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HomeMy WebLinkAbout10-1061, -- _ _ _ _ _�`_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 PRESS '� (909)839-7020 Fax(909)861-311'7 Building I��r �t���,$39-7 7 �%����W BUILDING PERMIT APPLICATION "�'�`� �J FIRMLY � JOBSITE , n n ' ,�` APPLICATIO PERMIT / P/C o ADDRESS ZZ NZ y ���v� ' '^�' V~�+ � DATE O ''IiZ NUMBE��%� # � ISSUE TYPE OCC APN LOT TRF�T DATE���'"�� CONST. GROUP I p OWNER 0� Gt ,� ZONING SETBACKS o ADDRESS d�� '� w C17Y �n0�.a • ZIP TEL. 0 FRONT RW ❑ � APPLICANT a" oS �-st�^^O�.r. TE�. REAR ❑ SIDFJSIDE STREET RW ❑ � CONTRACTOR f.� SIDE ❑ � ADDR SS PROPOSED USE O C�Ty ZIP TEL. / w ARCH/EN z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � C1TY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNEA-BUILDER DECLARATION SFR/ADD/REM O • 0 I HEREBV AFFlRM UNDER VENALTY OF PERJURV THAT I AM EXEMPT FROM TNE CANTRACTORS LI� GyfBgB/CBfpOfl W CENSEUN�FORTHEFOLLOWWOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODEPNVCITYOR (� ZC,pUNTYWHICHRE�UIRES�PERM�TTOCONSTHUCT,RLTER.IMPROVE.DEA10L15H2ORREPAIRANYSTRUC� W P8�10/DBCK W TURE,PRIOR TO ITS ISSUANCE,ALSO REW IRES 7NE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STA7EMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PHOVISIONS OF THE CAMRACTORS L4 � CENSE UW(CHAPTEF e(COMMENCINO WITM SECTION 7000)OF DIVISION 30F THE BUS{NE55 AND PRO- V' POOVSPB FESSIONSCOD�ORTHATHEORSHEISE7(EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� TION.ANY VIOLATION OF SECTION 7a31.5 8V ANV APPLICMfT FOR A PEFMIT 5U&IECTS THE APPUCANT TO Z Re-Roaf � A dVIL VENALTY OF NOT MORE h1AN FIVE HUNDRED DOLLARS(t500).): 0 ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTNEIqSOLECOMFENSATqN, � COffIRl6fCl81 Z VALL DO TME WORK,M1�TNE STRUCTVRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,8U51- J � NE55�VlD PROFESSIONS CADE:7F�E CONTRACTORS LICENSE LAW DOES NOT APPiV TO AN OWNER OF � GqOPERTV Mh10 BUIIDS OR IMPROVES TNERE�N.�ND WHO OOES SUCH WORK HIMSEIF OR HERSELF OR Q iHROU(3M HIS OR HER OWN EAIPLOYEES.PRO��DED TFtAT SUCH IMPROVEMEIiTS ARE NOT INTENDED OR m OOFFEREDWRSALEIF,NOWEVERTMEBUILDMCiORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE� Z TqN,7HE OWNER-BUILDER WILL HAYE THE BURDEN OF PROVINO THAT HE�R SHE DI�NOT BUIID OR � IMPROVE FORTHE PURPOSE OF S/�LE). ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELV CONTRACTINO WITH LICENSED CONTRACTORS Q �O CONSTRUCT THE P0.QIECT(SEC.TWa,BUSINESS ANO PROFESSIONS COOE:TME CONTMCTORS U� V8IU8tlOf1 ADJ.AREA � CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWFIOBUILDSORIMPROVESTHEREON,AND WHOCONTRACTSFOFlSUCHPR0.IECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTNECONTRAC- QUANTITY DESCRIPTION FEE TORS LICENSE V�W.). Y J O ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON � � � � OATE �'�ER U � Z W � UCENSED CON7RACTORS DECLARATION J . � W I HEREBY AFFIRAI UNOER PEN�LTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEF U. ✓ n� �� � i(COMMENCING WfiN SECTION 7000)OK DIVISION J OF THE BUSINESS ANO PROFESSIONS CODE,AND Z '� X AIY UCENSE IS IN FULL FORCE ANO EFFECT. m LLI �3� 3-�s�-3 � � UCENSE CLASS LIC.NO. J � U DATE �'7T��.