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HomeMy WebLinkAbout13-689 �!_ CTTY OF DIAMOND BAR , / � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � V 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��'��'� BUILDING PERMIT APPLICATION �� FIRIIflLY � JOBSITE /� � ,7 i U rncr►� �i r. APPLICATIO � l '3 PERMIT��� ��P/C o, ADDRESS I�O S•�VLlYIy� DATE NUMBE # � ISSUE '{ TYPE pCC APN �7 M LOT TRAC DATE � � l`-' CONST. GROUP p OWNER � � �' `` ADDRESS d� S� 4 ZONING SETBACKS Z CIIY Gt Y' ZIP �� TEL.� IPI• �GL� FRONT RW O � � APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ z ¢ CONTRACTOR � S SIDE ❑ Q ADDRESS Z2 '-1 p PROPOSED USE W��� C'f Yl CITY �US�h�(IP,S ZIP �'1 TEL �3 �o� 28 �,. w ARCH/ENG/ z DESIGNER w NO.DWEL NO. NO. a ADDRESS � CITY Z�p -�L UNITS STORIES BEDROOMS cn �, cn DESCAIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECIARATION SFRlADO/REM O � I HER�Y AFFIRAI UNDEA PEIULTY OF FE0.RIRV 7HAT 1 AN E%EA1PT FROA1 THE CDNTRACT00.5 ll- Garage/CarpoA W CDlSEUWFOqTHEi'OLLOWINGRFASON(SEC7m1.3&15WESSMIDPROFESSION9COOEANYCfTYOR (n U �q�M`/WWp�REOUWESAPERMITTOCONSTAUCf,ALTEf�qdPROVEOE/AOLISH,ORqEPNRANYSTRUG w w T1RE,PPIOR TO RS ISSUANCE,/L50 REOl11AE3 7HE APPIICAMf FOR SUCH PERMIT TO FlLE A 51(iNC-0 w PatidDeck - � STATEMENT THAT Hfi OA 911E IS LICENSED PU0.SUANT TO TME FROVI;JONS OF 7HE COHTRAGTOR4 L4 � � GENSE UW(LHIIDTEA G(COAIMEN�lO WfTH SECiION]000)OF OIVISION 7 OF THE BUSWE59 NJU PRO� PooVSpa O FESSIOHSCOOE�ORTHATMEORSl1E15D(FAIPTTHEREFROMAN07HEBASISFORTHEALIEa�E%EMV• (� , U 710N.MIY VIOlA710N OF SECiION 7o]t.5 9Y ANY M7LIGNi FOq A PERAIIT SU&IECTs THE A➢PUCAN7 TO Z RAROOI � A C1VIL PElULTY OF NOT NORE iTUN FlVE HUNORED DOlLAHS(3500).r � ❑1,/�SOWNEROFTHEPROPfRlY.OHYYEMPLOYEESWITHY/Ac3E5A5TH�R50LECOMPEN9Ai1(Nl. 0 �mmercial • z 1MLL DO THE wOHI(ANO THE 9TfiUCTURE IS NO7 IMFNDED Oti OFFERED FOR 9ALE(SEG 7oU,9U54 J � � NE55/�ND PROFE5510N5 COOE THE COHTRACTOfiS UCENSE UW OOES NOT MVIY TO AN OWNER OF � ' PiiOPERTY WFIO BUIIOS OR IMPqOVES TNEAEOl1 AN�Nh10 DOES SUQi NOFK HWSELF OR HER$p„P pq Q h1A0UGH H15 OH HER ONM EAIPLOVEES,PROVIDE�THAT SUUi IYPROVEAIENTSARE NOT PITENOED OR m Q OFFERmFORSALEIF,1iOwEVERTHE&1LLDINGOHwVROVEMEHTt55aDWfTHWONEYEAROFWN7lE- Z iION,TNE OWNER-BUHDER WILL HAVE TME BURDEN OF PNOWiO THAT HE OR SHE DID NOT 9URD Oq . � OdPROVE FOR TNE PUfiPOSE OF SLLE} � w ❑L�oWNER OF 7NE PROVEHIY,AY IXClUSNELY CAHTRACTW6 VrtTH UCENSED CONTRACLORS [[ TO CONSTRUCT T1E PRQIECT(SEG 70N,BUSINE55 AND PROFESSIONS COOE THE CONTRACTOflS LI- Valuallan � ADJ.AREA I W CQLSE UW DOES NOT A➢VlY TOAN OWNER OFA PqOPEATY WNO 9UG.p,4 OR WPROVES THEREON,M!D � � WFiOCONTAACTSFOflSUCHPHOJECfSWfTHACONiMCTOR(S�LlCEHSEOPUpSUANT7p7}{E�pMq�G qUANTITY DESCF�PTION FEE . Y i00.5 L10ENSE uw.� � ❑I AA1 EXEMPT UNDFA SEG B,t P.C.FOR TNL4 REASON Q ?