HomeMy WebLinkAbout12-970 (6) _�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
' 21810 Copley Drive,Diamond Bar,CA 91765 G
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ` PRESS
:�'"^'. BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE /��^ �%��7�_��� `�1 - APPLICATION PERMIT C/--7� P/C
ADDRESS L v -RQ ��' DATE � 'L� NUMBER Z� F < p
OCC
`r APN L T TRACT DATEE CONST. GROUP
p OWNER �
o ADDRE S � .1'� �t.¢R� � V ZONING SEBACKS
z CITY ZIP q196fTEL. FRONT pyy � .
� APPUCANT TEL. REAR �
¢ SIDE/SIDE STREET RW O
� CONTRACTOR SIDE �
ADDRESS
� CITY�• . ZIP a��� TEL Q. PROPOSED USE �
w ARCH/ENG/
. iz DESIGNER NO.DWEL. mO NO. J NO. �
a ADDRESS
� C�1' ZIF TEL UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.FG FACTOR PSF ADJ.AREANALUATION
OWNER-BUILDER DECLARATION
O � SFR/ADD/REM �
p I HEREBY AFFlRAI UNOER PENAL7V OF PERNRY THAT I A1I E%EMPT FROM TME CONTMCTORS LI. GefB B/C9 � .
W CENSELAWFORTHEFOLLOWINOREA30N(SEC.7031.6BUSINESSANDPROFESSIONSCOOEANVGTYOR . (n 9 ��
ZCOUNNWHH�HREOUIRESAPEMIRTOCONSTRUCT,ALTER,WPROVE.DEMOLISH.ORREPAIRANYSTRUC W P8t10/DBCI(
W TURE,PRIOR TO RS ISSUANCE,ALSO REpU1pE5 THE APPLICANT FOR SUCN PEAMIT TO FlLE A 51f3NED w
� STATEMEHT T}UT HE OR 6HE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOR9 ll-
� CENSE UW(CMAPTER B(COMMENCl/JO N7TH SECTION 7000)OF DIVISIOH 3 OF iHE BUSINE55 NJD PR6 � POOVSpB .
FESSqNSCAO�OqTY1ATHEORSHEISEXEMP7THEREFROMANDTHEBA515FORTHEALLEOEDE%FJ.IP- C7
TION.MIV.VKKATIONOFSECT10N7031.68YANYAVFLICANTFpRAPERMITSU&IECTSTHEAPPLICNJTTO Z Re-Roof
� A CIVIL PENALTY OF NOT MORE R1AN FIVE HUNORED DOLLARS(3600).); � '
Z ❑4�SOWNEROF7NEPROPER7v,OqMYE1dPLOYEEelN7H1NAGESASTHEIRSOtECOMPENSA710N, � Commeroial � � �
WtLL DO THE WORI(AND hiE STRIKNRE 19 NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BU$b J
� NESS AND�ROFESSIONS COOE THE CONiRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF j
PROPERTY WNO BU0.D9 OR IMPROVES THEREON,M1D VM0 DOES SUCH WpRK HIMSELF OR HERSEIF OR
w TIIROU6H HIS OR HER OWN EMPLOVEES,7ROVIDED THAT SUCH fMPROVEMEMS ARE NOT INTENDED OR m �
Q OFFEAmFi�R3ALEIF,/pWEVER7HEBUILDP100RIMPROVEMENT195oLDWfTHp10NEYEAAOFCOMPLE-
Z TION.THE�OWNER-BUILDER WILL HAVE TNE BURDEH OF PROVW6 TFU7'HE OR SHE DID NO7 BUIID OR
� W PROVE FOR 7HE PURP0.SE OF SALEJ. � . .
W �4�.40NMEROF7HEPROPEHTY,'/U/E%CIUSNELYCANTRACTPI(iWfTHIICENSEDCOPITRACTOR3 �
Q TO CONS7AUCT THE Pi1WECT(SEG 7oN,BUSINESS AND PROFESSIONS CODE:7HE CQUTRACioRs LI- V81Ufl1i0f1 q�,qR� '
� CENSE UW DOES NOT APPLV TOAN ON7lER OFAPROPERTV NM1fO BUILD9 OR IMPROVES 7HERE-0N,ANp � � �
MMOCOHTRACTSFORSUpiPRO.IECTSWfTT1ACONTRACTOR(5)LICENSEOVUR6UANTTO7MECONTRAG pUANTITY DESCRIPTION �E ,
70RSl10EN5ELAW.).
� ❑I A4 E%EMPT UNDEA SEC. -'�
Q B.d P.C.FOR THIS REASON
� U
`—` o� OWNER ¢
�Q LICENSED CONTRACTORS DECLARATION w O
CL 1 HEREBY AFFIH/A UNOER PENALTY OF PE0.IURV THAT IAM LICENSED UN�EH PROVISIONS Of CIIAPTER � / - �
� Y(COMMENCM(3 WITH SECTION 700D)OF DMSION J OF THE BUSINESS M1D PROFESSIONS CODE,AND Z '
11J W LICENSE 19 pl FULL FORCE AND EFFECT. m
� UCEN � UC.NO. � � �
V DATE��7� CONiRACTOR d . . � .
W
� WORKERS'COMPENSATION DECLAR TION � 5 � v � - �
� 1 HEREBY AFFIqM UNDER PENAITV OF VERJURY ONE OF THE FOLLOW WG OECURATqNS: U � -
N Z
� _�HAVE AND WILL MAINTAIN A CEATIFlCA7E OF CONSENT 70 SELF•INSURE FOR WORKERS' � � �
COMPENSATION,AS PROVIDED 8Y SECTION 37000F 7HE UBOH CODE.FOR THE PERFOqMANCE w�
OFJHE WOR)(FOR WHICH iHq PERMIT 19155UED. �
� /
�� �NAVEANDWILLMAINTAW�WORKEi13'�COAIVENSATIONMSURANC6;A4qEWIREDBVSECTION �.�- �
Q 37000F�THE LABOR CODE,FOR THE PERFORMANCE�OF THE WOR1C FOR WHK]i TMIS pERM17IS
65UFD.A7Y WORKERS'COM SATION INSURANCE CAHRIER'AND PO�ILY NUMBER ARE: CONSTRUC.TION��
jGRRIER �A �1 PLAtJ REVIEW �
0Z POLICV NUMBER . D L1 I� CY��lI�I ELECTRIC
Q �
� fn+rssFcriaar�noreF�f'rmoFt�a�ar.trswaa+EMrna�noav3sRiaqoa�ss! PLUMBING
w
Z �CERTIFY 7HAT M THE PERFORMANCE OF THE.WORK FO{i WHlqi 71115 PERMIT IS ISSUED,1 MECHANICAL _ �
C7 SHALL NOT EM7LOY ANV PERSON W ANY MMWER SO AS TO BECOME SUBJECT 70 THE�
(/) WDRKERSCOMPENSA710NUWSOFCALIFORNIh�NDAGREETHA71FI5HOVLDBECOME INSPECTIONFEE
SUB.IECT TO THE N�DHKERS COMPENSATION PROVISqNS OF SECTION 77000F THE UBOR -' �-
O cooe,i sruu wm�rwm�coup�r vnn+rHosE aRo�sar�s. ISSUANCE
p DATE: APPLICANE�. .SMIP
� WARNIN0.�FAIWRE TO SECURE WORKERS'COMPENSATqN COVEMGE IS UNLAWfUL,ANp SHALL BE ENERGY P/C �
�y SUB.IECrANEMPLOYERTOCRIMWALVENALTIESAND�CMLFlNESUPTOONEHUNDHEDTHOUSAND ENEROY�PERMIT
Dq1M5(Slao,000�IH�ODf710N TO THE COST OF COMPENSA710N,DMIA6ES AS PROVIDED FOR IN
� SECTqN 37oe OF 7HE LABOR CODE,IMEREST,AND ATTORNEYS FEES. � RETENTION�FEE: '
� . CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDER VENALTY OF P qy THA7 THEHE IS ACONSTRUCTION LENDINO A6ENCY ��--�
n- �f-0R THE PERFORMANCE OF TNE WO R WHIp7 TMIS PERMR IS ISSUED(SEC:3077,CIV.C,).
Z .l
W /'/
� LENDEA'S NAME V - . �
F- LENDERSAODRESS ' � -
� . . . . . T . . .. �' � .
� ICERTIFYTiATIHAVEREADTH13AppLICATIONMJDSTATETHATTHEABOVEWFORA/ATiON19CORRECL TOI'AL FEES
w 1 A(iREE TO CqMRV N7TH ALL CITYAND COUNfV ORDINANCE$/U�D STATE UWS REUTINO TO BU0.DIN0
� CONSTHUCTION,AND HEREBV AUTFIORRE REPRESENTATNES OF 7/R5 CWNTY TO ENTER UPON 7HE
� ABOVE-M EDPROPERTY. INSPE�E5.
Z
—p � � n-' � COMMENTS "
"� I I Y.iriV�/�
�
. ¢ P t NAME(VRINn � _
� � � /L �
Uj SIONA O ERMfTTEE DATE -
� RECPT.NO. PAID BY VALIDATION
WHITE—Departmen[Copy,YELLOW�Inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,OREEI�AppIk�M's Copy -
CITY 4F DIAMOND B�4R
INSPECTIOiV RECORD
. . , , ., ,
_ . ,
4 _ n o ., �.
�. .
�:. � � � ' ,�'. �_. , -
� 4'' .B . Sa ^. � i `�`-:='.-f : � Y ``t� � ..-E. ' �
,e� ��
SET BA�K ' ,. ,.. . _ .� ..
'FLQORJOIST
FTGS/FORMS/STEEL FNA REQMTS
ELECTRlC GROUNd UNDER FLOOR DUCT
GROUND PLUMBING UNDER fL00R CONdUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP PdbVER FIREP�ACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FltdAl BOND BEAM
-T
ROOF COVER PRE-GRADING
ROUGH HEATING i BENCHING
ROUGH ELECTR�C g ROUGH GRADING -
ROUGH PLUMBING � RNISH GRADING
SNOWER/TUB TEST I p00L ELECTRIC
EXT.LATH/SIDING POOL FENCIPIG
WALL INSULA710N POOL FINAL
CEILING INSULATION QFF S�TE IMPS.
DRYWALL NAILIP9G DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAI C�NST. FIRE DEPT.FifdAL
FINAL HEATING HEALTH DEPT.FItdAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING �' ENERGY
FINAL PLANIIVG �
FINAL ENGINEERING � �
COMMENTS
,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
����i � ---
� � �
.;{,�. �
p=�
ry '