HomeMy WebLinkAbout10-1092 _��„`_ , 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)839-7027 PRESS
"�"" BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE 1n I
¢ ADDRESS Z�--S�Z- G'QA\ �. APPLICATION PERMIT p/CJ'
p � DATE i O NUMBj�O�/�9�# !O�IO �
� ISSUE � TYPE OCC
APN 4OT� � TRACT DATE '� CONST. ' �� GROUP
p OWNER (Z.Ol7!'Y�b.��]Y1C9 \
� ADDRESS � 0. � ZONING SETBACKS �
Z CITY � � F.�'�Z�IP,�L'll�� TE �iD�1 FRONT ZZ RW �
o APPLICANT hV14's�1r� `.i�� rLa/1 TFI I CA_1R1• f n_� ��� REAR p
Z SIDE/SIDE STREET ` RW ❑
� CONTRACT C1� SIDE ��- ❑
ADDRESS I d � +� �
� CITY d ZIP Il TE . - � PROPOSED USE �S � ��l� �C�.
o ARCFUENG/ 0 f... ,� . �� e
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
cn •
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFlHM UNDER PENhLN OF PERJURV THAT I AM EXEMPT FROM THE CANTRACTORS LI� G3f8gB/CBfpOR
W CENSE UW FOR THE FOLLOWING REASON(SEC.7o31.5 BUSINESS AND PROFESSIONS CADE:ANV CITV OR (n
U COUFfTVWHICHREOUIRESAPEFiMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W
w NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Pat' eck � Oeh//1
STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll�
V�
� CENSE LAW(CHAPTER B(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS ANO PRO- � POOUSpB
� FESSIONSCODE)ORTHA7HEORSHEISEXEMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
V 710N.ANVVIOU710NOFSECTION7o31.58YANYAPPLICAN7FORAPERMITSUBJEC75THEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLAFS(f5ao�.):
Z ❑I,ASONTlEROFTHEPROPERT/,ORMVEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � CORIrtIBfCi81
WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70��,BU51- J
� NESS AND VROFESSIONS CADE:THE CON7RACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF �
— PROPERTYNRiOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDFORSALEIF,HOWEVER,7HEBUILDINGORIMPNOVEMEN71550LDWITHINONEYEAROFCAMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSNELV CONTRACTING WITH LICENSED CONTMCTORS
W
[[ TO CANSTRUCT THE PRQIECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI- V8IU8flOf1 ADJ.AREA
W CENSEUWDOESNO7APPLV70ANOWNEROFAPR07ERTYWHOBUILDSORIMPROVESTHEREON,AND
� NM1iOCAN7RACTSFORSUCHPRQIECTSWITHACANTRAC70H(S)LICENSEDPURSUAN770THECONTRAC- QUANTITY DESCRIPTION FEE �
Y TORS LICENSE UW.).
� ❑I AM EXEMPT UNDER EC. B,8 P.C.FOR THIS REASON Q '
� U
� �
DATE OWN F–
� w
� LICENSED CONTRACTORS DECLAAATION W
� I HEREBY AFFIRM UNDER PEN/�LTY OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� 9(COMMENCING WITH SECTION 7000)OF DIVI510N 3 0F THE BUSINESS AND PROFES510NS CODE,AND Z �
�� MV LICENSE IS IN FULL FORCE AND EFFECT. m
� UCENSE CLAS LIC.NO. � 1 � j
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLIOWING DECURATIONS: Z
Z _I HAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q CqMPENSATION,AS PPOVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED. �
w �I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PEHMI7IS � . �]
ISSUED.MV WORKERS'CAMPENSATION INSURANC CARRIER AND POLICV NUMBER ARE: CONSTRUCTION /� �
Q ". �
� CARRIER C LAN R VIEW � D
ZPOLICYNUMBER [_ti1 =, ~6Z-- ELECTRIC
Q
� (MISSECTIONNEmNOTBECOMPLEfEDOFTHEPEMY�ISFORONEHUI�D{iEDDOIIl�fiS(5100)ORLESS} PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(3 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSA710N UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
= SU&1EC770 THE WORKERS'COMPENSATION PR9 ISION F ECTION 370o OF 7 BOR `
CADE.I SHA FORTHWITH COMPLY WI 7}10 E F SS AN �J.
� � .�f�/
p DATE: � APPLICANT: / �P • /`�►'
J WnRNING.FAILU E TO SECURE WORKEfiS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5700,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SEC710N 3708 OF THE LABOR CODE,IN7EREST,AND ATTORNEY'S FEES. RET ION F f I�
OCONSTRUCTION LENDING AGENCY E-ALT FEE:
� 1 NEREBY AFFIRM UNDER PENAL7Y OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY ��/L / ��
FOR THE PERFORMANCE OF THE WORK FOR HICH TH PEHMIT IS ISSUED(SEC.3097,CIV.C.). � � f
Z
W
� LENDER'S NAME
F— LENDER'SADDRE55
� TOTAL FEES ��� �j� ��L
� I CER7IFV THAT I HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE INFORMATION IS fARRECL _ �/�
w I ACaREE TO COMPLY WITH ALL qTY AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING f �v'_
� CANS7RUCTION,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON THE �//�����/ �ctJ�
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. L.��
COMMENTS
� p
J
� ,
m PE ITT AME PR ) �
� lcs Z
� SIG O PERMIT.�EE ATE -
= RECPT.NO. PAID B VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROa-File Copy,GREEN—Applicant's Copy
�I�V �(� ��AVVi�i�9� �Aff� . ,
B�Sf�I��YUO� @�EC��B�
._ - _ � � ' - : . .
:�= Oa�pC�C�400a DQ4C: ��,Q�C��C�40G3 � ;, O[�1�pCC�4QOG] DGJ4� . -_� �OGG�J��P�� � � ��;;
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'L 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
SHOWERITUB 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
���� .
COMMENTS
� � 0 � 2 0 ���.. ( zz � o r--
���� � ,-�,,a�� .�
�, — - --- — -------------------
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a --
� �
