HomeMy WebLinkAbout10-878 � CITY OF DIAMOND.RAR � -----��� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES r 21825 Copley Drive,Diamond Bar,CA 91765 PRESS "� (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 �����W BUILDING PERMIT APPLICATION FIRMLY � JOBSITE t� ���.�� ��(vI� -�j�V, �� P►.,� APPUCATION ��2/`O NUMB R�_v#/C 1O" g,S o ADDRESS/r �� SSUE /� /T-T`!PE OCC � APN LOT TRACT DATE A�C�D e '�D CONST. ( � GROUP � OWNER t� f'► � v� � ZONING SETBACKS o ADDRES FRONT RW ❑ Z C��Jy Z�P TEL. REAR ❑ g APPLICANT TEL. - - SIDFJSIDE STREET R�N ❑ I � CONTRACTOR SIDE ❑ I o ADDRESS ZIP TEL. PROPOSED USE � � cirv I w ARCH/ENG/ i I w�(�i� � - z DESIGNER ��"� � NO.DWEL. NO. NO. � ADDRESS UNI7S STORIES BEDROOMS � C17y 21P TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER•BUILDER DECLARATION SFR/ADD/REM O � I HEFEBV AFFIRAI UNpER PENALT�OF 7ERJURV THAT I AM E%EMPT FROM TNE CONTRACTORS LI- GHf89B/CefPOA W CENSEUW.FORTHEFOLLO�M�Nl3REAS�N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCIiYOR (n U COUNTVNh{If�FIREOU�RES�PEFiMRTOCONSTRUCT.AITER�MPROVE,OEMOl15H2ORREPAIRANYSTqUC- �J} P8�lO/DBCI( wTURE,PRIOR�TO ITS ISSUANCE.AL30 REOUIRES THE APPLICANT FOR SUqi PERMIT TO FIIE A SI�NED W � STATEMENT 7}IAT HE OR SHE IS LICENSED PURSUANT TO THE�ROVISIONS OF THE CONTRACTORS L4 � CENSE UN'(CHAFTER 8(COMMENCWO WITH SECTION 7000)OF DIYISION 3 OF TME BUSINE55 AND PRO- � POOUSPB FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROAI AND THE&�SIS FOR THE ALLEGED EXEMP� C7 TION.ANY VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE�PPUCANT TO Z Re-Root .� A CML VENALTV OF NOT MORE TI�IAN FNE HUNDRED D011ARS(f500).): O /' ❑I,ASOMMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COR1RIBfC18I bO Z WILL DO THE WORK ANO TME STRUCTURE IS NOT INTEN�ED ON OfFEHED FOR SALE�S£C.7011,BUSI- � , N NESS AND PqOFE5510NS CODE:TME CANTMCTOFS LICENSE LAW DOES NOT APPLV TO N7 OWNER OF � PROPEFiT'N�MOBUILDSOHIMPROVESTHEREON,ANDWMODOESSUCHWORKHIMSELFORMEFlSELFOR m Q TMNOUONHISOFHEROWNEMPIOYEES,PROVIDEDTHAT5Up11MPROVEMENTSARENOTINTENDEDOR w OFFEREDFORSALEIF,HOWEVER7NEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� � TION.7HE OWNER�WILDER WILL HAVE TNE BURDEN OF PROVINd THAT HE OR SHE DID NOT 9UILD OR o Z IMPROVE FOR THE PURPOSE OF SAIE). - � D �� � _ ❑I,AS OWNER OF THE PROPEHTV,AM E%CWSNELY CANTMCTINO WITH LICENSED COMRFCTORS w TO CANSTRUCT THE PR0.IECT(SEC.7oa�,BUSfNE55 AN�PROFESSIONS OOOE THE LONTMCtORS U- Valuation O v ADJ.AREA � CENSE UW DOES NOTAPPLV TO AN OWNER OFA PROPERTV WHO BUILDS OR IMVPOVES THEREON.AND WIiOCANTRACTSFORSUCHPR0.1ECT5WITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE Y 70R5 tICENSE LAW.). O ❑I AM E%EMPT UNDER SEC. � B.d P.C.FOR THIS REASON � I� � - Q LL DATE OWNER V . ' . Z W � LICENSED CONTRACTORS DECLARATION J ' . � •. .� W I HEREBY AFFIRM UNDER PENALTV OF PERIURV TNAT I AM LICENSED UNDER PROVISIONS OF CHA7TER � � 'Y . d� D(COMMENCINO WITH SECTION 7000)OF DIVISION 3OF THE BUSINE55 AND PROFESSIONS CAOE.AND Z � X YV UCENSE IS W FULL FORCE AN�EFFECT. , , ' � m Q LLI �3 4 .,t, . g . � ' LICENSE CLASS__; '�' LIC.NO. � � J ' Ur�R� ,� �'�.:w�'-�. CONTRACTOR a � DATE`!