIRM UNDEfi PENAL7Y OF PERJURV THA7 I AM EXEMPT FROM 7HE CANTRACTORS LI- Gyf890/CBfPOR W CENSELAWFOR7HEFOLLOWINGHEASON(SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W P8i10/DBCk w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF TNE CONTRACTORS LI- � CENSE UW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � POOVSPB � FESSIONS CODE)Ofi THAT HE OR SHE IS EXEAIP77HEREFROM AND THE BA515 FOR 7HE ALLEGED EXEMP- (� V TION.ANVVIOUTIONOFSECTION7031.5BYANYAPPLICAN7FORAPERMITSU&IECTS7HEAPPLICANTTO Z Re-Roof A CIVIL PENAL7V OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f5oo).): Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSA710N, � CORIrtIBfClal WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFiED FOR SALE(SEC.7oad,BUSI- J � NESS AND PROFESSIONS CADE:THE CONTRACTOFiS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPER7V NhiO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPHOVEMENTISSOLDWITHINONEVEAROFfqMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOH THE PURPOSE OF SALE). \ . w ❑I,ASOVMEROFTHEPROPEHTV.AME%CLUSIVE�YCONTRACTINGWITHLICENSEDCONTMCTORS � TO CONSTRUCT THE PRQIECT(SEC.70�1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VOIUaIlOf1 ADJ.AREA W CENSELAWDOESNOTAPPLY70ANONTJEHOFAPROPER7VWHOBUILDSORIMPROVES7HEREON,AND ' � WHOCONTRAC75FORSUCHPRQIECTSWITHACONTRACTOH(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY D SCRIPTION FEE ' Y TORS LICENSE LAW.). oc J �'1 Q ❑I AM EXEMPT UNDEfi SEC. B.8 P.C.FOR THIS HEASON 3 ,, i �J � –� �e ~ LL DATE� . i I� OWNEH7� ��' � �` . •��;\ • ' r Z �— �- T, �,c � -e �� � PCZ 10 - 'T 31. � LICENSED CONTRACTORS DECLARATION � I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � � e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CODE,AND Z ��� 4Y LICENSE IS IN FULL FORCE AND EFFECT. m � � UCENSE CLASS LIC.NO. � . V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDEFi PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUFE FOR WORKERS' a 2 Q CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE w Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIRED BV SECTION Q 3700 OF 7HE LABOR CO�E,FOR 7HE PERFOFMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS y �� ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION �`.J`� J � CARRIER PLAN REVIEW � POLICY NUMBER Z ELECTRIC ¢ � (i}iISSECfqNNE�NOTBEOOMPLEfEDOFhIEPE{UNfISFORONEMNi)REDOOUAHS(S10o)ORLESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (3 SHALL NOT EMPLOYANY 7ERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE �3 •�� = SU&IECT TO THE WORKERS'CAMPENSA710N P IONS F SECTION 3700 O E LABOF CODE,IS ALLF THWITHCOMPLVWITHTH� P OVIS NS. ISSUANCE �S•� � SMIP p OATE: �� APPLICANT J WARNING FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHAIL BE ENERGY P/C � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(Stoo,00a),IN ADDI710N TO THE COS7 OF COMPENSA710N,DAMAGES AS PHOVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEflEST,AND ATTORNE�"S FEES. RETENTION FEE: \� � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONS7RUCTION LENDING AGENCY � FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7087,CIV.C.). . Z W � LENDER'S NAME H LENDER'SADDRESS � TOTAL FEES �3��3 ��s����a� ►5`�. � � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CARRECT. w I AGREE 70 COMPLY WITH ALL CITV AND COUN7V ORDINANCES AND STA7E IAWS HEUTING 70 BUILDING � � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF THIS COUN7Y TO ENTEF UPON THE ZABOVE-MENTIONED VROPERTV FOR INSPECTION P���ppp OSES. V O � � COMMENTS���/`M�C'�' V`e,�v��'�EJC�_'���✓1 J I/c G �C�P �v s(a y-1�a � �'�r-�,:k �X��,r�-s �.� _ [ � £'^1 � E ITTEfi �NT) � % �/ / � �Q�J r� � Y N 5 URE OF ERMITT E DA7E / 1��� � = RECPT.NO. ��1�W PAID BY N VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Copy \/ �0� 9 �� �OPilYVO�Itl� �P4� .. .