HomeMy WebLinkAbout12-569 ��_ CITY OF DIAMOND BAR / DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I� �. T,;; 21810 Copley Drive,Diamond Bar,CA 91765 , (909)839-7020 Fax(909)861-3117 Bu�ding Inspection Hotline(909)839-7027 PRESS ��'°^', BUILDING PERMIT APPLICATION FIRMLY ¢ DDRESS � � �"ID APPLICATIO � r � / PERMIT 12� p/C o DATE v NUMBER� # � ISSUE PE ��—� �C APN LOT TRACT DATE CONST. OUP p OWNER _ _ p ADDR S � ZONING SEfBACKS Z CITY �Iq `` ZIP b TEL FRONT pyy 0 p APPLIC NT TEI. REAR 0 zd SIDE/SIDE STREET qyy p � CONTRACT SIDE � ADDR S i � CITY ZIP TEL PROPOSED USE � I o ARCWENG/ z DESIGNER w NO.DWEL NO. NO: a ADDRESS � C�TY ZIP TEL UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION �� SFR/ADD/REM O 0 I HEREBV AFFIRM UNDER PENAL7Y OF PERNRV THAT I Nd EXEAIPT FROM THE CONTpAC7ppg�H da�9���rt � � ' W CENSELAWFOR7HEFOLLOWWOREASON(SEC.7o31.6BU5INE55ANDPROFE5S1pN5COpEM1YC7TYOR _ (n C.� CIX1HfYNRi1G1RE0UIFiESAPEHMR7000NSTRUClAL7ER,fA1PROVE.DEMOLISH;ORREPAIR�M7YSTRUG p8110/DBCk � w NqE,PRIOR 70�RS ISSUANCE,A4S0 REOUIHES hiE A➢PLICANT FOR SUCH PERMR TO FlLE A SIQNED �W g STATEMEM TFU7 HE OR SHE IS LICENSED PURSUANi TO hIE PROVLSIONS OF THE CONTRACTOR9 lL ., . � CENSE UW(CHAPTER a(COMMENCwO WI7H SECTION 7000)OF OIVISpN 3 0F THE�BUSINE59 AND�PRb V' POOUSp9 � FESSIONSOOO�OR7HA7HEORSHEISEXEMPThiEREFROMANOTHEBASISFORTHEALLEOEDEXEMP• (� TION.ANYVqLAT10NOFSECT10N7031.6BVANYMPLIC/�NTFORAPERMITSUBJECTSTHEAPPIICANTTO Z� Re-Rool ACML�ENAL7Y OF NOT MORE THAN FrvE HUNDRED DOLURS(i5oo).): � ❑I,ASOWNEROFTHE7ROPER7Y,ORMYEMPLOVEESWfTHWAOESASTHEIRSOLECOMPEN3AT10N, � COrtIlfl8fCi81 ' Z WILL DO THE WORK AND 7HE 9TRUCTURE IS NOT INTEn�ED OR OFFERED FOR SALE(SEC.�7ou,BUSF. _1 � ' � NE53 AND PHOFESSIONS CODE THE CONTiUCTORS LICENSE LAW DOES NOT APPLY TO AN ONMER OF j �� PROPEHTY NM1IO BUII.D$OR IMPROVES TiEREON,M1D WHO DOES SUCM NpRK HIAISELF OR HERSHF OR � CL iHA0U0HHI50RHEROWNEMPLOVEES,VROVIDEDTHAT3UC1/1MPROVEMENTSARENOTP7TENDEDOR m � , � UFFERmFORSAI.EIF,HOWEVER71iEBUILDINOOHIMPROVEAIENTIS&OLpNRiHP10NEYEAROFCOtdPLE. Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIND THAT HE OR SHE DID NOT BUqD OR . � IMPROVE FOR THE PURP0.5E OF SALE). - � � w ❑I.ASOWNEROFTHEPROPERTI;AME%CLUSIVELYCONTRACTPIU1NfT11lIL'EPJSmCONTq��7pqg CL TO CONS7RUCT THE PRQIECT(SEC.70N,BUSINE53 A!6]PROFESSIONS WDE;7}�E�CONTRAC70RS U- V01Ufl11Of1 (��,qR��. ' LLI CENSEUWDOESNO7APVLY70ANOWNEROFAPROPERTVNM1iOBU1LD90RIMPROVE67HEREON,AND - � WHOCOMRACTSFORSUCNPROJECfSWfTHACOMRACTOH(S)LICENSEDPURSUAMTOTHECONTAAG pUANTITY � DESCRIPTION �E . roas uceNse uw.�. i a 0 ❑1 W E%EA17T UNDER 6EC. . 