HomeMy WebLinkAbout12-906� ,
� CITY OF DIAMOND BAR /
_� , ;��"-��� DEPARTMENT OF CONIMUIVITY&DEVELOPIVIENT SERVICES � V
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 RE$$
��''"'. BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE /��A�•���^ C. l��O
� APPLICATIO PERMIT P/C
o ADDRESS ��) /V �`� DATE � NUMBER �
� APN LOT TRACT D TEE i l �� NPE p�C
p OWNER tT � � ,n CONST. GROUP
" ADDRESS ZONING SETBACKS
o I
FRONT �
z CITY (�1� ZIP TEL. RW
� APPLICANT TE �� REAR p
¢ ' SIDE/SIDE STREET RW
� CONTRAC OR �C .0 SIDE �
� ADDRESS �
� CIN ZIP � TE - � PROPOSED USE
w ARCN/ENd
z DESIGNER —�
a ADDRESS NO.DWEL. NO. NO.
UNfTS BTORIES
� CITY . ZIP TEL BEDROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION �
O � � � SFR/ADD/REM
p I HEREBV AFFlRM UNDER'PENPLTY OF VER1URy 7HhT I AM EXFJAPT FRpAI 7ryE CONiMCTORS LL Gerage/CarpoA -
LLI CFNSELAWFOqTHEFOLLOWWOREASON(SEC.7031.6BUSINESSANDVROFESSION9COOE:ANYCfTYOR � . (n
ZCOUNTVWHICHRC-0UTAESAPERMI7TOCONS7AUCT.ALTER�PROVE,DEApLISH.ORREPAIRANYSTRUG W P8ff0/DBCI(
W NRE,PRIOR TO�fTS L4SUANC�AL50 qEWUiES hIE APPLICANT FOR SUCH PERMIT TO FlLE A SI(3NED w
� STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROYISIONS�OF THE CONTiUC70R3 LL
c CEf14E UW(GiAPTEA Y(COAeMENCINO Wf7H SECTION 7D00)OF DIVISION 9 OF THE BUSWESS AND PR0. u' POO�SpB � .
vFESS�DN3COO�ORTHATHEOHSHEISIXEMPT7HEREFROMANpTHEBA515FORTHEALLEOEDE%EMP- (�
T�ON.ANYVIOI.ATIONOFSECTION7031.6BVANYAPPLICAN��FORAPERMITSUalECT9THEACPIICANiTO . Z R8-ROOI
� AGVILPENAI.TYOFNOTMORE�THANFIVEHUNDREDDOLLARS(iboo)J:
� ❑I,ASOWNEROFTHEPROPERTV,ORMYENPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 Cwnmerdaf ' �
Z N�ILL DO THE M/ORI(AND THE 37RUCTURE L4 NOT INTENDED.OR OFFEAED FOR 3ALE(SEC.�7ow,BUSF J ' �
N NESS ANO�ROFESSIONS COpE:THE CONTMCTORS LICENSE�UW DOES NOT MVLY TO AN OWryER oF � -
PROPEHfY NM1iO OUyD$pq IMPROVES THEREON,ANO WHO DOES SUCH NqR1(N7MSElF OR HERSELF OR •
FC 7HROUGHHlSORHEROWNEMPLOYEES,PROVIDEDh1ATSUp/1MPROVEMENTSARENOTMTENDEDOR m
Q OFFERmFOR3ALEIF,VqN,EVEF�7HEgU1LpplppqqdPROVEMEMISSOLDWfTHINONEYEAROFCOAI7�E- .
Z 710N.htE�OWNER�BUILDER WRL NAVE TNE BURDEN OF.PHOVINo 7HAT�HE OR SHE DID NOT BU0.D OR .
� IMPROVE FOR 7HE PURP0.SEOF SALE} . . .
� ❑4.�.�^oWNEROFTHE.PROPEiRY,M1IXCLUSNEIYCONT{UCTWowfTHIICENSEDOpNTqAC7ppg .
TO Cp15T{p1CT TME PRO,IECT(SEC.70N,�BUSINE55 AND PROFESSIONS COpE;7r{E.CONTMCipR9 U- V8IU91I011 AD,I.AREA�
CEHSE UW DOES NOTMPLY TOAN OVMER OFA VROPERiY WHO BUILDS OR IMPROVES THEREON,N7D �
� MMOCONTRACTSFOR5Up1Pqp,lECfSWITHACONTWICTOR(S)UCENSEDPURSUAHT70THECONTRAC pUq�,�71TY - DESCRIPTION - �E
� TORS LICEl7SE UW.).
0 O I AY E%EAIPT UNDER 6EG B.8 F.C.FOR 7HI3 REASON
7i U
� DATE ONMER -�
Z V
¢� LICENSED CONTRACTORS DECLARATION �
2 w
I HEREBYAFFlRAI UNDER PENALT'i OF PERJURY 7HAT IAM LICENSED UNDER PqOVISION3 OF CFIAPTEq � � �- � .
� Y(COMMENCIMO W17H SECTIDN 70DD)OF DNISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z �
LLI ��NSE IS IN fULL FORCE AND EFFECT.
O m
� UCENSE S � UC.NO., Z �� � �
U �A ` CONTAACTO� d . . .
