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HomeMy WebLinkAbout12-1016 � _��_ CITY OF DIAMOND 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 �"°^'.W BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATIO PERMIT�� �����P/C ADDRESS Z�0� ) ��h �a DATE O �z-- NUMBE # � ISSUE � TYPE OCC APN LOT TRACT DATE g�����CONST, p r U pa�, GROUP o OWNE�a,,,a o�F:s-� o ADDRESS �Z4CNv 1 ��cArp�,�,., Qc� ZONING SETBACKS Z CITY �1 G�►ox�a 3�� ZIP a���STEL.q'S 1-741-3C� FRONT q�/y ❑ ' o APPLICANT Suwz� S s ' TEL. q51-2.+i1-(c$7 REAR ❑ ¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR �l O c± �� � �� SIDE ❑ ADDRESS y 1 'C� � CITY G��rU ZIP 4��10 TEL SIOb�qSb'��� PROPOSED USE ^ w ARCH/ENG/ z DESIGNER a ADDRESS• NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 HEREBV AFFIRM UNDER PENAL7Y OF PERIURY THAT 1 M1 EXEMPT FROM THE CONTMCiDRS LI- Ci0f8JB/C8f�10If W CENSEUWFORTHEFOILOWINGREASON(SEC.7o31.5BU5ME5SANDPROFESSIONSCODE:ANYCfTYOR (n � C-) COUHTYWHICHREWIRESAPERMIT7000NSTRUCT,ALTER,�MPROVE,DEMOLISH,ORREPAIRANYSTRUG W � w NRE,PRIOR TO RS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED w Patio/Deck � STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS�Oi THE CONTRACTORS LI- � � � CENSE LAW(CHMTER Y(COMMENCING WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- POOVSpB , � FESSIONSCOOE)ORTHATHEORSHEISFXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� . . V TION.ANVVKK.ATIONOFSECTION7031.SBYANYAVPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z qa.Roo1 A CML VENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(i50D).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHYJAGEStiSTHEIRSOLECOMPENSATION, � 0 COrtIrtIBfC181 - Z lNLL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR 3ALE(SEC.7o4i,BUSF J � � NESS AND PROFESSIONS CWE:THE CONTRACTORS IICENSE UW DOES NOT MPLY 70 AN OWNER OF j � PROPEHTY N?10 BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HEHSELF OR CL TNROUGN HIS OR HER OWN EMP�OYEES,PROVIDED THAT SUCH IMGROVEMENTS ARE NOT INTENDED OR m - � - Q OFFEREDWRSALEIF,FIOWEVEi�THEBUILDINGORIMPROVEMENTISSOIDWITHINUNEYEAROFCOM7LE- Z TpN,THE OWNER-BUIIDER WILL HAVE T}1E BURDEN OF PROVING THA7 HE OR SHE DID NOT BUItD OR . � IMPROVE f-0R THE PURPOSE OF SALEJ. � w ❑I,ASONMEROFTHEPROPEHTV,AAIEXCLUSNELYCONTMCTMUWfTHLICENSEDCONTflACTORS .. � TO CONSTRUCT THE FROJECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:iHE CONTMCTORS LI- V01UHtfOR ADJ.AREA W CENSE UW DOES NOTAPVLV TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND � -� � W/iOCONTRACTSFORSUCHPpOJECTSWITHACONTMCTOR(SjLICENSEDPURSUAMTOTHECONTMG QUANTITY DESCRIPTION FEE . � TORS LtCENSE LAW.). ❑1 AM EXEMPT UNDEF SEC. B.6 P.C.FOp iH15 REASON Q � U � ¢ OATE OWNER U Z � ��. : . - � � � w � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRAI UNDER PENALTY OF PERJURV 7HAT IAM LICENSED UNDER PROVISIONS Of CHAPTER � � Y(COMMENCINO W17H SECTION 7oa0)OF DIVISION J OF THE BUSINESS M1D PROFE5510NS CODE,AND Z XL� AIY LICENSE IS IN NLl FORCE AND EFFECT, m LLI / -7/�gLu'1 � � UCENSE C SS C . �� LIC.NO.. b GJOO O�T � - _ V DATE O Z CONTRACTOR d � � . W � WORKERS'COMPENSATION DECV+RATION Q � 1 HEREBV AFFIRM UNDER PENAl1Y OF VERJURY ONE OF THE FOLLOWING OECtARA710N5: Z � � _I HAVE AND WILL MAINTAW A CERTIFICATE OF CONSENT TO SELFdNSURE FOR WOHKERS' _ Q CAMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR 1HE PERFOHMANCE W Q �y. OF 1HE WORK FOR WHICH THIS PERMIT IS.ISSUED. � ' ' Qw �],IMAVEANDWILLMAIMAIN�WORKERS'COMPENSATIONINSUMNCE;ASREOUIREDBYSECTION � ' ' � � 37000F THE LABOR CODE,FOR THE PERFORMANCE�OF THE WORN PoR WHICH THIS PERMIT IS. _ ¢ n ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER�AND.POLICY NUMBER ARE: CONSTFlUCTION � CARRIER l...G/S����� OO1n� PUWAEVIEW � POLICV NUMBER w3�� G lZ3 S Z 1�. ELECTRIC � �nissecr�rvN�r�oreEoons�r�oFn�a�rsroaa+�Mx�voa.wsgtoo)oqtFss} PLUMBING � Z 1 CEHTIFYTHAT IN THE PERFORAIANCE OF 7HE WORN FOR WHICH iHIS PEfU/R IS ISSVED,1 MECHANICAL U' SHALLNOTEMGLOYANYPERSONINANYMANNERSOfSTOBECAMESU&IECTTOTHE � WORNERS'COM7ENSATION LAWS OF CALIFORNIA�ND AGREE THAT IF I SHOULD BECOME �NSPECTION FEE = SU&IECT TO 7HE WORKERS'COM7ENSATION PROVISIONS OF SECTION 37o00F THE LABOR co i s u Fo�rrriwrrr�couv�r wm�Tr+ aaovisaNs. ISSUANCE • � p DATE: � i0 lZ" APPLICANf:�.t�� � �SMIP J WARNINO:FAILUHE TO SECURE WORKERS'COMPENSA710N CAVEMGE IS UNLAWFUL,AND SHALL BE ENERGY P/C . � SUBJECT AN EMPLOYER TO CRIMINAL VENALTIES AND CIVIL FW ES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(i10o.00o),iN ADDITON TO THE C0.5T OF CAMPENSATION,DAMAGES AS PROVIDEDfOR IN � SECTION 370E OF hIE LA80R CODE,INTEREST,AND ATTORNEY'S FEES. � RETENTION FEE: ' � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBY AFFlRM UNDER PENALT'OF PERIURY THAT THERE IS ACONSTRUCTION LENDINO AGENCV FOR TNE PERFORMANCE OF 7HE WORK FOP N?iICH 7HIS PERMIT IS ISSUED(SEC:30v7,CIV.C.). Z W '. � LENDER'S NAME F- LENDEfYS ADDRESS w I CERTIFY TiAT 1 HAVE READ THIS APPLICATION AtJD STATE THAT THEABOVE INFORMATION IS CORRECT. TOTAL FE ES g� � 1 A6REE TO COMPLV N7TH ALL CITV AND COUN7Y ORDWANCES AND STATEUWS REU7INC,TO BUILDINO CONSTRUCiION.AND HEREBY AUTHORIZE REPRESENTATNES OF 7HI5 CWNTV TO ENfER UPONTHE z ABOVE-MENTIONED GROPER7Y FOR INSPECTION VURPOSES. COMMENTS �� . �I � �\W�.�('� a�f\hLeA� . � PERMITT NPAIE(PRINn " � � ���L ����- ��l U�l Z /' � SIONATUREOFPERMITTEE DAT � RECPT.NO. PAID BY VALIDATION WHITE—Deparlment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy;GREEt�AppllcanCs Copy CITY 0� DlAMOND BAR INSPECI'IOPV RECORD - �� -� � ����� �� . �¢ �, � . .,�� o e - �..:Ao � �,��' � ' �4„�. s � o _ . �. ..� ,�y� ' - .Q -b�� sb�', �,+.'� _ SET BACK i FLOORJOIST ---------- ---- ---- ------- - ----------- -------- ------------ FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNQATION TEMP P01�VER 'fIREPLACE BOND BEAM WATER SERVICE `MID HT.BONO BEAM ROOF SNEATHIt�G 8 FT.BOND BEAM FRAMING/VENTILATION �FINAL BOND BEAM ------ -------- — ----- ----- - -----------—..------ --------- --- ROOF COVER 'PRE-GRAOING _._...--- ------..- ------ -- --..___ _.___-----. ._.__ _._._.__ _...__._ ._ _ —. _....--- .._._ .....__.. __... _._.—..._..----._ ...._.._. ROUGH HEATING BENCHING _._.._._..---._..__._.----------- _._.-- ----._.._._..__—._.._._...-------_--- �----.___..—._..__...__—____.._..—....._._... --------------------.. ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING ti �FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT.LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION 'OFF SITE IMPS. DRYWALL NAILING ;DEDICATIONS SEWER --------------- --- --------- F I NAL ENG--- ---------- ------------------- SEPTICTANK LANDSCAPE/IRRIG. SEEP PIT/L.L ON SITE IMPS. GAS AIRTEST FINAL ZONING FINAL CONST. 'FIRE DEPT.FINAL FINAL HEATING HEALTH DEPT.FINAL FINAL ELECTRIC �DEV.FEES PAID FINAL PLUMBING �ENERGY FINAL PLANING = ------------------------- ------- FINAL ENGINEERING • o 0 ___.----- -- ----------------- _. _.__... ----..._ ___..._ .__--_ ------------- .. ....------ -. __ _...------ --- --- ------- COMMENTS _— -- �`� � �� ��'`�` _ _ --�-���� � — — ' �— SEPTIC TANK SIZE SEEP PIT/U SIZE �'��' ,;�� ---- -- ------------------------ -- ---- H , �� .. .,..� . . "'_'-'_--'—_'— _--_ '--'—_"_— '_ �'�T� — — -------' t�: r'��=� -�� ' T � q i`��5 N; �.t:`pT„� _--_ ___.__ __ _'__ '�y�':.�,:: � ��� p���, . �a' .� ,_ _—_'__'____"—'__— ___'__'_ "—"'—__ ""_____"'___' _"_____.._.."'"____.... _'—__.._..... ._._._..—"_'—_'_____.— ..—...._. _ ,;�t�.�N��,