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HomeMy WebLinkAbout12-1031 (6) CTI'Y OF DIAMOND BAR � rJ(� L�O "--��' DEPARTMENT OF COMMUNITY&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 ¢ DDRESS_���I S_ G�C�(�� A�I . I � APPLICATIONQ� PERMfT �{ p/C p DATE U � ?✓ NUMBE��� �" `'' ' # � ISSUE Q TYPE pCC APN LOT TRACT DATE v � 2�CONST. GROUP p OWNER p ADDRESS ZONING SEfBACKS FRONT z CITY ZIP TEL. RW ❑ o APPLICANT TEL. REAR p ¢ SIDFJSIDE STAEEf RW O � CONTRACT R P��,�j�IY1C , SIDE p ADDRESS���LT[' C.�Cx . � CITY �"�ll C!� ZIP�� TEL - - (, PROPOSED USE j o ARCH/ENG/ �- '' � � �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL UNITS STORIES BEDROOMS � � DESCRIPTION SQ.Ff. FACTOR PSF AW.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEAEBV AFFlPod UNDER PEIUL7V OF 7ERIURY THAT I AM EXEAIPT FROM TryE CONTqACiOR3 LL Garage/CarpoA . . . . W CENSEUWFOR7HEFOlLOWWOREASON(SEC.7o31.6BU5WE55ANDPROFESS10N5CODEANYpTYOR (n ' U COUNTYWHIGiREOUIFiE3APERM7TTOCONSTAUCT.ALTER,IMPROVE.DEMOlISH.ORREPAlAAN1'97RUC. W Pet10/DBCk � � � NRE,PRIOR TD RS ISSUANGE,/�LSO REWIRES THE APPLICMf�WR SUCH PERMR TO FILE A SIONED W � STATEMENT 7HAT HE OR SHE IS LICENSED.PURSUANT TO THE PROVISIONS�OF 7HE CONTMC700.S Ll- ... . � CENSE UW(CHAP7ER e(COMMENCINO WfTH SECTION t0oo)OF DIVISqN J OF 7HE BUSwE55 AND PRO u' POOYSpB _ � FESSIDNSCOO�ORTHATHEORSHEISE%EMPThiEREFROAIMATHEBASISFORTHEALLEOEDEXEMP- � C7 . . V TION.ANVVqUTIpJOFSECTION7u�1.6BVANYAPPLICAPJTFORAPERMRSUBJECTSTHEAPPLICANTTO Z� Re-Raot ACML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAHS(f6oD)J: 0 ❑I,ASOWNEROFTHEPROPERT',ORMYEMPLOYEESWI7HlVAGESASTHEIR50LEC0�IPENSATIOH, � �m01C181� Z YALL DO THE WORI(,AND THE 9TRUC7URE 13 NOi INTENDED OR OFFERED FOR SALE(SEC.7ws,BU51� J � l N NE53 ANO PFOFESSIONS COpE THE GpNTRACTORS UCENSE�UW DOES NOT A7PLY TO AN OWNER OF � ' -� � PROPEHfV WIiD BUILDS OR IMPROVES THEREON,AND NM1fO DOES SUCH WORK HIMSELF OR HERSELF OR W7HROUON WS OR HER OWN EMVIOYEES,PROVIDED THAT�SUCM IMPROVEMENTSARE NOT INTENDED OR m ' , � OFFEAmFORSA�E1F,FqM�EVERTHEBUILDNOORWPROVEMHlT1550LDWfTHv1oNEYEAROFCOA/PLE- Z TIDN.THE�OWNER�BUILDER WILL HAVE THE BURDEN OF.PROVPlO THAT HE OR SHE DID NOT BUILD OR . � IMPROVE FOR THE PUHPOSE OF SALE� . W OI.ASOWNEROF7HEPROPEHTY,AME%q.USNELVCONTRACTPIUN7TNLICENSEDCONTWiCTOR3 � TO CON5TRUCT THE PRO.IECT(SEC.7011.�BUSINE53 A1�PROFESSIONS CODE:THE CONTRACTORS LI' V8IU8IIOf1� /1Q�.AREA'. . . . W CENSEUWDOESNOTAPPLV.TOANOWNEROFAPROPERTYWFIDBU8.D90RIMPROVESTHEREON,MlD ' ' � ' � NM1fOCOMAACT5FOH6UpiPRO.lECf5N7THAODNTRACTOfyS7LICENSEDPURSUANf70THECONTRAO pUANTITY �DESCRIP"fION � TORS LICENSE LAW.�. FEE � � ❑I AM E7�MP7 UNDER 6EC. B.8 V.C.FOR THIS REASON Q . � U ZDATE OWNER - U I � LICENSED CONTRACTORS DECLARATION . w � I HEREBY AFFIAAI UNDER PENAI.TV OF�PER.RIRY THAT IAM�LICENSED UNDEA PROVISIONS Of CHAP7ER � - ' �� - � Y(COMMENGNO WITH SECTION 7000)OF OMSION 7 OF THE BUSINESS M!D PROFESSIONS CODE,AND Z � - ��� MY LICENSE IS PI FW.L FORCE AND EFFECT. m � LICENSE CLASS �`7 B UC.NO.. I V'��_�� j� � .. . . U DATE _ CONTRACTOR d - -- . . .. . . LL � WORKERS'COMPENSATION DECLARATION � � � � � � � �� - � � U � 1 HEREBV AFFIRN UNDER PENAITY OF PERJUFiY ONE OF THE FOLLOWWl3 DECLARATIONS: Z � ' ' � . � _IHAVE�AND.WILLM/VNTARIACEArIFlCATEOFCONSENTTOSELF�WSUREFORWWU(ERS' T � - - COMPENSATION,AS PROVID�BY SECTION 3700 of 7HE UBOR CODE,FOq THE PERFORMANCE �U OF hIE WORK FOR WHICJ7�IS PERNIT IS ISSUED. � . . . 