HomeMy WebLinkAbout13-776 CITY OF DIAMOND BAR ���y��
---�� — DEPARTMENT OF CONIMUPTITY &DEVELOPMENT SERVICES
I
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Iiotline(909)839-7027 PRESS
���^^�� BUILDING PERNIIT APPLICATION FIRMLY
a DDRESS�`tO�b �, �iamvnd 8a�z B(vd i DATECA O J�_ NUMBER�3���� #/C
o ISSUE IYPE OCC
� APN��- LOT TRACT DATE CONST. GROUP
p OWNER 1 SI YI I
ADDRESS S� ')'YI DMI ZONING SETBACKS
z CITY a�Gw�ohd Ba r z�P a►�6s TEL ' g FRONT RW ❑ � '
� APPLICANT TEL. REAF� ❑
o SIDFJSIDE STREET �' RW ❑
� CONTRAC7 R a i �i( C��I CQ SIDE ❑
Q ADDRESS � � /'
� CITY �L ZIP gS D T,EL D ' - PROPOSED USE O � GY G� K.
w ARCH/ENG/ OO
z OESIGNER NO.DWEL NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL i
cn
N DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANAlUAT10N
¢ OWNER-BUILDER DECLARATION SFR/ADO/REM '
O
p 1 HEA�Y AFFIWA UNDER PEN/�LTY OF FERIUPV TNAT I AII E7(EM7T FAO1.1 T7E CONffUGT00.5 ll- Garage/Carport
W CENSEUWFORTIEFOLLO\MWOREASOt1(SEG7m1.SBU5WE55INOPROFE55ION5CA0ENIYGTYOR (/)
U p�7r!{yyyHICHRE0U1RE5APEAMITTOCONSiRUGT,ALTEF�WPqOVE,OEA10115M,ORREPNRANYSTSiUG W pa�O/DeGI(
w TURE PRbA 10 RS LSSUM7CE./�L50 REaUIqES THE APPIICANT FOR SUCH PERAIR TO FILE A SIGNED w
STATEAIENT THAT ME OR SNE LS UGENSED PURSUAM TO THE PROVISIONS OF THE CONTMCTORS LL
� CFNSE Uw(OUPTER v�COMNENCulG WITH SEGTIOt!70o0�OF O1VLSqN]OF 7HE 9V5WESS AND PpO� � PooVSpa
FESSqNS COOE�OR THA7 HE OR SHE IS F7(EIIPTTHEHEFROM ANO THE BASlS FOH THE AILEG�EXEMP-
� TION.�N7VIOLATIONOFSECTION7o]t.SBYINYAPPLICANiFORAPERWTSUBfECTSTHEA➢PUGNiTO Z RaRool
A CML PENALTY OF NOT MORE THAN FNE MUNORED OOlLAi75�SSoo�.k
O ❑1,/SOWNEROFTHEVHOPEHTY,OFAIYEAIPLOYEESWRHYlAGESASTHE1RSOlECOMGEN5AT10N, � C,pmmBfCldl '
z WILL�O TF�E WORI(ANO THE STf0.1CNRE IS NOT INTENOm oq OFFF,AED FOR SALE(5EG 7aa,BU31- J
� NE55 MID PROFESSIaHS CODE'THE CWlTMCTOqS UCENSE Uw OOES NO7 APVLY 70 AN OWNER Of � '
PqOPEHTY NAiO BUROS OFl IMCROVES TIEAEON.NJO WHO DOES SUCN WORI(HW9ELF oH FIERSEIF OR
Q THROUGHWSORHEA04MEMPlOYEE5.7fiOVIOmh1ATSUCJ111,IPPOVEA/ET/TSARENOTO7fENOmOR m
w OFFERmFURSKEIF,FiOWEVERTMEBUlOP1GORW7fiOVEMEHTI550LDN7TMWONEYEAqOFCONA.E-
� T10N,7NE oWNER-0UILDER WILL NAVE TNE BUqDEN OF PROY41(7 7HAT NE OR SHE DID NOT BVIID oR
Z V.IPROVEFOHTHEPURPOSEOFSAI.E} '
_ �L1ISOWNEflOFTNEPROPERTY.AA/E7(ClUSNELYCOMRACTW6WITHlICEKSEDCOHTMGTOfLS
W
Q 70 CONSiqUCT THE PiiQIECT(SEC.7oa�.BUSINE55 ANO PROFE5570N5 COOE 7HE CONiRAGIORS L4 VaIUHI�M AQI.AREA
W CENSE UW DOES NOTMPIYTOMI OWNEA OFA VflOPEflTY WFiO BUEDS OR IMPFlOVE9 TNEREON,IND
� XTqCDIf�AACi5FOR5UOIPRQ1ECf5WT7ACONIMCTOR(S�LICENSEDPUq9UANTTOTHECOHTTUG pUANTiTY DESCFUPTION FEE
Y 7o0.S UGENSE Uw.�.
