HomeMy WebLinkAbout12-2004 .��_ CITY OF DIAMUND BAR
� DEPARTMENT OF COMMUNPI'Y&DEVELOPMENT SERVICES ^�"
� 21810 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 E$$
���^^'. BUILDING PERMIT APPLICATION FIRMLY
¢ DDRESS✓"sl U[�1.�E1J t'I'L/�'(�OS 1/�. I � � I7s �� ZQT
>- APPLICATION PERMIT P/C
p DATE NUMBER #
� APN LOT TRACT �SSUE � y� /?� TYPE OCC
� �� DATE I CONST.� GROUP
p OWNER �1-E�RY��S 1--t�'PL4�2-'C�
o ADDRESS �'�^�e ZONING SETBACKS
z CITY Diw/A• dPl2 • ZIP q���oS TEL. FRONT q�/y p
� APPLICANT TEL. REAR p
z SIDFJSIDE STREET RW ❑
� CONTRACTOR AG�FIG J�4D/Vf� /ZeM. �/uG. SIDE
❑
ADDRESS �Z(ns FS W s S H��+9 t'o.v g�-V O .
O C�Ty �••A, Z�F`�DG��vTEL ��"I37•�(7Cp PR O DUSE � _ �
w ARCH/ENG/ ���
z DESIGNER
w NO.DWEL. NO. Np,
� ADDRESS I
� CITY ZIP TEL. UNITS STORIES BEDROOMS ,
� I
�n DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUIIDER DECI.ARATION SFR/ADD/REM I
O
p I HEREBY AFFlRM UNDER VENAL7Y OF PERAIRY THAT t AA1 E%EMPT FROM T1E CONTRACTORS U- GHfa JB/CefPOfl
W CENSEUWFORTHEFOLLOWINI3REASON(SEC.7Q'1t.6BU5WE55ANOPROFES510N5CO0E:ANYqTYOR (n
C� COUMYWHICHREWIRESAPERMITTOCONSTAUCT,A�TEA,IMPqOV�DEMOl15H2ORREPNRM1YSTqUG W �
W NRE,PRIOR TO RS ISSUANCE,�LSO REOUIPES THE APPLICANT FOR SUdi PERYIT TO F0.E A SIONED w PatiolDeck
� S7ATEIAENT T}1AT HE oR SHE IS LICENSED PURSUANT TO THE VROVISIONS OF THE CANTRACTORS LL � _
� CENSE LAW(CHAPTER G(COMMENCUJ6 WfTH SECTIDN 7000)OF DIVISION 9 OF THE BUSINESS ANO PRO PDOUSPa
� FESSqNSCOD�ORT1iATHEOR5HEI5E%EMPTTHEREFROMANDTHEBASISFORiHEALLEOEDE%EMP- C7
V TION.MIYVIOI.A710NOFSECT10N7o]t.5BYANYAPVLICANTFOqAPERMITSU&IECTSTHEA7PlICANTTO Z R0-ROOf
A CML PENAL7Y OF NOT MORE THAN FIVE HUNDqED DOLLAHS(fSOD).):
� ❑I,ASOWNEROF7FIEPROPERTY,ORMYEMPIOVEESWfTHWAGEStiSTHEIR50lECOMPEN5A710N, � Commercial �
z WILL DO THE M/ORK�ND THE STRUCNRE IS NOT INTENDED OR OFFERm FOR 9ALE(SEC.7oa�,BU54 _J '
� NESS ANO FROFESSIONS G9DE 7HE CONTRACTORS IJCENSE UW DOES NOT AVPLV TO AN OWNEH OF � -
PROPEHiY WHO BUILDS OR IMPROVES THEREON.M10 NMO DOES SUq1 WOHK H WSELF Oq HERSELF OR
WTHROUGH WS OR HER ONM EMVIOYEE3,FROVIDED 7HAT SUp11MPROVEA1Fj1TS ARE NOT WTENDED OR m
Q OFFERmFORSALEIF,HOWEYER711E8URDINOORwPROVEMENTI55oLpWRHWONEYEAHOFCOMPI.E-
Z TION.7HE OWNER-BUHDEA WfLL HAVE THE BUROEN OF PROVINQ TFiAT HE OR SNE DID NOT BUILD OR
� MPROVE WR THE 7URPOSE OF SALE).