� U � . Q OATE _ OwNER F- � W _ � LICENSED CONTRACTOFS DECLARATION w ' � 1 HEREBY AFFiqAI UNDER PENALTY OF PEAAIRY TNAT I AL LICENSED VNOEA VROVIStONS OF CFH7TER � �y '✓ � 0(COMMENCIN[3 WITM SECTIOM 7000)OF OMSK7N]OF THE BU3WE55 M�D PROFESSIONS CODE,AND Z Z IA�'N �S lV w�ENSf IS IN FUIL FORC£AND EFFECi, m� � IJCENSE CIASS �� LIC.NO. I��IOW`J. � � V OA7E CONTMCTOR .L d . � � WORKERS'COMPENSATION DECLAFil�TION SOINf17mr. � 1. e � S � I HEA�Y AFFIRM VNDER PENALTY OF 7ERIUfiY ONE OF THE FOI.LOW470 OEQ.AMT70N5: Z � _IHAVEANDWILLWUNT�INACER77FICATEOFCqJSENTTOSELF�WSUREFORWOiL(FRS' ¢ _ Q CONPENSATION,tiS VFiOV10�BY 5ECT10N 770o OF THE LA90R COD�FOR T1E PERFOfWANCE U Q OF 7HE WORK FOR WHIW h115 PEAAtlT L4 ISNED. � . w _I MAVEIN�WILL 1.WMAPI WORNEFLS'COMPENSATION INSURANCE,AS REpU�RED BY SECTION Q 7)0o OF THE LABOR COOE FOR THE PERFOFA7ANCE OF THE WOPo(FOR YlFCGI THIS VEAAtlT t5 . ' I:SU�.MY WOPo(EAS OOYPQlSATqN PISURAN CAqqIER AND POUCY MJMBER ME CONSTRUCTION � �w,Ea � n av+r,aev�Ew � 70LICYNUMBER ��,QIXID�J 82 �12i �ecrwc � . � (�xssEcr�a+r�mr+oieeaa�ETIDeFn�vEw.Trswaorrtw�aa�as�sioo�oqtFss1 PLUMBING � w Z I CERTIFY iHAT IN THE GERFORMANCE OF THE WOH)(FOR WMp1 THIS 7ER111T IS LSSUED,1 MECHANICAL C�3 SHALL NOT EMPLOY AHY 7ERSON W ANY MANNER 50 AS TO BECOME SU&IECf TO 7HE � WOHKERS COMPENSATION UlWS OF GLFORNI.�ANO AGREE 7HAT IF 1 SNWLU 9ECAME �NSPECTION FEE . = SUBJECT TO THE WOAI(ERS COAI➢ENSATION PRONSqN50F SECTH]N]7a0 OF h1E LABOq f.� �Z COOE I SMALL FOHTMMTH COAIPLY YIfRi THOSE PROVISIONS. ISSUANCE V�f J '" ' 0 on� a 11 �3 ,,av�,c,u,r: � E�u l,�fiYi-�C z s�,,iP ' . J WMMN(L FA1lLfiE T0 SE(x/HE WOW(EAS GOMPENSATqN CAVEMGE t5 UNUWFUL AND 9HALL BE EMEAGY P/C � SUAIECT AN EMVIOYER 70 CRIMINAL PFNALTIES ANO CML FWES UP TO ONE MUNUPED 7YfOUSAND DOlLAH9(Stao.oaol.W ADDITON TO THE COSi OF COMPENSA710N.DAMAGES AS PROVIDED FDR R/ ENEAGY PEAMIT � SECTION]7oL OF THE UBOR CODE WTERES�C/�f1U ATTORNEYS FEES. RETENTION FEE: �� O OCONSTRUCTION LENOING AGENCY PRE-ALT FEE � I NER�Y AFF6iM UHDER PENALTV OF PEAAlRY THAT TNERE IS ACONSTAU[.RION IENOW6 AGENCY � Z FaN TME PERFOHAIANCE OF 7HE WOAK FOfi WHICH h119 GERMIT IS ISSUEO(SEC]Osl,QV.G} W � LENOEFS NIiIE F- LENDERB'AODRE55 � iCEATIFYTHAT�HAVEREWTF&9AVPLIGITIONANOSTATETiATTHEABOVEPlFOqA/AT%]NISCOHilECT. TOTAL FEES � Z�D•Z� � I AGREE TO CAMPLY WITH�LL C1TY M!O COUNTY OROWANCES AN�STATE UWS PF].ATWO TO BU0.DINO � CONSTHUCTION,AND HEREBY AtfTHOWZE HEPflESENTATIVES OF TN1S COUNTY TO QfTEH UPON iHE Z �eove�Mornor+eo vAovean r�wsaEcrqH vuaaoses. COMMENTS 0 _ �+Z Z ¢ v E� � (� G/J � fiTEE OATE � RECPT.�NO. � PAID BY VALIDATIO � WHffE—DepartmeM Copy,YELLOW—F�anee Copy.PINK—Assessor Copy,GOLDENROD--F1e Copy,GREEN—Applkanl's Copy � �s�y' +��k�' ����`�a��� ���a� �i`5�����:`�9�a'�� ����3�� �'---=-�3--��a�z -`S"`�,,'.-�. -�, �;r,..�,,��*Ar+�a .S - r_�-�— ^��, �i' � i. 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FOOL FI�.IAI ' CEILI�dG 1NSULATIO�J CFF SITE IMFS. GRY�IALL NAILING i DEDICA.TIONS SEN/ER — ------- --- - ---- FINA�ENG---- — -- SEPTIC TANF: LANDSCAPE/IRRIG SEEP PIT;'L.L. ON SIT�IMPS. � GAS AIR TEST FINAL ZONING FIN�L CaNST. F!RE DE�T..FIPdAL - FINAL HEATING HEA.LTH DEPT.FINAL FINAL ELECTRIC DEV.FEES P?,ID FINP,L PLUNIBING EPdERGY ' FIN�,L PLANING FINP.LENGI�IEERING---`--�-------- --_ � � q � ------ ------- COMMENTS —.----- —��.--�� — ( 1.��. — -- --- j};��. l i — \ ------- --- ----- --- - -- \ -- --- ---- -- ---- - I -- =�— ---- - ----- -- -- SEPTICTANK5IZE SEEP PIT/U SIZE —� - -- -- —