HomeMy WebLinkAbout14-4759 �.�,,.,...���'�� � CITY OF DIAMOND BAR � ' „�` � I I�
` 1;�1, � I I .IA'I DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES� � �a��
''; c� 21810 Copley Drive,Diamond Bar,ca 9i�6s � PRESS
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`;, u y, (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
"��'"� BUILDING PERMIT APPLICATION
g � a � �' APPLICATION DATE: G P/C#
x JOB SITE ADDRESS �/��/a�� Y PERMIT# i'�y?�'4
�
1 ISSUE DATE:
z APN "'�: LOT TRACT
�
L OWNER N u- TYPE CONST. OCC GROUP: I
� ADDRESS .� PC CE[�� T t�
n CITY ZIP TE . ��C, �yF��V ZONING F ONT KS RW ❑
= APPLICANT TEL. REAR ❑
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n SIDE/SIDE STREET RW ❑
� CONTRACTOR � L� �A' 1 SIDE
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� ADDRESS � � " / PROPOSED US Fi�z� f� t{.
� CITY ZIP �EL.�3�s,��b � �
� ARCH/ENG/DESIGNER
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� ADDRESS
� #DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL.
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREA/VALUATION � •
OWNER-BUILOEH DECLAflATION
s SFR/ADD/REM
= I here6y affirm under penalty of perjury that I am ezempt from the Contractor's State License Law for the reason(s) I
� indicated below by the checkmark(s),I have placed next to the applicable item(s)[Section 7031.5,Business and Garage/Carport I
� Professions Code:Any clty ar couMy that requires a permit to conshuct,alter,improve,demolish,or repair,any �
� shucture,prior to its issuance,also reqWres the applicant for the pertnit to file a signed statement that he or she � Patio/Deck i
i is Iicensed pursuant to the provisions of the Contractor's State License Law(Chapler 9)Commencing with Section w
� 7000 of Division 3 of the Business and Professlons Cade]or that he or she is exempt from licensure and the basis for � Pool/Spa I
� the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjecLc the applicant to a civil penalty �7
� Z Re-Roof
T of not more than five hundred dollars(5500). Q
� ()I,as owner of the property,or my employees with wages as their sole compensation,will do(�all of or�1 portions � Commercial I
y oi the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The m I
Z Contractors'State License Law does not apply to an owner of property who,through employees'or personal effort,builds
� or improves the property,provided that the improvements are not intended or offered for sale.If however,the building or I
� improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not built
� or improved tor the purpose of sale.�. I
�
L)I,as owner of the property,am exclusively contracGng with licensed Contrachors to construct the project(Section V8luation 0 Adj.AfeB: I
Z 7044,Business and Professions Cade:The Contractors'STate License Law does not apply to an owner of propert/who
� buildsorimprovesthereon,andwhocontractsfortheprojectswithalicensedContradorpursuanttotheContractors'State QUANTITY DESCRIPTION FEE I
license Law.).
� (_)I am exempt from licensure under the Contractor's State License law for the tollowing reason(s): � , I
� I
zBy my signature below I acknowledge that,except tor my personal residence in which I must have resided for at least one w I
� year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have huilt as an w
¢ owner-builder if it has not been constructed in its entirety by licensed contractors.I understand that a copy of the applicable I
Y law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at � I
� the tollowing Web site:http/www.leginfo.ca.gov/calaw.html. � I
z
= DATE: SIGN: �
— �;, LICENSED CONTflACTOH'S DECLARATION � I
y I hereby affirm under penalry of perjury that I am licensed under provisions af Chapter 9(commencing with Section 7000) I
n of Division 3 of the Business and Professions Code,and my license is in full force and etiect. I
n / a
n LICENSE C S : LIC.NO.: /� �S� 7 � S z I
Z DATE: • CONTRACTOR:_ ����i✓�G"t ,,f/'�,, o.t��_ �
-��-/� I
¢ WOflKER'S COMPENSATION DECLAFIATION" V � . � I
� I HEREBY AFFIRM UNDER PENALTY Of PERJURY ONE OFTHE FOLLOWING DECLARATIONS: r
L `/ x�
? I have and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION:
� Sedion 3700 of the Labor Code,for the performance of the work for which this permit is issued. • p�qN REVI EW:
> I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for, ELECTRIC:
� the performance of the work for which this permit is issued.My Worker's Compensation Insurance Carrier and
¢ PolicyNumberare: '� PLUMBING:
� CARRIER
� M EC HAN I CAL:
� X POLICYNUMBER INSPECTION FEE: {�
n (I}iIS SECIION NEED NOT BE CAMPLEfED IFTHE PFAMR IS F-0R ONE HUNDRED DOLLAAS(5700)OR IESS�. ISSUANCE: ,/-F 7
= I certlly tl�at in the pertormance of the work for which this pertnit' ' ued,I shall n ploy any person in any manner so as to
�
become subject to the Worker's CompensaUon La hat'rf I should become subject to the Worker's SMIP: ,/Yf
J Compen tio provi'ns af Sectian 3700 of the orthwith comply with those pmvisions. ENERGY P/C:
J DATE: � � APPIJCANT:
i ENERGY PERMIT:
� WARNING:Failu to secure Worke' coverage is unlawful,and shall subject an employer to criminal RETENTION FEE: b,��_
y penalties and civil fines up to re housand dollars(S100,000�,in addition m the cost of the compensation,
1 damages as provided tor in ' 3708 ot the labor code,interest,and attorney's fees. PRE-ALT FEE:
7
i CONSTpUCTION LENDING AGENCY BSAF: I-�6
y I hereby aHirm under penalry of perjury that there is a Construction Lending Agency for the pertormance of the work for
= which this permit is issued(Sec.3097,Civ.C.).
