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HomeMy WebLinkAbout11-1410 ��_ CITY OF DIAMOND BAR p � 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 PffiESS ''""'� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE ��GI / / i1C C�r��. 'D D• DATE CATION'v � 'I PERMIT ��� I YI J P/C o ADDRESS l �J �../ F- NUMBER # °r APN LOT TRACT DA EE I �I�T �� TMPE � OCC p OWNE�(,t.f �/Le CONST.���--+ GROUP � ADDRESS �L���� bcJ co ra,' �jZ�D• ZONING SETBACKS 0 z CITY FRONT ��Ql✓K�rt l �r- ZIP TEL. RW ❑ � APPLICANT TEL. REAR p Z SIDE/SIDE STREET RW p � CONTRACTOR ° SIDE � ADDRESS . � CITY ZIP TEL. fI -S -��K'PROPOSED USE o ARCH/ NG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS �n UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENAL?V OF PERJURV THA7 I AM E%EMPT FPOM 7HE CONTRACTORS LI- G318g0/Ce�Off W CENSEUWFORTHEFOILOWINGREASON(SEC.7o31.5BUSINESSANDPROFESSIONSCADE:ANYCITVOP (n U COUNTYWHICHREOUIRESAPERMI77000NSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC� W P8S10/DBCk w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICAN7 FOR SUCH PERMI7 TO FILE A SIGNED w � STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUANT 70 7HE PROVISIONS OF 7HE CONTRAC70R5 LI- � � CENSE UW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 Of THE BUSINESS AND PFO- POOVSP3 . � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAN�THEBASISFORTHEALIEGEDEXEMP� (� V 710N.ANVVIOI.ATIONOFSECTION7o91.5BYANVAPPLICAN7FORAPERMITSUBJEC75THEAPPLICANTTO Z RB-ROO} � A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f5o0�.): Z ❑I,ASOWNEROFTHEPROPER7V,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � Commercial WILL DO THE WORK,AND THE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SAIE(SEC.7041,BU51� J � NESS AN�PROFESSIONS CADE:THE CANTRACTORS�ICENSE UW DOES NO7 APPLV TO AN OWNER OF j PROPERTY WHO BUILDS OR IMPROVES THEREON,AND Vh10 DOES SUCH WORK HIMSELF OR HERSEIF OR � CL THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHA7SUCHIMPROVEMEN75ARENOTINTENDEDOR m Q OFFEREDFORSPLEIF,HOWEVER,hIEBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPHOVE FOR THE PURPOSE OF SALE). ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELY CONTqACTING WITM LICENSED CONTFACTORS Q TO CANS7RUCT THE PR0.IECT(SEC.701I,BUSINESS AND PROFESSIONS CADE:THE CONTRAC70RS LI- V81U8i1 ADJ.AREA W CENSE LAW DOES NOTAPPLV TO AN ONRJER OF A PROPER7Y WH0 BUILDS OR IMPROVES THEREON,AND a � WHOCON7RACTSFORSUCHPRQIECTSWITHACONTMCTOR(5)LICENSEDPURSUANTTOTHECONTMC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.8 F.C.FOR THIS REASON Q (rj •�-Lry 1 O� O r" U � DATE OWNER F j � O � w LICENSED CONTRACTORS DECLARATION -� � w I HEREBY AFFIRM UNDER PENALTV OF PEFiJUqV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER � � D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z ��� MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASS LIC.NO. � ._ � V DATE ��f/4 CONTRACTOR d W / � � � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AfFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARA710NS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a 2 COMPENSA710N,AS PROVIDED BY SEC710N 3700 OF 7HE LABOR CODE,FOR THE PERFOFMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w W � �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q3700 OF THE LABOR COOE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �O � ISSUED.MV WORKERS'CAMPENSATION IN URANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION � CARRIER S . T 'e �V✓1i1� PLAN REVIEW �— ZPOLICYNUMBER__�+7_7 2_�r — , / ELECTRIC Q � (fHLSSECiIONNE�NOTBEOJMR.EfE00FhiEPEPMfTISFORONEFNPDRED00LlAHS(f100)ORLESS} PLUMBING W Z I CERTIFY 7HA71N 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL (� SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJEC7 TO THE (fj WORKEFS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJEC7T0 THE WORNERS'COM7ENSATION PROVISIONS OF SECTION 37000F 7HE IABOR � CADE I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. �SSUANCE � G � �C G�nC�,r�� C�h-�.xc� � SMIP a 5� p DATE: �L � APPLICANT: J WARNING FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&lEC7ANEMPLOVERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100.000).IN AODITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN r, � SEC710N 37oe OF THE LABOR CODE,M7ERES7,PND ATTORNEV'S FEES. RETENTION FEE: ,� �./O OCONSTFiUCTION LENDING AGENCY pq _ F • � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY C E4��r� � n- FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CN.C.). Z ' W � LENDEFi'S NAME F— LENDER'SADDRESS w I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CORRECT. TOTAL F E ES � � I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTIONED PROPEfiTY FOR INSPECTION PURPOSES. COMMENTS � � J � ¢ PERMITT NA (PRINT)r ' �, lD /G � AT O ERMITT DATE = RECPT.NO. �q 3o PAID BY VALIDATION ~ ' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy C��'V O� D8�61�0�� ��� I�Sf�I�C�'�Oi� 6�I���C�� � - �. Oa�3pC�C�4�0a DQ4C� �a�3pG(�40Q Oa�pLC�400a bQ4C� Oa�pC�C�4Co�a� 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 BQND BEAM WATER SERVICE MID NT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAI BOND BEAM ROOF COVER PRE-GRAOING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POQL 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 ---- — -- �"1 �a � , — ---- COMMEfVTS SEPTIC TANK SIZE SEEP P1T/U SIZE �l G7 G ------- ---- - �