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HomeMy WebLinkAbout10-1087 CITY OF DIAMOND BAR -""-��'— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ''^'! BUILDING PERMIT APPLICATION FIRMLY JOBSITE ���� K� � �. �ve ,� APPLICATION PERMIT o ADDRESS J DATE NUMBEF�D O q � APN LOT ACT D TEE /D'-�CJ"r/� CONST�� GROUP p OWNER o ADDRESS Q ZONING SETBACKS z CITY ZIP � FRONT qyy � p APPLICANT T L. S DE/SIDE STREET qyy ❑ � CONTRACT R SIDE ❑ ADDRESS � CITY Z�p PROPOSED USE w ARCH/ENG/ � z DESIGNER I a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS N DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFlHIA UNDER PENALTY OF PERIURV THAT I AM EXEMPT FHOM THE CONTRACTORS LI� G8f8gB/CBfPOf1 W CENSEUWFORTHEFOLLOWINaREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANYCITYOR (f� ' C� COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,AITERIMPROVE,DEMOLISH,ORREPAIRANVSTRUG W Petlo/Deck � �< NRE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIQNED w � STATEMENT hiAT HE OR SHE IS UCENSED VUFSUANT TO THE PROVISIONS OF THE CANTRACTORS Ll- CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOVSpe ` ` • , Q FESSIONSCODE)OR7HATHEORSHEISE%EMPTTNEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� , U TION.ANV VqLAT10N OF SECTION 7031.5 BV ANV APPLICAM FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Root A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAHS(f500).): 0 ❑I,ASOWNEROFTHEPROPERTV,ORMVEMGLOVEESWITHWAGESASTHEIqSOLECOMFENSATION, 0 COrt1R16fC18I Z WtLL DO THE WORK,AND THE STRUCTUqE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.70u,8U51- J N NESS AND VHOFESSIONS CADE:THE CONTRACTOPS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEHTV NR10 BUItDS OR IMPROVES THEREON,AND NM1IOOOES SUCH WORK HIMSELFOR HERSELF OR Q TNROUGH HIS OR HER OWN EMPLOVEES,PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILAINOOqIMPROVEMENTI550LDWRHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR � IMPROVE fOR THE PURPOSE OF SALE). W ❑I,AS OWNER OF THE PROPEHTV,AM EXq.USIVELV CANTRACTING WfTH LICENSED CONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V01U8t1Of1 ADJ.AREA W CENSE LAW DOES NOTMPLV TO AN OV/NER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS LICENSE UW.). FEE � � O I AM E%EMPT UNDER SEC. B.a P.C.FOR THIS REASON � � U LL DATE ONRJER � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIPAI UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � i � Y(COAIMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z , �� MY LICENSE IS IN FULL FORCE ANO EFFECT. m � bS � LICENS/E�CLASS�y LIC.NO. � � U DATE V� "✓��� CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTY OF PERIUFY ONE OFTHE FOLLOWING DECLARATIONS: V � Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' ¢ _ Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF 7HE UBOR CADE,FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w �I HAVEAND WILL MAINTAIN WOW(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN Q 3700 OG THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.M••Y�WORICERS'COMPENSATION INS/U�RANCE CARRIER AN�POLICY NUMBERARE: CONSTRUCTION jCARRIER/n�Fwil� �iwr /��((�jl]�i/�e" PLANREVIEW 0 POLICY NUMBER � � — � C1I�T EL � U � /,J �/ .../ (IFLLSSECTqNNE�NO7BENh�qFTEppFi}EpEq,f��$FpqpPIEFiU�DRED00.lARS(t100IORLF5S1 PLU � �i. �a Z I CEfiTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMIT IS ISSUED.1 MECHANICAL L} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE S � SUBJECTTO THE WORKERS'COMGENSATION PROVISIONS OF SECTION 37o00F THE LABOR � CODE,1 SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. O E/o-a� _,� . . . p DAT APPLICANT: ��) SMIP W J WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � J � SU&IECTANEMPLOVERTOCHIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSMlD ENERGYPERMIT DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN J SECTION 37oe OF THE LABOR CADE.INTEREST,AND ATTORNEV'S FEES. � aC TEN ON FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRAI UNDER PENALTV OF PERJUFV THAT THERE IS ACONSTRUCTION LENDING AOENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70G7,CIV.CJ. W � LENDER'S NAME . F— LENDER5ADORESS �j w 1 CERTIFV THAT 1 HAVE READ THIS APPUCATION AND STATE THAT 7HE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �� �V � � I AGHEE TO COMPIV WITH ALL CI7Y AND COUNTV ORDINANCES AND STATE UWS RELATW6 TO BUILDINO � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTpNED Pq07EF7Y FOR INSPECTION PURPOSES. COMMENTS � � J � m PERMITTEE NAAIE(PR1NT) � � � � ��� ,.�� _�� � SIONATUREOFPERMITTEE � D�TE � RECPT.NO. P/UD BY VALIDATION WHITE—DepeRment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOIDENROD—File Capy,GREEN—Applicant's Copy CI�V QJ� DGA6ViCDND �AR , INS��CTIOi� C��CORD _ _ . _ . . . . ,, . s,. � . ... . ., .,. . . _ . �. , � : _�_ Q� � oa�p���oa } . �o�����- ���� �� c� � : �,' `���1�3pCC�400Gr1�� ' o'�' r.�:.�; �� " '� o ;� C� �..�. SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR GONDUIT 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 HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING "� FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING P�OL 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 �O ENERGY C��OC�� COIVIMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � Q 4�� _ ,�, o: � ���