HomeMy WebLinkAbout12-1265 �� CITY OF DIAMOND BAR ,
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� ' � 21810 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
, ��''"'. SUILDING PERMIT APPLICATION FIRMLY
Q DDRIESS � 2 � ��L�'�3••'� /�- /�a� APPUCATIO� �� �� PERMIT fZ./iJ/,�P/C
p DATE � NUMBER� ��'�J #
q,4 ISSUE � 2� 1� TYPE OCC
APN LOT TRACT DATE CONST.�� GROUP
p OWNER /�'�1
o ADDRESS � ��- � � ZONING SETBACKS
z CITYD/�`1PlD/�,�0 st4/L- Z�P��,� TEL.�CS' F�+I�'y7� FRONT p�ry � .
� APPUCANT TEL. REAR p
¢ SIDE/SIDE STREET RW ❑
� CONTRACTOR M� /L. SIDE p
ADDRESS IT E• �
� � CITY � ZIP� TEL E'� ,3'•'-d!s PROPOSED USE
o ARCH/ENG/
z DESIGNER
a ADDRESS NO.DWEL. NO. NO.
� CITY ZIP TEL. ' UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION �� SFq/ADD/REM
O
Q 1 NEREBV AFFlRM UNDEA PENALTV OF PERRIRV THAT 1 AN E%EMPT FROM THE COM�MCTO0.5 L4 Gerage/Carport
W CENSEUWFOR7HEFOLLOWINOREASON(SEC.70.9t.6BUSPIESSANDPROFE5S10N5CODEANYCT'OH , (n
� COUNLYNRiIp1REWIRESAPERMITTOCONSTAUC7,AL7ER.WPROVE,DEMOLISH,ORREPAIHMfY57RUG W Patio/Deck
NRE,PRIOR TO RS ISSUANCE,AL50 REWIPES THE APPLICAM FOR SUCH PERMIT TO FlLE A SIONED W
� STATE4ENT THAT HE OR SHE IS LICENSEO PURSUANT TO h1E PROVISIONS�OF.THE CONTRACTOR9 U-
_ � CENSE LAW(GHA7TER D(COMMENCWO WITH SECTIDN�000)pF DIVISION 9 OF T1E BUSINESS AND PRO- � POOVSpO
FESSIONSCOOEJOHTHATHEORSHEISE%EMPT7HEREFROMMA7HEBASISFOR7HEALLEOEDE%EMP• � (�
V TIOti.ANYVpLA710NOF5ECT1oN7o3t.6BVANYAPPLICANTFORAPERMITSUAIECTS7HEAPPIICANTTO . Z R8-ROOf
ACML PENALiV OF NOT MORE THAN.FNE MUNDRED DOLURS(i500)J:
� OI,ASONRIEROF7HEVROPERTV,ORMY�EAIPLOYEE3WRH14AGESASTHEIR50LECpMPENSA7K)N, 0 �mmercial� � -
Z WILL DO THE WORK,AND THE 3TRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�1,BUSF J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE.UW DOES NOT M�IY TO AN OWNER OF � �
PROPEHTY NM1Ip gU6DS pq IMPROVES THEREON,AND VA10 DOES SUCH NpRK MAISELF OR HERSELF OR '
WiHi10U(iHM50RHEROWNEMPLOVEES,PpOVIDED7HATSUp11MPROVEMENTSARENOTPlTENDEDOR m .
Q OFFERmFORSALEIF.FIOWEVERTMEBUILDPlOORDAPROVEMEMISSOLpWfTH1NONEVEAHOFCOA/PLE-
Z TION.THE OWNER�UHDER M7LL HAVE THE BURDEN OF PROVIN6 THAT HE OR SNE DID NOT 8111LD OR .
� IAIPROVE FOR 7HE PURPOSE OF SALE). . .
w O4�OWNEROFhiEPROPEHTV,AMEXCLUSNEIVCOMRACTIN(iWfTHLICENSEDCOPITRACTOqS
Q TO CONSTRUCT THE PRO.IECT(SEC.7a�,BUSINESs AND PROFESSIONS CODE THE�CONTRAC70RS LL V81U8tlOn qpJ,qpEq� '
W �H,SEUWDOESNOTAPPLVTOANOWNEROFAPHOPERTYNM1iOBUEDSORWPqOVESTHEREON,AND � -
� N'MOCOMRACTSFORSUCHPROJEC7SWTIACONTRACTOR�S)LICENSEDPUR&UANT70THECONTRAa qUqN7�7y �� DESCRIPT7pN
� Toas ucENSE uw.�. FEE .
� ❑I AM EXEMVT UNDER 6EC. �B.8 P.C.FOR THtS REASON �
?� U
LL' OATE � ONMER H
Z U
� LICENSED CONTRACTORS DECLARATION W � � �
� I HEREBY AFFliW UNDER PENALTY OF PERJURV 7HA71AM LICENSED UIJDER PROVISION9 OF GIAPTER � � �� �
� 9(COAIMENCMO WITN SECTION 7000)OF DIVISION�OF iHE BUSWESS NID PROFESSIONS CODE,AND Z
��� M'/IICENSE IS W FULL FORCE AND EFFECT.
� UCENSE pCU1SS C �� LIC.NO. Y�rZ'L�7 ? . ..
U DATE ( �f'7 � Z CONTRACTOR a . . _
W
� WOFKERS'COMPENSATION DECLARATIO � ���
� U
� 1 HERE9YAFFIq►1 UNDER VENALTY OF PERIUFY ONE OF THE FOLLOW W6 DECLAAATIDN3: Z � � � � .