LLI
� WORKERS'COMPENSATION DECLARATION Q - - - � � . �
� I HERFBV AFFIPM UNDER PENALTY OF VERJUHY ONE OF T7E FOLLOW WG DECURA7ION5: V
C� . . . . . Z . .
� _IHAVEANDWILLMNNTAINACERTIFICA7EDFCONSENT705ELF�7NSUREFORVqPo(Q�S' QS � -
Q COMPENSATION.Ag PROVIDED BY 6ECTION J7000F THE IABOq CppE,FOq TME pERFORMANCE C„).
OF THE WORK FOR WHICH iH13 PERAqT IS ISSUED. W
0 �
FW— �IHAVEANDWILLMAIMAIN.WORKEi13'�COM7ENSATIONPISU�UNCEA4REOUlAEDBYSEC710N � .
Q 37000F�THE L/�Bpii CppE,FOR THE PERFORMANCE OF THE WORI(FpR WHICH TH�S PERMR IS
ISSUED.MV OPot OOMP A710N INSUfiANCE CARqIER AND.POLICY MIMBER ARE: �CONSTRUCTION�
� �
Q CAARIER_;�k�._�+ �' PLAN REVIEW � .
� Z POIiCY�NUMBER S���.�G . ELECTRIC
¢
o frr�sEcrioNN�rareemnr�rmaFn+EaEw.ir�sr�a+EMira�oaulslrao)oa�ss? PLUMBING
w
Z 1 CERTIFV.T1iAT M 7HE PERFOfUW�CE OF THE.W'ORI(FOq WFllql TFj�g pERA1R tS ISSUED,I �MECHANICAL
CS SMALL NOT EMFLOYANY PERSON W ANV MANNER SOAS TO BECOME�9UBJECT 70 TiE' , /
(/) WORNERS'CONPENSATqN LAW$OF CALIFORNIA,AND AGREE 7HAT IF I SHOII�p BECOME INSPECTION FEE
SUBJECTTOTHEWDpKER5COM7EN$ATIDNPRONSIONSOF�SECTION37o00FTHELABOR - � ���
O COD.I S FORfHWIhi COA/pLY N7iH E PROVISIONS. ISSUANCE
� DATE4�� APPLICANT:: � . . . . �SMIP . . . . � .
J WARNINO:��FAILURETOSEWREWORKERS'COMPENSATIONCOVERAQEISUNUWFUL,ANDSHALLBE ENERGYP/C
�y SUBJECTANEMPLOYERTOCRIMWALPQdALTIESANDCMLFWESUPTOONEHUN�RED7HOU$/Wp ENEROY�PERMIT
� D�L1/1fi3.(5700,000),W PDDITON TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN
6ECTION 370!OF h1E LABOR CODE,W7EpEgT,AND ATfORNEY$FEES. ' RETENTION FEE: '
W
� . CONSTRUCTION�LENDING AGENCY PRE-AlT FEE:
� IHEREBVAFFlRMUI�ERPEN�LTYOFPERIURY7FIATTHEfiE�19ACONSTAUCTIONLENDWOAc3ENCY - �
�Z� �FOR TNE PERFORMANCE OF THE WORK FOR NM1i1CH 7HI9 PERAIR IS ISSUED(SEC:3071,qV.CJ.
W
� LENDER'S NAME _ . .
� LENDER'SADDRE55
., � -ICERTIFVTHA7IHAVEREADTHIgMpLICATqNµpgTATETIIATT3iEABOVEWFORMATIONISCOqAECT. TOTAL FEES ' -���
� 1 A(ifiEE TO COMPLV WITH Ny CT'AND COUNTy pppp�µ�g N.�p STATE UWS REUTINO TO BUILDINO l�
� CONSTRUCTiON,ANU HEREBV AUTIfORIZE qEPRESENTATIVES OF TH1S COUNTV 70 ENTER UPON TiE '
Z ABOVE-MENTqNEDPROPERTYFORWSPECTIONWRP0.SES.
p COMMENTS ' �
�
°O ve i v
¢ � .
�
VJ 5�� E DA E �
� RECPT.NO. � PAID BY VALIDATION
WHITE—DepaAment Copy,YELLOW--Flnance Copy.PINK—Assessor Copy.GOLDENpOp—Ff1e Copy,GpE�T�qppli�B C�y -
CITY 4� Dlp►MOND BAR � � .
lNSPECTION RECOFtD
. . ,
.� _:
�� :h-� ` .: . �- :..� e.a rY,. .Y;'�� •. � .. � � s � . . Q.:o ..
� . 0 : �.,� , . �-F� � . a...
`d:�.., . . .. . . . �
SETBACK ' � FLOORJOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUPID PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER �FIREPLACE BOND BEAM
WATER SERVICE I MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BONQ BEAM
FRAMINGNENTILATION �FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOVdER1TUBTEST POOL ELECTRIC
EXT.LATH/S�DING POOL FENCING
WALL INSULATION POOL FINAL
CEIUNG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. _
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. Otd SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. �(7 FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC QEV.FEES PAID
FINAL PLUMBING EIdERGY
FINAL PLANING
FINAL ENGINEERING � o e '�
connnnE�vTs
SEPTICTANKSIZE
SEEP PIT/U SIZE
� ��