HomeMy WebLinkAbout13-686 �� _ CITY OF DIAMOND BAR 'I
� DEPARTMENT OF CONIMUPIITY &DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
���'��^� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE ��,J /�� � �{ Q APPLICATION / 3 PERMIT/rj P/C
o ADDRESS�O�U S�C►Zlf([�J (�VQ• cJiGI�YlGYIU fJl(r DATE � c NUMBEFtc� a
� DATEE !� r 3 TYPE OCC
APN Fa LOT TRA T CONST. GROUP
p OWNER �� ��S ✓
o ADDRESS � O S� '1 YlC ZONING SEfBACKS
Z CITY�I UWIGyQ ajUY' ZIP ��IP�J TEL. I• � FRONT RW ❑ �
� APPLICANT TEL. REAR ❑
� SIDFJSIDE STREET RW ❑
z
Q CONTRACTOR U11 V�IC� MQI 1-G l,�{-{� SIDE ❑
� ADDRESS�la� 5, (�P/1}vG1I �
PROPOSED USE I
o ciTv Los/-�,�t�eS ziP q�5� TE�,3�3 5�i•aSaS W
w ARCH/EN�
z DESIGNER '
W NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL UNRS STORIES BEDROOMS
� ��
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION ,
p� OWNER-BUILDER DECLARATION SFR/ADO/REM
O
p I NFAEBY AFFlRM UNDEA 7EIULTY OF,PEANRY THAT 1 AII E%EIIPT FROM THE COMMCTO0.S ll- Garage/Carport
, W CF715EUWFOHTiEFOILOWINaRFA50N(SEC.7mt.5BU5WE55ANDPROFE5510N5CA0EN1YC17YOR (n -
C-� COUHfYNMICHREd1WESAPERMfTTO00N5TAUCT.AL7Ei�DAPHOVE.OEMOUSH.ORREqUq/�M/STAUG w
w 7URE,PfUOR iD RS liSUANCE,ALSO REOUIRE9 THE MPIICANT FOR SUCN PEAMti TO FllE A 91GNC-0 w PatiolDack
� STAiFJ,1EHT THA7 NE Ofi SHE LS L10EN4ED PU0.iUANT TO 7HE PROVISlONS OF THE CONTRAC70R5 LF �
� CENSE UW(CIUPTER Y�COAINENG47�WfTN SECiION'l000)OF OIVISION]OF Tl1E BUSINE55 AN�PRO- POOUSPB
� FESSqNSCOOE�OqTHATHEOR5HE19IXDAPTTHEHEF{lOA1ANO7HEBA575FORTHEALLEGEDE%EMP- C7 .
V TION.MIVVIOLATIONOFSECTION7W1.5BYANYAPM.ICANTFORAPERWTSUAIECf5T1EADPlICINTTO Z R�ROOI
� A CML➢EfULTY OF NOT 1AORE TIAN FNE HUNORED DOLURS(3'SOo�Y
� � ❑lASOMlNEROFTHEPiiOPEHTV,ORYYENPLOYEESVJfTHYJM3E5A5THdR50lECOMPEN5AT10N. � (',pmmefClal ..
Z VALL 00 THE WORI(AND THE STRUCTURE IS NOT IHTENDED OR OFFERED FOH lALE(SE4 7ou,B1151• _1
� NE55 ANO PROFESSIONS COOE 7HE COHTRACTOpS UCFNSE Uw OOES NOT APVIY 70 AN OWNER OF � �
PR07ERfY NRq BU0.05 OR IMPROVES 7NEAEON./Ji0 Nh/0 OOES SULN WOfiK HIAISELF OR HEASELF OR
Q THHOIfGHW50qHEPOWNEAI7LOYEE3,7HOVIOEOTHA75UCl1UAPROVEAlEMSMENOTMT@lDEDdI m
QOFFERmPoHSALEIF,HOWEVER7NEBU4DWGORIAICROVEMEHi15501DMATIWONEYEAAOFCOYPLE- ,
Z T10N,iHE OWNER-0ULLDER Y/1LL HAVE THE BUROEN OF GqoV WO iHAT HE oR SHE DID NOT BURD aR
� UAPROVE FOR THE PURPOSE OF 9ALE}
(yJ O1.�90NMEROFTHEVROPEArY,M/EJ(ClUSNELYCOMRAGTW6VRTHlICENSEDCOM{UCf00.5
� TO CANSTRUCT TNE PROJECT(SEG 7oa�,BUSINE55 AND PROFE5570N3 CODE TNE COrRAACTOFIS LL V81Ua�3an AQI.AREA
W CENSELAWDOESNOTAPPLYTONIOVMEAOFAPROVERTVWH09U1DSORWPHOVE57HEREON,M7D -
� wHocoKra�crsvoawcrivaaEcrswmi�corrrrucroa�s�uco+seoaur�.wurtro'rxEmr+Tw�c pUANTITY DESCA1PT10N FEE
TORS UCENSE Uw.� Q
Q �I AA�D(EAIVT UNOER SEG 8.�P.C.FOR 7HI5 REASON Q ' U 1 v .