� _I HAVE�AND�WILL MAINTAIN A CERTIFlCATE OF CONSENT TO SELF-INSURE FOR WORKERS' � �
� CONPENSATION,AS PROV�ED BV SECTION 37000F THE UBOR CODE,FOR THE PEAFOqMANCE W�
.Q OF THE WORK FOR WHltlf THtS PERMIT IS ISSUED. � � . . .
� _I HAVEAND WILL NAIHTAW.WOqKERS'COMPENSATION INSUqANCE,AS REOUTAED BY SECTION �
Q37oD OF THE LABOR COOE,FOR 7HE PERFORMMICE�OF THE WORK f-0R WHlqi iHIS PER S
�SSUED.MY WORK 'COMPENSATION INSLU�NJ CE CARHIER AND VOl NUMBER M �CONSTRUCTION�
� CAARIEA ��`��•f�•�•��/7 . .
PLAN qEVIEW
Z ��Y��ER � ,��!/ _ . ELECTRIC
Q
0 (rrassecr�r�r�o7eeoons�r�oFn�v�.rrswaaae�ooaiu�sfs+oo�oa� PIUMBING � .
w
Z I CERTIFY THAT IN THE PERFOfiMANCE OF THE WORK FOH NMIC/i TIi1S PERMIT IS ISSUED,1 MECHANICAL�
C} SHALLNOTEMPI.OYANYPERSONWANYMMWERSOASTOBECOME'SU&IECTTOTHE � �
(,/) WORKERS'COA/PENSATION UVIS OF CAIiFORNt/�AND AOREE 711AT IF I SHOU�D BECOME INSPECTION FEE
SUBIECT TO THE WORKERS'COM7ENSATIDN PRONSKKJS OF SECTION 9700 OF THE UBOR - '-- � - - �
Ocooe.i sqMnu Forrr�mnrH ca�a�v wm�n+osE aAo s�s. ISSUANCE
p DATE: �L` � �pLICANT: �SMIP
W
� WARNINO:FAILURE TO SEWRE WORKERS'COMPENSATION GOVE E IS UNUWFUL,AND SHALL E ENERGY�P/C
� SU&IECTANEMPLOYER70CRUAWALVENALTIESAND�CIVILFWESUPTOONENUNDREDTHW3ANU ENERGYPERMIT
DOLLAH9(5100•000).W ADDITION TO THE COST OF COMVENSATION,DAMAOES AS PROVfDED FOR IN
J BECTION 370E OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. � � '
OC RETENTION FEE:
O , CONSTRUCT1qN LENDING AGENCY -PRE-ALT FEE:
� I HER�V AFFlRM UNDER�PENAI.TY OF PERIURY THAT THERE 13 A CONSTRUCTION I,ENDINO AOENCY
�Z-' FOR THE PERFOfiNANCE OF THE WOR1C FOR WHICN MIS PERAIIT IS ISSUED(SEC.30W,qV.C.}
W
��. LENDERSNAME .. . , . . •
F— LENDER'SADDRESS � �
�w ICERTIFYTHATI�HAVEREADTHISMPLICATIONAND9TATETUTTHEABOVEWFOAMATIONI9CORRECT. TOTAL FEES� /%/
1 MiREE TO COM7LV N77H ALL CITV AND COUNTY ORDINANCES AND STATE UWS REUTINO TO BURDINO / ��
.� CONSTHUCTION,AND HEREBV MJ�HORIZE REPRESENTATNES OF THiS COUNTV TO ENTER UPON 7HE '
Z ABOVE-MENiKNJED PROPERTY FOR INSPECTION PURVOSES. COMMENTS ' �
� �-/_��L� .
J
�. ' �..���� r -
m VEAMITTEE NAME(PaM) ^ � .
Q , y r�, ��
�
N SIONATURE OF FERM DATE
� RECPT.NO. PAID B V/WDATION
WHITE—Depailment Copy,YELLOW—Finar�ce Copy,PINK—Assessor Copy,GOLDENROD--Ffle Copy;GREEM—
. AppllcanCs�CoPY
� GI�'Y pF DIAM�N� BAR
� � �- INSPECTIUN RECORD � ` ,
.. ,. .. .... .. ... .�. .U.- : . .. . .. " - �-��.... .u:'1`: � p -A . .
_ • � � � B � ' t .A��. e �Q O � .•� t.. ��' �� '�: ��y ~� 1 ., � �'�. �e
� �
...� . > . ._.. . . .� ' ' -y. �r ':t
�. . ,.. � . ... . �. ., ..
SET BACK i FLOOR JOiST
FTGS/FORMS/STEEL 'FH RA EQMTS
ELECTRIC GROUND CUNDER FLOOR DUCT • �
GROUND PLUMBING i UNDER FLOOR CONDUlT
SLAB GRADE i FIREPLACE FOUNDATION
TEMP POWER I FIREPLACE BOND BEAM
WATER SERVICE !MID HT.BOND BEAM .
ROOF SHEATHING �8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BONQ BEAM
ROOF COVER �PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING I POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING QEDICATION5
SEWER fINAL ENG. �
SEPTIC TANK LANOSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FiNAL ZONiNG
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC � �1. 1 DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING m
COMMENTS
SEPTICTANK SIZE
SEEP PIT/U SIZE
�
� y,.�-�,� - -