HomeMy WebLinkAbout13-916 (7) -�
1f� __ CITY OF DI�MOND BAR� " �
"�"' � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765°
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �
"�^'. BUILDING PERMIT APPLICATION FIRMLY
o� JOBS�TE '\ � Q � �1 �t, �fp�t� �1 � APPLICATION PERMIT p/C
ADDRESS 1 ���� DATE �I•S l� �' NUMBER��#i_ I?j�-C'(1 (o
Q ISSUE ' TYPE OCC
, °-° APN OT T AC DATE � �S��� CONST. GROUP
p O W N E�' �' �.
p ADDRESS � O ZONING SETBACKS
' Z CITY �. y ZIP � TE .'>� � ^
g FRONT R�/�/ p
p APPLICANT ��.ivf�l% TEL. REAR p
SIDE/S�DE STREET RW ❑
� CONTFiACTOR ' L� rL SIDE p
O CDDRESS T ZIP TEL. PROPOSED USE r'D
, o ARCWENG/
�z DESIGNER NO.DWEL. NO. NO.
ri ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
¢ OWNER-BUILDER DECLARATION SFR/ADO/REM C tAy N 0 RN
O
p I HEHEBV AFFIRM UNDER PENALTY OF FEiiIURY THAT I AIA E%EMPT FROM THE CONTMCTORS ll- G8fdy0/CBfPOA
W CENSEUWFORTVEFOLLOWINGREASON(SEC.)o31.5B1151NE55ANDPROFESSIONSCODE:ANYCtTYOR (n
U COUPfTYyi1{ICHREWIRESAPERMITTOCONSTRl1CT,ALTER,IMPROVE,DEMOLISH,ORREFAIRANYSTRUG '
w TURE,PHIOR TO RS ISSUANCE,I150 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
� STA7EMENT 7HA7 HE OR SHE IS UCENSED PUHSUANT TO 7HE PROVISIDNS OF 7HE CANTMC70RS L4 � �
� CENSE UW(CHAFTER 9(COMMENCING WITH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO- POOVSPB
� GESSIONS COD�OR THAT HE OR SHE IS EXEMPTTHEREFROM AND TME BA515 FOR THE ALLEGED E%EMP• �
V TION.ANY VIOU710N OF SECTION 7o3t.5 BY ANV APPLICPNT FORA PERMIT SU&IECTS 7HE AVPIICANT T0 Z Ro-Roal
ACML PENALTY OF NOT MORE THAN FIVE HUNORED DOLLAAS(SSoo�.):
❑I.ASONMEROFTHEPROPER7Y,OqMYEA1PLOVEESWITHI4AGESASTHEIq50LECOMPENSAiION, �
Z WIIL DO THE WORK�ND THE STRUCNRE IS NOT INTENOED OR OFFERED FOR 3ALE(SEC.7oat,BU51• J COR1R10fCla1 �
� NEiS ANO PROFESSIONS CODE:THE CONTRAC70RS IICENSE LAW DOES NO7 AG7LV TO AN OWNER OF �
— PHOPEHTYNM1iOBUIIOSORIMPROVESTHEREON,ANDN?10DOESSUCHWORKHIMSELFORHERSELFOR
� THROUGH HIS OR HER ON7J EMPIOYEES,PROVIDED THAT SUCH IMFpOVEMENTS ARE NOT INTENDED OR m �
Q OFFEREDWRSPLEIF,HOWEVERTNEBUILDINGORIMPROVEIAENTISSOLDWfTHINONEYEAROFCAMPLE-
z TION,7HE OWNER-BUILDER WILL HAVE THE eURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR �
� IMPROVE FOR iHE PURPoSE OF SALE).
❑t,AS OWNER OF 7HE PROPERTY,AM E%ClU51VElY CANTRACTIN(i WITH IICENSED COHTRACTORS
W -
� TO CONSTRUCT THE PR0.IECT(SEC.70a1,BUSINESS AND PROFESSIONS CODE:TNE CANTRAC70R5 LI- V81U0fI0f1 0 ADJ.AREA
W CENSE UW OOES NOTAVPLY TOAN OWNER OFA VROPER7Y WHO BUIlDS 0fi IMVROVES THEREON,AN0 i
� WHOCOMiUCT5FOR5UCH7R0.1ECr5WITHACON7MCTOR(SjUCFNSEDPURSUAHTTOTHECONTRAG QUANTITY DESCRIPTION � FEE . �
Y TORS UCENSE LAW.).
� O I AM E%EMPT UNDER SEC. B.8 V.C.FOR THIS REASON Q
Z DAT OWNER�.__ ` U � �` •
� LICENSED CONTR TORS DECLA ATION �
�
1 HEREBY AFFIRM UNDER PENALTY OP PERIURY THAT IAM LICENSED UNDER VROVISIONS OF CHAPTER �t III
a, B(COtAMENCINO WI7H SECTION 7000)OF DIVISION�OF THE BUSINESS�NO PROFESSIONS CODE,AND
X MY IICENSE 45 IN FULI FORCE AND EFFECT.
w [D
� IICENSE CIASS LIC.NO. j
� s )
V DATE CONTAAGTOR a
� WORKERS'COMPENSATION DECLARATION � �.I av
� U ��,
� I HEREBY AFFIRM UNDEH PENALT/OF VERJUHY ONE OF T}IE FOILOWING DECURATpNS: Z
Q
� _I HAVE AND WILL MAINTAIH A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORI(ERS' _ '
CAMPENSATION,AS PROVI�ED BY SECTION 77000F THE U00R CODE,FOR 7ME PERFORMANCE U
OF THE WORK FOR N?1ICH THIS PERMIT IS ISSUED. W ' '
� �
w _1 HAVE AND WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REOUIHED BV SECTION
Q J70o OF THE IABOR CODE,FO THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7 IS Q
ISSUED.MY WORN:AS'COMPE�ATION IHSURMlCE CMRIER AND POLICY NUMBER ARE: CONSTRUCTION ��1 1�
' J
� CARRIER PLAN REVIEW ^�
� POLICYNUMBER EIECTRIC Jp���
p (M55ECfICNNFIDNOTBECLARETmOFT¢PEPMffISFOFONEMR�DREDO0lLM5(StO�OqLESS} PLUMBING
W .
Z I CERTIFY THA7 IN THE PEPFORMANCE OF THE WOR)(FOR WHICH THIS 7ERMIT IS ISSUED,1 MECHANICAL S��� I
C7 SHN1 NOT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECAME SU&1ECT 70 hiE -.-�. '
V�� . WORKERS'COMVENSATION UWS OF G�1IFORNIA,AND AGREE THAT IF I SViW�D BECAME INSPECTION FEE
= SUBJECTTOTHEWOHKERS'COMPENSATIONPROVISKKJSOFSECTION�7000FTHELPBOR . y [�
CODE,I SHALL FOR�HN'ITH COMPLV N77H THOSE PROVISIONS. ISSUANCE ( .� �II Q
p DA7F: APPLICANT: SMIP I�d a
J WARNINC FAIWHE TO SECURE WOH)(ERS'CAMPENSATION CAVEMGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYER TO CFIMINAL PENALTIES ANO GVIL FINES UP TO ONE Hl1NDRED T1i0U5AND ENERGY PERMIT �
DOLUAS(f10o,000),IN IDOI710N TO THE COST OF COMPENSATION,DM1Nf'ES/�S PROVIDE�WR IN
� SECTION 37oe OF THE LABOR COOE,INTEREST.AND ATfOiW EYS FEES. ' RETENTION FEE: �O O
OCONSTRUCTION LENDING AGENCY PRE-ALT FE
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS ACANSTPUCTION LENDINO AGENCY ��� 1 O�
FOR THE PERFORMANCE OF 7HE WOFK FOR WHIG1 THIS PERMIT IS ISSUED�SEC.3047,CIV.C.). �
Z
� LENDEi75NM1E �...� / '� �
�—�—
F— LENDER'SADORESS
� TOTAL FEES
� I CERTIFY THAT I HAVE READ 7HI5 APPLICATION AND STATE THA7 THE ABOVE INFORMATION IS LORFiECT.
w 1 AGREE TO COMPLY N77H ALL CtTY AND COUNTY ORDINANCES AND STATE UWS REU7INO TO BUILDINC
� CONSTRUCTION,M1D FIERE6Y AUhIbRIZE REPRESEN7ATNE5 OF THIS COUNTV 70 ENTER UPON hiE
� A EMIDNEO P PEHTY FOR INSPECTqN FURPOSES.
Z COMMENTS
�
J R� !
