HomeMy WebLinkAbout12-758 . CITY OF DIAMOND BAR /
I ----��'�— DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES � �
:��,y� . 21810 Copley Drive,Diamond Bar,CA 91765 PRESS
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
� ���+��W BU��DING PERMIT APPLICATION FIRMLY
v J�, / APPLICATION PERMIT 'Z_�c� P/C � �
I o ADDRESS 1l ��%�j ��� �T�i S�� DATE_� � ` � NUMBER � a �a1--t S�
ISSUE � TYPE OCC
� APN LOT TRACT DATE ��� � 1 �NST.� GROUP
p OWNER V�f�1 l�l ��� G � �Sr�G
� G�� ZONING SEfBACKS
o ADDRESS ' FRONT RW ❑ '
� CITY f�j TEL. _ � REAR O
APPLICANT � TE SIDE/SIDE STREET RW O
� CONTRACTOR , � -Z SIDE �
� ADDRCSS � PflOPOSED USEX TC�CI�T/i+�IPI`ZD�CM�
� CITy ZIP�TEL -fl�' h, � �r
w ARCWENG/,/ '
z DESIGNER� '� NO.DWEL NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� C(Ty . ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� � OWNER-BUItDER DECLARATION SFRlADD/REM
O
� 1 F4ER�Y AFFlqM UNDEA PENALTY OF VERNRY TUT 1 AM EXEAIVT FR01A TNE CANTFUCTORS L4 GarageiCarport.
W CENSEUWFONTHEFOLIOWINOREAS�N(SEC.7031.68USWESSANDPROFESSIONSCODEAN'/C�TYOR (n .
G� COUNTYMMN]iREOUIRESAPEH1AT7000NSiRUCT.ALTEflIMPROVE.DEMOLISl1.ORREFAIR�NVSTPUG W Pd��0IO0Gk . .
�ZNRE,PRIDR TO RS ISSl1ANCE.AL50 REWIRE9 THE APPUCANT FOR SUCH PERM17 TO FlLE A SIONEO
� 5fATEYEHf THA7 HE OR SME IS LICENSED PURSUANT TO 7HE PROVI.�XJNS OF.THE CONTMCTOR9 lF {,� pQOUSpe
� CEN9E UM�(LHAPTER D(COMMENCIN�N�ITH SECTION�000)OF DIV{SION 7 OF T/E BUSME53 AND PR6
Q FE6S�DNSCOD�ORTHATHEOPSHEISE%EAIPT7HEREFROMANDTHEBASISFORTHEALlEOEDE%EMP•
V TION./JJYVIOIATqNOFSECT10N70316BVANYAYPLMJ�NTFORAPERMITSUBJECTSTHEAPVLICANTTO Z R�Roof
� �A CML PElULT'OF P10T MQRE T1-UN FNE MUN�RED DOLLMS(1500).):
Q ❑I,ASOWNEROF7HEPROPER7Y,ORMYEMPLOYEESWfT11YJACiE5A5TNEIR50LECOMPENSA710N, � CORI(fl0fCl2�
Z WR.L DO THE WORK,AND 7HE BTRUCTURE IS NOT INTFNDED OR OFFEREO FOR 9ALE(SEC.7�,BU56 J
� NE59 AND PROFESSIONS COOE:TNE CONTIUCTORS LICENSE UaM DOES NOT A7PLY TO AN OWNER OF � .
PROPEH7Y N710 BU0..D8 OR IM VROVES THERLON,AND WHO DOES SUCH WOAK HIAISELF OR HE�ELF OR ,
� THHDUGHWSORHERONMEMCLOYEES.PROV�EDTHATSUCMWPROVEMEM6ARENOTMTENDEDOR m
W pFFEqmWR9ALEIF,/qWEVER7MEBUILDMlOORIMPROVEMENTISSOLDWfTM�NONEYEAROFCOMPLE-
0 TqN,THE OWNER�BUILDEA NnLL HAVE TME BURDEN OF PROVIN6 THAT HE OR SNE DID NOT BUILD OR � ' '
Z UAPROVE FOR THE PURP0.SE OF SALE� . �
_ ❑I,AS OWNER OF 7HE PROPERfY:AM EXClUSNELY CONTRACTINa Wf�H LICENSED CONTFACTORS ' - '� •
�[[[W��� 70 CON57RUCT THE PR0.IECT(SEC.7oN,�BUSINE55 AN�PROFESS�ON3 CODE:7MECONTMC70R3 ll- V01U9t A0.I.AREA� �
CENSEUWDOESNOTAPVLVTOANOWNEROFAPROPERTYWFiOBULDSORIMPROYESTHEREON,AND , ' ��
WFqCONTAACT5iOR3UCHPROJEC7SN7TMACONTRACiOR�S7LICENSED%1fi5UANf70THECONTRAG pUANTITY DESCRIPTION EE �
� TC1R5 LtCE E LAW.I. . n. � I,
O �EXEMP7lN�DER SEC. �B.6 P.0.FOR 7HI5 REASON U /I� ✓ �
� / r� ds ' D
� DATE � � OWNER���L.i . U /�
J - 'n ✓/
� LICENSED CONTRACTORS DECLARATION �W . �► _Z � (�Y D �
� 1 HEREBY AFFIRM UNDER PENALTV OF PERNRV 7HAT I AM�LICENSE�UNDER PROVISION9 OF GfAPTER � � r��n)'�fjlym{ �
d a(COMMENGN(1 WITH SECTION 7000)OF DMSI�N 7 OF THE BUSINESS ANO PROFE^�S�ONS CODE.AND . ���.�r
N
X A/Y IICENSE IS M FULL FORCE AND EFFEC7. ��� -.y
LlJ S;r L�/��
o Lz �D.._ �f•-ctJLf_'�,
� UCENSE CLASS LIC.NO.. `jr S
V OATE �7� I�`I� CONTRACTOR _(� �� I
lL � GA
� WORKERS'COMPENSATION DECLARATION U G j�
� 1 HEA�Y AFFIRM UNDER PENALTV Of PERNf1Y ONE OF THE FOLLOWWG DEGAFATIONS:
� �
O _I HAVE AND W�LL M/UNTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR MIOR1(ER5 ,� Q
Q COMPENSATIDN,IlS PROVtDEU 0Y SECTfON 7700�F TIE LA00R CODE,FOR THE PERFOHMANCE W
OF 711E WORK FOR WHICH T719 PERMIT tS ISSUED. �
�
_I HAVE AND WILL MAIMAW WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 970o OF�7HE LABOR�CODE,FOR 7HE PERFORMANCE�OF THE WORK FOR WNIp1 THIS VERAl17 iS, L��
ISSUEO.MY WORKERS'OOMPENSA710N INSURANGE CMRIER AND POL1C/NUMBER AfiE CONSTRUCTION�� . �Z � • - • — a l
j �qAiEq PLAN.REVIEW �'��"q �9
� POI.ICV NUMBEH ELEGTRIC ���� • 9�
� (nassEctia�lr�IDr+o7eE�rIDOFn�a�r�swaane�x�ooauasMaMOA�ssl FLUMBING � . . . . �
W MECHANICAI �5(p,Sg
Z 1 CERTIFV TNAT IN TTiE PERFOiiA1ANCE OF THE.WORK FOR WHICH h113 PERIAR IS ISSUED,1
(} SHALL NOT EAIPLOY ANY PERSON Pl ANY MANNER SO AS TO BECOME SUBJECT TO THE INSPECTION FEE�
� WORKERS'COMPENSA770NUN50iCP11FORNIA,ANDAGREETIiA71FI5NOVL08ECOME . . . . L}� —
SUBJECTTOTHEWORKERS'�C01.1PEN9ATqNPRpVIS1�ISOFSECT10N37o00FTHEUBOR �SSUANCE \� ` '�\
CODE.I SIIALL FOFlT11W�7H COMPLY VA7H THOSE PROVISIONS
p DA7E aaPL�cANf: ���1� .SMIP �Q • �'O
W ENERGY P/C ��' ��
J WARMN(i:�FA 70 SEGURE wORKEF75 COMPENSATIOH CAVEiUGE IS UNLAWGUL.ANO SHALL BE � � �]/,
J SUBJEC7 AN EMPLOYER 7o CRININAL PENALTIES AND CML FWES UP TOONE HUNORED THOUSAND S� • �1�'!�
� ENEROY PERMIT
DOLLAR.4�5100.000),W ADDITKN3TOTHE COSi OF COAIPfN5A710N.DAMAOES AS PAOVIDED FOR IN �
J SECTIOM 370!OF 7HE LABOR CODE,INTEREST,AND ATTCMNEY'S FEES. ' RETENTION FEE: ��' b� .
Q
� CONSTRUCTION�LENDING AGENCY -PRE-ALT FEE: �
n..
CC 1 HEREHY AFFlRM UNDER PENALN OF PER7URV THA7 7HERE IS ACONSTRUCTION LENDWU AOENCY �� �`-��
Za-� �FOR 7ME PERGORMANCE OF THE WOR1(FOR WV11CH 7HIS PERIAR IS ISSUEU(SEC:3007,CIV.C.). .
W '
�� LENDERBNAME
1=- LENDERSADDRE55 � � - �
$a TOl'AL FEES `�'`}� • �� ���� ` ��
w I CEfiTIFV THAT I HAVE READ THIS APRICATION AND STATE THA7THE ABOVE WFOMIATION IS CORRECT. .
� 1 A6REE TO CAMPLY WITH ALL CT'AND COUN7V ORDINANCES AND S1ATE LAWS RELATWO TO BUILDIN(i
COPISTRUCf10N,M!D HEREBV AIf�HONZE REPRESEN7ATNES OF 71U5 COUMY 70 EHfEH UPON hIE
A90VE-MEMIONED PROPERTY GOR INSPECTION VURP0.5E5. �
z COMMENTS� �7a`r`�— ��Q�'`� ����
� ����
�
m PEa{arr���
� � l�-����z--- �� � ��, .� - ��
� SIONATURE OF PERM�iTEE DA7
RECPT.NO. PAID BY ALIDATION
� WHITE—Deparbnent Capy.YELLOW--Finence CoPY.PINK—Assessor Copy.GOLDENROD--File Copy,6REEN—ApplkanYa Copy
CITY OF DI/�MOND: BAR
,
IRISPECTION RECORD .:y �j
�
_ o ��- .R'���'p � �� p g *.r��3 �.r„ o� � - _ � + .��' - `� ,�
:"� �.,P v +t t.�-`
SET BACK FLOOR JO(ST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRlC 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 SHEATHI(JG 8 FT.BOND BEAM
FRAMING/VENTILATION � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC '3( �3 ` ~ ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING " POOL FENCIPIG
WALL INSULATION POOL FINAL
CEILING IfJSULATION OFF SITE IMPS.
DRYWALL NAIIING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AfR TEST ' � • fINAL ZONING
FINAI CONST. Q-z; i FIRE DEPT,FINAL
FINAL HEATING ' ' HEALTH DEPT.FINAL
FWAL ELECTRIC -Z° ) dEV.FEES PAID
F1NAL PLUMBING -�,:- ; ,, ENERGY
FINAL PLANING �
FINAL ENGINEERING .��f� . • m e
COMMENTS �
3 d, �
� l
SEP7ICTANK SIZE
SEEP PIT/U SIZE
i;�'
_ �