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HomeMy WebLinkAbout12-1054 �� CITY OF DIAMOND BAR DEPARTMENT OF COMNIUNITY&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS :4'"^'. BUILDING PERMIT APPLICATION . FIRMLY � JOBSITE / I Z' D ¢ ADDRESS �S�S G I �'�.�P � APPLICATI N PERMIT , t,�1 p/C p DATE � ' I`L NUMBER 'r� p � APN LOj TRACT DATEE o � ( 7/ ONST.I-"''�'�--� GROUP p OWNER 1 o ADDRE S L. �' ZONING SETBACKS Z CITY ZIP 4/�'6c�TEL B FRONT pyy p . � APPLICANT TEL. REAR p 0 � SIDFJSIDE STREET RW' ❑ � CONTRACTOR SIDE p ADDRES o CITY ZI 7� EL �f ��J�}/ PROPOSED USE ' o ARCH/ENG/ �z DESIGNER NO.DWEL NO. NO. a ADDRESS � CITY . ZIP TEL. UNITS STORIES BEDROOMS ti � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � p 1 MEREBV AFFIRM UNDER PEMILTY OF PERNM 7HAT I Nd E%EMPT.fRDAI T}Ib CONJqACTORS LL Garage/Cerport . . W CFNSEUWFORTHEFOILOWWOREA50N(SEC.7a9�.6BU51NESSANDPROFESSION50DDE:MIY-CfTYOR � (n C� COUNfYNRiN]iREOUIRESAPERMfT7000NSTAUCT,ALTER,IMpROVE,DEMOIISH;ORREPAIRANVSTRUG W PB�b/DBCk � �< NRE.PRIOR TD RS ISSUANCE,ALSO qEWIRE$7HE APPLICANT FOR SUCH�PEAMR TO FlLE A SIONED W � STATEMENT THAT HE OR SME IS LICENSED PUASUANT TO THE FROVISIDNS�OF THE CONTHACTORS l4 . � CENSE UW(pUP7ER Y(COMMENpNO WITH SECTIDN 70D0)OF DMSqN 3 OF THE BUSINESS AND�PR6 LL' POOUSpB FESSIONSCOD�Oq7HATHEOH3HEISEI(EMPTTHEREFROMANDTHEBASISFOfi7HEALLEOEDE%EMP• C7 TqN.AHVVIOLATIONOFSECTION7031.8BVANYMPLICANT�FORAPERAlITSUBIECTSTHEMPLICANTTO Z Rg-ROOf ACIVtt.PENAL7V OF NOT MOqE 7HAN FNE HUNDRED DOLLARS(iSOD).): - Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWRHIVAOESASTHEIRSOLECOMPQ1SATqN, � � �mmarcial� � - VAIL DO THE WORK,AND hiE 9TRUCTURE IS NOT IMENDED OR OFFERED FOR SALE(SEC.7oas,BU51- J � NESS AND FROFE55lONS CODE:THE CONTRAC70R3 UCENSE LAW DOES NOT APPLv 70 AN OWNEq OF � ' �� PROVEit�YWHO8UR0.40RIMPROVESTHEREON,M1DNM1fODOE55UCFIWORKH�MSELFORNERSELFOR ' ' WiHROUGN MIS OR HER OWN EMVLOVEES,PROVIDm THAT SUCN fMPROVEMENTS ARE NOT PlTINDED pq m � . Q OFFERmFORSALEIF,FiOWEVER7NEBU4.DINOORIMPROVEMENTIS50LpWfTMNONEYEAROFWM7LE- , Z TION,THE�ON7JEA�BUILDER WILL HAVE 7HE BUFDEN OF.VROVINO THAT'HE OR SHE DID NOT BUILD OR . . , � IAIPROVE FOR THE PURP0.SE OF SALE). � � � �y„� ❑4�.40NTlEROFiHEPROPEATY,/W�(CLUSIVEI.YCONTRACTINOWRHIICENSEDCONTMCTpqS � TO CONSTRUCT THE PIIWECT(SEC.70sI,BUSINE55 AND PROFESSION9 CODE:TFIE CANTMCTOfl3 LI- V81UHfI0f1 qp,�,pqEq � � - � W CENSE UW DOE3 NOTMVLV TOAN ONMER OFA PROPERTY Wh1O BURD90R IMPHOVE3 TIEREON,AND ' ' - ' � MMOCONfMCT6FORSUCHPRO.lECT3N7TF1ACONTRACTOR(S)LICENSEOWRSUAMTOTHECONiqAG qUqN7�Ty � DESCRIP'fION 700.9 UCENSE LAW.). FEE � � ❑1 W IXEMGT UNDER SEC. �8.8 V.C.FOR THIS REASON JQ �? U¢ � OATE OWNER F- z U � LICENSED CONTRACTORS DECLARATION � w - � � � � - - - � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT IAM LICENSED UNDER PROVISIONS Of CFNPTER ' � Y(COMMENCPIO WfTN SECTtON 700o)OF DMSION J OF THE BUSINESS IWD PROFESSIONS CODE,AND Z. Q Y � ' ��� W LICENSE L4 W FULL FORCE AND EFFECT, A m 1 � � � UCENSE C LIC.NO.. '� L . �� y V DATE CONTRACTOR d . . . W � WOAKERS'COMPENSATION DECLA TION � � � � - � � � U � 1 HEREBV AFFtRM UNDER VENALTV OF�ERJUflV ONE OF THE FOLLOWWO DEC�ARATqNS: � - � . � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF•INSUREFORWORKERS' /j