HomeMy WebLinkAbout10-1072 _ _ _ ___ __ __ ____ __ . _ _
__ r.
---��' DE ARTMENT OF COMMUNITY&DEVELOP��NT SER����� �
21825 Copley Drive,Diamond Bar,CA 91765
- ' (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS
'"""� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE
I Q ADDRESS .����� /��/�U�'! �C��I� A/� r�� APPLICATION PERMIT / p/C
p DATE NUMBER/�'�O
� APN�_ LOT TRACT DA EE/�r���O CONST. GROUP
p OWNER
o ADDRESS���- i •I t1 C� ��Z ' � ZONING SETBACKS
z CITY n/Lln1d�l GY ZIP�'��TEL.qO�T-� V FRONT qyy �
o APPLICANT ���j�h l.J i I t(,� /V' TEL. REAR �
Z SIDE/SIDE STREET RW ❑
� � CONTRACTOR t O�F.V� _ )'U' , �/ / SIDE
ADDRESS )NC7 c •(��-7 O
� CITY �v//PD"'L�J1"+ ZIP Cu TEL. "�/ PROPOSEDUSE �,L}THI�pU/1 /ZP�vc�� I
o ARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS
u� UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-Bl11LDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM E7(EMPT FAOM THE CANTMCTOHS LI� Gefe9B/C8lPOfl
W CENSEUWFORTHEFOILOWINOREA50N(SEC.7071.6BUSINESSANDPROFESSIONSCODE:ANVCITVOR (f�
U pp�JpJJ�'W�{ICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORFEPAIRANVSTqUG PyIlO/DBCI(
Z NRE,PRIOR TO RS ISSUANCE,/�L50 REOUIFES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIQNED W
w STATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- w
, O� CENSE LAW(CHA➢TER�(COMMENCWO WITH SECTION 7000)OF DIVI910N 3 OF 7HE BUSINESS AND PRO- LL- PooUSpa
FES910N9CODE)ORTHATHEORSHEISEXEMPTTHEREfROMANDTHEBASISFORTHEALIEGEDEXEMP� �
V TION.ANVVIOLATIONOFSECTION7031.5BYANVMPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(t500)J:
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAdESASTHEIRSOLECOMPENSATION, � COrtIR16fC18I
Z WILL DO THE WORK,AND THE STHUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701t,BUSI- J
� NESS AND VROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF y. �
PROPERTVWFiOBUILDSORIMPROVESTHEREON,ANDYR70�0ES5UCHWORKHIMSELFORHERSELFOR � C�� L�II� / C.(/'(r���� '
CC THROUQHHISORHEROWNEAIPLOVEES,PROVIDEDTHATSUCMIMPROVEMEMSARENOTINTENDEDOR m
� OFFEREDWRSALEIF,HOWEVERTMEBUfLDINGORIMPROVEMENTI550tDWfTHINONEVEAROFCOMPLE�
Z TIDN,THE OWNER�BUILDER WILL MAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR T/iE PURPoSE OF SALE).
W �I,AS ONMER OF THE PROPERTV,AM EXCLUSIVELV CONTRACTINO WITH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- V91UfllI0f1 ADJ.AREA
CENSE LAW DOES NOT APPLY TO AN ON?JER OF A PROPERTY W HO BUILOS OR IMPROVES THEREON,AND
� MMOCONTRACTSFORSUCHPRQlECTSWITHACONTRACTOR(5)�ICENSEDFURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION
70RS LICENSE UW.). FEE �
Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q I U
U
ODATE OWNER U � ,(V/H(7�If
�¢ LICENSED CONTRACTORS DECLARATION w r>�.� �����'
2 �
I HEREBY AFFIRM UNDER PEfULTV OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
�CL� AIY LICENSE IS IN FULL FORCE AND EFFECT. m
LLI �n ^7
� UGENSE CLAS& 1.1 LIC.NO. L!�I q 3 I �
U DATE �L� • ��� ' 1 D CONTRACTOR �v1Gl iP Rc��'�Jc4oT„�' pJ.
w
� WORKERS'COMPENSATION DECLARATION �
� I HERF�Y AFFIRM UNDER PENALTV OF PERIUFV ONE OF THE FOLLOWING DECURATqNS: U
� / Z
� `� 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
� COMPENSATION,AS PROVIDED BY SECTION 3700 OF iHE LABOR CADE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
� �
w _I HAVE AND WILL MAINTAW WORKERS'CAMPENSATION INSURANCE,AS REOUIqED BV SECTION
Q 370a OF THE LA80R CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��]
ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND 70LICV NUMBER AAE: O TRUCTIO ���V�
jCnaRIER EVIEW
Z POLICV NUMBER CT ��
¢ J C)
0 (f1dSSEc��a�INE�Mo7eE00MP1.EfEDOFnffFEAMfiISWROrvE OOLLut5Rloo)oaLESSI UMBIN
W
Z I CERTIFY7HAT IN THE PERFORMANCE OF THE WOPo(FOR WHI THI PERMIT IS ISSUEO,I MECHANICAL
C,'} SHALLNOTEMPLOYANV7ERSONINANVMANNERSOASTOB OME,SUBJECTTOTHE
[/� WORKERS'COMPENSATION LAWS OF CALIFORNI/�AND AOREE HAT�IF I SHOUID BECAME INSPEC
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF 710N 370o OF THE LABOR �
CODE,I SHALL FORTHWITH COMPLV WITH h105E PROVIS AN
O / J�
p DATE: ��.�� �L^� �� qPPLICANT:
W
� WARNING FAILURE TO SECURE WORNERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALLBE ENERGY P/C �
� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLAflS(S10o,000),IN ADDITION TO THE COST OF COMPENSATpN,DAMAOES AS PROVIDED FOR IN
'� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. ION F �
OCONSTRUCTION LENDING AGENCY pqp.q�� '
� I HEREBV AFFIFM UNDER PENALTY OF PERJURY TNATTHERE IS ACONSTRUCTION LENDINO AOENCY /r �.
FOR THE 7ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,GV.C.�. � �
Z
W
� LENDER'S NAME
F— LENDERSADDRESS
w I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL F E ES �����
� 1 AGREE TO COMPLV WITH ALL CI7'Y AND CAUNTV ORDINANCES AND STATE UWS REUTINO TO BUILDINO
� CONSTRUCTION,AND HEREBY AUTHORRE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
Z ABOVE-MENTIONED PROPER OR INSPECTION PUR705ES. COMMENTS
0
J
�
m PEqMITTEE NAME(PRIIJn ' �
N ,- .� .3C•�v
� SIGNA7URE0 �fT7EE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—DepaAment Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,dREEN—Applicant's Copy
-„ `��; , .:,,,CB:TY O� DI��flO�� B�►R. ..
� . II�SPEC�IOi� �i�CORD "
r� � �':���ULJUV "- � �J � � �y�,� D . ; _ 4;`�i1W�4�4/^4"V�,=/Ui.l�� 4'��. 1�:�:'�n£� �` m� y�
-�:�,_a tR1V,lJ��� � ..r
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 HT. BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � �� C ROUGH GRADING
ROUGH PLUMBING � FINISH GRADING
SHOWER/TUB 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 �
C��?'1 OG�o � `"'
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
. a
�����
�� �
��
+: :
;��;. � .
,