�
LENDER'S NAME:
� LENDER'SADDRESS: �
x
i I ceAify that I have read this appliration and state that the above information is correct.I agree to comply with all city and TOTAL FEES
county ordinances and state laws relating to building construction,and hereby authorize representatives of this county to
� enter upon the above-mentioned property for inspection purposes. COMMENTS:
J r� G
�
¢ PERMITTEE NAME(PRI Y
� ^ � ��
:n
x SIGNATURE OF P DA RECEIPT# PAID BY: � VALIDATION:
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
i:fTY �aF DIAMOND BAR
INSPECTIOfV RECORD ` "
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�5ET6;4GK/LEfTER -` �_ , r��, ��� _�� ���� . �� �TRACT AND LEDGER
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FOQTINGS FORNlS��p: ' ���m- ', :: ��� ,: ' !SWITCH GEAR j. —�
;SLAB ��'� ��'�i � ��`°� ,���-� �� „ � � ;COMMERC►AL HOOD
UG.PLUMBING�` _ � � ,' �,�� � `�T-BAR ---- _ ' —. _ �
,UG�ELECTRICAL , �a ' �;a�, ` ���,�; ���E° �°;` - ����. i INTERCEPTER _ I
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,UFE'R�GROUND�_. �: � -:.;�- , '`� ��' �. ,,. ,''�„�M � HOT MOPISHOWERPAN �
SEWER LATERAL � ;SEPTICr'CESSPOOL �
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MAIN WATER LINE j j HERS REPORT RECEIVE� j _
SEWER CLEANQUT ; !QEMOLITION i
ROOF SHEATHING � f ROOF DRAINS
FLOOR SHEATHING �ROUGH CONDUIT !
SNEAR WALLS`EXTERIOR� ��� ' Ra��,� �, "��� '� � ��fi i'PUDI,lSPA€� ;'' �'" �,'� ,� � �� _ i,��...� � �r: �����
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`SNEARWALLSINTERIOR'; ,� � .m..�. � � = ;�.�. _. _ _�� .a ��ROUGH.RLUMBING��= �,�( ;. �� _ �°�..- , :.. "�.
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' R�UGH�ELECTHICAE- =�_
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ROWGH MECHANICAL,.�,�-'���� ' � ,,� __�° � . r`��� . u� �iROUGH MECHANICAL_,� � �� -, :;��,�a,. �_ . �,� •�. ��
ROUGH ELECTHIG,AI.aW{',?���i'��). : �j� , � �� �GAS�IEST ; €:�: ���, .,,� �.�.,.;�m ,� 3�N� ��
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ROl1GhI:PLl1MBING�. M��... �,s ' 4 � ::� PHE Gt1IVITE. _�� �? ; � �� , .,�_
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INSULATION WALL �P(�O�RE�QECiC QONDIN�s,�; _. ^'' . �:��� �r��."' ,,�;,„ ''�` ' �
INSUlATION CEILING I `P���=TRAP ������ ��' �� ��7,���� °��'�
� �� � �.���t� „��, � ��t
DRYWALL � a � v� I i���ENCE lrGATEt�ALARI� u `'a�''��q�� ;. _ �;�� �. ,;
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LATH(PREI �
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�Hh1AL P�OL �� � -° '�
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LATH EXTERIOR : � p � :WALLS:
IATH INTERIOR WALL FOOTING/STEEL
GAS TEST INALL STEEL 15�� 12N0( )LIFT �
SCRATCH COAT p WALL BOND BEAM
ELECTRIC METER RELEASE , ;WALL QRAINi SEAL
GAS METER RELEASE ; !NIALL FINAL '
SPECIAL INSPECTION � €RO FHA(VtING PLANNING�'MPFS iOUAL. s�' ;;��,�,��w . ;, „� r �k.�- , �°'
m, b,. _ ..
FINAI:.�BUILpING, °, ..���- . ,- ''' OI� tYi9 �. ��; �:. „ ,,,°�`+ ,^., , ' 4 R(}UGH,FIi2E APPFt(}UAl ,f, -� a,�;,,Y � t �.�.
FINAL MECHANICAL '.: °} �:h.,. ��M,. .�� . ��; ` '��INAC FIRE DEPARTMENT ;` �„,,,.., ���;��' 3..���' X
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FINAL ELECTRI��CAL` "��... �..��� A �`� " ' ; =FINAL PL�ANNING ��� ` 3. � � ' �, '
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`FINAL PLUMBING �, �..���' � '$�„ ;�;: . <_. ;�� ' � ,�_,. � �����
- �'�INAL�NGINEERINGJ�PW =,. � , ��=
F,�: �a ., y . .
;T.C.of OCCUPANCl'�� >_��� ° .s A _ �,�a FINAL COMMUNITY.SERVICES F�.�,; . ,F , ""� . m_-- : ,�� d � �., �
�CERT.of OCCUPANCY��;:. .. �, �' .�_ _��. �� °"":��� ��_��'�' ;�FiNRI HEALTH DEPT ,,�; �'..� �,�`" ,�„M��� � �"��"�� ;
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COMMENTS: ��✓ �Ir�"`''S �i�� �in� t..J� �•�S � I,�I�,3�(,`t� '
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