� ❑I AY D(EMVT UNOEA SEG B.i P.C.FOR TU5 REASON Q D �—G✓�� �
� U
� ¢
Cn?= _i_'__'_'_ OWNER U
Z W
�Q IJCENSED CONTFACTOAS DECIAHATION W
CL 1 HERFBY AFFW.1 UNDER PENALTY OF PER0.IRY TMAT I MI UCENSFD UNOEA VROVISIONS OF CiM➢TER '
� 9(COMMENCu7O VIITH SECfION 7oao�OF OMSION]Of 7HE BUSWE55 M1D PROFESSIONS COOE,MO Z
X 41Y L10EN5E LS PI FIIIL FOFiCE MlD EFFEC7.
Q LICENSE CUSS � !✓ LtG.NO. I I I j
U �ATE CONTRACTOR
W
� WORKERS'COMPENSATION DECLARATION � '
�� 1 HFAEBY AFFRiM IW�ER PENAITY Of GEAIUfiY ONE OF THE FOLLOVNNG OE0.AMTpNS: Z .
� I NAYE ANO WRL NNNT/�W A CEHTIFlGTE OF CANSEHT TO SELF�INSURE FOR WOW(FA.4 a
� — 2
COMPETlSATION,/5 7ROVIOED BY SECTION]�oa OF THE LABOH COOE FOA THE PEHFORMANCE w
Q �QF TNE WORK FOR WHIOi 71U5 PERAUi IS ISSUED. �
W ��
r1UVE/WO WILL I.WM/JN WORKEAu CONPENSATION INSUqANC�AS REOUIHED BY SECTU]N
Qa7o0 oF TNE LABOH COOE.FON TNE PE RM/JlCE OF THE WOfiN FOq WH1017HI5 PEAMfT IS
J ISSUED.IAY S CO PENSA SURANCE GRRIER AND POUC/NUMBER ME CONSTRUCTION ��8.�9
j GRRIER ��'a-�e �u�vtd P�,���E,�, �
. 0 POIICY NUMBER � .
Z ELECTRIC
¢
� • (n+ssecrin+r�r+aree¢xnFrIDaFn�v�rsieaor+Er+w��ca�ls�mfea�ssl PLUMBING . .
w
z i ceATicr nur w n�e�aFow.unce oa nie woroc wa wwa�nus aEawr a asuEn.� MECHANICAI
�J SH/U.LNOT EIAC�OY MlY VERSON R1 AN'I Y�W1Efl SOAS TO BECOME SUBJECT T0 7NE
� WORKERS COMPENSATION UWS OF fJLLIFORNl1 AND AQAEE 7HAT IF I SIiOUID BECOME INSPECTION FEE
= SU&IECTTOTHEWO�CEfiS'COMVEN5AT10NPROV15qNSofSEGTION]7aoOFTHEU00R
cooE arHvnn�cw+v�rwm� evaqvis�a+s. ISSUANCE •��
� 12 �aG�n�rcc �a 1/(o,U
OATE APPLICANT: SMIP
wWARMN4 FMLi7E TO SEGLHE wOiiKERS WAIPENSATION COVEMGE 45 VNLAWFUL AND SIULL BE EJ�IERGY P1C �
� SUB1ECi AN EMPLOYER 70 CAI4WAL FENN.TIES ANO CML FwEs UP TO ONE FNRiOREO Ti10U3AN0 .
ooivas(sim.000�,w rnnmar+ro rnE cosr oF caravws,mor�,o�c�.s tis aaoviom wa in � ENERGY PERMIT ��
¢ SEGTION]7oa OF h1E U80R COOE�EFlESL ANO AITOPNEYS FEES. Z�OO
RETENTION FEE:
a CONSTRUCTON LENDING AGENCY PRE-ALT FEE
O
� 1 HEREBY AFFlRM UNDER PENI�LTY OF 7ERNFY 7HAT TNERE IS A CAIA7AUC710N LEllDINQ AGQlCY �
Z FOH TiE 7EAF0(iMANCE OF THE WOH1C FOR WF11CN 71U5 PERMR IS tSSLED(5EG]C'll.CN.GF
W
� LENDERSl/M�E �
� LENDEA'S POORE55
¢ ICEATIFYTHATIHAVEREAOTHISAVFLJCATIONAN09TATETUTTHEA80VEPIFORMAT10N19CORAECT. TOTAL FEES �� �Z�
w I AGREE 70 CAMPIY VA7M ALL C7lY N10 COUM'Y ORDPlJiNCESIND STA7E UWS REUTWO TO BULLD W(3 -
� CONSTRUCf1ON,lJID HEREBY AUTNOWZE RFPFESENTATiVES OF h115 CIX1NiY TO EMEH UVON THE
Z �ew6-a�ornor+eo vaoPERrr wa wsvecrar+warosES. COMMENTS ,
� ��r�ra �G?'�/�OU�
N `�`��� a/ia ��3 'o,
� 5 EOFPERMRI � � �� OATE ZII�7� YALIDATION
�. RECPT.NO. �� PAID BY . . .