� , � � � , � S�S�IEC�BOi� �I�COR� - , , , . , �IY����IN �µ =0 ` '�?,� "� � � m M E � D � � � SET BACK FLO�R 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 BENCHWG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�fUB 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 �� .. _;�E � .«x-. 0 0 �.., .-x COMMENTS �.lw�.�o��r.� - � � - _ � �Y�--�:�N- -��-�+,—��_..�� l-�fdl��� SEPTIC TANK SIZE � SEEP PIT/U SIZE �_. a ����� �.,�� �ti, s, /� ;' F �1�. _ L7. � - � �+ i 4.^"`ti i,�`' ��,:�'� u'f� �A 7, 6 -�j( ir�� 5�� I '> •: � '' ` CITY OF DIAMOND BAR - � rr--� �. --'--��- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/� G�— �)i 1���� . � � 21825 Copley Drive,Diamond Bar,CA 91765 � (� �..w . (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ,'^�'� BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE ^1 c-� � ' APPLICATION PERMIT p/C ADDRESS �22'�pd�/ 6►r'�`✓ C�I _ �I�Q.. DATE_ I�I I I�Po NUMBER�Cu9Q�j # "��� � ISSUE TYPE OCC APN LOT TRACT DATE 1'�I� �E+� CONST. GROUP p OWNER � (' � o ADDRESS D �r S Q, 117�. ZONING SETBACKS z CITY 'W1 . ZIP 1 TEL.�(�-eZ(X�-g��l FRONT Ryy p o APPLICANT TEL. SIDE/SIDE STREET RW ❑ z � CONTRACTOR � ?J' kl r SIDE ❑ QCDDRESS ZIP TEL. PROPOSED USE � 2.�1�-Z l�r TWY+Q, o ARCH/ENG/ � � z DESIGNER J a ADDRESS N0.DWEL. S;(P 1b�10. NO. u� UNITS STORIES BEDROOMS- � CITY ZIP TEL. - � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERJURY THA7 I AM EXEMPT FROM THE CONTRACTORS LI- G8fe90/CBfPOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANYCITYOR (n U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPFiOVE,DEMOLISH,ORREPAIPANVSTRUC- W Pet10/DBCk w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOH SUCH PERMI7 TO FILE A SIGNEO W � STATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � � CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7a0o)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSpO , � FESSIONSCODE)OR7HATHEORSHEISE%EMP77HEREFROMANDTHEBASISFORTHEALLEGEDExEMP� (� V TION.ANVVIOLATIONOFSECTION7037.SBVANYAPPLICAN7FORAPERMITSUBJECTSTHEAPPLICAN7T0 Z g-ROOf � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): Z ❑I,ASONMEROFTHEPROPEfiTY,ORMVEMPLOVEESWITHWAGESASTHEIR50LECOMPENSATION, ❑ CORIrtIBfCl81 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI- J N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WHO BUILDS OH IMPROVES THEREON,AND YA-10 OOES SUCH WORN HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m w OFFEREDFORSALE.IF,HOWEVER,TiEBUILDINGORIMPROVEMEN71550LDWITHINONEYEAROFCOMPLE- 0 TION,THE OWNEFi-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OF Z IMPROVE FOR THE PURPOSE OF SALE). = O I,AS ON?!ER OF THE PROPEHTV,AM EXCLUSNELV CONTMCTING WITH LICENSED CONTRACTORS W � TO CANS7RUCT THE PRQIECT(SEC.70�1,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V81UetlOfl ADJ.AREA W CENSE LAW DOES NO7 APPLV 70 AN OWNER OF A PR07ERTV WHO BUILDS OR IMPfiOVES 7HEREON,AND � WHOCONTRACTSFORSUCHFROJECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.�. , � J � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE � � OWNER' � . Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDEF PROVISIONS OF CHAPTER � � B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z ��� MY LICENSE IS IN FULL FORCE AND EFFECT. m � � LICENSE CLASS LIC.NO. � . �, J V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q I u� U � I HEREBV AFFIRM UNDER PENALIY OF PE0.IURV ONE OF THE FOLLOWING DECU(iA710N5: Z � _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF�INSURE FOR WORKERS' _ Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw _1 HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSUFANCE,AS REOl11RED BV SECTION 370o OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WOHK FOR WHICH 7HIS PERMI715 C � ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION 1y� r �� J j CARRIER I'LAN REVIEW Z POLICY NUMBER ELECTRIC Q � (IHISSECTqNNE�NOTBEOJMR.EfEDOFTF�PEW.IffISFORONEHIN�DREDDOLLPAS(5700)ORlESS} PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALL NO7 EMPLOY ANY PERSON IN ANV MANNE AS TO BECOME SUBJECT TO THE ----� �/j WORKERS'COMPENSATION LAWS OF CALIFO A,A AGREE THAT IF 1 SHOULD BECAME INSPECTION FEE � � SU&1EC770THEWORKERS'COMPENSA710 ROVIS SOFSE ON37o00FTHELABOR /�� '� � CODE,I SHALL FORTHWITH COMPLV WITH T OSE P I NS ISSUANCE tF G1-�` ��` `��� p DATE:�/{[J1 l �S APPLICANT:9� SMIP � \ 1 + 1� J J WARNING FAILURE TO SECURE WORKERS'COMPENSATION C ERAGE IS UNIAWFUL,AND SHALL BE ENERGY P/C \ \�"----L��"/ � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVIL ESl1PTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100,000),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: �' l�� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBYAFFIRM UNDER PENALN OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERF-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. W � LENDER'S NAME � � LENDER'SADDRESS � TOTAL FEES i E'�t�� c7� � I CERTIFY THAT I HAVE READ THIS APPLICA710N AND S7A7E THAT THE ABOVE INFORMATION IS CARRECT. w I AGflEE TO COMPLV WITH ALL CITY AND COUN7Y ORDINANCES AND STA7E UWS RELATING 70 BUILDING � CONSTRUCTION,AND HEFEBY AUTHORIZE REPRESEN7A71VE5 OF THIS COUN7V TO ENTER UPON THE � � � ABOVE-IAENTIONED PROPE TV FOR INSPECTION P POSES. Z ,,�J COMMENTS � �%�',X�' Ve� �l�i'�- � m PERMITTEE NAME(PRINT) ' � Q � = SIGNATURE OF PERMITTEE DATE FiECPT.NO. PAID BY , I G1� ( VALIDATION ~ WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanPs Copy � � CI�V O� DIM6VlO�D ��4R ' , � . ,;= 4 o�s��c�oo� ���o�� , . . . � M �U'���-�!;%�; @ � • � " � � D � • SET BACK FLOOR JOIST � FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT. SLAB GRADE FIREPLACE FOUNDATIQN TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. 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. LATHlSIDING PQOL 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 •FINA�ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY o �'� ���' COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE � � ����f-.��`< � ��,'� �eYe � ':�� 1` ��tr���: ,�- ��n r , ax a�r'. xf fi+ _ � ��-"'�, . � .3 `^��'i• ��,.C�� • ,�,��� x�� � �,. � ;t�+� n ��� ":� F.w�aW'"�^5' Y"",'. M t� �� � ,}t�� �` �i'. i�.} y,iX.. �1ii � n�i 4�'�-. � i' r� �� s � " ' ' �` � CITY OF DIAMOND BAR � ��' ^--�-�— DEPARTMENT OF COMMUNITY&DEV�LOPMENT SERVICES � � � . 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS � "�^' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �r R �I�/# �� } ADDRESS / DATE CATION NUMBER P/C � ISSUE TYPE OCC � APN �LOT TRAC, DATE CONST. GROUP p OWNER /� p ADDFiF�S�S ZONING SETBACKS Z CITYf� OA ZIP��TEL9 FRONT Ryy p � APPLICANT TEL. REAR p Z�• SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR � ✓ SIDE ❑ � ADDRESS PROPOSED USE � CITY ZIP TEL. ' oARCH/ENG/ � ' � r1 I �z DESIGNER NO.DWEL. NO�. NO., �) a ADDRESS /�F7 � CITY ZIP TEL. UNITS STORIES BEDROOMS u� cn - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION 0 � , � , SFR/ADD/REM I HEHEBY AFFIRM UNDER PENAL7V OF PERJURV THAT I AM EXEMPT FROM 7HE CONTRACTORS LI� Gafe(JB/CBfpOA W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROGESSIONSCADE:ANYCITVOR (n U CAUN7VNMICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTRUC- - W TURE.PRIOR TO ITS ISSUANCE,AL50 REDUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck . S7A7EMENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE,CON7RAC70R5 LI- � CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAND PRO- � PooVSpa �,,, Q FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR 7HE ALLEGED EXEMP- C7 I V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLURS(S5oo).): � Z ` ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEINSOLECOMPENSATION, � Commercial ' WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDE�OR OFFERED FOR SALE(SEC.701�,BUSI� J ' � NESS AND 7ROFESSIONS CODE:7HE CANTRACTORS IICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND Vrt10 DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HEH OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m � OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOlDWI7HINONEYEAROFCAMPLE- Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXClU51VELYCONTHACTINGWITHLICENSEDCANTRACTOfiS � TO CONSTRUCT THE�PRQIECT(SEC.�014,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V0IU0�1Of1 � � ADJ.AREA I W CENSE UW DOES NOTAPPLV 70AN ONRJER OF A PROPERTV WHO BUILDS OR IMPROVES THEfiEON,AND '� � WHOCONTRACTSFORSUCHPROJECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � TOqS LICENSE IAW.). , � O I AM EXEMPT UNDER SEC, B.8 P.C.FOR THIS REASON Q . � . U 2 •� LL DATE OWNER U Z W �Q LICENSED CONTRACTORS DECLARATION w 2 I HEREBY AFFIRM UN�ER PENALTV OF PERIURV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAP7ER � � 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAN�PROFESSIONS CODE,AND Z Xu� MV UCENSE IS IN fULI FORCE AND EFFECT. m u� � LICENSE CLASS LIC.NO. j � J V DATE CONTRACTOR a � W I � WORKERS'COMPENSATION DECLARATION � � I HEREBV AFFIRM UNDEH PENAL7V OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNEFS' _ Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOH CODE,FOR THE PERFORMANCE w Q OF THE WORK FOR WHICH THIS VERMIT IS ISSUED. � ' w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION � Q , 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ^� $ J ISSUED.MV WORKEFS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION /�m_ ' � CARRIER PLAN REVIEW ZPOLICV NUMBER ELECTRIC Q � (iHISSECIqNNE�NOTBENMR_ETEDOFiF�PEPMfTISFORONEHUPDREDDOIIARS(S10D)ORLE55). PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE Of THE WOHK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL ' �}' SNALL NO7 EMPLOY ANV PERSON IN ANY MANNER SO AS 70 BECOME SUBJECT TO THE � WORKERS'CAMPENSATIONLAWSOFCALIFOR DAGREE7HA71FISHOULDBECOME INSPECTIONFEE ? SUBJEC7 70 THE WOHKERS'CAMPENSA7l0 ROVI 10 F SECTIO o OF THE LABOR �J CODE SHA FORTHWITHCOMPLYWI HOS SIONS. ISSUANCE C��^� � SMIP DATE:�9�D APPLICANT: wWARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEfiAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECT AN EMPLOYEF TO CRIMINAL PENALTIESAND CNIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: C� G � CONSTRUCTION LEN�ING AGENCY PFiE-ALT FEE: O - � I HEREBY AFFIRM UNDEfi PENALN OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY ✓ �j FOR THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). � Z W ? LENDER'S NAA/E � F– LENDER'SADDRE55 � I CERTIFV TFIAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES � /% o O � I AGREE TO COMPLY WITH ALL CI7Y AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUIL�ING � ( � � � CONSTRUCTION,AND HEREBV AUTHORIZE FEPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTV FOR INSPECTI ruaaosEs. COMMENTS � � m PER TEE PRIN . � � � 9 /U � SI EO EE. ,DATE � " = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy � _ ,. .,b.•., .•��..,'t.9, ,. . .c;e� v. ..iA '�.. . ., .w , i: .. � ' . v ... c c.a. . ? v 4 ,. ;1 . . . . . . . .v. ���� �� ���tl�'��� �{�� � ` : � • I.. � ' �1�����/���Ytl ������ . � � �. �.���:oa�p�c�400a � Qa�� ,��� ���c��a �� at�p���n�a o ��� � ���c�o� �, '�: 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 B�ND 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 PITlL.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 ____ _ __ ---- - --- -------- ���� ° COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a c� � ��_ �:; r. �