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