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HomeMy WebLinkAbout12-1117 (6)� CITY OF DIAMOND BAR �--��` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21810 Copley Drive,Diamond Bar,CA 91765 PRESS � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)539-7027 ��'%�����W BUILDING PERMIT APPLICATION . FIRMLY � JOBSITE 1 APPLICATION PERMIT��'� f? P/C/Z� /�'(� ' o ADDRESS S�� � CCINV N � 1 V�. DATE NUMBE �i � $ ISSUE � CONST.� GROUP APN LOT TRACT DA7E p OWNER I " ADDRESS ZONING SETBACKS o FRONT RW ❑ ' Z CITY ZIP TEL. REAR 0 o APPLICANT TEL. SIDE/SIDE STREET RW O � CONTRACTOR ��'e ✓' SIDE � o ADDRE PROPOSED USE � U O 4/r � �/ C�Ty 1Df 1t IP TEL w ARCWENG/ � �(F � z DESIGNER NO.DWEL. NO. tJO. a ADDRESS UNITS STORIES �BEDROOMS � C�7y ZIP L. � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BUILDER DECLARATION � SFR/ADD/REM O - I MEREBV AFFIRM UNDER➢ENALiY OF PERIUAY THAT I AA1 E%EMPT FROA1 THE CONTRACTORB L1� Gfif890/CB�OR W CF]JSEIAWFOHTHEFOILOM�WOREAE3CM1(SEC.7o31.68U51NE55ANDPROFESSION9CODEANYG7YOR (n � C1 CqJNryNT11CHREWIRESAPENA�TTOCON97FiUCT.ALTEH,IMPROVE.OEMOUSH,ORRE7AlAANYSTfiUG W PBI�QJDBLI( u� 7UAE,PHIOR TO RS ISSUANC�ALSD REW�NES THE MPLiCANT FOH SUC11 FE�R TO FlLE A SIONED w N � STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS�OF 7HE�CONTRACTOR9 LL IL pppVSpa � CENSE lAW(G1if�C7ER Y(COMMENCING W1TN SECTICN7�000)OF OMSION 7 OF TNE 6USWE54 ANO�PqP FES510N5 COO�OR iHAT HE OR SHE IS E%EMPT 7HEREFROM AND THE BA5�5 FOR THE N.LEOED E%EMP- TqN.ANYVqLAT10NOF9ECT10N7031.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPIICANTTO Z Re-Roof � A CfyR pEN/�LiY OF NOT MORE iHAN FIVE NUNDRED D01.LAR5 1t60o).1: , � ❑1ASOWNEROFTHEPR07ERTY,ORMYEMPLOVEESVATHI4AGESASTHEIRSOLECOMPENSA710N, � 0 (`,pmmBfCl81 Z WILL DO THE WORK.ANO THE STqUCTUpE l9 NOT INTENOED OR OFFEPEU FOR 3ALE(SEC,7oM,BUSL J � NESS AND PROFESSIONS CODE TNE CONTMC7oR5llCENSE LAW DOES NO7 A7PLY 70 AN OWNER OF � . pROPERT'NMDBUILASOR�MPROVESTHEREON,ANDWHODOESSUCHNOfiKH1A1SELFORHERSELFOR m � T/qOU6HFU50AMEROWNEMPLOYEES,PROVIOEOTFIATSUCHIIAPROYEMENTSARENOTINTENDEDOA . WQ OFFEAEDFORSALEIF.HOWEVERn1E8UILDINOOR�MPROVEMENT1550lDWRMNONEYEAROFCOAIPLE- Z TqN,.THE OWNER-BUILDER WRL HAVE THE BUROEN OF PROV WO THAT HE OR SHE OID NOT BUIID OR � DAVROVE FOR TFIE PURPOSE OF SALE): � . .. , W ❑I,AS OWNER OF 7HE PROPEHTY,AM EXCLUSNELY CONTMCN1fi W(1H UCENSED CONTRAC700.5 � TO COHS7pUCT THE PR0.1EC7{SEC.7aa�.BUSINESS AND PROFESSIONS CODE:iNE CONTMCTORB LI- V01Ufltlofl A0.1.AREA CENSE uW DOE9 NOTAPPLV TO AN ON'NER OFA PROPERTV WHO BU�L0.5 OR IMPROVE9 THERC-0N.AND �. NR7000MRACTSFORSUCHPROJECTSWfTHACONTRAG70R�S)LICENSEDPURSUANT70THECONTMP Q�Jq(�7�'r( DESCRIPTION FEE � � T00.S UCENSE LAW.). O p I AM E%EMP7 UNDER 6EC. 8.8 P.C.FOR 7HIS REASON � LL DATE - OWNER � U Z W � UCENSEO CONTRACTOFS DECLARATION � � w � 1 HEREBV AFFlRAI UNDER PENALTV OF PERIURY TNAT IAM LICENSED UNDEfl PROVISIONS OF CNAPTER � d a�WMMENCPI(i M'�i1i SECTfON 7om)oF OM910N�OF THE BUSINE55 AND PROFESSIONS CODE,l�HD Z. X I,/Y LICENSE IS Pl FULL FORCE AND EFFECT. m � , LLl � 0 UCENSE CLASS UC.NO. J � � CONTRACTOR d DATE r� WOflKEHS'COMPENSATIONDECLARATION -� � ¢ � V � I HERE6YAFFIHAI UNDER PENAITY OF vERJl7RY ONE OF THE FOLIOWWG DECURATIONS: (!