HomeMy WebLinkAbout13-323 �� _ CITY OF DIAMOND BAR '� �' �°
� DEPARTMENT OF COMMUPIITY &DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765 PRE$S
. (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ,
I �������W BUILDING PERMIT APPLICATION FIRMLY
o DDRIESS II S✓� �- D«� DATE CATION f l ev I � NUMBER��� " Z� #/C
a ISSUE TYPE (� OCC
O° APN LOT TRACT DATE � � � � � CONST.�.v►'�.J GROUP I
¢ OWNER
� ZONING SETBACKS
o ADDRESS FRONT RW � �
z C��-y ZIP TEL. REAR � II
o APPLICANT TEL. SIDFJSIDE S7REET RW �
z SIDE � I
Q CONTRACTOR
O ADDRESS ZIP TEL. 2 PROPOSED USE � ` H
CITY Q��� �� � �
w ARCWENG/
z DESIGNER NO.DWEL NO. NO.
a ADDRESS UNITS ' STOftIES BEDFi00MS
NCITY ZIP TEL
� DESCRIPTION SC1.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-OUILDER DECLAHATION SFR/ADO/FlEM
O
I HER�Y AFFlfUI UNOEA PENALTY OF PE0.IURV TUT 1 HI E(EMPT FROM THE COMTRACTOiLS LL Garage/CarpoA
W CFNSEUWFOHTHEFOILOYIINONE/SONISEG7o]1.SBUSWESSANOPROFESSIONSC.00EANYQTYOR (n
ZCOl1MYWF1ICHREOU1FiE5APEAMITTOCONSTHUCT,ALTEfLOJVHOVEOQ.lOU91,0AREPAIHANYSTRUG W patiolDedc �
w NR�PF10R TD RS ISSWWCE,ALSO RC-0UWES TME AVPlIC1NT FOR SUdi PERAfIT TO FRE A SIGNEO w
� �STATEMEHT T1AT HE OR SNE LS LICEN9ED PU0.5UANT TO hIE PROVLSIONS OF 7HE CONTMCTORS L4
� CENSE Uw(C1iAYTEH G(�WMENCWC N'IT�'�SECTY]N 7oo0)OF DIVLSION]OF 7HE 9USINE55 ANO 7R6 u' Paol/$pa
Q FESSIONS COOE)OR THA7 HE OR SHE 19 E7(ETIPTTI7EREFROM AND THE BA515 FOR7HE AILEG�IXElAP•
U TION./.r1Y VId.AT10N OF 5ECT10N 7wi.5 eY ANY MPLIC/J7i fOR A PERAIIT 5U&lECT57HE APPUCANT T0 Z RaRool
� A C�VIL PENALTY OF NOT MORE TFUN FlVE HUNORED OOLLAAS(iSao�I: '
� ❑4/S�WNEROFTHEPROPERT'I.ORYVENPLOYEESWfTH14A6E5A4TiE1F50LECONPENSATION, � Commercial
Z VALL�O THE WOHI(�170 THE STRUCTURE L`NO7IMEl1�Eb OR OFFERE�FOR SN_E(SEG 7041.BU54 J
� NE55 ANO PROFE551ON5 COOE'7HE CaNTiUCTOfLS UCENSE LAW DOES NOT A➢VlY TO AN oWNEF oF �
PHOPEHfYNM1i00U1LOSORIMGiiOVESTHEAEON./�HONMOOOFS3UCNWORKHUASELFORHFASELFOR m
Q hIROUGli WS OH HER OVM EMPL01'F.ES.FHOVIOEO 71UT SUCJ/IMGROYFJdENTSARE NOT INTB10m OR
QoFFEREDPoRSKEIF.HOwE`/ER�1'�EBU�IDwGaqwVROVEMENTI55dDwrt1lwoNEYEAROFCOMPIE
Z T10N,7HE OWNERAUILDER YALL HAVE TME BUFOEN OF PROV WO THAT ME OR SME OIO NOT 9VRD OH
� UdPROVE Fofi 7HE PURP0.5E OF SI�LE}
❑4�OWNEA OF TNE PROPEAiY.AM O(CLUSNELY COfl�FUCTPl6 VRTH UC£NSED COH�iW."fORS
. � TO CANSTRUCT iHE PRO.JECT(SEG 7aa�.9USME55 M!O PROFESSIONS CODE'iHE CONfRACNRS L4 VeIUdlI0I1 AOJ.AREA '
W CENSE UW DOES NOT APPLY TO AN OWNER OFA PflOPERTY YRIO HURDS OR IMPF10VE5 THEAEON,N/D
= WF1000tlTRACTSFONSUOIPHOJECfSWTiACONTMROR(S)UCEI�EDPURSUAHTTOTHECOHTAAG Q�JqH7'�7Y DESCR1PT10N FEE
~' To0.5l10EN5EUw.1.