W 04�+`ONRJEROF7HEPROPEfm;M/E%CLUSNELYCAHiRACTW(iWfTNUCENSEDCONTRACTORS
Q TO CONSTRUCT THE PR0.IECT(SEG 70H,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS U- V81U81IOf1 � � ADJ.AREA
W CENSE UW OOES NOTAPPLY TO AN OWNEA OFA VHOPEA7Y riH0 BURDS OR�M7ROVE5 THEREON,AND
� 1N�OCONT�RACTSFORSUO/PRQlECf9WfTHACOMRAGTOR�S)UCENSEDPURSUANTTOTHECONTRAG Q�J(u.J'�j'N DESCRIPTION �E ,
TORS L�CENSE LAW.).
Q ❑I MI EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
?y U
� DATE ONMER � .
Z U
�Q LJCENSED CONTRACTORS DECLARATION W
2 1 HEREBY AFFIRM UNDER PENALTY OF PERp1f1V TMAT I AM LICENSED UNDER PqOVISqNS OF CNAPTER �
� Y(COMAIENCINO WITH SECTION 7000)OG Dm510N]OF THE 9USINE55 MlD PROFESSIONS COOE,Ml� Z
��� W LICENSE LS PI FUl FOnRCE AND EFFECT. �j. (y / m
_ � UCENSE CIASS 'v LIC.NO. [ � V �`-'� \ �
U DATE 4'� 20 � I/ CONTRACTOR d
W
� WORKEAS'COMPENSATION DECIARATION � �
� IHER�YAFFIRMUNDER�PENALTVOFPER1UFiYONEOFTHEFOILOWWGDECUtLt710N5: Z �
� � 1 NAVE AND WILL MNNTAIN AGERTIFICATE OF CON$ENT TO SELF�INSURE FOR WOHICERS ¢
� COMPENSA770N,A4 PROVIOED BY SECTION]70o OF THE UBOR CODE,FOq THE PERFORMANCE U
Q OF 7HE WORN FOR NM1i1C}I THIS PERMlT 19 ISSUED. � ' �
� _I FUVE AND WILL MAWTAIN WOHI(EAS'COMPENSATION INSVRANCE,A9 REOUIRED BY SECTION �
Q 77000F THE LABOR CODE.FOR THE PERFORMMICE OF THE WOPo(FOR WHICH THIS PERMIT IS
, � ISSUm.MY�WOtPo(FA5 COMPENSATqN INSUfiAIJCE CMRIER AND POLIGV NUMBERARE: CONSTRUCTION
] CARRIER �T�R(T FO�� PLAN REVIEW
� POLICYMlMBER �1 V FG�I K ?j7 Z�
Z ELECTRIC
¢
0 (RiL4sEcftorJN�No7eE00hRE7IDOFhEaEARTfSwfioNE/iIA�DREDpoLLl�S(ftoqpqLE55y � PLUMBING �
W
Z �CERT�FY TUT IN T7E PEAFORMANCE OF 7HE NOfU(FOR WHICH THIS PERAIR IS ISSUED,I MECHANICAL
C7 SH/U1 NO7 EMPLOV M7V PERSON W ANV MANNER 50 AS TO BEWME SU&IECT TO THE
(/� WORNERS'COMPENSA7qN UWS OF GLLIFORMA ANO AOREE T1iA7 IF I SNOULD BECOME INSPECTION FEE
SUAIECT TO THE NT.)Po(ERS'COMPENSA7ID OVISIONS OF SECTION�700 OF THE UBOR
Ocoo �s wRrHvnn+corap�v s rpov Hs. ISSUANCE • �
p DA1E: 9 G �Z APPLICA : �SMIP /
W ENERGY P/C
� WARNIN6:FA4LRETOSE(.UREWOflKER COMPENSTq CAVEM ISUMUWFUL,MIDS/VLLBE
� SUeJEC7AN EMPLOYER TO CRIIdWI1 PE TIES AND L ES UP O ONE 1NNDRED THOUSAND ENERGY PERMIT �
DOlUR9fft00.0001.WADDITON70THE OF v MAAGESASPROVIDEDPDqW
J SECTION a7oB OF 7HE LABOR CODE,INTERES. RNEY'S FEES. �
[t � RETENTION FEE: .O
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFlRM UNDER 7ENAL7Y OF PERIURV THAT THERE IS ACANSiRULTION IENOWO A(3EN(.Y �
� FOR TME PERFORMANCE OF THE WOR1C FOR WHMJI THIS VERMIT IS ISSUED(SEC]OII7,GV.C.� ,
Z
W
� LENDEA'^NAME , �
� LENDER'SADDRE53
� I CERTIFV THAT I HAVE READ THIS A7PLICATION ANO STATE7F1AT7HE ABovE wFORMATION IS CORAECT. TOTAL FEES `2vg, 2 ,
� I AGREE TO COMPLY N77H�LL CRV ANO CAUNTY pqDINANCES AND STATE UWS RELATIN6 TO WILDIN6
� COHSTRUC'f10N,ANDHEREBVAUTHORIZEqEPRESENTATIVESOFTHISCOUN7YTOENTERUPONTHE � ,
Z ABOVE�AIENi1DNE0 PROPEATY FOR INSPECTION PURP0.SE5. COMMENTS
� 3bSE �C) cZ(l�l�- -
a VE (PRINn A •�O• � � '
4
� �
� IONA VERM �A7E
� RECPT.NO. PAID B VAl1DATION
WHITE—Deparlment Copy,YELLOW--F�inance Copy.PINK—Assessor Copy,GOLDENFlOD--File Copy;GREEN--ApplkanCs Copy
� '� a !' t i`trt r tr����,�r ^ :�
�w� s�� �,.��' _�'3 t,�1!;)`�.?1 n� �5 f-1 7'� �
� 7�li��'7�.'�s����!.�J�=i S-`i�_''�.r'4+'L��
i..-�.f T ...f w r'4 .F"�' �i t4 �a-ry,wc��.'�£-�c-^jS7�v.�.F'ir^�:;�- ' "�:"Y"'•ti _.r�F� ���P'". 4 2^'�\. ^� �
�v� 'T: a'`�t i :.t^', �'., 'frl.. 1. r.��'Ti,� _ -i.� ..rrr..
