HomeMy WebLinkAbout121325�
�� _ CITY OF DIAMOND BAR � ,
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91�65
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 PRESS
"'"'. BUII.DING PERNIIT APPLICATION FIRMLY
o DDRESS�� \i�(1)C!'.lV� � DATECATION 1 O � � NUMBEH�`✓�#/C
=° APN LOT TRACT D TEE D � �/ TMPE OCC
p OWNER � CONST.�D���ROUP
" ADD SS � ZONING SETBACKS
� FRONT RW ❑
Z CITY � �C�OMO ZIP . TEL.
� APPLICANT TEL. REAR p
� SIDE/S�DE STREET RW p
z
¢ CONTRACTOR SIDE ❑
ADDRESS 'C
� CITY �e2uSGl ZIP 41�A TE - PROPOSED USE
o ARCH/ENG/
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCAIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
Q 1 MEREBY AFFIRM UNDER PENhl.iY OF PERIURY THAT I AM E7(EMPT FROM THE CONiMCTORS LI- G8f8QB/CBfPOA
W CENSEUWFORTHEFOLLOWINGREASON(SEG)o37.5BU51NESSANDPROFESSIONSCODEANYCI7YOq (n
V COUHTYMRiICHREWIRESAPERMITTOCONSTRUCT,ALTE0.�MPROVE.DEA10U5H2ORREPAIRANVSTRUG �
w 7URE,PRIOR TO RS ISSUANCE,ALSO REOUIRES THE AVPLICANT FOR SUCH PERMIT TO Fl�E A SIGNED W PaliO/DBCk , ,
STATEMEHT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll-
0� CENSE UW(CHAP7ER D(COMMENCING N7TH SECTION 7000)OF DIVISION�OF THE BUSINESS ANO PR6 � PooUSpa II
FESSIONSCOO�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP- C7
V TION.ANY VIOUTION OF SECTION 7031.5 BY ANV APVUCANi FORA PERMIT 5U&IECTS THE APP�ICANT TO Z R�Root .
� A CML PENALTY OF NOT MORE TMAN FIVE HUNDRED DOLURS(SSoo).): .
� ❑I,ASOWNEROFTHEPfiOPERTY,ORMYEMPLOYEESWITHI4AGE5ASTHEIR50LECOMPENSATION, � Commercial �� /
WILL�O h1E WORK�ND hiE STRUCTURE IS NOT IMENOED OR OFFERED FOR SALE(SEC.70��,BU51- J
� NESS M!D PROFESSIONS CODE:THE CON7MCTORS LICENSE UW OOES NOT APPLY TO AN OWNER OF �
PROPEHTY W}i0 BUILOS OR IM7ROVES THEREON,AND VhiO OOES SUGf WORK HU.ISELF OR HERSELF OR
Q 7HAOUGH HIS OR HER OMM EMPLOYEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NO7INTENDED OR m ,
Q OFFERmFORSALEIF,FIOWEVER71fEBUILDINGOHIA/PROVEMENTIS50LDWfiT11NONEYEAROFCAMPLE-
z TION,iHE OWNER-BUILDER VALL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NO7 eUItD OR
� IMPROVE FOR THE PURFOSE OF SALE).
W ❑I,ASOWNEROFTHEPROPEHTY,MIEXClUSNELYCOMRAC71NCiWfTHLICENSEDCOMRALTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7o�I,BUSINESS AND PROFESSIONS CODE:hiE COMMCTORS IJ- Va1U2110f1 ADJ.ANEA
W CENSE UW DOES NOTAPVLYTO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
� W1iOCANiMC7SFORSUCHPR0.IECTSWITHACONTRAC70R(5)LICFNSED7URSUMlTTOTHECONTMG QUANTIN DESCAIPTION FEE �
Y TORS LICENSE UW.).