� J
Q ❑I AY IXE?1VT UNOER SEG 8.1 7.C.FOR TWS REASON �
� �
� OnTE _ OYMER V •
z W
� LICENSED CONTAACTORS OECLARATION �j
CL 1 HEREBY AFFIAAI UNOER PENALTY OF PERAIFY iNAT I AA1 LICENSEO UNDEA PROVISIONS OF CNAPTEA Ur
p_, i�COMMENCWO W1TN SECTION 7000�OF OM310N]OF THE&15WESS AN0 FESSpNS COO�AND Z
� ur ucer+sE�s w Fvu w ,���. q�°3c�-�--� m
� 110EN5E CLASS LiG.NO. �
. U DATE cONfMCTOR �
W
� WOFKERS'COMPENSATION DECLARATION � �
Q
N U
� I HEAEBY AFFIRN UNOER PENAL7Y Of VE0.1UHv ONE OF THE FOLLOW WG OECLARATIONS: z
Q
� IHAVE/WONALL4AIHTNHACEiiTIf1CATEOFCONSEMTOSELFaNSUREFORWOPo(FAS' _
� MPEN4ATION./S PqOVID�BY SEGTON 7]OOOF THE LABOH COOE FOii THE PEAFORMANLE W ,
F hIE WOPK FOfi WHK7i T1I5 PERA1f71S ISSUED. �
O
w I MAVE�MID WiLL WVMAW VIORKEAS'COMVQlSATION IN3VHINCE A4 i1EIX11RED 9V SECTION
Q ]700 OF THE UHON CODE.WA TME PEAFOFM/VlCE OF THE WOHK FOH'NHK?/T/95 7EAM�T R '
L53UE0.pf/WpqK ENSATION INSURAN E URRIER ANO POUCY MJYBER ME CONSTRUCTION Cf�
j c�awea �� � PLAN REVIEW v_ � J
ZPO��CYNUMBER� ��i- O _-_ __ _ ELECTWC _
¢
Q (M65Ecff[NN�r�lO7BEa:M�E7IDCFlYEPEPMrsP]Hor+EMaDa�Oou/3�R��laalF�sl PLUM6ING
w MECHANICAL
Z I CERTIFY THAT W iHE FEHFOFNPNCE OF THE YJOHIC FOR WMIQ1 THIS PERMfT IS 65UE�,1
CJ' SH'LL NOT EAIPIOY AM!7ERSON W NI'I YIJINEfi SOAS TO BECOME S11b�1ECT TO 7NE INSPEC710N FEE
�� WORKER5 COMPENSATKIN Ul�NS OF CALIFORN�A AN�M1AEE 7)iAT IF 1 SNOUIO BECOME
S SUBJEGTTOTHEWORKERTCOMFENS�TIONPROvi510NSOFSECT70N]7aoOFTMEU80R ��cUANCE
CppE,1 SFIALL W�/11VJI COMPIY WRN TMOSE PROVISIONS.
� ��TTMy� /�-. 1�_�A� SMIP
� DATE O PLICANT. �j�.� .
w ENEAGY P1C
� WARNWa FA4LiiE 7o SEGURE W0�1KEA5�OMPFNS�710N COVERAGE IS VNUWFUL ANO BMN.L BE '
� 4UBJEC�AN FIAPLOYER To CAMWAL FENty71E5 AND UViI FPlES VP To ONE NUH�HED 7YIWSANO . �jERGY PEAM�T .
DOILAfLS(SI00.0o0�W IDDITION TOTHE COST OF COMPENSATON.OAMAG£5 ti5 PHO�/�OED fDfl M
� sEcrnr+nae oF nrt ueoa cooE wTsaEs[,wo�rioar+ers cEes qETEMIpN FEE: �
w CONSiRUCT10N LENDING AGENCY PRE-ALT FEE
d
Q 1 HEA�Y AFFIPM UNOEH PENr11Y OF PEFUUf1Y THAT 7HEAE t5 ACANSTRUGTION IfN�W6IGENCY
aZ- FOH THE PEAFOiiNINCE OF 7HE WOAI(FOR MMICN hl13 PERMIT IS LSSUEO lSEG MSJ.CN.GF . '
W
� LENDER5141AE
F-- LENOEfT4AODRE55 /'L
� ICEATIFY717ATIMAVEREI�UT�'�9A➢7UCAT10�1ANOgTATEh1ATTHEA80VEWFORA/AT10N19CAFAECZ TOTAL FEES 6 `C��
W 1 AGAEE TO COMPIY WITH Al1 C1TY N�O COUNTY OfiOPlAHCES M7�STATE UWS RFIATING TO BUIDING ..