� �� . . . Za . . � IFNVEANDWILLMA1NTAfNACERTIFICATEOFCONSEMTOSELF-INSUREFORWOHI(ERS' S . Z pQ7gpT10N,/45 PqpVIDED BY SEC710N 3TOO OF TNE LABOR CODE,FOR iHE PEHFORMANCE w , . � ' �. Q THE WOR)f FOR WHICH THIB PERMIT IS ISSUED. � � ,I w I HAVE�ND MRLL M1wHTA�N WOW(ER9'COMPENS�TION�NSURANCE,AS REOUIRED BV SECTION ���t�y Q 370o OF THE LABOR COOE,FOH TNE VERFORMANCE OF THE WOR7C FOR WHICH TM�S PERMIT IS Q ISSUED.MY WOPo( RS'CAMPENSATiO,N,�+�RANCE CARRIER AND POIICY NUAABER ARE: �CONSTRUCT�ON�� - � � � CARRIER .,��-J'`�1'`'i er<<A� PLAN FtEVIEW '�. . � POLICV NUMBER ��7�����o � �� . ELECTRIC � (n�assEcrqr+r�rio'reFao�r�pFn+EaEw.�rswap,��pau�ls+ro)aq�ssl PLUMBING . . w 1 CEqTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WIiICH THIS PERMIT IS ISSUfD,I MECHANICAL� Z L}�" SHALL NO7 EMFLOY MtY VER50N w ANV MANNEN 50 AS 70 BECOME SU&IECT TO THE INSPECTION FEE� � WOPKERS'COM7ENSAT�O!!lA�M50F C✓1�F9RNIA,AND�GREE THAT IF I SF40VLD BECOME . SUBJECTTOTHE ERSCOMFENSATIONPROVISIONSOFSECTION37000FTNEUBOR ISSUANCE OCODE.I HWITHCO�VLVWiTHTH� �RlAISIQRb°. . . . _ _ � DATE APPLICANT: � _ �SMIP . w ENERGY P/C � WARNINl3:��FAILUNETOSECUREWDFlKERS'COMVENSAT GO'�EMGEISUNLAWFULANOSNALLBE � � SUAIECTAN EMPLOYER TO CRIMINAL PENALTIES ANO G L FWES UP TO ONE HUNDRED TH(%1SAN� �ERGY PERMIT DOLLAfiS(f100.Oro).W ADDIiiON T0 THE COST OF COMVENSATqN,DAMAGES AS PROVIDED FOR IN J BECTION 370e OF h1E LA00R COOE.�N1ERE5T,AND ATfORNEY3 FEES. ' RETENTION FEE: . � w CONSTRUCTION-LENDING AGENCY � j;RE-ALT FE . � 1 HER�V AFFIRM UNDER PENAL7V OF PERIURY THA7 THERE IS ACONw7RUCT10N LENDWO AOENCY �Yf �� z �FOR TME PERFORMANCE�F THE WOR)(FOR NTiICM 7M13 PERldfT IS ISSUED(SEC.30Y7,CIV.G} �T W �� LENDERSNAME . . . F- LENDER'SADDRE55 . �/'r� ' � ` � ICERTIFYTIIATIHAVEREADTHISMRIGTIONANDSTATE7HAT7NE�BOVF�NFONAATIDNI9CORRECT. TOTAL�EES J��� � �� , ✓ w IAl3PEE7000MPLYVATHALLCRYANDCOUNTYORDWANCESANDSUTEUW3REU7WOTO8URDINO � CONSTAUCiNNi.AND HEREBY AIJTNORIZE PEPRESENTATNES OF THIS COUNTV TO ENTf0.UPON iNE ZABOVE. ED PROP TV FOR INSPECTION VlJ es. COMMENTS � o `r s � m PERMITTEE NAME(VRINn � . /� . . . Q N vj �SIONATUREOFPERMI7TEE DA7E qECPT.NO. PAIDBY VALJDA710N � WHITE--Depertrnent Copy,YELLOW—Finence Copy.PINK—Assessa Copy.GOLDENROD--File Copy,6REEN—ApplicanYs Copy ClTY �F D1AfVIOND �AR INSPECTION RECORD , . . . r , ,� ,, . . �, . ,. � �, . , -�_ " • 8 9 ,`, � � . :� _S..� � ro', '�r. e r �:^. ., . , . o �p�.. , �+'`.` , . , � �, . • � •'' ' g � t, ,�r o Q o � .�;�, �� , � , � K. SET BACK _ _ �FLOOR JOIST fTGS/FORMS/STEEL j FHA REQMTS ELECTRIC GROUND �UNDER FLQOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE I FIREPLACE FOUNDATION TEMP POWER fIREPLACE BOND BEAM WATER SERVICE �MID HT.BOND BEAM ROOF SHEATHING I 8 Ff.BOND BEAM FRAMING/VENTILATION FINA� L BQND BEAM ROOF COVER PRE GRADING ROUGH HEATING �BENCHING ROUGH ELECTRIC �ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlTUB TEST POOL ELECTRIC EXT.LATH/SIDING POOL FENCING - ` WALL INSULATION POOL FINAL CEILING ItJSULATiON �OFF SITE IMPS. DRYWALL NAILIfdG DEQICATIONS SEWER FINAL ENG. SEPTICTF�NK_ LANDSCAPE/IRRIG. SEEP PIUL.L. ON SITE IMPS. " GAS AIRTEST FINAL ZONItJG FINAL CQNST. F(RE DEPT.FINAL FfNAL HEA7ING HEALTH DEPT.F�NAL FINAL ELECTRI� Zo (2 DEV.FEES PAID � FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING . � � COMMENTS SEPTICTANK SIZE SEEP PIT/U SIZE � �� � �' � -- , � --