HomeMy WebLinkAbout11-626 (5) �„`_ CITY OF DIAMOND BAR /
" � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7
�'""'� BUILDING PERMIT APPLICATION Y
JOBSITE /f� �n
Q ADDRESS ��' /" ' �/Q�'1-0 dLGK �G1" �IVc� APPLICATIO�Z PERMIT p/C
p DATE �� �U 11 NUMBER���I-��1�y
� APN LOT TRACT ISSUE TYPE ��//� OCC
DATE CONST..����.�-GROUP
p OWNER " �^t
" ADDRESS 1Z21�I /V- L Ct �^^-U� /?��� j3/�/� ZONING ETBACKS
z CITY �. r,' ZIFAn(DT� TEI�D���- x.�� FRONT qyy �
__ J ❑
p APPLICANT TEL. SIDE/SIDE STREET RW p
� CONTRACTOR P✓Y ' !0 K � SIDE p
ADDRESS
� CITY •� • ZIP� TEL. PROPOSED USE P ✓ t1 C O V
w ARCWEN / �
z DESIGNER '
a ADDRESS '�' NO.DWEL. NO. NO.
v� UNITS STORIES BEDROOMS
N CITY ZIP TEL.
N DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTV OF PE0.0.1RV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f8 B/C8
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANOPROFESSIONSCODE:ANYCITVOq (n 9 �rt
U COUMVNM1i1CHRE0UIRESAPERMITTOCONSTRUCT,p1TER,IMPROVE,DEMOL15H2ORREPAIRANYSTRUC� W P82i0/DBCI(
w NqE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPIICANT FOH SUCH PERMIT TO FIIE A SIONED w
STATEMENT T1iAT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS OF 7HE CANTRACTORS LI�
� CENSE LAW(CHAPTEF e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � PooUSpe
, � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMV� C7
TION.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CML VENALT/OF NpT MORE THAN FIVE HUNDRED DOLURS(t600).):
0 OI,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � COR1rt10fC18I
Z WIIL DO THE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.7W�,BUSI� .J
N NESS M1D PROFESSIONS CADE:THE CANTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF j
PROPEHTY NRiO BUILDS OR IMPROVES THEREON.AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR
w THROUGH HIS OR HER OWN EMPLOVEES.PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEAEDWRSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAAOFCAMPLE-
Z TION,THE OWNERAUILDER WILL HAVE TME BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OP
� IMPROVE FOR THE PURPOSE OF SALE).
�y,� ❑I,ASOWNEROFTHEPROPEHTV,AME%CLUSIVEIYCANTRACTINOWITMLICENSEDCONTRACTORS
Q TO CONSTRUCT THE PROJECT(SEC.)ON,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� V8IU8fIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OMMER OF A PROPERTV WHO BUILDS OP IMPROVES THEREON,AND
� WFIOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(SJLICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIP710N
Y roas ucENse uw.>. FEE �
� ❑I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS REASON �
?� U
� DATE OWNER ¢
Z U
� LICENSED CONTRACTORS DECLAAATION W .
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d, 8(COMMENCIN(3 WI7H SECTION 7000)OF DIVISION J OF THE BUSINESS ANO PROFESSIONS CA�E.AND Z
X W UCENSE IS IN FULL F/OFCE AND EFFECT. m
� LICENSE CLASS `-'�� LIC.NO. / � �
wDATE ���_+� CONTRACTOR v� d
� WOAKEFS'COMPENSATION DECCARA�uN�/ ���f � , v �� � .,
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLAAATIONS: Z
� _I HAVEAND WILL MAINTAIN A CERTIFICATE OF CANSENTTO SELF�INSURE FOR WORKERS' ¢
S
COMPENSATION,ASVROVIDEDBYSECTION37000FTMELABORCOOE,FOqTHEPEHFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
� �_I HAVEAND WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS FEWIRED BV SECTION �
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICN iHIS PERMIT IS
ISSUED.MV KERS'COMPENSATION INSURANCE CARRIER AND POLtCV NUMBERME: CONSTRUCTION
jCARRIER��w�� _ � PLAN REVIEW •
¢ POUCYNUMBER �� �� ELECTRIC
0 (fFi1S5ECi%XJNE�NDTBECOA/PLEfEDOF7HEPEpMTI3FpqpryEFily.�q�pp�URS(f1pp1�LESS� PLUMBING
W �Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORI(F-0R WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
G�S SHAIL NOT EMPIOY ANV PERSON IN ANV MANNER 50 AS TO BE T TO THE
(/) WORKERS'COMPENSATION LAWS OF CAIIFORNIA AND A�R AT IF I SHOULD BECAME INSPECTION FEE
SU&IECTTO THE WORNERS'COMPENSATION PROVISION F SECTION 37000F THE LABOR �� ��
O I SHALL FORTHWITH COMPLV WITH THOSE PqOV ONS. ISSUANCE
. p DATE:�-r, APPLICANP. SMIP
W
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SMALL 8E ENERGY P/C �
J
� SU&IECTAN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOILARS(f 100.000�,IN ADDITION TO THE COST OF COMPENSATION,DMIAGES AS PROVIDED FOR IN
J SECTION 37oe OF 7HE LABOP CODE,INTEREST.AND ATTORNEV'S FEES. ^ d�
w RETENTION FEE: d,y
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV TNAT THERE IS A CQ45TRUCTION LENDINO AGENCV
FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70G7,CIV.C.).
Z
W
� LENDERS NAME
1— LENDER'SADDRE55
w I CERTIFV THAT I HAVE READ THIS APPLICATION/WD STATE THAT THE ABOVE MFORMATqN IS COfiAECT. TOTAL FE ES �1Q�/O��
� I AOREE TO COMPLV WITH ALl CfTY AND CWNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE '
Z ABOVE-MENTqNED PROPERTV FOR INSPECTION PURPOSES. COMMENTS �
�
_' (/ a t/�'-'1
�
m PERMITTEE NAME(PR1NT) ' �
¢ �2 -
�
� 510NANREOFPEqMITTE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--Ffle Copy,GREEN—ApplicanYs Copy
CIT'V O� DE�,f�iCDiVD ��R _
�- �`���� �;�' ��}� I�lSP�CT001� 9��CORD �
t3�1
r � ��� ..��
�. � a , � ���. :: aa���a aa�p�c�oaa oa� :-d�����ta�, ,
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 BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING 17 BENCHING
ROUGH E�ECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION P�OL 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
o�o
COMMEfVTS
SEPTIC�TANK SIZE
SEEP PIT/U SIZE
a
':c� � .a.
�.� �� ; ; _