COMPENSATION,AS PfiOVIDED BY 6ECTION 3i000F THE LABOR CODE.FOR iHE PERFORMANCE U� ✓�� Q OF 7HE WORK FOR WHICH THI9 PERMIT IS ISSUED. � � . . I HAVEMID WILL MAINTAIN WOPo(ERS'�COMPEN$AT�pN INSURANCE;A9 REOUW ED BV SECTION /�I.O / O �37o00F�THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WOPo(PoR WFUCFt THIS PERMR IS. �SSUED-M1'MOPo(ERS� IpSURANCECMRIER'ANDPQIGYNUMBERME �CONSTRUCTION� / ' � CAARIER� r fV PLAN.REVIEW . . Z0 POIICV NUMBER�L,��=�_f � � I. . . ELECTRIC . . ¢ p (nas5�cr�oru�wTeE�IDOFn��'tsra+o�+Eµ�ra�oau�Rtoo)a+�sy' �PLUMBING � w Z �CERTIFY.THAT W hIE PERFORMANCE OF THE.WORN FOH WHICli TF11S 7ERA/IT I3ISSUEO,l MECHANICAL� CJ SNALL NOT EAIPI.OV ANY PERSON W ANV MANNER 50 AS TO BECOME SU&IECT 70 THE �� (q WOPoCERSCAMPENSATIONLAWSOFCJ�IFORNItiANDAGREETH 1LIFISHOIADBECAME INSPECTIONFEE� SUBJECT TO E WORKERS COMVENSATION PROVISKRlS OF���eee�TION 9700 OF THE UBOR "'� ' � � , o cooe, romrnvmi coua�r Nnni rH PR v1 oys' ISSUANCE p DATE APPLICANT: \/ �SMIP v w � WARNINO:��FAHUR TOSECUREwDiU(ERSCOMPENSA710N MGEISUNLAWFVI., .SHALLBE ENEROY�P/C . � � SU&IECTANFJdPLOYEqTOCRIMINALPENALTIESANOCM� ESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLAH3,(flao,000),W MDITION TO7HE C0.5T OF CAMPENSAT�qN,DAMACES AS PROVIDED FOR IN J SECTqN 370!OF T1E IABOR COOE,INTEREST,AND ATfORNEYS FEE3. � � ' ' � T W RETENTION FEE: �l O CONSTRUCTION IENDING AGENCY PR LT FEE � I HEREBY AFFlRM UNDER PENALTV OF PERri1RY TFIAT THE IS A CONSTRUC7ION LENDINO AOENCY ��^� �' �FOR 7HE PERFORMANCE OF hiE riORK f-0R N?i 7FII ERMJ7IS ISSUED(SEC.30v7,GV.G} Z W �. LEPIDERS NAME .. . . .. . , � LENDER'$ADDRE55 -� - - - � ICERTIFYTHATIHAVEREADTHISAPPUGTIONANDSTATETHATTHEABOVEINFOfU1ATIONI9CORRECT. TOTAL FEES� ���r �/� w 1 A6REE TO COMPLY WIiH AlL CIIY AND COUN7Y ORDWANCES AND STATE UWS RELATPIO TO BURDWO � CONSTRUCTION,M!D HEREBV AUTHORIZE REPRESENTATIVES OF hIIS CWN7Y TO EMER UPON THE � � ABOVE-M ED PROPERiY FOR INSPECTION PURPOSES. Z o � COMMENTS ' J �/ � V m VERMITTE . Q D C/� Q � s�orunR F E mEE � RECPT.NO. \ 3�.� PAID BY �� VALIDATION � ITE-0epaRment Co . O ance Copy,PINK—Assessor Copy.GOLDENROD--File Copy.GREEN—Appl{canl's Copy - CITY OF DIAMUND BAR IIVSPECTION RECOFtD �.. �,, � „ ,� , .. _. _:,.^�� ��� � � ,45� D��_ e � m ' -. �:� � e� ��� . � � �� o � o � ,. ' � '^ �� , „ � ��. . , SET BACK FLOOR JOIST FTGS/FORMSlSTEEL FHA REQMTS ___ _ ELECTRIC GROUND UNDER FLOOR DUCT • GROUND PLUMBING UNDER FLOOR CONDUIT ' SLAB GRADE FIREPLACE FOUNQATION TEMP PaWER I FIREPLACE BQND BEAM � WATER SERVICE � � MID HT.BOND BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING _ ___ _ ROUGH HEATING BEN�HING ROUGH ELECTRIC L� �L - ROUGH GRADING ROUGH PLUMBING t�J j�^ FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT.LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSUlAT10N OFF SITE IMPS. DRYWALLNAILING __ DEDICATIONS _ ___ _____�_ __ SEWER FINAI ENG. SEPTICTANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON 51TE IMPS. GAS AIRTEST FINAL ZONING FINAL CONST. FIRE DEPT.FINAL fINAL HEATING � HEALTH DEPT.FINAL RNAL ELECTRIC � DEV.FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAI ENGINEERING ' o e C�MMENTS _ _ ��E����� _ _ _ i i � � SEPTICTANKSIZE SEEP PIT/U SIZE � e i ��i ��� — -- , , . ,