Q ❑I AM EIIEMPT UNDER SEC. B.6 P.C.FOR iH15 REASON Q
� U
�t ¢
OATE OWNER F- -
z — w
�Q LICENSED CONTRACTORS DECLARATION W
CL I HEREBY AFFIRM UNDER VENALTY OF PERIURY THA7 I AM LICENSED UNOER PROVISIONS OF C/iAPTER � •� �•� �
d 9(COMMENCWO WITH SECTION 7000)OF DIVISION]OF 7HE BUSINESS AND PROFESSIONS CODE,M1D Z [
NY UCENSE IS IN FULL FORCE AND EFF C7. m
/ (y[�� i
� LICENSE C^IASS vl �`/ ��IG.NO. � �
V DATE 'T' '3\-S� CONTRACTO a
W
� WORKERS'COMPENSATION DECLARATION Q �
� 1 HEREBY AFFIRM UNDER PENALTY Of VER1UfiY ONE OF hiE FOLIOW WG DEp.ARATIONS: Z �
� _I HAVE AND N7LL AWNTNN A CERTIFICATE OF CONSEM 70 SELF-INSURE FOR WOiiNERS' _
Q COMFENSATION,AS PROVIDED BY SECTION 37000F THE UBOR CODE FOR THE PERFORMANCE U
Q \OF THE WORK FOR WHICH iH15 PERMIT IS ISSUED. _ � '
w _1 HAVEANU WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q J700 OF THE LABOR CODE,FOR THE PERFORMMlCE OF THE WORN FOH WHIq1 THIS PEAMIT IS
ISSUE�.MnV WORNEAS'CO`MGENSATION INSURANCE CARRIER AIJD POLICY NUMBER ARE: CONSTRUCTION
j CARRIER�^'V�C__LC9"�LJ� � _ PLAN REVIEW
� POLICY NUMBER�t7 O C�� — �
Z —. ELECTRIC
¢
0 (iFLL95E(.'f10NNFIDNOTBE00APLEfIDOF73EP6�MtBFORONE1i�NDR�OCUARS�5100)ORtESS� PLUMBING �
Z 1 CERTIFV TMAT IN THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ,
C� SHALLNOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECAME SU&lE TO THE
(/� WDRKERS'COMPENSA710N LAWS OF CALIFORNI/�AND AGREE THA7IF I 5 LD BECAME �NSPECTION FEE
SU&IECTTOTHEWO{iKERS'COM7ENSATION ROVISIONS FSECTIO OOFTHELABOR .`�
OCADE{.�I SHALL FOfRMHITH COMPLY WI E PRO 5. ISSUANCE � �
p DA7E:'3l1'0 �IZ APPLICANT: �SMIP "
J WARNINO:FI1q.URE TO SECURE WORKERS'CAMPENSATION CAVEMGE IS UNUWFUL,ANO SHALL BE ENERGY P/C
� SUBJECTAN EMPIOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TMOUSAND ENERGY PERMIT
DOLLARS(f100.000).IN ADDITION TO7HE CAS7 OF COMPENSATION,OMIAGES 0.5 PROVIDED PoH IN
� SECTION 370!OF TIE LABOR CODE,INTEREST.AND ATfORNEYS FEES. ' RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
Q 1 HEREBY AFFIRM UNDER PENALiY OF PERIURY iHA7 7HEfiE IS A CANSTAUCTION LENDWO AGENCY
a- FOR THE PERFORMANCE OF THE WORN FOR NM1iICH THIS PERAIIT IS ISSUED(SEC.3097,CIV.G�.
Z
W
� LENDER'S NAME �
F- LEN�ER'SADDRESS
W ICERTIFYTHATIHAVEREADTHISAPPUCATIONANOSTATETiAThiEA80VE1NFORMAT10N�5CAqRECT. TOTAL FEES ��. �
� 1 AGREE TO COMPIY N7TH ALL CI7Y AND CAUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING ' �
� CONS7RUC�ION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CWNTY 70 EMER UVON iHE �
Z ABOVE-MEMIONED PROP RTY FOR INSPECTION PURPQSES. COMMENTS
0
J
� �
m PE AM PRINn .
