HomeMy WebLinkAbout12 ^ �� CITY OF DIAMOND BAR � � i�
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
�''"'. BUII.D G PERNIIT APPLICATION . FIRMLY
y�, JOBSITE (1��a i�^-`\ APPLICATION y� �"[ I � PERMIT Z. p/�
o �ADDRESSZ3�\-� ��: �y� DATE �> r� � NUMBE� p
� APN LO'f TRACT �SSUE TYPE pCC
DATE CONST.� GROUP
p OWNER �A-��t�
o ADDRESS� c.� .�o� ZONING SEfBACKS
z C TEL. �T
RW ❑
g APPLICA TFi REAR p
� �� SIDE/SIDE STREET RW ❑
� CONTRACTOR ' �/ SIDE p
� ADDRESS
� CIN ZIP TEL PROPOSED USE �
w ARCWENG/. �
' z DESIGNER
a ADDRESS NO.DWEL. NO. N ,
� CITY . ZIR TEL UNRS STORIES BEDROOMS
�
� DESCRIPTION 5�.FT. FACTOR PSF ADJ.AREANALUATION
� Q OWNER-BUILDER DECLARATION SFR/ADO/REM
' O
� p I HER�V AFFlRM UNDER�PEWLL.7Y OF PERIURY TIUT 1 AM EXEMPT FROA1 THE CONTMCTORS LI- G9tege/CefpOR
W CENSEUWFORhiEFd.LOWINOREASON(SEC.7o31.6BU5p1E55ANDPROFE5510N9CO0E:ANYq7VOR (n
U COUNTI'WHICMREOUTAE3APERMRTOCONSTRUCT.ALTEi�IMPROVE,DEAqUSH.ORREPAIRANYSTRUG �t1��
' w TUHE,PRIOR TO RS ISSSUANC�ALSO REpU1qES THE APPLICAM FOR SUpi PERMIT TO FIIE A SIf3NED W
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO hiE PROVIS10N5 OF 7HE CANiRACTORS U- , .
� CENSE UW(CHAPTEA Y(COMMENCWO WI7N SECTION 7000)OF DMSION�OF THE BUSINE59 AND PRO- . � PooVSpa
, f'ESSIONSCOD�ORTTiATHEORSHEI9EXEMPTiHEREFAOMANDTHEBASISFORTHEALLEOEDEXEMP- � (�
� TqN.ANYVpLAT10NOFSECTlON7031.6BYANYAPVLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z RaRool
A CML PEW�1T`/OF NO7 MORE T/1AN.FNE HUNORED DOltARS(f6oD).j:
0 ❑I,ASOWNEROF.THEPROPERTY,ORMYEMPLOVEESWf7HWA�ESASTHEIRSOLECOMPENSATION, � � L`pmmBfC181
Z N7LL DO THE WORI(AND T1E STRUCNRE IS NOT INTENDED OR OFFEREO FOR 3/�LE(SEC.7aI,BU54 J � - �
� NESS AND PROFESSIONS CODE:7HE CONTMCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPEHfYNRiOBU�L0.SORIMPROVESTHEREON,ANDWHODOE35Up1WOR1(MAISELFORHEpSELFOR � �\ Z
w 7NROUGH HIS OR HER OWN EMPLOYEES.PROVIDED TFiAT SUp11MPROVEMFNTSARE NOT INTENDED OR m '
� OFFERWFORSALEIFHOWEVER7HEBUILDINOORIMPROVEMEHTISSOLDWrtHWONEYEAAOFCOMPLE
Z TION.7HE OWNER-BUIIDER WILL HAVE TNE BURDEN�OF PROVWO iHA7 HE OR SHE DID NOT BUILD OR . . .
= IMPROVE FOR THE PURPQSE OF SALE} . .
W ❑I,ASOWNEROFTHEPROPEHTV,AAIEXCLUSNELYCONTMCTWOWITNUCENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7041.�BUSINE55 AND PROFESSIONS CODE:7HE CONTRACTORS 1.1- V81U8fIOf1� ��C�i�� AU,J.AREA � .
W CENSE UW DOES NOTAPVIV TOAN OH7JEA OFA PROPER7Y WFq BUILDS OR WPROVES THEREON,AND � - -
� WHOCONTMCTSFOR6UCHPRO.lECf5N7TY1ACONiMCTOR�S)UCENSED7URSUAIIfTO7HECONTfUG pUqN7�Ty � DESCRIPTIpN �E .
TORS LICENSE LAW.}
� J
� O I AA1 EXEMPT UNDER 6EG B.a F.C.FOR THIS REASON Q
� - U
� DATE �� ER ��
Z U
�Q LICENSED CONTRACTORS DECLARATION W
LL I HEREBYAFFIq�I UNDER PENALTY OF VERNRY THAT IAM LICENSED UNDER PROVISION9 OF CHAPTER �. '- �
p� G(COAIMENCUKi N77M SECTION.700D)OF OIVISION 7 OF THE BUSINESS M!D PROFESSIONS CODE,AND Z �
X MY LICEHSE IS M FUIL FOACE AND EFFECT. m
� UCENSE CLASS UC.NO., j � � �
U OATE CONTRACTOR d .. . _
W
� WOFKERS'COMPENSATlON DECLARATION � � � - � �
� I HEREBY AFFIRM lR1DER PENALTV OF PERNHV ONE OF THE FOLLOW W(i OECLARA710N5: � � � � �
N . . . . . .. . . Z .
