HomeMy WebLinkAbout10-1259 (5) --� + R CITY OF DIAMOND BAR � � � �����
----�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERV�S
21825 Copley Drive,Diamond Bar,CA 91765 ������ �S
'�- (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7,�7 � FIRMLY
� �'%9�� BUILDING PE IT APPLICAI'ION
� JOBSITE APPUCATION PERMIT 'n��y P/C
o ADDRESS � DATE�7�_�,� - !�C_ NUMBER� #
� ISSUE /� TYPE f�j�L OCC
APN LOT RACT DATE����I����/ _ CONSL����� GROUP
� OWNER
� � ZONING SETBACKS
o ApDRES FRONT RW ❑
Z C��. Z � �✓.�TEL. REAR ❑
j� ��..-
o APPLIC TEL. SIDE/SIDE STREET RW ❑
� CONTRAC OR � � SIDE �
OADDR S Z� EL. PROPOSED USE
cirv
w ARCH/ENG/
� �� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
cn
pESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I NA E%EMPT FROM THE CANiRACTORS LI� GHf8Q6/C8ff10fl
W CENSELAWFORTHEFOLLOWWOREASON(SEC.7031.6BUSWESSANDFROFESSIONSCODE:/W�CITVOR (n
U COUNTYWNICHREOUIFESAPERMItTOCOtJSTRUCT,ALTEfl.IMPPOVE.DEAIOLISH,ORREPAIRANVSTRUG IW paUo/Deck
wTUqE,pR10R TO RS ISSUANCE,ALSO REQUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
� STATEAIENT TFUT HE OR SHE IS UCENSED PUfiSUANT TO THE 7POVISIONS OF THE CONTRACTORS LI�
� CENSE U�N(CNAPiER e(COAtMENCINp WI7H SECTION 7000)OF DIVIS�ON 3 OF TME BUSINE55 AND PRO� u' POOVSPB
FESSIONS CODE)OR iHAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOEO E%EMP-
TION.ANY V�OUTKKJ OF SECTION 7P91.5 BY qNV APPLICANT FOR A PERMIT SU&IECTS THE APPLICMlT TO Z R9-ROOI
� A CML PENALTY OF NOT MORE 71�1AN FIVE HUNDRED DOlUFS(f500).):
^ ❑I,ASOMMEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAOESASTHEIRSOLECAMPENSATION, � Commerciat
j VALL DO THE WORK M7D THE STRUCTURE IS NOT INTENDED OR OFFEHED FOA SALE(SEG 7ou,6U51� J
� NESS M!D PROFESSIONS CODE THE CANTMCTORS LICENSE LAW DOES NOT A7PLV TO M7 OWNER OF �
PROPERTVNMOBUILOSOi11MPROVESTHEREON,ANDWHODOESSUGHWORKHIMSELFORNERSEIFOR m
� Q 7}IqOUGH HIS OR HER OMTI EM7LOVEES,PROVIDED THAT SUC}1 IMPROVEMENTS ARE NOT INTENDED OR
W OFFEREDFORSALEIF,FiOWEVEFi,7HEBUILDIN�ORIMPROVEMENTI550lDW�THINONEVEAROFCOMPLE-
� TION,THE OWNER-9UILDER WILL NAYE THE BUROEN OF PROVIN4 TFUT HE OR SNE DIO NOT BUILD OF
Z IMVROVE FOR TNE PURPOSE OF SALE�.
_ ❑I,AS ONRJER OF THE PROPERTV.AM EXCIUSIVELY CONTRACTING WITH IICENSED CONTRACTORS �
Q TO CANSTRUCT THE PRPIECT(SEC.70N,BUSINESS AND PROFESSIONS CODE�.THE CONTMCTORS ll- V91U0110T7 ADJ.AREA
� CENSEUWDOESNOTAPPLVTOANOWNEHOFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
W1qCONTRACT5FOR5UCHPR0.1ECT5WITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
TORS LICENSE LAW.). /��)
O ❑I AM E%EMPT UNDEF SEC. B.8 P.C.FOH THIS REASON � O �v�.+
� Q
'. � DATE OWNER V i
I 2 W
� LICENSED CONTqACTORS DECLARATION �
� W
� I NEREBV AFFIHIA UNDER PENALTV OF PERJURY THA71 AM LICENSED UNDER PROVISKKJS OF CHAPTEA Lyr �
.� Y(COMMENCIN(3 WfTH SECTtON 7000)OF DIVISION J OF THE BUS�NESS AND VROFESSIONS CADE,AND Z
X W LICENSE IS M FULL FOFCE M1D EFFECT. m
lL • �
0 UCENSE CIASSci;��� LIC.NO. � ��� �� � �
J
V pp7F��"Z� 'I.� CONTRAC a
W
� WORKERS'COMPENS ION DECLAR 10 a .
