HomeMy WebLinkAbout12-681 __ --_-- -----
— ----__ _
�� CITY OF DIAMOND BAR �
DEPAR'I'MEN'T OF COMMUNI'I'Y&DEVELOPMENT SERVICES � �
21810 Copley Drive,Diamond Bar,CA 91765 PRESS
- � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
���+����W BUILDING PERMIT APPLICATION . FIRMLY
} JOBSITE ,! APPLICATIO �L � �Z� PERMIT 1� 1 P/C
o ADDRESS ��� /V �L O�itl S(�R!N�'S �R.__ DATE J NUMBER� �
II � ISSUE IYPE �`/ OCC
� APN LOT TRACT DATE CONST �/«"'GROUP
p OWNER (''L, F��ra R T U'T2 6Al.I-I iS 4 R ZpNING SETBACKS
o ADDRESS • FRONT RW ❑
oCITY�1 q nnU7�1 b f�2 ZIP�(i�S TE . REAR ❑
0
APPLICANT TEL. SIDE/SIDE STREET RW D
� CON7RACTOR �/^ � 1�1 " SIDE �
oADDRESS/�+SS� 1 � �'/lh'�2 Qt- a v� PROPOSED USE
CITY (1 P L,a N � ZIP�'� TELyQ�_Q�_Sy
w ARCH/ENG/
z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIF TEL
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBY AFFlRAI UNDER PENALTY OF PE0.A/RV THAT I AM EXEMPT FA01J THE CONTMCTO0.5 LI� GHfBgB/CBfpOf1
LU CtT19EUWFOHTiEFOLLOWWOREAuON(SEC.70.71.6BUSqJESSANDPROFESSIONSCODEANYCI7YOR . (n
U COUHfYVAi1CMREWIRESAPENdRTOCONSTRUCf.hLTER,IMPROVE.�EAIOLISH.ORREPMAANYSTRUG w P811p/DBCI( . . .
1ZP/q�,pppq 7p�{g��µCE,A�$p REpUIRE3 THE APPLICANT FOR SU(:H PERMfT TO FlLE A SIONED
� STATEMEM 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROv151DN5�OF iHE�CONTMCTORS L4 � pO0USp8
� CEN4E LAW(LHAPTFA 9(COtAMENCWG WITH SECYION�000)OF DMSION]OF THE BVSWE55 M7D PRO �
� FESS�ON9CODE)OPiHATHEORSME1SEJfEMPT7NEREFROMMIDTHEBA575FORh1EALLEOEDE%EMP• �
7qN, TIONOFSECTION7031.6BYANYAVPLICMlT�FORAPERMITSUBJECTSTHEMPLICANTTO Z RaRoof
� A GVI IUL7V OF NOT MORE 7HAN FIVE MUNDRED�OIURS(i506)J: .
� 4�.40WNEROF.THEPROVERTY.ORMYEMPLOYEESWITHN'AGESASTHEIRSOLECOMPENSAT%7N, 0 Cpm(�BlCi81 �
Z 00 THE WORK M�T/iE STRUCNRE IS NOT IMENOED OR OFFERED FOR SALE(SEC,70�i,BUSF J .
� �NE55 AND PROFESSIONS COOE:TME CONTRACTORS LICENSE LAW DUES NOT APPLV TO AN OWNER OF �
ppppEply yy�q g�Jl�p$pq IMPflOVES TiEREON,AND WIW DOES SUCM WORK HIMSELF OR HERSELF OR
� TT1iWiXiliHi50HHEROWNEMPLOYEE9,VROViDEOTHA75UCHRIPROYEAIENTSARENOTPlTENDIDOR m
QaFFEAmFORSALEIF.HOwEVER7F�EBU0.DINOORIMVROVEMENi�550LDWI7MNONEVEAHOFWMPLE- .
Z TpN„h1E�OWNER-BUIIDER WILL MAVE 711E 9URDEN OF.PROVINO THA7-HE OR SHE DID NOT BUILD OR
� WPROVE FOR iHE VURP0.SE OF SALE} . .. ,
w ❑1,ti90NMEROF7HEPROPERT`l;AAIEXq.U.,NELYCONTHACTPI(iV/fRiLICENSEDCONTMCTORS
� 7p CONSTRUCT THE PROJECT(SEC.70N,BUSINEu�N�PROFESSfONS CODE:THE CONTMC7OR9 U- V21U9t1Of1 ADJ.AREA
� CF11SE IAW DDES NOT APPIV TO/W ON'NER OFA PROPERTY WHO BU�LDS OF IAIPROVES THEREON,AND
WViOCONfRACTSFORSUCHPROJECTSWfTFIACONTRAC?OR�S)LICENSEDPURSUAHTTOTHECONTMO ounrmrr DESCRIPTION FEE .
TORS UCEN9E LAW.). �
� O I AM E7(EMPT UNDER SEC. B.8 F.C.FOR 7HIS RE �
� �
� OATE 'l �Z- OWNER . U
Z W
� LICENSEO CONTRACTORS CLARATIO -�
oC W
�{tEREBY AFFliW UNDER PENAL7V OF PERIURV THAT IAM UCENSED UNDEH PROVISIONS OF GHAPTER �
d a(COMA�ENCWO VATN SECTION 7000)OF DIVISiON]OF htE�BUSiNESS ANO PROFESSIONS CODE,J1M1 Z .
X M'/LICEN9E IS P1 FULL FORCE AND EFFECT. m ,
LlJ �
0 UCENSE CLASS LIC.NO. J �
V DATE CONTRACTOR a . � . . .
LII
� WORKERS'COMPENSATION DEGLARATION U �� ,�� �
� 1 HEREBY AFFIHA1lR7DER VENALT'OF PE0.NH'/ONE OF THE FOLLOW WG DECLARA7qN5: ZZ _
(/J �
O _IHAVEAND.WILLMNNTNNACEiiTIFICATEOFCpNSENTTOSELF•INSUREfORY/ORKERS'
Q COMpp�5A7qN,AS pqpVIDED ev SECTION s7oo OF 7NE LABOR CODE.FOR THE PERFOAMANCE W�
OF lHE WOLM FOP V/HICM THIS PERMfT IS ISSUED. �
�
W _I HAVE AND WIIL MAINTAW WORKERS'COAIPENSA710N INSURANCE,AS REOUIRED BV SECTION
Q 3700OF�THE LABOA C�OE,FOR 7HE PERFORMANCE OF THE WORK F�H NM�CM iH15 PERMR I5.
ISSUED.MV wOPoCEAS COAIPENSATION INSUHANCE CARR7EH AND POLICY NUNBER ARE: CONSTRUCTION�� -
j . c�aw� PLAN FEVIEW �
� poL�cv�eER ELECTRIC
o �ss[crior+N�r�oraE�rIDOFn�a�tsroAor+E�noatusK�a�oa�ssl PLUMBING
w I CERTIFY h1Ai W THE PERFOiUUNCE OG h1E WORK FOR WHICH 7H45 PERMIT IS ISSUED.1 MECHANICAL O'
Z
�3 SIIALL NOT EMPLOV M1V VERSON W ANY MANNEF SO AB T0 6ECOME SU&IECT T0 THE INSPECTION FEE
N WOR%ER5 COAtPENSATION 1AW50F CAI�WRNI/�AND AGREE THAT IF I SHOVID BECOME .
SUBJECTTOTHE`M)RKERSCOMPENSATqNPROVISIONSOFSECTIONJ7000FTHEUIBOR �SSUANCE - 'I �
-~j CODE.1 SHALL FOirfNWITM Cd1PlV WITH TNOSE PROVISIONS. . . . .
O SMIP
p OA1E APPLICANT: _ , �
� WAHNIN(L��FAaA1RE TO SECURE WORKERS'COMPENSA710N COVEMGE IS UNUWfUI,AND SHALL BE ENERGY�P/C
� SU&IECT IJJ EMPIOVER TO CRIMINAL PEHALTIES AND CIVIL FWES UP TO ONE HUNDRED THDUSAND EIJEROY.PERMIT
DOLLARS.(5700.000),-R1 IDDI710N TO THE COST OF COM7ENSATION.DMIAOES AS PROViDED FOR IH ` {�
J 6ECTION37oEOFiHELA80RCODE.�NTEFEST.ANDATTORNEY'SFEES. ' RETENTIONFEE: v �
�
w� CONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
.a . . � . -. � � '
� I NEREBY AGFlRM UNDER PENAL7V OF PERJURV THAT THERE IS ACONSTRUCTION LEND�NO AQENCY
FOR THE PERFORMANCE OF TME WOPo(fOR WHICN THS PERMIT�S ISSUED(SEC.30W.CN.C.).
Z
W
LENDERB NAA1E
� LEN�Efl'SADDRESS .
� ���EpTIFy 7rypT I HAVE HEAD THIH APPLICAT��N�ND BTATE TUT THE�BOVE�NiORMATqN 19 CORRECT. TOTAL FEES� �,�O �
� I ACiAEE TO COMPIV N7TH ALL.CITY AND COUNTV OROWANCES AND STATE LAWS REU7�N0 TO BUIL�INO ,
� CONSTRUCTION,AND HEREBV AUTHOR12E REPRESENTATNES OF T1�iS COUNTY 70 EN7ER UPON 7HE
Z ABOVE-MEMIONED PROPERiY FOR WSPECTION PURPOSES. �COMMENTS ��
O
� �L�F�C5 �.-.� E N �S� .
m PERMI E NAME(7PoHf) � . . . . . . . . .
Q Q .9 9
� L!/
� ° � E o�TE RECPT.NO. PAID BV VALIDATION
� ITE—Department Copy.YELLOW—Flnence CoPY.PINK—Assessor Copy�GOLDENR�Ie Copy.OREEN—Appl{canYs Copy
CITY OF DIAMOND BAR
INSPECTIOP� RECORD •
.. � . .
... „ s�„ � e , �i : -r a
. :
° ti
� � � • p .� p . < . o s
.<
;
s � . „ o i�,.; � .:x sy, � ' 6�, 0 + a.
� . . � � . ��� � .�.
... . �.�� . , y
.,
.a � . . .. _ .. �. .. . i �. ��t�.��
SETBACK _ _ _ _ �FLOORJOIST
FTGS/�ORMS/STEEC j FHA REQMTS �
ELECTRIC GROUND �UNDER FLOOR OUCT
GROUND PLUMBING I UNDER FLOOR CONDUIT
SLAB GRADE ;FIREPLACE FOUNDATION
TEMP POWER I FIREPLACE BOND 6EAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHIMG 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PIUMBING I FINISH GRADING
SHOWEWTUB TEST POOL ELECTRIC
EXT.LATH/SIDING i POOL FENClfdG
WALL INSULATION POOL FINAL
CEILING IIVSULATION OFF SITE IMPS.
DRYWALL NAILIPlG DEDICATIONS
SEWER -- --- - — --- FINAL ENG. --
SEPTICTANK _ �Li ANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST fINAL ZONING
FIfVAL CONST. fIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FWAL ENGINEERING • � �
�OMMENTS
�:
SEPTICTANKSIZE
SEEP PIT/U SlZE
i (�' ---
