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HomeMy WebLinkAbout10-1052 ��_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMEN��7��'��S�� 21825 Copley Drive,Diamond Bar,CA 91765 �r a �, (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839- PRE$$ �'°^'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE Q �`���� APPLICATIOy`�'� NUMB R�O�r�lC ADDRESS l]�� j DATE � � APN T T.FiACT D TEE �O--�9���I Q CONST. OUP p OWNER � o ADD SS ZONING SETBACKS g CITY � IP TEL. REART RW ❑ I APPLICA T TEL. ❑ ¢ SIDE/SIDE STREET RW ❑ � CONTRACTO SIDE p � ADD FSS ^ p�-�_ � CITY • ZIP TEL. - PROPOSEDUSE('��\�1F�P� o ARCWENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES �_ gEDROOMS�_ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWADD/REM O � I HEREBV AFFlRM UNDER PENALTV OF PERIURV TFIAT I AM E7(EMPT FROM THE CONTMCTORS LI• GBfegB/CBfPOf1 W CENSEUWFORTHEFIX.LOWINOREASON(SEC.70.'f1.6BU51NE5SANDPROFESSIONSCOOE:ANVCITYOq (n U �OUN7yWFIICHRE0UIRESAVEqMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W TURE,PRIOR TO ITS ISSUANCE,/�L50 REOUIRES THE APPLICANT FOH SUp1 PERMIT TO FIIE A SIONED w Pe���/DBCI( � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE GROVISIONS OF THE CANTMCTORS LI- � CENSE UW(CHAPTER 0(COMMENCWO WITH SECTION 70D0)OF DIVISION 3 OF h7E BUSINESS AND PRO- � POOUSPB FESSIONS CODE)OR TMAT HE OR SHE IS EXEMPT 7HEREfROM AND THE BASIS FOR THE ALLEGED EXEMP� (� TION.ANV VqLAT10N OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT 5U&IECTS TNE APPUCANT T0 Z Re-Root A CML PENAL7V OF NOT MORE THAN FIVE HUNDRED DOLLARS({500).): � ❑I,ASOWNEROFTHEPROPERT',ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrt1RIBfC18I Z WILL DO hIE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY N010 BUtLDS OR IMPROVES THEREON,M1D WHo OOES SUCH WORK HIMSELF OR HERSELF OR w THROUQH HIS OR HER OWN EMPLOVEES,PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEAEDFORSALEIF,HOWEVERTMEBi11LDINOOqIMPROVEMENTI550LDWRHINONEVEAROFCOMP�E z TION,THE OWNER-BUILDER WILL HAVE THE BUqDEN OF PROVWO THAT HE OR SHE DID NOT BUIID OH � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,AS OWNER OF THE PROPERTV.AM EXCLUSIVELV CANTRACTING WfTH LICENSED CONTMCTORS � TO CONSTHUCT THE PRQIECT(SEC.7W1,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI� VBIUOflOf1 ADJ.AREA W CENSEUWDOESNOTMPLVTOANONRJEROFAPROPERTVWHOBUILOSORIMPROVESTHEREON,AND , � NOrOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS LICENSE UW.). FEE � ❑I AA1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � �' � t �� � U � DATE OWNER' � Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTY OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z ' ��� IIY LICENSE IS IN FULL FORC�E AN/D EFFECT. m � LICENSE CLASS "'— LIC.NO. . P W � � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECURATqNS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' ¢ 2 Q COMPENSATION,AS PROVIDED BY SECTION�700 OF TFIE LABOR((XH1E,FOR THE PEHFORMANCE U OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � w ����E AND WILL MAINTAIN WORKERS'COMFENSATbN INSURANCE,AS REOUIRED BV SECTION Q 370o OF THE LAHOF CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV RKERS'COMPENSATIOJJ INSURANCE CAqRIER AND POLICY NUMBER ME: CONSTRUCTI ON � CARRIER � PLAN REVIEW � POLICV NUMBER Zd ELECTRIC � (n+�ss�cnor�r¢�r+oreEm'a3��aFn+Eve�wrrswaa+enuraamoa�wsR+aoloa�ss� LUM / 9e w Z 1 CERTIFY THAT IN THE PERFORMANCE OF 7HE WORN FOR WHlpi iH15 PERAl1T IS ISSUED,I MECHANICAL C,'} SHALL NOT EMPLOV ANY PERSON IN ANV MANNEP SO AS TO BECOME SU&IECT TO THE (n WORKERS'COMPENSATION IAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE S SU&lECT TO THE WORNERS'COMPENSATIO PROVISIONS OF SECTION 3700 Of THE UBOR �� O� COD,I SH FORTHWITH COMPLV WI E PR VISIONS. IS UAN � p DATE: ���PPLICANT. SMIP W � WAANINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHWSAND ENERGYP IT DOLURS(S10o.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTpN 37ae OF 7HE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. D� w ETENTION FEE: � O CONSTRUCTION LENDING AGENCY PRE-AL EE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJUFV THAT THERE IS A CANSTNUCTION LENDINO AGENCV � � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERIAIT IS ISSUED(SEC.309�,CIV.C.). Z W � LENDER'S NAME f-- LENDER'SADDRESS � I CERTIFV TNAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE WFORMATKKJ IS CORRECT. TOTAL FE ES /���� � I AQREE TO CAMPLV WITH ALL CfTY AND CAUN7V ORDINANCES AND STATE UWS REUTINO TO BUILDINQ � CONSTRUCTION,AND HEREBV AUTHOR2E REPRES NTATIVES OF THIS CWNTV TO ENTER UPON THE Z ABO NED PROPERTV FOR INSPECT avosEs. COMMENTS � � � m PERM E AME(PRINn . � /D /� � � TU F P E � RECPT.NO. PAID BY -VALIDATION WHITE—Depertment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOIDENRO�FIe Copy,(iqEEN—Appl{canYs Copy , \ CITY OF Do�►i1�O�1D �AR ��_����`�j�. � ,.OB�SG��C�'60N RECORD ''' � 0 ��i;. D � '� � 0 ' . . 0 � � � 0� ��,�Y . ,:�a���c�400a �. , -��� ���� �,�r�a��a � ., �a�p�c��a - �ra� .: . o�� ` SET BACK • FLOOR JOI&T � - 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 MID H'L BOND BEAM ROOF SHEATHING 8 FT.BOND'BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER ; PRE-GRADING ROUGH HE,4TING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADIPJG SHOWERlTUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER . FINAL ENG. SEPTIC TANK LANDSCAPE/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 DEV. FEES PAID FINAL PLUMBING � ENERGY , o�O ( / /, COMME(VTS G�OI_l-LC—:�N 'C�l`"Q—�—/— � � L�f�C�=�2�A�1��—��- - —��/�—`�— — � � � SEPT.IC TANK SIZE SEEP PIT/U SIZE a . �;r� � a �