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HomeMy WebLinkAbout12-1161 CITY OF DIAMOND BAR � �"--�'— DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES t. � 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS �'^^'. BUILDING PERMIT APPLICATION FIRMLY Q ADDRESS�S C:LOLLC�1 �'�a�4t' yr• APPLICATION� � Z PERMIT � _I'�/ P/C o DATE I NUMBE � # � APN LOT TRACT DATEE I y Z�_ONST.�C�C�W GROUP p OWNER �Q r1 �_ -un A,t.�. � ADDRESS � o r ZONING SETBACKS 0 FRONT g CITY Zi�� TE �` REAR RW ❑ APPLICANT TEL. SIDE/SIDE STREET Ryy p � CONTRACTOR �J SIDE p ADDRESS � CITY �L- ZIP ' TEL PROPOSED USE v c � p✓� o ARCH/ENG/ " z DESIGNER . a ADDRESS NO.DWEL. NO. NO: N CIJY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION � SFR/ADD/REM O p I HEREBY AFFIRM lRlDER PENALTV OF FERNRY hIAT I AM EXEMPT FROA1 THE CONTqApTORS L4 Garage/Carport " W CENSEUWFORTHEFOLLOWIN�REASON(SEC.703t.68U51NESSANDVROFESSIONSCODEANYGTVOR (n � COUNTVWHICHREOUIRESAPERMITTOCONSTRUCi,ALTEfLUAVROVE.DEMOLISH,ORREVAIHANV97RUG W P01I0/DBN( NRE,PRqR TO�RS ISSUANCE,AL50 REWIRES THE MPL�CANT WR SUCH PERMIT TO FlLE A SIONED w � STATEMEM THA7 HE OR�6lIE IS LICENSED PURSUANT 70 hIE PROVISIONS OF.THE CONTRACTORS LI- . . � CENSE UW(Cl1APTEA D�COMMENqNO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINE59 AND PRO- � POOI�SpB _ FESS�ONSCOO�ORTHATHEOHSHEISEXEMPTTHEREFROIdANDTHEeA515FORTHEALLEOEDE%EMP• (ry � TION.ANY.VIOLATIONOFSECTION7037.6BYANYMVLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Rool �� � � . � A CML PEN�LTY OF NOT MORE THAN.FNE HUNDRED DOLLARS(i50D).j: ❑I,ASOYMEROFTHEPROPERTV,OqMYENPLOYEE3WITHINAGESASTHEIR50LECOMPENSATION, - Q CpmmBfCl81 � Z WILI DO TNE WORI(AND THE STRUC7URE IS NO7 INTEN�ED OR OFFERED FOR 9�LE(SEC.7ai,�&156 J � J � � NESS�AND PROFES510NS CODE:7FIE CONTRACTORS LICENSE�LAW DOES NOT APPLY TO AN OWNER OF � . PpOPEHTY NM11D W 0.0.4 OR IMPROVES THEREON,PND WHO DOES�SUCM WORK HIMSELF OR HERSELF OR � WTHHOUON WS OR HER OHM EMPLOYEES,PHOVIDED THAT SUCH IMPROVEMENTS ARE NOT PlTENDED OR . m � Q OFFERmFORSALEIF,HOWEVER�BUILDWOOPIMPROVEAIENTI550LpWfTMNONEVEAROFCOMVLE- Z 710N..T1E OWNER�BUILDER N7LL HAVE THE BURDEN OF PFiOVING THAT�HE OR SHE DtD NOT HUIID OR , . � IMFROVE FOR THE PURP0.SE OF SALE). � � (y� ❑I,ASOWNEROF7HEPROPEfiTY,AME%ClUSNELYCANTMCTINOWlTHLICENSEDCONTRACT00.4 [C TO CONSTRUCT THE pqpJECT(SEC.70M,BUSINESS AND PROFESSIONS COpE:THE CONTRACTOR9 U- V01U8fIOf1 /��J,(�q� ' lll CEµqE LAW DOES NOTAPVLY TOAN OWNER OF A VROPERTY VMtO BU0.D3 Oq IMPROVES 7NEREON,AND - � WHOCOMAACTSFORSUCHPROUEC75WffHACONTRACTOR�S)LICENSEDPUASUAHT70THEODNTRAC• pUANTITY DESCRIPT1pN �� roas ucEruE uw.�. FEE � O 1 AM EJ(EMPT UNpEp$EC. 8.8 V.C.FOR Tl9S fiEA$ON Q U � DATE - OWNER �f- O W � UCENSED CONTRACTORS DECLARATION �—i � - � � � � � w 1 HEREBV AFFlRA/UNDER PENALTY OF PERJUqY THAT I AM�LICENSED UNDER PROVISIONS OF C}fAPTER � � p� Y(COMMENCINO WITH SECrION 7000)OF DMSION 7 OF THE BUS7NESS�flD PROFESSIONS CODE,AND Z � �X Ary LICENSE IS IN FNl FORCE AND EFFECT. m � LICENSE CLASS �� UC.NC. � �� � . V DATE T'�. CONTRACTOR i/(/L d . . . lLl �L���. � � . � WORKERS'COMPENSATION DECLARAT ON � � �� � �n U rMlv, N 1 HEAEBYAFFIRM UNDER PENALTV OF PERJUflY ONE OF