� WHITE--0epartment Copy,YELLOW--Finanee Copy.PINIhAssessor Capy,GOLDENROD—Fiia Copy,GREE?�Applk�nCs Copy
i:5�`,' �i.1� ��������1��� ����t
91�;a�=p'i.F�G�t.��'t� �jf�a,l����
3e.� i,C�. :.i � .: +t�J'S'r i �"`w��,i�° -y ...�a�'��'x�n. T�.� � i �� a.i,,.. . . �3i kt - " 'S'�'..-"'.�'�"Tr "�.. _.;yt '_ µr,. .�
4 -f1-� "�m- � '�,� hl -� � £ * 4+ p �{�
� ., 1 � � -`I JY' , a tN( � �.-,-�. �,j� r� r��.� r�,, '`� ' ��-",'���,:—.�_`�t-"��- -��€��1���7 a�"`-'4�__��o - _ � m
i �� , � t'�, � ti �T� ,�-'� � �g 4�'�"�F-� v r�`�'�e.a 5,. 4 r'�,.���F��I�i 3�� '�r•+ � �
't7.; . ..._a�-�`_ES�.t�S..'� � ,�a. k- -�c-i'.r'-,�`',�.��.-����.,-ss ybd����:_c.,._r�`L. !�ai�� ,..��r,-'�� 'll a ` �.,., � r����,- s
_E�Br��f' ._-- — ---� j I rL00RJCIST _ - ---- -
_.___. . ._..- - - �--- - -- ---- �------- - - - -- -- �— -
FT:iS;��Oriiv15i�TEEL � � FHP.REQNIT;
---------- - - ---• ------- -..
I
-- -------------------i -�----- - �-------- - ---
_ --�--... .----—
--
EL[C1�RIC G�=,OU,1� � � � liPdDER FLOOR OU�T
------ ----' -----' ---------- -----
GROIJid�FLU�vi61P1� � j � Uf•�GER FLudn COh1DUIT —�
---i—�——
SLfi9:�FADE i � FIREPLACE FOl)p�phTlUPa
"�ENi°PO'aVCR I �FIP,EFLACE 8Cfv0 BE�A4
V!ATtR��ERVICE i � PotID HT.BOf�ID BrAti9
ROOF SHEf\THI(•aG �_ _� I 3�T.BO�dD BEP.ht
FRAiVtlf•IG!VEf•ITILP.TION � FI�IAL BO�1D BER.M
ROOF COVER PRE- RADING _ _ ___
ROUGH HEATI�JG � �— �BEfJCI-11fdG _
ROUGH cLECTRIC � � + �OUGH GR.SDING
P,OUGH PLUi`+If31P�lG � FINISH GRAOING
SHOV�,'ER/TUB TEST � PQOL ELECTRIC
EXT.LATH;SIDI�dG POOL FE�`JCING
LVALL INSULATIO�I FOOL FII�IAL
CEILING��dSUlAT10�! CFf SITE INIFS.
GRY�NALL NAIIING DEDICP.TIO�lS
SE4+/ER FINAL E�JG
SEPIICTANK � LP.NDSCAPE/IRRiG _ _
SEEP PIT,%L.L. ON SIT�II�1P5. �
GAS AIRTEST FINAL ZONING
FI�!.4L CONST. FIRE UEPT.FIhJAL
FINAL HEATI�IG - - - � HEP.LTH OEPT.FINAL
FIP�IAL ECECTRIC DEV.FEES PAID
FINP,I P�UM8ING E�dERGY
FINAL PLANIfJG __ _� __ __ __
FINAL ENGINEERIP•!G I �� a a
---- -------�- --------- --- ---- -------
COMMENTS _..--. -- ------ -.- - -
SEPTICTANKSIZE
SEEP PIT/U SIZE