�
m VERMITTEE N RI �
a (��- /
�
�J NANREOFP ITfEE DATE
= RECPT.NO. PAID BY VALIDATION
~ WHI7E-Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�Ie Copy;GREEN--Applicant's Copy
�B`�';�' C3�- 4����������? ��F� ��, .J-
h���i���� u a��� �af�,��-�F'a�3
��,.'�.,".:;._...�i k a�.;�',� ..�§ ..:�`�_�Ts.`.,���`.s�:..��n""�,::�+'��r-"'�'�, ,'�';ftx .._;���T�w��r�����'�f — _:-.r,..,��,�... i;ay -.,
F�.r-� �1, �.u �": i,���tj�� r .� a��� 7 Fr�y1-�'��`li�'"'t°��,.�i ` �7���s'�i*4nY r,�:.a ��. �� �Fy;- �f E;;��k�r � '��� ��l- k�`� �`w d ,Q J 1���
Faj��;7;��rq,p,��°pfi�'.���4� �'+.: �,.,, � �,�.�ie 4. �''�,'A'4�1,:��� �f �.--si'`--,',�-.-.:tT'irr'����t��if� ,i..�„�..,4.t�-t,4_�ki4�^3-�,1����tt_r . '��e,.�_
.,. . L�h::c...r.�u-..,:.,_.�._...:,:.�:r �,.•.::.... ._xi.� -� -_.:-w�_�s �'r��.ac.'��' at _ � . - . - ,..§,� .�. �c
__..,. i .. � y �
�E?b,^,CK �JO
:__ 1 ,:� RJOIS� ---- I LL-- ---�
_....__'""'_". . ._._ ....___ . ._ r ......._.._ .. ., __ ... .._ .-.�'L.' " '—___ "'_'_'_"_"_ . —
___
f-TGS;FORivI�/STF�L i ! i FHA RE�P�iTS � �
-- ------- --- -- _._ . __._.... . f._ --- -�- -- ----- ;------ __ __.. ----- ..-�------------ , ----- -- -----
�LECfRIC GROUhJD � � ! lJ!•JDER F1.00R DUCT � I
----- -----------=--___-----------------------
' =------------------'
i ,- , i---- i--
GRGU�!p FLUititBI�G j � ;UNDFR FLOOR�OIVUUIT
--T--------� ------1 ;- -------�---- r—
SLA9 GRADE --------j--------!------ I FIREPLACE FOUNDATICN � I
T[ti1P PGUVER ---- � ----�- - — i :FIREPLACE BONL BEA.�.1 -- ---I -
- '----- —
� � I 'Fd11D Hl".BOf�! ----- --1 --
VSA7ER�ERVICE I j _ � ; D QEAtv1
--r-----------, --� �
ROOF SHEFlTFII�dG ! �_ ___� ;8 F-C QOND BE�NI �
-------�..------ ----- —
FRF�MING/VENTILATION I I FINAL BOND BEANI
---------------____---------...---...-----------._._..-._..-------------- --------------- ----_------------
---------
ROOF COVER � � �PftE-GRADING
- -------------__-----------• - - - -- - -'- ------�-----
� r--------- -------------------
ROUGH HEATING --� I--- - - ------------ -- � 'DENCF�ING ------- -----
� 1 i ROUGI-I GRADING
ROUGH ELECTRIC 1-----------�----------
ROUGH PLUfv1aING I � �FINISH GRADING
SHOWER/TU6"fEST � —� ';POOL ELECTRIC
EXT.LATH!SIDING I _L _ �PQOL FENCING _
4VALL INSUL�TION j _ i POOL FINAL
CEILING I�ISULATION � � —� ;OFF SITE IMPS.
DRY1rVALl_NAILING � �DEUICf�TI0PJ5
------------- '- -- - -- -
SE4�lER ----- ------------------ - �FINAL ENG.
--� �-- ------------- ---- -- - --------
SEPTICTANK r I �LANDSCAPE/IRRIG__________ __ ____
--�---------
SEEP PITiL.L. � � ':.ON SITE IMPS.
rA5 AIRTEST � �__ i FINAI_ZONING _ �
FINAL CONST. � � ;FIRE DEPT.FINAL � •
fINAL HEATING __i__ ~HEALTH DEPT.FINAL
FINAL ELECTRIC I � i DEV.FEES PAID �
FINAL P�UMBING I i ENERGY
FINAL PLANING � r
-- ---- - --- I ---------- �- -- ----� ' T�
F�NAL ENGI�EERING I , '� ,����-
� I �`.� ��,s��"�,.����
-------------. ._-- --1---- - -------
COM M E N TS -----------------------------------------------------------------------------------
---- ----- -------- -----------
`
SEPTIC TANK SIZE
SEEP PIT/U SIZE
A �'�'�
._; �
---- -------------_._
,� �r -- --------- — --
n��_ 5" -
`����ti 3 � __ ._- ._._�______-..-__._____.__-.'__ ____-_.___ -"___..__._'.____'-.
.t. - - �.� . .
_ ll.. -
�+h. a �
' .. _ �r . _"__._--. "-_ -_._-__"___-____-__' - __-_'_.
�� -.__
�.-.� -_.__ ______.__'--_ _'__- ._�__ -_ _'___
��u" __
'�4 