HomeMy WebLinkAbout13-801 �,` CITY OF DIAMOND BAR . /
`—'^-• � DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES �
21810 Copley Drive,Diamond Bar,CA 91765
,. (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
`��'�^'� BUII,DING PERMIT APPLICATION FIRMLY
o ADDR'ESS �ZaZD �� I"�� �7��1 U APPLICATIO PERMIT �� ���'� P/C
DATE ( 3 NUMBER�1�_� #
� ISSUE 1 TYPE � ��— OCC
APN LOT�� TRACT DATE ���I I l� CONST. GROUP
p OWNER �QI'L.�'h Y lr0 dSO�.J
" ADDRESS—� tnlC� �� a1'J ►4v ZONING SETBACKS
Z CITY S�'J � �� ZIP �-�) TEL.��`� �S3 FRONT RW ❑
p REAR ❑
o APPLICANT �s� � � TEL. �� S 030 SIDE/SIDE STREET RW ❑
� CONTRACTOR d S '7���"� � SIDE
ADDRESS �2 � ❑
� CITY �L-�47! C N ZIP �� TEL�Z�� p3GI PROPOSED USE
o ARCH/ENG/
�z DESIGNER , NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDF100MS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
�
1 HEA�Y AFFlRM UNDER PENAL7Y OF PERAIRV THAT I AII EXENVT FROIA THE CONTiUCTOR3 LM GaragelCarport
W CENSEUWFOR711EFOLLOWWOREASON(SEC.7031.SBI15WESSMJDPROFESSIONSCOOEANI'CITYOR (n �
U CpUNryWHIpIpEOUWESAPQiMI7TOCONSTRUCT,ALTER.DAPROVE.OEMOUSH.ORREPAIRMlYSTRUG W P0f10/DBCk
� NRE.PRIOR TO RS ISSUANCE,AL50 RC-0UIHES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIfiNED w
STATENENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTqRS L4
� CENSE UW(QM�TEA B(COMMENCNW WITH SECTION'1000)OF OIVISION 7 OF 7HE BUSINESS MID PRO � POOVSpB
FESSIONS cOO�OR TFUT HE OR SHE IS EXEMPT THEREFROM AND 7HE BA515 FOR 7HE ALLE6ED EXEMP-
� 710N.ANYVIOLATIONOFSECTION7031.SBYANYMVLIGNTFOAAPEWIITSUBJEC7STHE/WPIIGNTTO, Z qe-Rool
A C1VfL VENALiV oF NOT IAORE THAN FlVE HUNDRED DOlLARS(SSOD).r
� ❑4��N�NEROFTHEPROPERTV,ORMYEMPLOVEESWITHl4AGE5/STHEIRSOLECOMPENSATION, � Comme�cial - � '
Z VALL DO THE WORI�AND THE STRUCTURE IS NO7 INTFNOED OR OFFEAED FOR 3ALE(SEC.7oH,BUSF J
� HESS MID PROFESSIONS CODE THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNEH OF �
PROPEFTY W/10 BU4DS OR IMPROVES TiEREON.AND WHO OOES SUCH K�DiiK HLL/SELF OR HEHSELF OR
Q TFGi0UGF1 HIS OR HER OWN EM7LOVEES,PROV{DED THAT SUCH UAPROVEMENTS ARE NOT PfTENDED OR m
Q OFF�ERmPDRSILEIF,FIOWEVERTIIEBU1lDWGORIMPROVEMFMISSqDWfT/UNONEYEAROFCOMPIE ' �
Z TION.THE OWNER-BUItDEA WILL HAVE THE BURDEH OF PROVIN6 THAT HE OR SHE DID NOT BUILO OR
� IMPHOVE FOR THE VURPOSE OF SALE}
�y,� ❑4�OWNEqOFTHEPROPEHTY,MIIXQUSNELYCONTMGTP16WrtHLICENSEDCONTRACTOfi3
� TO CONSlRUCT THE VROJECT(SEC.7M4,BUSINE35 Ml�PROFESSIONS CODE:iNE CAMMCTORS LI- VBIUOliOf1 A0.1.AREA
W CENSE LAW DOE9 NOTAPVLY TO NJ ONRlER OFA VROPERTY WHO BUttDS 0R IMVROVES THEREON,AND
� WHOCOMRACTSFOHSUq1PRQIECTSWfTF1ACONTRACTOR(5)LICENSEOPl1R5UAHTTOTHECONTRAG ounrmrr DESCRIPTION FEE �
� TqiS LICENSE UW.).
