HomeMy WebLinkAbout13-01521 �' ' � '�', C1TY OF DIAMOND BAR �kpr rc�
' I I i ' � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
Ull��i;-:= 21810 Copley Drive,Diamond Bar,CA 917fi5 PRESS
�,,,, (909)839-7020 Fux: (909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY .
`�`'�"'�• BUD;DING PERMIT APPLICATION
� ' j�� �Q APPLICATION DATE: � 3 Pl �I �1a.1
i¢ JOB SITE ADDRESS I,S� s• �t�l Y110►"� G'�Lv' Y jV'e• 1
� ISSUE DATE: �lg t �� PERMITq �1j-- U 15y�, �
z APN • LOT TRACT '� L
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o OWNER TYPE CONST. OCC GROUP:
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� ADDRESS
� CITY ZIP TEL. ZONING F ONTCKS RW ❑
� APPUCANT TEL REAR ❑
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cn SIDE/SIDE STREET RW ❑
o CONTRACTOR �l�l �IVI SIDE
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o� ADDREnSS V�[a.� � �,
o CITY /��52/Y7 ZIP Ct 1 77A TEI 6Z0� ^�� �j PROPOSED USE �
" ARCH/ENG/DESIGNER �����f�✓L��—
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o ADDRESS
tl DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
OWNER-BUILDER DECLMATION
o I hereby afllrm wder penatty of Derryry Mat I am exempt hom the Contractofs Sfate License Law for the reason�s) SFR/ADD/REM
� InOicated bebw by fhe checkmark(s�,I have placed ne#to the aDDlicable item(s)[Seclion 70.315,Business a�M Garage/Carport
o Professio�Code:Any ciry or county that requires a Dermit to coreWct,alter,improve,demolish,or repair,any
w strucWre,DN�+1u�ts issuanCe,also requires the applicant for the pertnR to file a signed sWtement that he or she � Patio/Deck
� Is Iicensed pursuant to the provislons of the ConUactor's State IJceme Law(Chapter 9)Commencing wiM SecUan W
� 7000 ot Division 3 of the Bustness and Prafesslons Code]or lhat he w slia is ezempt hom licensure and the basis for u. PoouSpa
� the alleged ezemption.My violatian of Sectirn 7031.5 by eny applicarit for a pertnit sub�ecls the aDDlicant to a civll�nalry C7
N of not rtrore than five hundred dollars�5500). Z Re-Roof
o (,I,as owner of the property,or my employees with wages as Ne(r sole compensatlon,will do(�all of or(�purllorts � Commercial
� of the work,end ihe strucNre is not lntended a otteretl fw sale(Sectfon 7044,Business and Rofessions Code:The �
� Contractnrs'State License Law does not appry ro an ovmer of property vfio,throu em lo s'w m
gh p yee personal ettort,huilds
w or Improves ihe property,providod that the improvements are not Intendetl or offered for sale.If however,ihe builtling or
� Improvement is sold within one year ol completlon,the Owner-Bullder will have the burden ol proving that it was rrot buitt
por imprwed far the purpose of sale.).
U
F U I,as owner of the property,am exdusivety conVactlng with licensed Contractors to conshuci ihe project(Section �
0 7044,Business and Professiorts Code:The Coniractors'Stale License Law does rwt appty to an awner of property who Valuation: O� Adj.Area:
NbuHdsorimprovesmereon,andwhocontrxtsiortheprojeclswithallcensetlContractorpursuanitoiheConiracrors'State QUANTITY DESCRIPTION FEE
Y Ucense Law.). .
o U���empt from Ifcensure untler ihe ConVactor's State License law lor the following reason(s): �
� �
`�' By my signature below I acknwvledge that,except for my personal residence in which I must have resided fw at least one w
o year prior to completlon of Ne improvements covered by this permit,l cannot legalty sell a structure that I have bultt as an w �
a owner-builder if It has not been constructed In its entirety by Iicensed contractas.I understarM that a copy of the applipble
o� law,Section 7044 of ihe Buslness and Professlons Code is avallable upon repuest when this appliption is submitled ar at
X the following Web site:httpl�wnv.leginfo.cagov/calaw.hhnl. z
o OATE: SIGN: �
� LICENSED CONiRACTOH'S DECLAflATION �
wI hereb aftirm urMer �
y penalty of perjury ihat I am IicenseA under provisions of ChaDter 9(commencing wi�h Section 7000)
� ol Division 3 of tt�e Business antl Professions Code,and my license is in fiill force and eflect.
y IJCENSE D� `T S LIC.NO.:_ "l Z / Q S I ' ¢
oZ DATE: S�il��3 CONTRACTOR:� � U ' � �
¢ WOBKEH'S COMPENSATION�ECLAIiATION g
� I HFAEBY AFFIRM UNDER PENALTY OF PEAJURY ONE OF THE FOLLOWING DECLARATIONS:
o I have ar�d win maintaln a Certifinte ot Caisent to Self-tnsure tw Worker's Canpensation,as providee by CONSTRUCTION: {3�{-, �p
� SecUon 3700 o11he Labw Catle,for Ne perfamance of ihe wark far which th's permit is issued. p�qN REVIEW:_ —(�, L{•,p
� I have and will malntain Worker's Compensatbn Insurance,as requlred by Section 3700 of fhe Labar Code,for
Z the pertormance oi ihe work br which ihis permd is issued.My Waker's Compensatlon liuurance Carrier and ELECTRIC: _ �'j"'[ • O`�
¢ PolicyNumberare: ) 1_ A� .L� PLUMBING:
� CARRIER�� ��tQ.r►^7 v�'�) IV Q [iOr��) MECHANICAL:
� POUCYNUMeER �A�CD���� Z INSPECTIONFEE:
� (f}flS SECf10N NffD N0T BE COMPLETED IFTHE PERMR LS FOR ONE FIUPIDRED DOLLARS 1 OR
_ � �� �' ISSUANCE: �—'10 . �
o ceAily that in ihe P�ormarwe of ttce vrak Ia which this permit is issuetl,I shau not emP�Y�f'Person m any manner so a5 ro SM IP: � C��
p becane sub�ect to Ihe Workah Camperxation Laws of Calilomla.Mtl agree Nat il I slroWd becortie subject tu tl�e Wmker's
� Compe 6 of Sectim 3700 of Uie Labm�(°�e,��Shan��dh compy wim those prwisions. EN ERGY P/C:
LL DATE:���qpPL1CANT: WPA1hlL� C/h.�l ENERGYPERMIT.
