HomeMy WebLinkAbout12-639 _ ___�� CITY OF DIAMOND BAR �/��' �-'--4��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICFS
21810 Copley Drive,Diamond Bar,CA 91765 i
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS .
\�'TM'. BUILDING PERMIT APPLICATION . FIRMLY
o �B Fj SS APPLICATIO►J� �f�3 I r!i PERMIT /Z_�3 y P,� I
DATE � `� l� NUMBER� p ,
� ISSUE TypE pCC
APN LOT RACT
p OWNER DATE CONST. l� �"�' GROUP
�`p ADDRESS ✓ ZONING SEfBACKS �
z CITY ZIP ]-� TEL. FRONT pyy � . ,
p APPLI ANT TEL. R�R O
zd SIDE/SIDE STREET RW O
� CONTRACTOR ' H SIDE p
ADDRESS
� CITY ZIP TEL PROPOSED USE
w ARCH/ENG/. n /
z DESIGNER �-l��G �oto/�'�/1,�-C
w -= NO.DWEL NO. NO.
a ADDRESS
v� UNRS STORIES BEDROOMS
� CI7Y ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF AW.AREANALUATION
p� OWNER-BUILDER DECLARATION � SFR/ADD/REM
O
� 1 MER�V AFFlRAI UNDEH PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- GHf3g0/CBfPOR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSMlCIPROFESSIONSCODEM1YqTYOR (f�
� COUNTYN?i1CHRE0U1RE9APERMITTOCONSTRUCf,ALTER,MPROVE.�EMOUSH,ORREPAIRANYSTRUG W P8I10/DBCI(
�l� TURE,PRKKi TO RS SSUANCE ALSO REOUiRES THE APPLICAtdr FOR SUCH PEAMIT TO FlLE A SIONED W
STATEMENT 7HA7 HE OR SNE IS LICENSED PURSUANT TO 7HE PROVISIDNS OF THE COHTRACTOR9 LI�
� CENSE UW(CNAPTEA Y(COMMENCWa WITH SECTION 7000)OF DMSION�OF iHE 9U$�NE59 AND PRO � PooUSpa �-
Q FESSIONSCOO�OHTHATHEORSHEISElCEA1PTTHEREFROAIANDTHEBA515FORTHEALtEOEDEXEMP• (ry
V TION.ANVVIOlA710NOF5ECT10N7o3t.6BYANVAPPLICANTFOqAPERMI75UBJECT3THEAVPLICAN770 Z qg-ROOI
ACML VENALT'oF NO7 MORE hiAN FlVE HUNDRED DOLURS(f5oo),):
z ❑I.ASONMEROFTHEPHOPERiV,ORMYEMPLOVEESWI7HINAGESASTHEIR50LECOAIPENSATION, � COrtIf116fC181 �
N7LL DO THE WORK,AND THE S7RUCTURE IS NOT INTENDED OR OFFERE�FOR 9�LE(SEC.70N,W51� J
� NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE�UW DOES NOT APPIY TO AH OWNEfl OF j
PROPEHfV NR10 BUILDS Oq IMPROVES THEREON,AND NM170 DOES SUCH WORK H WSELF OR HERSELF OR �
� TMAOUGHHISORHEROWNEMPLOVEES,PROVIDEDTFUTSUp11MPROVEMENTSARENOTINTENDEDOR . m ,
Q OFFEREDFORSALEIF,HOWEVEiL7HE8UILDWOOHIMPROVEAIENTIS$pLpy/fTMNONEYEAROFCOAIPLE-
. Z 710N,THE�OWNER�BUILDER WILL HAVE TFIE BURDEN OF PROVPJO THA7 HE OR SHE DID NOT BURD OR ' '. .
� WP�FOR THE PURP0.5E OF SALE} � .
w ASOWNEROFTNEPROPEHTV,AAIEXCLU5IVELVCONTfUCTWOWfTHLICENSEDCONfRACTORS �
[[ TO RUC7 7ME VRQIECT(SEC.70N,�BUSINESS AHO PROFESSIONS CODE THE CONTMCTORS U- VBIUHtIDf1 qp,�.qpEq. � �- �
W CENSE LAW DOES NOTAPPLv7oAN OWNER OFA PROPER7Y WHO BULLDS 0R IMPROVES THEHEON,AND �
� MM11DC011T1iACTSFOR6UpiPRO.lECTSWfTMACONTRACTOR(3)L�CENSEDPURSUAMTOTHECONTRAC. QUANTITY DESCR1P710N
ioas ucErisE uw.). FEE .
� �I AM EXEMPT UNDER&EC. � �B.6 P.C.FOR 7WS REASON Q
� � � U
� DA7E �2 � Z. OVJN H
CLi �;
�Q UCENSED CON C , S DE TION � W � �Nc3 • �O -
CL I HEREBY AFFIW.1 UNDER PENALTV OF�PE THAT�IMA LICENSED UNDER PqOVI510NS OF CHAPTER � - � � �
� 9(COMMFl1CWO WITH SECTION.7000)OF 0 SION]OF h1E BUSINE55 M10 PROFESSIONS CODE,AND Z '
��� MY LICENSE L4 R!NLL FORCE AND EFFECT. m �
� UCENSE CIA�SfS r�_A �7 LIC.NO. J �` �� � . �
U DATE��C i r �G CONiRACTOR . a , . . ._ . .
IYJ ��,� G�
� WORKEAS'COMPENSATION DECLARATIO� . � �
� I HER�V AFFIP�1 UNDER PENALTY OF PERJUI7V ONE OG THE PoLLOW WG DECLARA710N3: � � -
C� Z
� _�FIAVEAND�Wtt1AWNTAINACFHTIFlCATEOFCONSEMTOSELF-INSUREFORWOq1(EAS � - � �
CONPENSATION,AS PROVIDm 8V SECTION 3]OOOF 7NE LABOR CODE,FOR THE PERFORIAANCE U'
.Q OF hIE WORN FOR WHICH THIS PERAl1T IS ISSUED. 111 . . .
Qw _1 HAVE AND WILL 1MIHTAIN WOR)(ERS'COMPENSATION IN3URAIJCE;AS RECUIRED BV SECTION � �
37000F THE LABOR CODE,FOR THE GERFORMMICE�OF THE WOPo(FOR WHIGI7HIS pERNIT i3_
ISSUFA.MV WORKERS'COMPENSATION INSURANCE CMqIER AND POLICY MIMBER ARE: �CONSTRUCTION
jCAHRIER PLAN REVIEW . . .
0 POLICY�NUMBER .
� ELECTRIC
p (���+���°�IDo�n���swaa+E�000u�as�s�oo)a+�ss} PLUMBING
w
Z �CERTIFV THAT IN THE PERFOfA1ANCE OF THE WOPo(FOR WHICH 71i45 pERMIT IS ISSUED,1 MECHANICAL
C} SHALL NOT EMPLOY ANY PERSON W ANY MpNNER SOAS 70 BECOME'SUBJECr 70 THE �
(n NIORKERSCOMPENSATIONlAW50FCALIFOfWIh�NDA6REETHATIFISFiOULDBECAME INSPECTIONFEE '
SUBJECT TO 7HE V�oRKERS'COMPENSATION PROVISIONS OF SECTION s7ao OF THE UBOR � � � � ' �
O cooe.i srwLL wRn+win�coua�v Hnn�nasE vRowsror�s. ISSUANCE
p DA7E:�� APPLICA . �SMIP
W
J WARNWO:FAILURE TO SECURE wORKERS' P GOVE GE IS uNUWFUL,AND SHALL BE ENERGY P/C -
J
� SU&IECTANEMPLO`/ERTOCRIMWALVENALTIE GVILFWESUPTOONEHUNDHED7YfWSANp ENER6YPERMIT
�s(5100.000),9J ADDITOt�TOTHE COS COMPENSATION,DAMA�ES AS PROVIDED f-0R IN
J SECTpN 370!OF 7HE LABOR CODE,UITERE .ANDATfORNEV'3 FEES. � � � �
W RETENTION FEE: �
O , CONSTRUCTION LENDING AGENCY � PREALT FEE
� 1 HEREBY AFFlRM UNDER PENALTY OF PERIURY THAT THERE f3 ACONSTRUC710N LENDW6 AOENCV
d' �FOR TNE PERFORMANCE OF 7HE WORK iOR NM1i1CH THIS PERMR IS ISSUED(SEC.30H1,CN.C.).
Z
W
��. LETIDER'SNAME . . .. . . . . �
f— IENDEfiSADDRE55 � � �
_ � �I CEHTIFV THAT I HAVE READ THI9 MPLICATION AtJD STATE.TUIT THE ABOVE MFOiWATION 19 ODRRECT. TOTAL FE ES I , �� / /"'1
� I A(3REE TO COMPLV WITH ALL CI7V AND COUNTV ORpW/JICES AND STATE UWS RELATWO TO BURDINO � �
� CANSTRUCTION,AND HEREBY AUTHOPRE REPRESENTATNES OF THIS COUNTY TO EMER U70N THE '
Z ABOVE-MEMIONED 7ROPERTY FOR INSPECTION PURPOSES. COMMENTS '
� v O✓V� lYL[� y �
�
m VERMI7TEE NAME(PRINn .
� ,S' Z� " � �
� E OF P fTrEE DA7E
� RECPT.NO. PAID B VALIDATION
WHITE—DepaAment Copy,YELLOYY—Flnarwe Copy,PINK—Assessor Copy,GOLDENR06—File Copy;GREEN—ApplfcanYs Copy -
CITY OF DIAMQfVD BAR
II�SPECTlOPV REC�R�
� o. . , . . �
��•� � � � e ° . . h
e o Q ;k _ .: . .
� � o �y.,rY'_ �� � � .. B � '��'� u 0 a
� r
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL ^ FNA REQMTS'
ELECTRIC GROU(VD UNOER FLOOR OUCT
GROUND PLUMBING UNDER FLGOR CONDUIT
SLAB GRADE FIREPLACE FOUNDA710N
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID NT.BOND BEAM �
ROOF SHEATHING �8 FT.BOND BEAAh ,
FRAMING/VEN7I�ATION HNAL BOND BEAM__
ROOF COVER ;PRE-GRADING
ROUGH HEATING I BENCHING
ROUGH ELECTRtC ROUGH GRADING
ROUGH FLUMBING FINISH GRPIDING
SHOWER/TUB TES7 POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEIUNG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
5EPTIC TANK LANDSCAPE/IRiiIG.
SEEP PIT/L.L. OM SITE IMPS.
GAS AIR TEST FINAL ZONiNG
FINAL CONST. FIRE DEPT.FINAL �~�
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC � DEV.FEES PA1D
fINAL PLUM8ING ENERGY
FINAL PLANING �— .
FINAL ENGINEERING • v a -
COMMENTS
SEPTICTANKSIZE
SEEP PITIU SIZE
h� ,� — --
; y;