�'�''�� W . � ,, . , . ,� . � � � WORKERS'�COMPENSATION{DECLARATION� Q � ' 1 U � 1 HEAE �FfIHM UNDER PENALTY 6F PERJURV ONE OF TNE FOLLOWING DECURATIONS: Z Q � I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSEM 70 SELF-INSURE FOR WORKERS' , S �1 �� �. �COMPENSATION,AS PROVIDED BV SECTION 370oOF THE LABOR CODE.FOR TME PERFORMANCE W � OF TNE WORK FOR WHICN THIS PERMIT IS ISSUED. � � . _1 HAVE AND WILL MAINTAIN WORI(.ERS'COMPENSATION INSURANCE'AS R�OUIFED BV SECTION �j/1`�U . Q • 370p OF THE I.ABOR CODE,FOF THE PERFOfUAANCE OF THE WORK'kOR WHICH THIS PERMIT IS �"'i • ISSUED.MY WORK 5' MPE�NSATyION INSU�CE CARRIER AND POLICY NUMBER ARE: ST CTION � � CARRIER � �"7�`[]�'/� W . �(., . ; ,�;!.�t.. . ' � POLICY NUMBER� ' �; ...^.�.';^;.^':'� ' Z¢ . �,.,,-•,a;s;..:,,�,a�(��= � (fHLSSECiIONNE�NOTBE00A�E��.�1-��TQ��E���1ao)ORLESS} ING • . � '' ��."'r" A Z I CERTIFV TiAT IN THE PERFOflMANCE OF THE�WORN FOR WHIC}i THIS PERAl1T IS iSSUED,I (} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE I CTION FEE � WORKERS'COMPENSATION LAWS OF CAL.IFORNIA;AND AGREE THAT IF I SHOULD BECOME S SU&IECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION37o00FTHElABOR ISS CE ' CODE,I SHALL FORiHWITH COMPLV WITH THOSE PROVISIONS. �y� p : * �' �c ..L.u, t-ra,n /• f�_3 DATE:� �� ' APPLICANT; _l..Y1l � W '��' � � ' �v—��d—�_ ENERGY P/C'� J WARNINO:FAILURE TO S CURE WONKER$'COMPENSATION CAVERAGE IS UNLAWfUL,AND SHALL BE ' �]� �y �SU9JECTANEMPLOYEFTOCRIMINALPENPLTIESANOCIVIIFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMI 7 /� DOLLAAS(5100.Do0�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN r ` ti J SECTION 3]oe OF THE LABOR COOE,INTERE51,AND ATTORNEV'S FEES. ETEN < <� �J��J � . w CONSTRUCTION LENDING AGENCY P�E � �- � o �.cy O � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AOENCV FOF THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB7,CIV.CJ. Z w . � LENDEfYS NAME F_ LENDER'SAO�RESS J/��') n � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TNAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES r� 3Q 2 �� V // � 6' � I AdREE 10 COMPLV WITH ALL CRY ANO COUNTV ORDWANCES AND STATE UWS RELATWO TO BUILDINO � � � CONSTRUCTION,AND HEREBV AUTHOR2E REPFESENTATIVES OF THIS COUNTV TO ENTEF UPON THE , ZABOVE-MENTIONED VROPEAn'FOR INSPECTtON PURPOSES. COMMENTS � � J � � m PERMITTEE NAME(PRIN " ' ¢ • l 1—�1 S'o Z-� \�-4 � � ^ � � SIQNA-I�FG�O ERM `7 0 E , RECPT.NO. PAID 8Y �" VALIDATION_ S ~ � WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy.OREEN--Applicanl's Copy V CIYV OF DEAMO�D �AR , . I�S�[�C�'901� R�CORD � ��'pGJ�pCC�400O fi`� A,�' C�, ��r. �I����t���'� �= OGJ�PG�4�0 �o � �'� a ,� � � _ . ; �. , o e f' � " a . `:... .. . . . , . ... _.... _ . � . � ... ... .^ ... SET BACK FLOOR JOIST FTGS/FORMS/STEEL c 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'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGN�-tC1N ( FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING � y � FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATHlSIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING Z lo DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPElIRRIG. 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 C��� � COMMENTS -�-�v_�s wc�b�� � z � �., v � _ , SEPTIC TANK SIZE SEEP PITlU SIZE a ; �� .:� =r t a ^ti`��.� � � �� �" ��'.; � i