�_ CONTRACTOR�pL ✓ ✓S 0- LiJ O � WORKERS'COMPENSATION DECLARAT�N Q � U � 1 HE EBY AFFlRM UNDER PENALTV OF PERJURY ONE OF THE FOI,LOWING DECUPATIONS: Z Q 0 I HAVE AND WILL MAINTAIN A CERTIFICATE Oi CONSEM TO SELF-INSURE FOR WORKERS' _ � COMPENSATION,AS VROVIDED B�SECTION 37o00F THE V.BOR COOE.FOR THE PERFORMANCE w OF h1E M�ORK FOR WHICH THIS PERMIT IS ISSUED. � d _I HAVE M1D WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION QQ J7oa OF THE IABOP CODE,FOR THE PERFORAIANCE OF THE WORK FOR WHICH TNIS PEHMIT IS ISSUED.MY WORKEHS'COMPENSATION INSURlWCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CAARIER PLAN REVIEW � POLICV NUMBER ELECTRIC .�f�� Q �.J V 0 (iH55EC11DNNE�NOTBE�7MPlFfEDOF7FIEPEPMflSFORONEHU1�f1FADd1?RSlsiOo)OiiLESS). BIN w MECHANICAL Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEfUAIT IS ISSUED.I � SHALL NOT EMPLOV ANY PERSON IN ANV AIANNE � TO BECAME SU&IECT TO THE � VfORKERS'COMPENSATION LAWS OF CALIFO ,AND AOR E THAT IF I SMOULD BECOME tNSPECTION FEE � SU6IECTTO THE K'ORKERS'COMPENSAT ROVIS ECTION 37W OF THE UBOR CE 2�(J� � CODE,I SHALL FORTHWITN COMPLY WITH OSE PR S�ONS. O �����/� ' SMIP p DATE:��' �F Ol�' Ll_I_— APPLICANP. . w �-��� ENERGY P/C J WARNING:FPJLURE TO SECUFE WORKERS'COMPENS RAGE IS UNLAWFUL AN�SHALL BE J SU&IECTANEMPLOVERTOCfi1MINALPENALTIESANDCMLFINESUPTOONEHUNOREDTFKKISAND � ENEAGY PERMI DOIURS(5100,oao).IN ADDITION TO THE COST OF COMPENSATION,DAMA�ES AS 7ROVIDED FOR IN � SECTION 3708 OF THE LABOR COOE.INTEREST.AND ATTORNEV'S FEES. ENTI F �l�� . w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEREBV AFFIRM UNDER PENALN OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AOENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LEN�ER'S NAME F_— LENDEfYSADORESS /� � �J� � I CERTIFV TNAT I HAVE READ THIS APPUGATION AND STATE 7HAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES / �� w I AOREE TO COMPLV WITH AI.L CT'AND CAUNTV ORDINANCES AND STATE LAWS RELATINQ TO BUILDINO � CONSTRVCTION.AND HEREBV AU7HORIZE REPRESENTATNES OF THIS CWNTV TO ENTEF UPON THE � ZABOVE�MENT70 ED VROPERr'FOR INSPEC PURPOSES. COMMENTS � � a� �a� � m PERMfTTEE NAME(PR� � � a� o ` r� Uj SIONATURE OF PERM E DATE RECPL NO. PAID BYC�IC.�-JS«7 VALIDATION � HITE-0epaAment Copy,YELLOW—Flnence Copy,PINK—Assessor Copy,CiOLDENROD—File Copy.GREEN—Applicant's Copy CBYY O� DO�NiONB� �,�R � I�IS�(�C�'90� R��OR[7 � � i�� — ' � i• � .���� ' -,�' >>s+-':�f`f 1: o� , � , ,� , ��1�3pLC�400GvJ ��� :��o� �`�L� .� '�O[n��3PC��p �,:� � � � - �� �_ � � Da�pC o�1' `� , �.� o � .. . Y , _. _ _. ,. : .. . SET BACK � FLOOR JOIST . FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MfD HT. BOND BEAM ROOF SHEATHING 8 FT: BOND BEAM FRAMINGlVENT1LATION FINAL SOND BEAM ROOF COVEA PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION QFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONIfVG FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING �—/Z—� % .y ENERGY � ��� COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � Q ��. a,� �