HomeMy WebLinkAbout11-1025 , ���_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
�:�
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 PRESS
"�"' BUILDING PERMIT APPLICATION FIIRMLY I
} JOBSITE • /�,, APPLICATION PERMIT p/C I
o ADDRESS 3 Z� �(p����• ��4MPn(�4jQl t-I�9�Io DATE NUMBER � � � # �
°^ APN LOT TRACT ISSUE �� / 7YPE OCC '
� DATE CONST. e GROUP �
p OWNER Y- ^
� ADDRESS b ZONING ETBACKS
0
z CITY � M h IP�� TEL Z� b FRONT qyy p
� APPLICANT TEL. REAR p I
� SIDE/SIDE STREET RW ❑
¢
� CONTRACTOR SIDE p
ADDRESS
� CITY ZIP TEL. PROPOSED USE
w ARCH/ENG/ i
z DESIGNER
a ADDRESS NO.DWEL. NO. NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMP7 FROM THE CANTRACTORS LI- G8f8gB/CBfPOff
W CENSE UW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CADE:ANV CI7Y OR (n
ZCIXINTYWHICHREOUIFESAVERMITTOCONSTRUC7,ALTER,IM7ROVE,DEMOUSH,ORREPAIRANVSTRUC- W patio/Deck '
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMI7 TO FILE A SIGNED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70RS L6 � ���
� CENSE LAW(CHAP7ER B(CAMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSP3 �
� FESSIONS CODE)OR 7HAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (�
710N.ANY VIOLATION OF SECTION 7031,5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICAN7 T0 Z Re-Roof I
A C�NALTY OF NO7 MORE THAN FIVE HUNDRE�DOLLARS(5500).):
ZI,ASOWNEROFTHEPROPER7Y,ORMYEMPLOYEESWITHWAGESASTHEIFSOLECOMPENSATION, � COrt1RIBfCiel
WIL HE WORK,AND THE STRUCTUqE IS NOT INTENDED OP OFFERED FOR SALE(SEC.70�/,BUSI� J
N NE55 AND PROFESSIONS CADE:THE CAN7RACTORS UCENSE LAW DOES NO7 APPLV TO AN OWNER OF ? � �/
PROPERTYWHOBUI�DSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR �t.(
2 THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMEN75 ARE NOT IN7ENDED OR m � W
w OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- �
� TION,iHE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE ON SHE DID NOT BUILO OR
� IMPROVE FOR7HE PURPOSE OF SALE). 1
w ❑I,AS OWNER OF THE PROPEfiTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
� TO CONSTHUCT THE PR0.IECT(SEC.7o�I,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V21U2110l1 ADJ.AREA
W CENSE LAW DOES NOTAPPLY TOAN ONTJER OFA PROPEHTV WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCONTRAC75FORSUCHPROJECTSWITHACONTHAC70R(5)LICENSEDPURSUANT70THECONTRAC- QUANTITY DESCRtPTION FEE
70R5 LICENSE LAW.).
� ❑I AM E%EMP7 UNDER SEC. B.8 P.C.FOR THIS REASON U e �
� ¢ 1� f
u" DATE OWNER H
� w b 1
� LICENSED CONTRACTORS DECLARATION W �
� 1 HEREBV AFFIFM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
� B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z � �
X`� MY LICENSE IS IN FULL FORCE AND EFFECT. m �1 �
lLJ �
� LICENSE CLASS LIC.NO. � n � ..w n
U
DATE CONTRACTOR a G vv
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AfFIFM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z � ,
� _I HAVEAND WILL MAINTAIN A CERTIGICATE OF CONSENTTO SELF-INSURE FOR WORNERS' a
2
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOH CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � '
Qw _I�HAVEAND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS HEQUIRED BV SECTION
37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WOPK fOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION �
� CARRIER PLAN REVIEW Q/h7/� � �.ZG-�
ZPOIICV NUMBER ELECTRIC
Q
0 (�HISSECTIONNE�NOTBE07lAR_ETEDOFTHEPEWNfISFORONEMII�DREDDOL1AfiS�5100)ORLESS� PLUMBING
Z I CER7IFV THAT IN THE PERFORMANCE OF THE WORK FOFi WHICH THIS PERMIT IS ISSUED,I MECHANICAL �
C} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE 'f
N WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&1EC770 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700�pF THE LABOR � �
CODE I SHA FORTHWITH COMPLV WITH TH 5 P OVISI NS. ISSUANCE
� C.� SMIP �_
p DATE: � APPLICANT.
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND ALLBE ENERGY P/C •
� SU&IECTANEMPLOYERTOCflIMINALPENA�TIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT
DOLLARS(Stao,Ooo),IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN
� SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PREf-f�1LT FEE�y�r� �
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV /L'�/'� �. �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). f .
Z
W
�Z LENDER'S NAAIE
i
F— LENDER'SADDRESS
� TOTAL FEES � ��3.�'�
� 1 CER7IFY 7HAT I HAVE READ THIS APPLICATION AND S7ATE THA77HE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITY AND fAUNTY ORDINANCES AND STATE LAWS REIATING TO BUILDING
� CONSTRUCTION,ANDHEREBYAU7HORIZEREPRESENTATIVESOFTHISCOUNTV70ENTERUPONTHE
Z ABOVE-MENTIONED PROPERTV FOR IN ECTION PURPOSES.
� � ^ (1���� COMMENTS
J �C ��
�
¢ PERMI77EE NAME(P � �� � '
UJ
� SIGNATUREOFPE ITTEE DA
= RECPT.NO. PAID BY VALIDATION
~ WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROa–File Copy,GREEN—Applicant's Copy
�"r I: ;
�.0��, �� ����I�I�� �e�1� F' j � .
0���������. ������ .,.
Oa�pLC�400a DGJ4C� �a�3pGC�40a �a�pLC�400a DGJ4C� Oa3pCC�`tt 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 BOND BEAM
WATER SERVICE � MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRP;MINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROUGH GRADING �
ROUGH PLUMBING Z �1 FINISH GRADING
SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SIDING POQL FENCING ' '
WALL 1NSULATION 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. Q � FIRE DEPT. FINAL
FINAL HEATING i �_� � f �, HEALTH DEPT. FINAL
— �� �'�`�
FINAL ELECTRIC � (. DEV. FEES PAID
FINAL PLUMBING �C� __ ENERGY ___ __
------- -_.___-- -----_ __...._----- — o _.__ ------- ----- ----------
� ���
COMMEfVTS ��� ��v�_�Z
��-g�— � -- —
�
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a - ---- ----
� �
,
a
1