0 Qw _IHAVEANDWILLAWMAWWORI(ERS'�COI.IPENSATIONMSUq/WCE;ASREWIREDBYSECTION 370o OF THE U1BOR CODE,FOR 7HE PER WRMANCE�OF THE VJORK FOR WHK71 THIS 7ERAIR IS I �/ � D � ISSUEO.MV WORKERS'OOMPENSAT INSURANCE CARRIER� D VOLICY NUMBER ARE �CONSTFlUCTION�� j CARRIER �1r_�� �utin�es's �ervi ces,Ti-�c. P�RE���, � O�. �y� 0 POLICY�NUMBER Zd ELECTRIC p OT����+��T��TmoFn+Ea�.rrswr+a+E�roamOatais(s�ro)or+�ss� PLUMBING � w Z �CERTIFV THAT Pl hIE PERFORA4WCE OF THE WORK FOq WHIGI THIS PERM7T IS ISSUED,I ��ECHANICAL� CS SHALL NOT Ea1Pl.OV ANV 7ERSON W ANV NqryNER SOAS TO BECOME SUBJECT 70 THE �� � (/� WORI(ERS'CAMPENSATIONUIWSOFCJ�IIFOiW1A,AHDAGREETHATIFISFqVLDBECOME INSPECTIONFEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION�7a0 OF THE UBOR - '� ' - .-�^ O cooE.i sruu FORri+ann�coua�r Nnn�n�osE eaowsar+s. ISSUANCE .. . . . . . . � . p DA7E: APPL�cANi: �SMIP n �O � WARNWO:�FAIWRETOSECUREWORKERS'COMPENSATIONCOVEMGEISIINUWFUL,AND.SHALLBE ENERGY�P/C . � SU&IECTANEMPLOYERTOCRININALPENALTIESANDpVILFWESUPTOONEHUNDRED7HCX/SAND ENEAGYPERM�T DOLLAFiS(5700,000),W ADDI7ICX�TO THE COST OF COMPENSATIDN,DAMAQES AS PflOVIDED�WR IN � J 6ECTION 370D OF 7HE LABOR COOE,INTEREST,ANDATTORNEY'$FEES. � ' � ¢ RETENTION FEE: � O . CONSTRUCTION�LENDINGAGENCV p /,0.�T../F�EE:�� . �•• DO Q 1 HEREBYAFFlRM UNDER PENALTY OF PERRIRV THAT THERE IS ACONSTRUCTION LENDPICi AQENCY �C�-�/ �Z� FOR THE PERFORAIANCE OFTHE WORI(FOR N7i1CH THIS pERMR IS ISSUED�SEC.3ov7,pV.C.} ��"�� W � LENDERS NAAIE . . . . .. . _ 1— LENDEfYSADDRES3 � �� I CERTIFY THAT I HAVE REAb TH19 APPLICATION AND STATE T11ATh1E ABOVE INFOiWAT10N IS CORAECT. TOTAL FE ES /' V /� / . � 1 AUREE TO COMRV VATH ALL CITY AND COUNTY ORDINANCES M1D STATE UWS fiEUTWO TO BU0..DINO � , � CONSTRUCTKK{ANU HEREBV AUTHORIZE REPRESEN7ATIVES OF T115 COUN7Y TO ENTER UPON TiE � Z ABOVE-MENTKINED OROPERTY FOR INSPECTION VURPOSES. COMMENTS � � . O J �'1 � V m PERMt7T .RINn � Q � .y . . . . . . . . N N �SK3NA REO E RTEE � DA � RECPT.NO. PAID BY VALIDATION WHITE-Department Copy,YELLOW—Finar�ca Copy.PINK—Assessor Copy,(iOLDENROD—Ffle Copy:CiREEN—ApplicanYa Cppy CITV �F DIAMOND BAR INSPECTIOl� RECOF�D � � . .e � . ..e . . �, � . . �,� ° � kv�' D � �-`z�� � � `�� `� Y � x� ' � { Q _ � �. .•� � _ _ ,� � � , - e o _ . , p , �, �� , , � �`:�3 SET BACK �� i FLOOR JOIST _ _ _ FTGS/FORMS/STEEL FHA REC2MTS ELECTRIC GROUND UNDER fL00R DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATIOPd TEMP POWER � I FIREPLACE BOND BEAM WATER SERVICE � !MID HT.BOND BEAM ROOF SHEATHIM1IG 8 FT.BOND&EAM FRAMING/VENTILATION FIIdAL BOND BEAM ROOF COVER '�PRE-GRADING ROUGH HEATING BENCH�NG ROUGH ELECTRIC I R UO GH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST �POOL ELECTRIC EXT.LATH/SIDING �POOL FENCIPIG WALL INSULATION POOL FINAL CEILING IMSULATION �OFF SITE IMPS. DRYWALL NAiLING DEDICATIONS __ SEWER fINAL ENG. SEPTICTANK LANDSCAPE/IRRIG. SEEP PIT/L.L. Otd SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. Q.27�J Z FIRE DEPT.FINAL FINAL HEATING ;HEALTH DEPT.FINAI FINAL ELECTRIC -2fi—I2 DEV.FEES PAIO FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING ' o e COMMENTS SEPTICTANK SIZE SEEP PIT/U SIZE F�f �