Q
� �
vj SIGNANREOFPER -- DATE
= FlECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Fnance Copy,PINK—Assessw Copy,GOLDENROD—File Copy,GREEN--ApplicanYs Copy
�� ��e/ i`�a� ;i�'��!ti�j�;i':_��i'�:j:�i ::::i�`i J"§ -
���9 a��- .�R,+�� 9 t.,�'!'j )-:�.._G.�,�;G�`�J,�
41. -'f s..��'A 't1 �:� f� �:I... r'��.���l':.��`�� �4�lT�3 1n.i.u;*`� :-�.:� ,,... .��.t. �. .'�y �..:�r� ;J. �r' i`� j�i:�`P 1 ,y����= ! (��.kl�-ljR�
;`-1I1 �����3`�v�v ,�3� y���-1 ' �� {���.'',� ay1�,- � i C+� ra,4T ��l �� �i ��u � ,;'� iJ/ '�V1 �"r� if�qt a �1�c1L ).� ti�ty:��,(�
� 1�Y 4 1 � *� �...._ I ':._ ' �V..I.__ �....._ yn1 Y..��kL+l �1 \ 1 1F+ � F 11 rLl�\lr\1\JIJ� I J�.+.£.LS� 1 ��� �:_�..� V ,+r �� � t 11_�u..�e..�..�.��_.��.i��'Jl
�:fi1:..: -......": __a::..: � �I .�Yatls f.4.'- �._ .:..v� rvsi .��r �...._
c 4 }
I SET PA:K .,L
._ _ . _ 1 __ __.
.._. I _ I----------
FTG��-C1Rfv15;ST;�L � ___- ; ;,FH4 REQivI f5
-____.._._. .__ _ ---- ------ --___ _ .. .. . _ _ _- - - -- - -----
ELECTRIC GR�11ND ' � � ;l.I��pFR�=1_OOR Dl1CT I �
�--_---- ------ -- _._. __.1
----...---------- ---- --------------------i :
---
C;ROUI��Pt.l!��iP,l;�!G I � ; �UNf_�ER FLOOR CO�IDUIT ,
-------------------
� -- -----------� j----------------
SLA6 CRADc � !FI^EPLACE FOU��DATION �---------
-------._------ -----------�- ------' �---�---- ;--------------- -------,
I E(v1P PO4l�ER ' �-----�-- _._ _I I FIRE°LACE BOf�ID BEAM -- -�
yVATER SERVICE 'MID HT.BOND BEAM _____
ROOF SHEATHItJG -� ;8 FT.BOND BcAM
------- --- --
FRAMIMG/VENTILATION i FIPJhL BOPJD BEAM
------.._..._..--------------___----------------------------- -- --_�-----...------------- ------------
ROGF C0�/ER - - �PRE-GRADING _.---- --------- — -
------------------____-- ------------------• --------------- � --- -.
ROUGH HcATiNG � �EEfdCHING
-------�-----�---------------- ---------- --.-_.__------------------. �_.._____•-------_.....----._----------------------- -
ROUGH ELECTf;IC i ROUGH GRADING
ROUGH PLUfv1611�1G ___� _ _ I FINISH GRADING _
SHOWEP,/TUBTEST I POOL ELECTRIC _
EXT.LATH;'SIOING -� I POOL FENCI�IG
�VALL I�ISUI_ATIGN I POOL FINAL
CEILING It•dSULATiON �— �i OF;SITE IMPS.
DR`(V�/ALL hlRILING �DEDIC�TIONS
.._.------------ --------___. _____ ----------_.__ _._..__ ___----- -.._.__ r�- ______ ------- -
;EVVER ;rI�aAL ENG.
--... ._.___ _ __.___-- ._...__ .._.--------------- -�---- ._...---.....- .-- ----_ ___.__--------- ____...- ----------
SEPTICTAt�1K �LANDSCAPE/IRRIG.
---
__._...._._._._
--- ------------__ ------------�---- ----------------._----------------_ _----
SEEP PIT;L.L. ,OPJ SITE INiPS.
GAS AIRTEST ;FINAL ZO�IING _
FI�IALCONST. I j FIRE DEPT.FINAL
FINAL FICATING j HEALTH CEPT.FINAL -
FINAL ELECTRIC � �DEV.FEES PAID
FINAL PLUP�161NG j �� I ENERG�(
FINAL PLANING �
----...------------------------- ------------------------ �yr.�._ ,, ..� - -------
FINALENGII�ItERI�JG ----- ------------ "�'�.��.;�1;'����,,� ,��': ..; w;-.` --- -
connnnEr��s _
SEPTICTAN!<SIZE
SEEP PIT/U SIZE
,,. ' .,
,,,
� �' r �
� -
��,
�
r y�
.,�n ,�at., _
� ,�
.�`_' �•