= U
� 1 HEREBV AFFlpM UNDER PENALTY OF PERJURY ONE OF 7HE FOLLOWING DECURAT�ONS: . '
� Z
Q
� _I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSEM TO SELF-INSURE FOR WOFKERS" _
Q COMPENSATION,AS PROVI�ED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICN THIS PERMIT IS iSSUED. _ .jr
�
w I HAVE AND WILL MAINTAIN M10Fl1(ERS'COM�ENSATbN INSURANCE,AS REOUIRED BY SECTION
Q 70o OF THE UBOR COOE.FOR THE PERFORMANCE OF THE WORK FOA WHICM THIS PERMIT IS CONSTRUCTION
SUED.MV WOBYERS'COMP/yr�SATION INSURANCE CARRIER AND POLICY NUMBER ARE:
� �I/��✓/�I�� QLAN REV1£W
CARPoER
0Z POLICV NUMBER�� ' �� ELECTRIC '
Q (twssecnot+r+�r+o7sE�tErEooFn+�vEar+rr�sraaor+E��oaln�sK��1��} PLUMBING
w CHA
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I i
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
� V70RKERS'CAMPENSATION LAWS OF CALIFORNII.,AND�GREE TFIAT SHOULD BECOME � I TI FEE
S SU&IECTTOTNEWORNERS'COMPEN OVISIONSOFSECT 37000FTHELABOR qNCE �
CODE,I S�H.V/�fOftT WITHCOMP 1 THOS PqOVISbNS.
p DATE:1-ICe_'�� APP ANT r .SMIP _
W . ENERGY P/C
J WAHNIN6:FAILUHE TO SECVRE KEF75'COMPE ATION VER E NLA FUL AND SHALL BE
� SUBJECT AN EMPLOYER TO CRI AL PENALTtES AND CIVIL ES T NE H 0 0 TttOU3Af10 ENERGY PERMIT
DOLLARS(f100.0ao�.IN ADDITION TO THE COST OF CAMPENSA . AOES AS VIDED FOR IN
J SECTION 370E OF THE LABOR COOE,INTEREST,M1D ATTORNEV'S FEES. pETENTION FEE: ��
�
w CONSTFUCTION LENDING AGENCY PRE-ALT FEE:
�
O
CC I HEREBY AFFIRM UNDER PENALN OF PERIURV THAT THERE IS A CONSTRUCTION LENDINa AOENCV .
� FOR THE PERFORMANCE OF THE WORK FOP WHICN THIS PERMIT IS ISSUED(SEC.J0o7.Ci�.C.�. � .
Z
W
� LENDER'S NM1E
� LENDERSADDRESS /�i
� I CERTIFV THAT I HAVE FEAD THIS APPUCATION AND STATE THAT hIE ABOVE INFOW.lAT10N IS CORRECL TOTAL F E ES � j'
w I AGREE TO COMPLV WITH ALL CRV AND COUNTY OHDINANCES M1D STATE IAWS RELATINO TO BUILDINO �
� CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF TFIIS COUNTYTO ENTER UPON THE
� AHOVE-MENTqNED VROPEFTY FOR INSPECTION PURPOSES. �
Z s . COMMENTS
� G S_ ,
J
�
m I NAA1E(PRIIfT) ^�
Q
(/�
TU 'O EE DATE I VALIDATION
RECPT.NO. - PAID BY
HIT paAment Copy,YELLOW�inence Copy.PINK—Assessar Copy.GO N Oo--File Copy,GFEEN—Applicanl's Capy
� � ".x�� ��.5 � � . �
��`c._'.1 !S 1i1�� �F:i`� ��� CBT'V O� DIAiViOi�lD BAF� r
��}i ,� : . � � I�ISPIEC�oOi� �iI�COIRD
�������� �� ����
_� � : . . . . �
:, Oa�pC�C�400a o �� C� '-: ,pG�}�pL�C��G3 = " O[n]�p�,C�400�}=�, ` .DL��'C�'.,. . �U�I�C� a m
SET BACK FLOOR JOIST
FTGS/FORMS/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 H'T. BOND BEAM
ROOF SHEATHING 8 FT:BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH NEATING � � '� BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT, FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
���
COMMEIVTS � � "�/��, %z s;�� ��
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a
r� �
a .