8.d P.C.FOA THIS REtiSON � . � U � � DATE ONMER �-- � - . . . . . �. � U �Q LICENSED CONTRACTORS DECLAAATION �w� •� - - Cr I HEREBY AFFIRAI UNDER PENALTY OF PERIURY TNAT I AIA LICENSm UNDEfl PROVISION$pF CW�pTER � � � � Y(COMNENGNO WI7H SECT�ON 7000)OF DIVISION]OF THE BUSINESS M1D PROFESSIONS CODE,AND Z / ` r" ' �j� W LICENSE IS M L F(OR EAND EFFEC7. / � IICENSE CLASS �/' � LIC.NO. ���D�, m � � V DATE CONTRACTOR d . _ W � WOFiKERS'COMPENSATION DECLARATION � � - � � � � � - � 1 HER�V AFFIHAI UNDER PENAL7V Of VERIUM ONE OF THE FOILOWINO OECLAMTIONS: V ' � � � � _�FiAVE AND WILL MAINTAIH A CERTIFlCATE OF CANSENT TO SEIF�INSURE FOR WORKERS' � � � COMPENSATION,AS VROVIDED BY 6ECTION 37o00f THE LABOR CODE,FOR THE PEqFOqMANCE W OF 7HE WORK FOR N711CH THIS PERMIT 19 ISSUED. � � � _iHAVEANDWILLMAIMAWWORNERS'�COMPENSATIONINSUIUNCE;A$qEWIREDBVSECTION � O 3700OF THE LA80R CODE.FOR THE PERFORMMJCE�OF THE WORK FOR WHlq/THIS PERMR 19, ISSUEO.MYWOR�(E 'COMP NSA7 �INSURANCECARRIER�ANU.POLICYIJUMBERARE �CONSTRUCTION� jcu+RiER PLlW REVIEW 0 POLICYNUMBER � � � �� ELECTRIC p (���+�ID�Te�°o�a�T�o�n��Ts�oaa+Er�xn�noa�nsls�ao)oatFss} PLUMBING w Z I CERTIFV THAT W hiE PERFORMNJCE OF 7HE WOfU(FOR WHICH THIg PERMIT IS ISSUED,1 MECHANICAL CS SFULLNOTEM%.OYANYPERSONWMIYMANNERSOASTOBECOME�SU&lEGT70THE' � � � (/� WORNERS'COAIPENSATION LAWS OF CALIFORNI�ANO AGREE THAT IF I SHOULO BECOME INSPECTION FEE� SU8JEC7TOTHEWOAKERS'COMVENSA710NPROVISqNSOF�SECTION37000FTHElABOR � ' O cooe.i sw�u.warHvnnr cour�v wm+r�+osE Paov�sw�s. ISSUANCE p DA7E: APPL�CANi: �SMIP W J wAHMN�:FAILURE 70 SECURE WORKERS'COMPENSATION COVEMGE IS UNLAWFUL,M1D SFULL BE ENERGY P/C � J SUBJECTANEMP�OYEFTOCRIMWALPEt1ALT1E5ANDGVILFWESUPTOONEHUNDREDiHOU$/Wp � ENERQY PERMIT DOLLARS(f10o,000),W ADDITON TO THE CQST OF COMVENSATION,DAMAGES AS VROVIDED FOR W . J SECTION 37oe OF hIE LABOfl CODE,INTEREST.ANDATTORNEY9 FEES. � ' ' ' � w RETENTION FEE: O . CONSTRUCTION�IENDING AGENCY � PRE-ALT FEE: � I HEREBY AFFlRM UNDER PENALTV OF PE0.IURV THAT THERE IS ACONSTRUCTION LENOWO AOENCY d FOR TNE PERFORMANCE OF THE WORK FOF NM1i1CH THIg pERAUT IS ISSUED(SEC.3097,CIV.CJ. Z W ��. LENDERS NMIE - ' I— LENDER'SADDRESS � - . w ICERTIFYT{iATIHAVEREADTHISAPPLICATIONAND$TATETHATTHEABOVEWf-0RAIATqN19CORRECT. TOTAL FEES l .� d IACiREETOCOMPLYN7THALLCRYANDCOUNTVpppW/JJCESAHDSTATEUWSREUTWOTOBURDWO � CANSTqUCT10N,iWDHEREBYAUfHORREREPRESENTATNE50FTH1SCWNTYTOEHTERUPONTHE ' Z ABOVE-MEMIONED PROPERTY FOR WSPECTbN V11R70SES. COMMENTS �' � 0 _' C J � m PE IT7EE E � Q CQ � SKiNA OFPERN E DATE - � RECPT..NO. PAID BY VALIDATION WHITE—Department Copy.YELLOW--Fhnence Copy.PINK—Assessor Copy,GOLDENROD—File Copy.pREEN—pppl{r�nra CpPy CITY OF DIAMOND BAR Ii�SPECTION REC4RD � � � � " � � � � � ; . , : p,. . � ����,i , , ` ' ���� �t. - , _. . , � , .: p , , � SETBACK FLOORJ015T � } - „ ti• — _ -- — -- FTGS/FORMS;STEEL fHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GR�UND 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 ELECTRI� ROUGH GRADlNG ROUGH PLUMBING FI►dISH GRADlNG SHOWERlTUBTEST POOL ELECTRIC EXT.LATH/SIDING �POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANOSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIRTEST fiNAL ZONING FINAL CONST. FIRE DEPT.FItdAL FINAL HEATING HEALTH DEPT.FIfVAL FINAL ELECTRIC DEV.FEES PAID FINAL PLUMBING EfdERGY FINAL PLANItdG FINAL ENGINEERING ' • a e COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE � ? ; , ' , ,r