HomeMy WebLinkAbout12-844 - - a� C c5e^c c �1 c��E
�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drivc,Diamond Bar,CA 91765 PRESS
, � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
������W BUII.DING PERMIT APPLICATION FIRMLY I
} JOBSITE APPLICATIO � !� PERMIT rJ g P/C
N
o ADDRESS � �� DATE NUMBER �� #
� APN LOT TRACT DA EE � � CO ST.� GROUP
°C OWNER �
� ZONING SETBACKS
� ZADDR S FAONT RW ❑
C�Ty GI O r` ZIP TEL REAR ❑
I Z APPUCANT 7EL. SIDE/SIDE STREET RW O
Q SIDE ❑
� CONTRAC R �
ADDRE S PqOPOSED USE r � � m
� CITY � ZI TEL �
w ARC N / �
z DESIGNER NO.DWEL NO. NO.
a ADDRESS UNRS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNER-BUILDER DECLAAATION SFR/ADD/REM
O
1 MEH�Y AFFlRM UNOER PENFlLTY OF 7ERNRY THAT 1/JI IXEMPT FROM THE CONTMCTORS LL GarageJCarport.
W CENSEUWFORTHEFOILOWINOHEASUN(SEC.7031.6BUSWESSANDPROFESSlON9COOEANVCfTYOR . (n . .
U CAUN(YN?iK7iRE0UIRESAPERMI7TOCON57AUC7,ALTEKIMPROVE.OEA10115H.ORREPAtRANY57HUG W PeIiU�DOCk
Z NRE,PHbR TD t75 ISSUANCE���a1�iiE8 TNE APPIICANT FOR SUGi PERMlT 70 FlLE A SIONED w
W S7ATEMEM 7W�7 NE OR SME IS LICENSED,PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LF ��� �
� CENSE UW(CHAPTER Y SCOMMENqNa WfTH SECTION�000)OF DIVISqN 7 OF THE BUSINE59 AND PHO� � Pao�De
� iESS�ONS COD�OR iHA7 HE Ofi SHE IS EXEMPT7HEREFROA/AND THE BA515 FOR THE ALLEOED E%EMP• � � �
� 7qN.ANYVplAT10NOFSECTION7U3t.6BYANYAPVLICANT�FORAPERMI75U&IECTSTHEAVPLICANTTO Z� R9-FOOf
� AGY4.VEtULTV OF NOT MOAE TF1AN FNE FNNORED DOlURS(SSoo).): � .,
� ❑SASONMEROF7HEPROPERTV.ORMVEMPLOVEESWfT111VA(iESAStHEIR50lECOMPENSATK)N, O Cpmry�Bfd01
Z WILL DO THE WONC AND TNE S7RUCTURE IS NOT INTEN�ED OR OFFERED FOR 5ALE(SEC,7ou,BU51- .J .
� NESS/JlD PROFESSIOtiS COOE:THE CON'TMCTORS LICENSE IaW DOES NOT AVPIY TO AN OWNER OF � .
ppppEq7yWfqgUq,p$pRIMV{iOVEST1iEREON,ANDWHODOEsSUCHNbNKHWSELFORHEASELFOR m
Q THROUGHWSORHEROWNEMPLOYEES,PROVIDEDTHAT�SUOIIMPROVEMENTSARENOTMTEN�EDOR
W pFFEqmFORSALEIF.HOWEVER7I�EBU�LDWUORUAPROVEAIENT�S50LDNrtiMNONEVEAHOFCOMPLE-
� TION,TNE OWNER-BUIIDER WILL HAVE TF�E BURDEN OF PROVINO THAT HE OR SHE OID NOT BUIID Op '- '
Z 1MPROVE FOR�F1E PURPOSE OF SAIE} - . .
_ ❑I.ASOWNEROF7HEPROPEfin;AAIEXQUSNELYCONTMCN1aMA'fNLICENSWCO1JTiUCTOR3 . . . .. �
� Tp CONSTRUCT THE VilOJEGT(SEC.7oN,BUSME33 ANO PROFE6510N3 CODE:THE�CONTMCiOR3 IJ- VBIUe�IOf1' ADJ.AREA'
W CFSlSE UW DDES NOT APPLV TOAN OWNER OF AGROPERTY WFiO BU�LDS OR IMPii�VE3 THEREON,AND . ..
� Y1M1fOCOPRMCTSFpRSUCHPR0.1ECf9WfR1ACONTfUCTOR�S)LICENSEDPURSUPMTOTHECONTRAC QUANTITY DESCFIPTION FEE �
70RS UCENSE UW.). {-
O I AM EXfJ�IPT UNDER 6EC. �B.6 P.C.GOH THIS REASON Q � 1
O U �O
� �
� DATE OWNER - . . (,~j J iL (�,f /f
$ o1CJ �
� 110ENSED CONTRACTORS DECUIRATION w S.. �
� I HEREBV AFFlRM UNDER PENALTY Of PERJUFV THAT IAM�LICENSm UNDER PROVISION5 OF GinPTER V. � �
d, 9(COMNENGNO WITH SECTION 7000)OF DIVISION J OF 7HE BUSINES9 AND PROFESSIONS CODE,ANU Z,
X Af/LICENSE IS PI O C EFFECT. � m
LLI �.., �
� UCENSE CLASSFu�_ UC.NO.: �/ � J� �
U DATE CANTRACTOH a . . . .