� O I A4 E%EMPT UNDER$EC. 8.8 P.C.FOR THIS REASON �
� U .
� Q
DATE OYMER �
. Z W
�Q LICENSED CONTRACTORS DECLARATION W , �
CL 1 HEREBV AFFlRII UHDER PENALTY OF PERJUqY THAT IAM LICENSED UNDER VROVIS10N5 OF CNAV7ER p
� 9(COMMENCIN�W17H SECf10N 700oj OF DIVISION 7 OF THE BUSINESS M1D PROFESSIONS OOOE,AND Z V�� � � 1 A
X MY UCENBE IS IN FULL FORCE AND EFFEC2 m
LLI /
UCENSE LIC.NO. {!���.Z �
� J
V DATE � � CONTRACTOR � �
W
¢� WORKERS'COMPENSATION�ECIARATION J "
� I HEREBY AFFWM UNDEA PENALTY OF VERJURY ONE OF THE FOLLONMI�OECURATIONS: Z �
O _IHAVEANDWRLMNMNNACERTIFlCATEOFCANSEHTTOSELFdNSUREFORWORICERS a
S
Q COMPENSATION,A4 7ROVIOED BV SECTION 770o OF 711E UBOR CODE FOR THE PEfiWFMANCE �U
Q OF THE WORK FOR WHICH THIS PEHMIT IS ISSUm. � '
w �HAVE AND WILI MAkJTAW N^ORICEAS'COMPENSATpN INSUHMICE,AS HEOUIRED BY SECTION n
Q �7aa OF THE LABOR CODE,FOR THE PERFORA/ANC OF THE WOFU(FOR WMlq/TMS PERMIT IS /� � \ —_ ��C L„��
ISSUEO.MY WOPo(EfiS'°°�PE�N TIOy1N5URAN�CARq1ERM%)POl1CY NUMBERME CONSTRUCTION _�� ✓�` �/�f 1'� l, -f-.�t ()..� �
(
j c,�a�„�, �+��f�rv*-% _ PLAN REVIEW
� POIICYNUMBER �� , ELECTRIC �✓��
0 RrussEcrioNr�r+oieEoons3tr�oFn��xrrswaor+E�oatu�sR�mloatFss� PLUMBING 1.��+'�
Z 1 CERTIFV THAT IN hiE PERFORMANCE OF 7HE WOPoC FOH wHICH THIS PERAIIT IS ISSUED,1 MECHANICAI
(,'} SHALL NOT EMPLOY ANY PERSON IN ANV IMNNER SO AS TO BECOME SUBJECT TO TFIE
� wORKERs'CAMPENSATION LAWS OF CALIFORNIti AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE
SUBJECTTO 7HE WOPoCERS'COAI➢EN9AT10N VROVISIONS OF SECTION a7o0 OF THE UBOR -
-�j cooe,i srw.�roRr�+win+coMa�r win�THosE vRov�sroras. ISSUANCE
� SMIP '
DATE APPLICANT: /�
� WI1RNfN�:FAIWRETOSECUREWORKER3'CAMPENSATIONCOVERAGEISUNLAWFU�ANDSHALLBE ENERGYP/C K. [` ♦v�
� SU&IECT AN EMPLOVER TO CRININ/�L PENALTIES AND CIVIL FWES UP TO ONE HUNDRED T10USAN� ENERGY PERMIT
OOLUIH3(St W.aOa).�N IDD�710N TO THE C0.ST OF COMPENSATqN,DAMAGES AS PflOVIDED WFi IN
� SECTqN 37ae OF 7NE LABOR cODE,ItiTEREST,M1D A77oW�EYS FEES. � RETENTION FEE: �4��
a CONSTRUCTION LENDING AGENCY PpE-AlT FEE: �
O ��'� 1 �
� I HEREBY AFFIHM UNDER PENALTV OF PERIURY THAT hIERE IS ACONS7RUCTION LENDWO AUENCY
�� FOR THE PEAFORNANCE OF THE WOPoC FOR WHIQ1 THIS PERMR IS ISSUED(SEC.70v7,pV.G.� 'r
Z
W
� � LENDEASNAME
� LENDERSADORE55
� ICERTIFYTFiATIHAVEREAD711ISAFPLICATONMID5TA7E7HATTHEABOVEINFOR/AA7qNISCORRECT. TOTAL FEES � �
w 1 A6REE TO COMRY N7TH ALL C1TY AND COUNiY ORDINANCES AND STATE UWS fiEUT1NG TO BULLDINO
� CONSTRUCTION,AND HEREBY AUTHOfUZE REPRESENTATNES OF THIS COUNfYTO EMER U�OII THE � �
� �BWE�MENTIONED PROPERTY FOR WSPECTION PURPOSES �
Z COMMENTS
�
J
�
m VERAa7TEE NAME(PRllfn "
Q .
�
�J SIONANRE OF PERMf1TEE - �� RECPT.NO. I PAID BY VALIDATION
' � WHITE--0epartment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,(�1bLpENRO�Ie Copy,GREEl�Appl(canYs Copy
- �iT`d �� f�!l�6U1��l� ��� � , �..
Ii��P�C:TI�� �����C?
- � - � � �,.. � .o. .� � � �B 1 ,�F D ��
~ w '�*
, �
e ; � . ,
.�,;. . . -
SETBt\CK FLUORJOIST _ __ __,__
------------------ --------- ------------- --------
FTGS/�OhMS/STEEL �FHA REQWITS
�LECTP,IC GROUND -------- ----- --- — I UNDER FLOOR OUCT --_— --_--- -----
GROU�!D FLUiV161�G � —� UNDER FLOOR CONDUIT
SLAB GRAdE �— FIREPLACE FOUNDATION __
TEti9P POVVER � FIREPLACE BOND BEAM
WATER SERVICE tvtlD HT.BOfdQ BEAM
ROOF SHEATHI��dG 8 FT.BOND BEAM
FRAMING/VENTILATIO�I _ j _ ________ FINAL B�ND BEAM ____ __
ROOF COVER PRE-GRADING ___ _____ _
ROUGH HEATING _ ___ � __ _______ BENCHING _ _
ROUGH ELECTRIC � ROUGH GRADING
FOUGH PLUME31P1G FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENQNG
WALL INSULATION POOL FINAL
CEILIPdG IIJSULATION OFF SITE INiPS.
DR`fV�/ALL�IAILING ____ DEDICATIONS__J___ _ __.______
SE4�lER .----------- ---- — ---.�.—_._ FINALENG. __ -----
SEPTICTA�aK _____ _ LANDSCAPE/IRRIG. _ _ _
5EEP PIT/L.L. ' ON SITE IMPS.
GAS AIRT[ST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY �
FINAL PLANING _.__ —_ --
� ----- -�---- --_' r -
FINAL ENGWEERING ' '� � _______ ____
COMMENTS -- ���..�,_._�------- ����-�, � Go n5—�2 .
----- --�'^^��,.�,1� Gl i 7�0 �--- �
--------- 31�5 t 3 �-- --------- — ---- . --- ---
SEPTICTANKSIZE
SEEP PIT/U SIZE
'� 1 -------- ------ ---- — ------
a --------- --- —