THE FOLLOW W(i DECURATIONS: Z - � , � _�HAVE�AND Wttl MAWTAIN A CERTIFlCA7E OF CONSENf TO SELF-INSURE FOH WORNEqS � - - COMPENSATION,AS PROVIDEp BV SECTION 370D Of 7HE UBOR CODE,FOR THE PERFORMANCE U� E WOPof FOR NTi1CH THIg pERMIT 19 ISSUED. � � w �MAVE AND WILL MAINTAIN WORKERS'COMPErySAT�pH INSURANCE;A4 REWIRED Bv SECTION Q 370o OF-THE LABOR�COD�FOR THE PERFORMANCE OF THE WORK FOR NR9CJ1 h115 PERNIT IS � ISSUEO.MY EA5 PENSA710N INSU CE CARRIER�AND POLICY NUMBER ME �CONSTRUCTION�� > ��,�`lor.�'ev)ot�`� PUW REVIEW 0 POLICY�NUMBER . .�G L � � ELECTRIC p (�s��+r�rr°Te�°a�a�rIDocn�v�.*�awr+ar�wwr+Eooa�usfs+ooloA�ssi PLUMBING w Z �CERTIFV TNAT W THE PERFORMANCE OF THE WORK FOR WHICM THIS PERMIT I$ISSUED,1 MECHANICAL� � ,� CS SHALL NOT EMPI.OY ANY VERSON W ANY MANNER SOAS 70 BECOME SU&1EC770 TiE � (/� WOPo(ER5 CAMPENSATqN lAWS OF CALIFORNIh �D AGREE hUT IF 1 SHOULD BECOME INSPECTION FEE S SU&IECT TOTHE WOHICERS'�COMPENSATION P O�NS OF SECTION 3700 OF THE UBOR � � � O E i s FORrM+nn�coua�r wm�nw vis�rs. ISSUANCE _ � p OATE��� APPLICANf: �SMIP � WAANINQ�FALURE 70 SECURE WORKERS'COAIPENSATqN CA GE i5 UNLAMfFUL,AND sHALL BE ENERGY P/C J � Sl1B.lECTANEMPLOYERTOCRIMWALPENAL71E5ANDGVILFWESUPTOONEHUNDRED7HWSAND ENERGY�PERMIT OOILMS.(S1oo.000�,�IN ADDI710N TO THE COST OF COMVENSATpN,DAMA�ES AS PROVIDED FOR IN J SECTION 37oe OF iHE LABOR CODE,INTERE57,AND ATfORNEY'S FEES. � � W RETENTION FEE: � O . CONSTAUCTION�LENDINGAGEN6Y � PRE-ALTFEE: � I HEREBY AFFlRM UNDER PENALTY OF PERIURY THAT THERE IS ACONSTRUC710N IENDMO AOENCY � �' FOR THE PERWRMANCE OFTiE WORI(FOR NM1iK]/TMIS PERA1fT IS ISSUED(SEC.�]aD1,qV.CJ. Z _ _ LLJ �, LEHDEI7S NAME . • � IENDER'SADORESS - . � ICERTIFYTHATIHAVEHEADTHI9APPl1CATIONANDSTATE7HATTHEABOVEPIFORMATqNISCORRECT. TOTAL FEES /� � / � 1 A6PEE TO COMP�Y N7TH ALL CfTV AN�COUNTY ppDINANCE4 AHD STATE.UWS RELATWG TO BU0.AINO ( / .� COHS7RUCTIpN,ANDHEREBYAUhpRIZEREPRESENTATIVE50FTHI5CWNTYTOENTERUPONiHE ' . Z ABOVE-MENTIQRED�P�FOR INSPECTION WRPOSES. COMMENTS ' 0 �� O J 0�� � m PEAMITTEE NAME(PRI/Jn � /� . Q _ '/L cn y � �SIONATURE OF PERMRTEE DA7E � RECPT..NO. PAID BY VALIDATION WHITE—Department Copy.YELLOW--Finence Copy.PINK—Assessor Copy.GOLpENR06—File Copy;GREEN-- - ' ApplkanCs CoPY CITY �F D1�41UIOND B�4R If�SPECTI�M RECOFtD b ° g �. � � F ,T� m Q �'t�_ N��� a � B � �. o ��m ., ,t � . ..., - . � P- . .� � : .., - . ' '` � ' � �s �,. ,. . .. . . ,. :. ,, SETBACK_ _ --- — — __ �FLOOR)OIST . —— FTGS/FORMS/STEEL �FHA REQMTS ELKTRlC GROUND UNDER FLOOR DUCT •� GR�UND PLUMBING i UNDER FLOc�R CONDUIT SLAB GRADE FIREP�ACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT.BOND BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE—GRA�ING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT.LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEIIING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAI ENG. SEPTICTAfVK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAI ZONING FiNAL CONST. FIRE DEPT.FIPIAL FINAL HEATING � Q � HERLTN DEPT.FINAL FINAI ELECTRIC DEV.FEES PAID FIN,4L PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING . B p COMMENTS � SEPTICTANKSIZE SEEP PIT/U SIZE , �I,, ` b t �� j �, , . ',:1,' . . . 'r