W
� WORKERS'COMPENSATION DECLARATION � � �
N 1 HEREBYAFFIRM UNDER PENALTV OF VERJUN'/ONE OF hIE FOLIOWINO DECLARATIONS: �
� Z
, � _1 HAVE AND NALL MAINTAW A CERTIFlCATE OF CONSENT 70 SEIF-WSURE FOR WOPo(ERS' � 2 �
� COMPENSATION./�5 PROVlOm 9V SECTION 37000F TNE U1BOR COOE.FOR THE PERFORMANCE �U.
f)F 7HE WOPo(FOR WHICH TF11S PERMIT IS ISSUED. �
W V i������MaN WORKERS'COMPENSATION INSUHANCE AS REWIRED BV SECTION . .
Q 37000F THE IABOP CUDE.FOR THE PERFOMIANCE�OF THE WOR7(FOR WHK]i THIS PERMR IS
ISSUEp.My�COIAPE SATp INSUHANCE CMHIER AN�POl1C NUMBERME CANSTRUCTION�.
j ��ER G pLAN REVIEW
� Paicv r�rtiMeeR � ELECTRIC �
� � �russEcnor+r�r+oreEca aFn�vE'n.�r5r�a�runo�+EnoaunsK�amoA� PLUMBING . . . � � .• �
�
W MECHANICAL �
Z 1 CfR71FV TY1A�M THE PERFORAIANCE OF THE YlOPo(FOA YM1iICli THIS DERMIT lS ISSUED,1
� swLL�NOTErnv�pvuaraes+5or+wu+vuaur+easo�sroeEcaa��sue�ecTTorHe 'INSPECTIONFEE
� WORI(ERS'CAMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I S/fOULD BECAA/E ...
SU&IECT TO THE WORi(ERS'COMVENSATION PFiOVIS1ON9 SE N 7 OF THE UBOR I O
� coo v cw�a�vvnn�r a � P ISSUANCE
� —/ ���1���' SMIP
0 pAlr;� , APPLIC ix� 4i �
J � ENEFGY P!C
J WARNINO:FAl1.URETOSECVREWORI(ERS'COMPENSA7qNCOVERAGEISUNLAWFUL.ANDSNALLBE
� SUBJECTAN EMPLOYER TO CRIbtWAL VENALTIES AND GVIL FwES UP TOONE HUNDRED 7HOU."iANU ENERGY PERMIT .
DOLLAR9(1t Oa.000).w ADDITION TO THE COS7 OF CAMPENSAT%k7.�hMAL3ES AS PROYIDED FOR W � -D
¢ SECTION 370E OF 7HE LABOR CODE INTEREST,AND ATTORNEY'S FEES. ' RETENTION FEE: .
� CONSTRUCTION LENDING AGENGY PRE-ALT FEE:
�
Q 1 HEREBY AFFIRM UNDER VENALTY OF PERIURV THAT THEpE iS ACONBTRUCitON LENDtN6 AAENCY
d .FOR THE PERFORMANCE OF THE M/ORK FOR N'Hlp/THIS PERMR IS ISSUED(SEC.30V7,CIV.C.). .
Z `
W
� LEHDEIYS NAME ' . .
F=- LENDER'SADDRESS . . . . /)� ' � ^
� 1 CERTIN THAT 1 HAVE READ THI3 MPLICATION ANU STA7E 7TUT TIiE ABOVE�NFORMATION 19 CORAECT. TOTAL FEES `�� (/
w I A6REE TO COMPLY WITH ALL C11Y AND COUNTV ORDPIANCES�ND STATE IAWS RELATPXI TO BUILDINO
� COHSTRUCTION.AND HEREBY AIJfHONZE REPRESENTA7NE5 OF�CWNT'70 EHfER UPON THE
Z11BOV-MEMIONED FROPERTY OR wSPECT1oN vURPOUES. COMMENTS � ,
O
J
�
m VE 1 E N £ Po � � . . -
¢ � 3 1 r'
�
� �SIONAN EOF RMfTTE DATE
RECPT.NO. PAID 8Y VALIDATFON
� WHITE—Department Copy,YELLOW--Finance CopY.PINK=Assessw Copy.GOLDENROD—Ffle Copy.GAEEI�Appllcant's Copy
V
CITY QF DIAMOND B�4R
ItVSPECTI4W REC4RD
. _ � ,
. � ; - „.
,
�
'". � ' g ,,,`- B ' _ * ° 9 ::� _ �t p , ,:; t�+
�. � �r. � ,`�, � � ��':
. . , , �.. ., .. .... . .... .. .._ , , .. ..,.
SET BACK _ � 'FLOOR JOiST
FTGS/FaRMS/STEEL ' FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING �BENCHING
ROUGH ELECTRIC �ROUGH GRADING
ROUGH PLUMBING FINISN GRADING
SHOWERIfU6 TEST P�OL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CQNST. fIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRlC DEV.FEES PAID
fINAL PLUMBING ENERGY
FINAL PLANING � �
FI�IAL ENGINEERING • o e
COMMEf��� _ -
�
, e � �`�
' L,�
_ `�j �-`�-,z.� -
i�/Y1�i_ :,� �
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�; ; ��I - -
',,, �,� � .
,�,`i
�z li