w? i i`__li sl � a, t �� j�'�.�,"'t�a t{ ��. �±�n ``� �l � �, E �`"�Cni � L.��-tt� Y f 3`p.,�,r r ;�,:. :,�'�`�.����;�
�'._.*�L� : `- .�1��� �1�,� ,� h�.'�,� � F�\;.�� �t'�-�� i. �-c'd.�,� ���1��'3.e3�;�t �fi�'��� � n�2{�3"�,L },j .�-'�� '.y � '� '� s � �
_ ..__. j�������.1._ _:�:�. _t �; 3�:�-,� .���-. _S.�T,�, .�_w.�������-�;� �.���„�; �:��E����., ;��-,�.1��
SET BACK �FLC)OR 101ST �;� '
ym� ��.
_. __ � --- _ _- __ . _ _.. -- _ ._ _ �. __. I -
FT�S/r(�R�V14��TEEL i _ — --- � FH4 REOINTS
_ _ -- - __.._. --. .- _ .- - ----I �- ------ .......--------- I
� - - ---- -
ELEC_TRIC GRpUtJD ' I I i_I�JDER FI.00R DUCT
------------- —f---------------------- __---- �--------- _----�------------
�::�RC)Uh0 Pl.t!i��iP,l�!G I ; �UNDFR FIGOR COM�UIT
------�------------- ,
� --------—i I------------- �--
.,LAB GRA(�,= FIPE?LFCF FOU(JDATIa�!
�.. -� �—=— —
TENIPP04VER - -------y---i---- ----------------- -I �FiREPLACEBONDBEANI --- --�---
bVATER SERVICE ��MID HT.BOI�1D EEAM
ROOF SHEATHI�JG j 8 FT.BOND BEAM
FRAMI�JG/VENTILATION i FI�lAL BOPJD BEAM
----_-----------.-____----------- ----------..�--- — '-_.—._---------- --------
ROOF COVER i PRE-GRADI�IG
----------- -----.-...---- ---- ------- ----------
ROUGH HEATI�JG �EEfJCHING
--------�----------- ------- -- ---------------- �-------------- ---------
ROUGH ELECfRIC i ROUvH GRAOING
ROUGH PLUMBING I FINISH GRADING
SHOWERlTUB TEST (p00L ELECTRIC
EXT.LATH/SIDING �POOL FENCING
�VALL INSULATION j POOL FINAL
CEILING If�lSl ILATION j OFF SITE IMPS.
DR'f�VALI�JAILING �DEDICATIOVS
�E4VER ----.._�---- ------ ----- -------- �FINAL ENG. ------
-------------------_..--- ------------------__— '------- -------.�.__.._
SEPTICTANK Ih LANDSCAPE/IRRIG.
SEEP PIT/LL. --.— -_____ - ---- (OhJ SITE IMPS. -----------
GAS AIR TEST FItdAL ZONING
FINAL CONST. �FIRE DEPT.FINAL
FINAL FIEATING �HEALTH DEPT.FINAL — �
FIN�1L ELECTRIC I DEV.FEES PAID
FINAL P�l IPABING Ef�IERGY
FINAL P�ANING
FINAL_E�1GIMtERfNG--- ---- -- -- --- , � :� + � '.
r a,� �- ----
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�
_ g