� CONSTPUCTION.AND 11EPEBY AIfTHOWZE RFPfiESENTATNES OF 7ML5 CIX1Ni'/70 DlfEA VVON 7HE
� ABOVE�EM1oNED iROVEATY FOH W5PEC770N PUAPo5E9. � .
Z COMMENTS
� "7""T`'�� �0..�
J
�
m PERMIrfEE NAME(PWI I
� �^ _ 01� '1 ��
� SIGNA7Uf1E OF PERMfTTEE � DATE
RECPT.NO. PAID BY V/LLIDATION
� • � WHITE-0epartment Copy.YELLOW---Finance Copy.PINK—Assessor Copy,GOIDENROD—File Copy.GREEN—ApPlkanCa Copy . .
� 9
�'�.,;�s Y.,J� �''�/���v�a�11�� 'r.��w�
y1`��•�=�:.'� 6 3���� ���'����
� �-- s�`C -�-�--_--<-�--���,�,�t-.�-- �, ��.,. - -
.�r�' 7�3 �' x.r ,...'�-. 'y. p -� s�. �,�-r-•,ff�y.- �- 4,�Yi. :-a,�.,1]� '����ia, �.{� a�Rf =� ��? �•�� ,��"f-�-'7�.� °4 ° p
�� � i�tl a ,j 1��.S`���i k'�P r "�'�� k�����,� ��;'m .i �-1 vA�W:j�.,.7.;x �^"tl£��'I '4���.+���C. '��t`✓�.�,�"4�J,ur"5�,�,���. �_:,�'45� -
�' ��t.,.__`L�3�`�;t'�-.'.'�^'. ._.il�.�<tik�_.L�. }n�.,:.�-t��.�,F�.1.�._,.�} - .�r____s}.'�..,-^�'--''+�,"`v} --y _�C�.a,_,_:=`T�..-�'.sc�... ���_ ::r
SEi br.CK � � --------� �rL00RJCIST .-- --- ---- - ---� -- - -
- • --- ---- ---
--�------ ----- -- �--_-_
�_..----- -- �
I--f:ufF0�i�1�:'�TEEL i � rH,4 REQ�,4T;
---------�- - ---- ------ - --- --------- ---•-----, ----- --�--- -------- ------. ___.._�
FL[��I�RIC GF,OU;10 � ; ' �l)t•JDER rLU��R.OUCT ---
^��FLU�v121�dii r— —� �UhdGER FLt�On CO�JDUI�
GFr i i,.,� ---j- ----I I
I
— _ �---�----�---�--,_� ------� l FIRE?LA�E FOUP.OATIUha �
SLS9 C�F;,C?E I � � �
�i�EtiiP PO4VCP � �FIREFIACE UCfdD BEAh1
V�lATtFZ SERVICE � I ^�— �P:ND HT.BOP�1D BEA(�9
R�JOF SHEATFIING � I 3�T.SOt4D BcP.Ni
FRA.MIt•IGNEPITILPTlON -- - -- ------- I FINAL BOND BcP.�I _ --
ROOF COVER P—RE-�RADING _ __ .___
- -- ---- L--�-, J _
ROUGH HEATING ___^___�__ BEfJCI�If•IG _ _ _ _
ROUGH cLECTRIC � I ROUGH GRADINC�'i
P,OUGH FLUi'+IQIM1IG FINISH GRADING
SH04VER/TUB TEST � POOL ELECTRIC
EXT.LA7H;SIDING POOL FEPlCING
4VALL I�ISU�Al10�1 POOL FIrIAL
CEILII`JG I�dSUlATIOf`J CFF SITE IMFS.
GRYbVALL MAILING ______ __ _ ____ DEDICP.TIONS__ _�
SE�;'ER -- ----- - FINAL EP1G_------ --- -
SEPTICTA�JK ` L�NDSCAPEiIRRIG. y_ _ __
SEEP PITi L.L. ^ ON SIT�IiY1P5. i
GAS AIR TEST FI�IAL ZONING
FI�AL CON57. �F(RE DEPT.FIfdAL ,
FINAL HEATI�JG HEP.LTH DEPT.FINAL
FIPI�L ELECTRIC DEV.FEES PAIO
FINP,L PLUMBING 1 EPJERGY
FI�JAL PLANIiJG --
fINAL ENGINEERIPdG--- -�-- -------- - — ' �'� o ---- . -------
co�v�nnENYs _..__._ --.-----._. —.— � — —
ScPTIC TANK SIZE
SEEP PIT/U SIZE