. � U
"-- o�re _ ovmea V i
Z w
� LICENSED CONTRACTORS DECIARATION w
� I HERFBY AfFlAAI UNDER PENALTY OF PE0.0.1fiY THAT IAA1 LICENSED IAlOEA PROVISION$OF OfA7TEA � p„! I,n0�
� Y�CDMMENCUK3 VATH SEC�ION 7000)OF 01V15qN]OF THE BU31NE55 N/D PROFESSqNS COOE MA Z V I 1 Fi
lLl �LICEllSE 19 QI MI.FORCE AND EFFECT. m
� uc�se cuss � �3(P C�U ��.,�. q 3�i o�v5 �
� o�rE GOMAACTOR a
� WORKEAS'COMPENSATION DECLARATION S�')U'I'IGMS• Q 1� '
� I HEA�Y AFF6iM UNOER PENPLTY Of PE0.NFiY ONE OF THE FOLLONv10 DERAMTqNS: Z
� _IHAVEANDN7LLMIlNTAWACERTIFICATEOFCONSENTTOSELHNSUHEFORWOPo(ERS' ¢ ,
2
GONPETlSA7iON,AS VROVIDm BY SEGTION]1o00f THEU80R CODE FOqTHE PERFORMANCE IU
Q OF THE WOfiK FOR WHlqi TWS PERAtlT IS ISSUm. �
w _IMAVE/JIDWILLAWMAWWORI(ER4'COMPENSAT70NWSURANCE,ASqEOl11RFpBYSECT%k1
Q ]7ao oF TiE IABOH COOE.FORTHE 7ERFOfiMIu10E OF 7HE WORN FOA wKK7/TNIS 7EAMl7I5 �
i55Um.MY WOPo(EAS'COYPENSATION INSUfiAHCE CAAHIEF Ml�POUCY MIMBERARE: CONSTRIICTION
� �,�Eve r�s�- ��f�i�i crU I I ns���-c+hc� �mPAn PLAN REVIEW
� �«��A '7lpa�Qiaa �a� �Ecraic 1v.33
p (rrtssEcnv+�mr�o7eEa�Ei�cFn+evw�wrsrcqa��x�+�awxu�s�oo�or�itss1 PLUMBING
Z I CERTIFY i/U1T P1 h7E PEiiFOfWM10E OF iHE WOR7C FOR WIW71 7HIS PEFWT IS ISSUED,1 MECHANICAL h • � �
U' SHPLL NOT ENPLOY ANY 7ERSON P!INY IJI�wdEH SOAS 70 6ECOAIE SUBJECT TO T1fE
� U7 WORIfERS COIAPENSATION lAWS OF GLIFORW/�AND AOqEE THAT IF I SHWIL OECOME tNSPECTION FEE
SUBJECT TO THE WORICERS COMPENS PROVISqNS OF SEC71oN]7aa OF 7HE UBOR
� COOE,I FOFt�HN7TH CAIAPLY E PROVIS I$$UANCE O
� %� 1 (�
p oATE � (/ APPLICANT: Q�� '111/YI��/�'Y�iZ SMIP
W ENERGY P/C
� WARNINO:FA4LRE TO SECVRE WOfi10ERS CAIAPENSATqN COVEMGE IS UNUWFUL IND 9ULL BE
�y SUBJECi AN EMPIOYER TO CAIMINAL VENALTIES ANO CIVIL FlNES UV TOONE HUNORm 7MOUSANO •
DOU.MS(SIOD.000�P/AODfT19N TO iHE C0.5T Oi COMVENSA710N.OAMAGE4 AS PROVIDED FOR PI ENERGY PERMIT
� BECTION T7oa OF 1NE LABOR COD�WTEAEST.AND ATTORNEY9 FEES �D�
RETENTION FEE:
OCONSTRUCTION LENOING AGENCY pRE-ALT FEE �
� I HEREBY AFFiR1I UHOER PENALTY OF PERRIM THAT TNERE IS ACANSiRUCT10N IENOfN6 A(iENCY �
FOH TNE PEAFORAIANCE OF 7HE WOAK FOH N?7IU7 7W9 PENUT IS i55UE0(SEG 7Csf,OV.C}
Z
w
� LENOERS NNAE
� LENOEHSAODRE55 � �J �
w ICEATIFYiHATIHAVEREADTHISAPPl1GT10NANDSTATETHATTHEABOVEWFORAlAT10NISCOfiAECT. TOTAL FEES vbo•2
� EE TO C6MPlY WIT/ALL ClTY ANO COUNf'/OROPlANGES ANU STATE UWS NEUTVlO 70 BUCDWG
� CONS ,ANDHEflEBYNJ'THOWZEREFqESENTATNE50FTYiLSCOUNTYTOBRERUPONTHE
Z �BOVE-M ED 7ROPER7Y FOR IN57ECTION PURPOSES
COMMENTS
� � N'I'�/YY .
m P TiE
a z( �3
�
� SIWJAN E DATE
� RECPT.NO. PAID BY VAl1DAT10N
� WHITE rtment Copy.YELLOW—Ffnanee Copy.PINK—Assessor Copy.GOLDENROD—Fla Copy.GREFI�F—ApplkanCs Copy .
�;;`�'°r` �,:4� ��,��v��!>i� ��$=°:
9i��������.�; a a�.a��i ���'���
j'�i-�'� '4 '����sWi"'ti'N Un� 5'..J� ��-,.�-✓�_l'vr+Q"Ti� .. . . y ��� jr-�.. "" " �} :,�y�Y "I.
'�' .;'tl I ����� uJ '4 .�A'�.t��Jr.�� wc�'� � �y ���tat �r%i `�`� � �f�sia i,7 � �nn��'r.�•�(�'� � 3.� ' .,�� . � '�` �
�_�'-�, � . J .c' F�t�'�. s- .i�,��e.3.�� t:`r14'�"i o�i� �,�_�.,'*'1.}�..�F'5,�:�. i�'�Yi.P,�,����,� � r r� �,;.�. �s 9- ��o..
:.. �v..3: -'�:#�:_..Yta...w.�.. _a,�i:3i.-�9e,...,...r --,.���..s�.E:.r�.-.,_,.s.,.. = t '� � �
=�—��r� - -- --� � I �r�00RJGIST -- — ----- ------- ----- - -
—�- ----- —-- -- --- --- -------- -
F7:;:;;',=�JR�1_;;�TEFL i j FHP.REQf��IT,
--------�----- - --- -----�-- --- -
-� ---...--------------�--- -
- ----- -�-- --._�.--�-- ---..---_.._ ..
,
�L[CTRIC GRG�UiJD � ' OtJDER FLOOR DUCT
GRr UidD FLU��r161N� ----�- ------�----------� UhdGER FLOOR CONDU(T I
SL4F.�RAUE �_�_ _� FIR�ACE FOUP�OATIOhd—T
�rEtiiP PO4VEf? I �FIREFLACE EOtvD BEAA1 �
V!ATtR 1ERVICE _ I �tvtlD HT.BOf�1D BEANi
ROOF SHEATHIf�aG �3 FT.BOtdD BEP.NI
FRAiVIIfdG!VEf,1TILA.TION FINAL BOND BEP.r�A
ROOF COVER PRE-GRADING
ROUGH HEATING —1—__ �BENCh`iraG _ __
FOUGH ELECTRIC '��Z'�2��j �- �P,OUGH GRF,DING
P,OUGH PLUfNt31M1lG � FINISH GP,ADING
SH04�,'ER/TUB TEST POOL ELECTRIC
EXT.LATH;SIDIPIG �POOL FETJCING
�,VALL INSULATIO�! POOL FIr.IAL
CEILING 1�dSULATIOhJ CFF SITE IMFS.
GRYbVALL NAILING DEDICPTIONS
SE4�lEF FINAL ENG V
SEPTIC TP,NP: LA.NDSCAPE/IRRIG _
SEEP PIT!L.L. ON SITE IN1P5. �
GAS AIRTEST FINAL ZONING
FI�IAL CONSi. FIR�DEPT.FIP•!AL "
FINAL HEATING HEP.LTH DEPT.FINAL
FINf\L ELECTRIC DEV.FEES PAID
FINP.L PLUN181NG EMERGY
FINP.L PLANING ---� --� ----- --
FINA.L ENGINEERIMG----`--�- L--------_ .J � 9�� `� ---- -------
COMMENTS _..--_ __.___—__ —.— — —
— ------- ---- ---- — , —
SEPTICTA�KSIZE
SEEP PIT/U SIZE —�
, ,,