� WARNING:Failure to secure Worker's Campensation coverage is unlawFul,and shall sub�ect an empbyer to crfminal RE7ENTION FEE: L'�p
w penaltles and chril(�nes up to one hundred Mousand dollars(3100,00p),in addition to the cost of Me compensation, - �'
o damages as prmrided for in section 3708 of the labor code,interest,and attomey's fees. PRE-ALT FEE:
a CONSTRUCTION LENDING AGENCY BSAF: � . �
w I here�y afOrm unAer penafty oi per�ury thal there is a Constructim LerMing Agen�y lor the perlortnar�ce ol the work fm '
� whic�this permit is ts�ed(S¢c.3097,Civ.C.�.
� LENDER'S NAME
� LENDER'SADORESS:
� I certity that I have read this aDP����ion anA state that the above informatlon is conect.I agree to compty with all city and TOTAL FEES ���
Z counry wtlinar�ces and state laws relatlng to buiiding consUuctlon,and hereby authorize representatives of Nis rounry to COMMENTS:
o enter upon the above-mentioned property tw inspection purposes.
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a PERM � S18�� 3
� T� F P�� �ATE RECEIPT q k+ r�ZS� PAID BY: S VALJDATION: �
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessw Copy,GOLDENFOD—File Copy,GREEN—Applicant's Copy
CITY OF DfAMOND BAR • '
INSPECTION RECORD
• � � � • ' • � ' • '
SETB.AGK/LETTER� . _ ,:'� r ' =` `� `� '�_ �'�'�� TRACTAND LEDGER
FOOTiNGS FORMS • � -- - = lF:' � ,= SWITCH GFAR
g�qg.,;, � � �; �, ,a_ COMMERCIAL HOOD
�UG.PUIMBING•'' � �' � ` �: '" ` _ ;: T-BAR
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UG:'ELECTRICAL , ` ' � '�__ . ,'��4 . �' INTERCEPTER
.UFER�GHOUND�;;�: � �'�; .n�, ` ; ,. :��� ,� �.'. -��'''`� :'� HOTMOP/SHOWERPAN
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER L1NE � HERS REPORT RECENED
SEWER CLEANOUT DEMOUTION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
�_ _. : , , r= - , _ - __ -
POOUSPA ;` $ �
SHEAR WALLS'EXTER(OR ' ' � ; ` �
SHEAFtWALI:S INTERIOR`;. � � `' ` -,? `' v {� `" ' r ROUGH PLUMBING ' �c ` ' " %, `.r' "��,-;
' � - � �lUGH ELECTRICAL'`� � � �:� ' - � ,�` �' �, '���
'FRAMINGNENTING -� - '. � '
�;; ;,�e r f'` ROUGHMECF�ANICAL; �. , � � r c �
ROUGH MECHANICAL< -�� ' � ' �
ROUGH�ELECTRICAL N!(��)C( 3 � ` , r ���� G= � 'GAS TEST ' `�� ` ' ����'` � , ��k" �` `
�..� F : i �Y r "s
'ROUGH:PL•UMBING " , ` ��� � '- � PRE GUNITE , �� • ' " 1 �` '
.. „ ;;. . ,.< �
INSULATION WALL POOL PRE DECK BONDING `r' c r�� F m ' ` �_ 4- .
INSULATIONCEILING .P=TRI�P .`^ ,., � `� � �'��>'�'`a : r-' ��` �' � �- �'� ��
g �`�,;� �:`
DRYWALL FENCE/GATE/ALARM � . ;� �;
:lf
LATH(PR� FiNAL POOL` f '-� ` _� _ _ },_< � ,. ,_� `
LATH EXTERIOR WALLS:
IATH INTERIOR WALL FOOTIN6/STEEL
GAS TEST WALL STEEL 1�( )2N0( )LIFT
SCRATCN COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DR,41N/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION RO.FRAMING,PIANNINGAPP,RO.VAL � ` ti � ,� ` �s. �.;�
� T h t�`5'-F. 1 ' i��
FIN�'BUILDINGr � ° ` :; tf. -`�" 1 ' � - R�UUGHFIREAPPROVAL �� �� `
fINAL'MECNANICAL,:( " _ � FINAL.FIRE DEPARTMENT ':- < � ° `
FINAI:sELECTRIC�L � �:% '. ` _ � ` ° � EINAL PLANNING �- � ° �; � � �
FINAL'PWMBING '` �, - �� '':' .x{;" �':� � �`� FINACENGINEERING7 PW '' ' '`� - ' �r`
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,: ,: , .' �;
T.C:of OCCUPANCY. •- :;, . _ FINAC COMMUNITN SERVIGES �. �'> �=< t ��
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� �� .�'� FINAL NE/1LTH DEPT � F , �
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CERT"of,OCCUPAHCI!,'` . . , " ,r.�'�� >� �_ , .���. � � ,..: ,, ��.��, . �: -.: _ `•
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FINAC�INDUSTRIAL=�WASTE�.�;�^ f_ �- , �� - ',
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