HomeMy WebLinkAbout14-4070 __._ '�, �._�.�,, C1TY OF DIAMOND BAR ` � ( � It�2�`Dy����
.�'�. _
�; ( I 1 � _ +; DEPARTMENT OF COMMUNITY&DEVELOPM�NT SERVICES ��
"'�;�� I��p„� �t, 2181U Copley Drivc,Diamond Bar,CA 91765 PRESS
� � „ �� , (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027
����.'v"'�'" BUILDING PERMIT APPLICATION FIRMLY
g 'J /� 1 APPLICATION DATE: 1II S I 1�{�- P/C# � ��- '40'1 0
� JOB SITE ADDRESS 7 Y CJm P l!/LT�. !CI` D �,/ `/ p y
a ISSUE DATE: I��-/�1�'l PERMIT# /���y0 /�_
z APN LOT TRACT
oOWNER �.� f(( P.er1 �PL6h TYPE CONST. OCC GROUP:
� ADDRESS B ��n,� U Pdlla� PI • ZONING SEfBACKS
� CITY GI!9✓���7 i�A-�" ZIP ` 6 C TEL. FRONT RW ❑
¢ APPLICANT �-I��l�J" TEL. REAR ❑
�
a� / - n > > SIDE/SIDE STREET RW ❑
CONTRACTOR 7�PGIGkCl �h��,irQl� �rCo<HT/'c.r�/tc.v/� SIDE ❑
oro ADDRESS.�� � f� �f�Li - . � • y
¢ CITY Da-���,r�2 ZIP %/��TEL.�D 4J 3Z�j_JQ'�'S' PROPOSED US u - �Z �i+
o ARCH/ENG/DESIGNER � �'e'r��-�l _H �n t �,,,�,r� S�-o,,,.h-ed �,��,s pCrM'��
o ADDRESS I S �7 S f�01�riz.,+'V�&A �'J� �� #DWEL.UNITS 1t STORIES #BEDROOMS
a CIN ��1((h� ZIP � TEL. ��L� �i-v4 Zy
� oWNFR-BUILDFA DECI.ARAtION DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
°C I hereby attirm under penafly oi perjury that I am exempt from the Contractor's State Licenx Law for the reason�s) SFR/A�D/REM
� indicated 6elow the checkmark s,I have laced next to the a licable item s Section 70315,Business and
p bY O D DP� O[ GaragelCarport
o Professions Code:Any city or county that requires a permlt to construct,aller,improve,demolish,or repair,any
w strucNre,prior W its issuance,alw requires ihe applicant for the permit to file a signed statement that he or she � Patio/Deck
a is licensed pursuant to lhe provisians of the CoMractor's State License Law(Chapler 9)Commencing with Section w
= 7000 of Uivision 3 of the Business and Professlons Code]or that he or she is ezempt hom licensure and the basis for LL Pool/Spa .
� the alleged exemption.Any violation of Section 7031.5 by any applicant for a Dertnit subjects the apDlicant tu a civil penalty C7
� of not more than five hundred dollars($500). Q Re-Roo(
o (]I,as owner of the property,or my employees with wages as their sole compensation,will do(,all of or(�portions � Commercial
� of the work,and the structure is not intended or oftered,for sale(Section 7044,Business and Protessions Code:The m
� Contractnrs'State License Law does not apply to an owner of property who,through employees'or personal ettort,builds
� or improves the pmperty,provided that lhe improvemenLs are not intended or ottered for sale.If however,the building or
� improvement is sold within one year of completion,fhe Owner-Builder wili have me burden of proving ihat it was not built
p orimproved for the purpose ot sale.j.
� I,as owner ol ihe ra e
0 (� p p rry,arn exclusively conVacling with licensed ConVactors to cansWct the project(Section Valuation` � Adj.Area:
7044,Business and Professions Code:The Contractors'Stale License Law does not appty to an owner of proDehY who
z buildsorimpmvestnereon,andwhocontractsiortheprojectswithalicensetlContractorpursuanttotheContracrors'State QUANTITY DESCRIPTION FEE
�
Y License Law.).
o U�am exempt hom licensure under the ConVactor's State License law for the follawing reason(s): �
� �
LL By my signature below I acknowledge ihat,except for my personal residence in which I must have resided for at least ane W
o year prior ta completion oi the improvements covered by this permit,l cannot Iegaity sell a struclure mat I have buitt as an W
Q owner-builder if it has not been constructed in iL5 entirety by licensed contractors.i understand mat a copy of the applicable
� law.Section 7044 of the Business and Professions Code is availa6le upon request when this application is submitled or at
X the tollowing Web site:httpAm�w.leginfo.ca.gov/calaw.html. �
z
0 �ATE: SIGN: �
� LICENSED CONTpACTOH'S DECLARATION �
� I hereby aftirm wUer penalty of perjury that I am licensed untler provisions ot Chapter 9(commencing with Section 7000)
w
m of Division 3 ot ihe Business antl Protessions Code,and my license is in full force and eftecl. J
y t10ENSE CLASS: �/��C Z ( 4G a��7� �,�.No.: 9� D�►�7 g z
Q
o DATE: �-�S—I� CONTRACTOR: �"pGl�ivl �_GYr.s� ./�P��B !'ml�,T /l! _
w
a WORKEfl'S COMPENSATION DECLARATION g
� .� I HEREBY AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
o ✓ I have and will maintain a Certificate of Consent to Self-Insure lor Worker's Compensation,as provided 6y CONSTRUCTION: � �g. �, ���
Q �Section 3700 of the Labor Code,for Ihe peRormance of the work for which this permit is issued. p�qN REVIEW: 1��, 1 a '
> 1 have and will mainfain Worker's Compensation Insurance,as repuired by Section 3700 oi the Labor Code,tor
� the pedortnance ot ihe work for which ihis permit is issued.My Workers Compensafion insurance Carrier and ELECTRIC:
z
¢ Polic,yNumberare: / ' PLUMBING:
� CARRIER Co+G Lva i/ i wJ��/'Gf�
Z , MECHANICAL:
� POLICYNUMBER i�/C e9O 215CS�-O INSPECTION FEE:
� (THIS SECf10N NEED NOT BE COMfl.ETEO iFTHE PERMR IS FOR ONE HUNDRED DOL.WiS($100)OR LESS).
� ISSUANCE: " 3S • �S,
o I certify mat in ihe perfortnance oi the work fw which Ihis permit is issued,I shall not employ any person in arry manner so as to
o become subject to the Worker�CompensaGon Laws of Califomia.Mtl aqree ihat if I should become subject in me Worker's SM I P: j p
� Compensatim prwisions ot Section 3700 of�he Labo de, hall lortlnvilh compry witn those provisions. EN ERGY P/C:
LL DATE:��S-/`� aPPllCnr�7: ENERGY PERMIT:
� WARNING Failure to secure Worker's Com ation covetage is unlawtul,and shall subjed an employer to criminal REfENTION FEE: $ . OQ
w penalties and civil lines up to one hundred tho d tlollars($100,000),in atldi6on to the cost of the compensatlon, �,
a damages as provided for in section 3708 oi the labo�code,interest,and attomey's fees PRE-ALT FEE: '
0
a CONSTRUCTION LENDING AGENCY BSAF: �. �p
W 1 hereDy aKrm under penalty of perjury that ihere is a ConsUuction Lending Agency tor the pedormance ol the vrork for
= which ihis permit is issued(Sec.3097,Civ.C.�.
�
� LENDER'S NAME:
� LENDER'SAD�RESS:
a 1 certify that I have read this application and state mat the above intormation is correct.I agree to comply with all city and TOTAL FEES ,O�."'� a 3`�.. 4�
county ordinances and state laws relating to building construc[ion,and hereby aumorize representa[ives of this county to
z COMMENTS:
p ente�upon the above-menlioned property f r inspectian purposes.
J
m -�' �.� ��� � --����r-u.
a PERM EE NAME(P INn �� aba'a(� 33�a, �yy�
�
� � PAID BY:' �� VALIDATION: t
� SIGNATURE OF PEflMITTEE DATE _ S._f U RECEIPT S1�� �
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
1
CITY OF DIAMQN� BAR
INSPECTIOfV RECORD �
. � � , . � . . � � , � .
SETBAGK/LETTER, � ' TRACT AND LEDGER
FOOTINGSFORPli y S� .�Q.-1� , , 2 �.. SWITCH GEAR
SLAB- �." - COMMERCIAL HOOD
UG.PLUMBING - T-BAR
UG.fLEGTRICAL' " INTERCEPTER
UFER GROUND - HOT MOP/SHOWERPAN
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
SHEARWALLS'EXTERIOR `: ;; . ; POOL/SPA ,�.
SHEAR WALL'S INTERIOR ` ROUGH PLUMBING ' '
FREIMINGNENTING . ' •: , ;% ,ROUGH ELECTRICAL , ' .
ROUGH MECMANICAL - -.;•: ;.,. . . �� , :';�' . : �RQUGH MECHANICAL . `
., , . .
ROUGH E'LECTRIG;L W( )CO � ` GASTEST -.
ROUGH PLUMBING �,, � ; PRE GUNITE ' -
INSULATION WALL POOL PRE DECK BONDING
INSULATION CEILING P-TRAP
DRYWALL FENCE/GATEI ALARM
LATH(PRE) FINAL POOL - I
LATH EXTERIOR WALLS: �
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�( )2"0( )LIFT � � I
SCFiATCH COAT WALL BOND BfAM ' � - � ., /
ELECTRIC METER RELEASE WALL DRAIN/SEAL '
� GAS METER RELEASE WALL fINAL
SPECIAL INSPECTION R0.FiiAMING PLANNINGAPPROVAL
FINAL BUILDING;'. ' ' � '�' �$ - ROU6H FIRE APPROVAL ' �
FINAL MECHANICAL ; ' ' `` FINAL FIRE OEPARTMENT ' � ��:
, .
F{NAi. ELECTRICAL .'. .: ;.', , FINAL PLANNIN6 -' �
fINAL PLUMBWG . '' : `". . ' '• FINALENGINEERIN6/PW ` ' `
t.C:'of OCCUi'ANCY ' ' . •; �FINAL COMMUNITY SERVICES `�
CERT.of O�CUPANCY': � - � � � ��FINAL HEALTH�DEPT. � � �� � �
_._ FINQL INDUSTRIAL WASTE ' � . �, � �
COMMENTS:���►`��'d� ��111J —�— �c:CeC �F �;1��7",�%a��,i�✓'-�=����l�lv I?-�c ;� �;��:e.��;•� :..:
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