� ��I HAVE AND�WILL MNNTAIN A CERTIFlCATE OF CONSENf TO SELF-INSURE FOR V/ORKERS = � �' '
� WMPENSATION,AS VROVIDm BV SEC710N 37ooOF T11E UBOR CODE,FOR 7HE PERPoRMANCE U�
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
_I HAVEAND WILL MNMAIN.WORKER3'CAMPEHSATIOH MSURAHCE;Ag qEWIRED BV SECTION
Q37000F�7HE LABOR CODE,f-0R 7HE PERFOPMANCE�OF THE WOPo(PoR WHICH THIS PERAQT IS ��/'i./�
ISSUm.Mv WORKERS'COMFENSATION INSURANCE CAAqIER�AND,POLiCY NUMBER ARE �CONSTRUCTION 7
� �R�� PLNJ REVIEW
� POLICKNUMBER . . . �
dZ ELECTRIC
p (n�ssEcnor+r�wreEoonq�rIDacn�a�xtrsraaa+eMr�+�oatusB�oolw�y .PLUMBING �
w
Z 1 CERTIFY.7HAT IN THE PERFOi4AANCE Of TNE WORK FOR WHlpi THIS PERMIT tS ISSUED,1 -MECHANICAL
C7 SH�LL NOT EMGLOV ANY VEHSON W ANY MpNNER SOAS TO BECOME SU&IECT TO RiE�. �
� WORKERS'COMPENSATIONLA OFCKtFOANIAANDAGREE eecoraE �INSPECTIONFEE
SU8JEC7 TO THE WORKERS NSATION PRONSIONS OF TION J7 E LABOR �--" � � - I �
s cooe,i coarrnwn�caa o�s�or+s. ISSUANCE
O —
p DA Z�,til(ppLICqNT: �SMIP 6�S O
W
� WAANINO:�FAILURETOSECUREWORKEHS'COMPENSATbNOOVERAGE1SlINUWFUL,AND.SHALLBE ENERGYP/C
�y, SUBJEC�ANEMPLOYERTOCRIMWALPENALTIESANOCIVILFlNESUPTOONEHUNDRED7YqW^ANU ENERGY�PERMIT
DOLURS(5100.00D),W ADDITION TOTHE COST OF COMPENSATION,DAMA6ES AS PROVIDED PDR W
J SECTION 37oe OF 7HE LABOR CODE,INTERE9T,AND ATTORNEY'S FEES. � - "-� �
OC RETENTION�FEE:
0 CONSTRUCTION LENDING AGENGY ppp_pi T�
� 1 HEREBY AFFIRM UNDER�PENALTY OF PERIURV THAT THERE fS A CdJSTAUCTfON LENDMO AOENCV �j �
�FOR 7ME PERFORAIANCE OF.7HE WORK FOR WHlpf THIS PERMI7IS ISSUED(SEC.30v7,CIV.C.).
Z
W
�� LENDER'SNAIAE . . . . .. .. ' . •
I-- LENDERBADDRE55 �
�
w ICERTIFYTHATIHAVEREADTHI9MPLICATIONANDSTATETUTTHEABOVEPIFORlAATION1900RIiECT. TOTAL FEES
� 1 A6REE TO COMPLV N7TH ALL CfTY AND COUNTV ORDWANCES AND STATE lAW3 RELATiNO TO BULLDINO �
CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF h115 COUNTyTO EHTER UPON hIE �
ABWE-MEMtONEUPROPER7YFORWSPECT PURPOSES.
o � COMMENTS
J `
PE E(PRINn �
� g � 1
. Uj �SIONATURE OF PERAIITTEE DATE
� . RECPT..NO. PAID�BY VALIDATION
WHITE-Depaitment Copy,YELLOW—Flnar�ce Copy,VINK—Assessor Capy,GOIDENROD--Ffle Copy,6REEN—ApplfcanYs Copy
�� ''.�'-�'"b ''9 �' '..°
CITY �F DIAIVI�ND BAR
IIVSPECTIOI� RECORD
• Q .t'�� � ° � � ° � .:i � p � .ry.P • �� s '..
���.,- �;b _
SETBA�K __V �_FLOORJOIST _
FTGS/FORMS/STEEL �FHA REQMTS
ELECTRIC GROUND 'UNDER FLOOR DUCT
GRQUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE �FIREPLACE FOUNDATION
TEMP POWER �FIREPLACE BOND BEAM � '
WATER SERVICE �MID HT.BOND BEAM
ROOF SHEATHING I S FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER I PRE-GRADING
ROUGH HEATING I BENCHING
ROUGH ELECTRIC i ROUGH GRADING
ROUGH PLUMBING 'FINISH GRADING
SHOWER/TUBTEST �PQOL ELECTRIC
EXT.LATH/SIDING �POOL FENCING
WAIL INSUlATION �POOL FINAL �
CEILING INSULATION �OFF SITE IMPS.
DRYWALL NAILING I DEDICATIONS ___
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
5EEP PIT/L.L. ON 51TE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CQNST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING ' � @
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE