HomeMy WebLinkAbout12-1276 ���_ CITY OF DIAMOND BAR Q21 G�J A �� l _
� DEPARTMENT OF COMMUNI'I'Y&DEVELOPMENT SERVICES � �"
21810 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS
�'''"'. BUILDING PERI�IIT APPLICATION FIRMLY
APPLICATION q�J�pr n � PERMIT i-I'L lC
o DORESS ZZ�O� �-A1�Q W+4� .3 2Q�?/Qv� �3 G DATE ` "�l� v NUMBER 7/ t #
� ISSUE � / TYPE pCC
APN LOT TRACT DATE (� CONST. GROUP
p OWNER ���('h��b►}-� �l A 'T�1�uLS—�.'.IS2�
o ADDRESS R��,��"'C�_ ''��?� �� ZONING SETBACKS
Z CITY ZIP TEL�pp,,Q��l� (� FRONT RW ❑
� APPLICANT TELS..% '�`� REAR ❑
� SIDFJSIDE STREET RW ❑
� CONTRACTOR OR�`ty2,i4CTl�JG�_�Q//�� SIDE ❑
o ADDRESS PROPOSEDUSE �'� ��D(�� �f'l�� �f/�/L�UtI'►2-I�•
CITY i��� IF _G��-��TEL e�
o ARCW G/ ���� .�
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL UNITS STORIES BEDROOMS
�
cn DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFlRAI UNDER PENALTY OF PERIURV-7HAT I AM EXEMVT FAOM THE CONTRACTORS LI- Garage/Carport
W CENSEUWFORTHEFOILOWW�REA50N(SEC.7471.5BUSWESSANOPROFESSIONSCODE:ANYCT'OR (f�
C-� COUNT'/M'HI4IREOUIRESAPERAARTOCONS7AUCT.KTERIMVROVE.DF.MOLISH,ORREPNHANYSTRUG W patb/Dedc
w TURE,PRIOR TO RS ISSUANCE,AL50 REOUIRES THE APPLICANi FOR SUCH PEAMR TO FILE A SIGNED w
� STATEYEM THA7 HE OR SHE IS UCENSED PURSUAM 70 7HE PAOVISIONS OF 7HE CONTMCTORS LL �
� CENSE UW(CHA➢TER G(COMMENCWQ WITH SECTION 7000)OF OIVISqN 3 OF THE BUSINESS AND GR6 POOUSpO
^ FESSIONSCOD�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEB/SISFORTHEALLEOEDEJ(EMP- C7 .
V TION.MIYVIOIATIONOF5ECT10N7031.58YANYAVGLICAMTfORAPERMITSUBlECTSTHEMPLIGNTTO Z RaRoof
A C7VIL VENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLURS(fSOD).r
� ❑LASOVl11EROFTHEVROFERTY,ORMYEMPLOYEEBWfTHM'ACiESASTHEIR50LECOMPENSATION, � COfill118fCial -
Z VAIL DO THE WORI(AND TiE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEc.7ou,BU56 J "
� NESS MID PROFESSIONS COOE:T1E CONTRACTOR3 LICENSE LAW DOES NOT AVPLY TO AN OWNER OF �
PROPEAT'f WFID BUIL0.S OR IMPROVES 7HEREON,AND WHO OOES SUpi NOHK HIAISELF OR HERSELF OR
w7HROUCH WS OR HER OWN EAIPLOVEES,PROVIDED THAT SUCH INPROVEA/ENTS ARE NOT INTENOED OR m
� OFFERmPoRSKEIF,IiOWEVE0.117E8UILDW�ORu17ROVEMEN71550LDWfTwNONEVEAROFCOMPLE-
Z TION.7HE OWNER�BUILDER WILL HAVE 7NE BURDEN OF PROVINa 7HA7 HE OR SHE DID NO7 BUILD OR
, � IAIPROVE FOR THE PURPOSE Of SALE}
W �4��MIIdEROFTHEPROPEHTV,AME%CLUSIVELYCANTRACTINOWfTHUCENSEDCONiMCTORS
Q TO CONSTRUCT THE PR0.IEGT(SEC.70N,BUSINESS AND PROFESSIONS CODE:T1E CONTMCTORS Ll- V81UatIOf1 O ADJ.AREA
W CENSEUWDOESNOTAPVLYTOANOWNEROFAPROPERTVWHOBUM1DSORWPROVESTHEREON,AND
� 1NIDCOHTRAC75FORSUCHPR0.1ECf5WfTYfACONTMCTOF(S)LJCENSED7URSUANTTOTHECONTMF pUANTITY DESCRIP'fION� FEE -
� TOiiS LICENSE UW.�.
� ❑I AN IXEMPT UNDER SEC. B.l C.C.FOR T/11S REASON Q �
� U
� DATE OYMER F-
Z - -- U
O W
LICENSED CONTRACTORS DECLARATION -� �
� W .
I HEqEBY AFFlRM UNDER PENALTY Of VERJUfiY TMAT I AM LICENSED UNDFA PHOVISION9 OF CHAPTER �
d Y(COMMENCNO WI1H SECTION 7000)OF DrvISION�oF THE BUSINESS AND PFOFESSIONS CODE,AND Z
L`� 41Y UCENSE IS IN FIAL FORGE AND EFTECT, m
� UGENSE CIASS �C.�� LIC.NO. C/J�Q (lJ l I j
wDATE�=�_�� �Z COKTRACTOR d
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIfiM UNDER PENALTV OF PE0.NflV ONE OF 7HE FOLLOW WG OECURATIONS: �
� _�HAVE AND WILL MAINiAIN A CEATIFlCATE OF CONSENT TO SELF-1NSURE FOR KORKEAS
Q COMPENSATION,AS PROVIDED BY SECTION J7000F THE UBOR CODE,FOq THE PERFORMANCE U
Q Of THE WORN FOR NM1i1CH THI3 PERMIT IS ISSUED. � �
1 HAVE AND WILL AWNTAIN WORKERS'COMPENSATION INSURANCE,A4 REOUIRED BV SECTION ^ A
Q ]7000F THE UBOR C-0DE.WR THE PERFORMANCE OF THE WORN FOR WHIp1 T11S PERA11715 �)(// ��
, � 4SSUm.MY WORKEAS COnM➢ENSATION INSU{iANCE CARRIER A�PoIICV NU6IBER ME: CONSTRUCTION � �
] CARRIER ��-�t'�S�C I h9S U�A�,1'C L�. PUW REVIEW
� POIIGY NUMBER � �'�[n lnffl �����J�� ELECTRIC
p (nass[cnonr+Emr+oreemnwFrmoF vFra*rswAor�r�oal�s(sioqca�ss� PLUMBING
Z 1 CER7IFY THAT W THE PERFOFiMANC OF E WOPo(FOR WFllqi T113 PERAUT IS ISSUED.I MECHANICAL
CJ SHALLNOT EAIPLOY ANV PERSON IN ER SOAS TO BECAME SUBJECT TO THE
� WORKERS COMPENSATION UWS o CALIFo IA.AND AGREE 7HAT IF I SHOULD BECAME INSPECTION FEE
SUB.IECTTOTHEWOPoCERS'COAIPE SA71ON RON51oN50F5ECTION77o00FTHEU80R
� cooe,i sruu wrrrr�w�n�caav�v TH� E PROV151oNy� ISSUANCE t
p DATE�PLICA `-•C�✓ .SMIP . �
� �� Y ENERGY P/C
WARNWQFALURETOSECUREWOFlKERS' ENSATIONCOVERAGE45UNUWFUL,AND9/ULLBE
� SU8.IECT AN EMPLOYER TO CAIMMIL CENALT AND CNIL FW ES UP TO ONE HUNORED THOUSM70 ENERGY PERMIT
DOLLMS(5100,000),W ADDI710N TO THE COSY OF COMPENSATKNI,DAAUGES AS PRONDED FOR W
, ¢ SECTN7N 770!OF THE UBOR COD�WTEREST,AND ATTORNEYS FEES. ' RET�ENTION FEE:
O� CONSTRUCTION IENDING AGENCY P EALT FE •
- � I HEREBY AFFlRM IINOER PENALTY OF PERNRI'THAT THEflE IS ACONSTRUCTION LEN�P1Ci A(3ENCY � •
�Z FOR THE VERFORMANCE OF THE WOfiK FOR WHIPf T1I5 PERAIIT IS ISSUED(SEG]OP7.CN.C.�
W
� LENDER'SNAME� ,
' F-- LENDEfYSADDRESS
�
w ICEATIFYTHATIHAVEREADTHISMPLICATIONANDSTATETUTTiEABOVEMFORMAT10N19CORAECT. TOTAL FEES s . �
� 1 AGREE TO COMPLY N7iH ALL GTV MW COUNIY OROWANCES AND STATE UWS FEUTINO TO BUSDWO � , � ,
� CONSTFUCTION,AND HEREBV AUT}NJi11ZE REPqESENTATIVES OF 7}IIS COUHTY TO EHtEH UPON iNE
Z ABWE�MENTIDNED�ROPERT'FOR INSPECTION PURPOSES. COMMENTS
� D �
m VEAMITTEE (PRl /�' .
¢ 9-�=rz-
u� `�%.,�
uJ SI(iflA7UR OF PE E DATE
= RECPT.NO. PA1D BY� VALIDATION
~ WHRE-DepaAment Copy,YELLOW—Flnence Copy,PINK—Asseuor Ca GOLDENROD--F'de
py. Copy,GREEN—AppUcant's Copy
p l ,,�,
�� i�a! a�"�,�a�•�. �D B�"4 9'�J`;.,�j�`i� i.�3!�1 i!
��'3��'����:��'9i:���l ;�`:��:�,:��,���
� �..ti(.. � .'� :� r';,y.-C'�--y.���,u�5 �'� ti��j .rr�;t..^9,n:tia ,i�i�r,�p7 z.� .. :a^- ;;y''�9�'^ ".�,�;i�'�C�-iy-S�:'o°, � ,;�r.t .y�'~�:�.�J 1��'����l�'���y��
�� `�� � s � ��'"�� �{.N���.,���'1�. � .,� "�" 'y t i�� . ,,�i ���-��`:>�y.. �J'fJ� 1� � ` -��I� �'� �.�1
F ,. .f �4� -_1�.�v.1�-+7__::���,!'n, � � F .-�,- +p � Pr-�r '.s'� �- a �.�, �� ���1j �'-�'- �._`�^r i t� 4, a .-A t? �."3'`!,= 4. �
i � cv�
, ,, t �� c ' � u il�.n . , r ..__ ic� ��--„a'* �s .,- x. , 7,r[. iE'.. .-i."..� ' �"���`' tiw.- i�� �_�..9°�
1
...al:.._ �4u:u'��.�tc� �- -' 3s.:..ri;i•:ir.� _...y.^-.�i_.._d..�.y,_.. -�� - � . `� . - . ...,
' �....._. .. ...
_.,�" '.�.�....
SET BA�K �FLOOR 1015T __
�--- , .. __ _ _ __ .. _ __ . _.__. _... , _. .___.
_ . .-- -
FTGS/FORiv14/�T�EL � - - ;FH.4 RFOMTS �—
i
--- - -' -- --- --- - --
ELECTRIC GROI�ND � ---- - _ _ -- -- I ;t1t�DFR�I OOR DtJCT
- --- — -'------ —
(��ROUhDPIJJi��iP,li�!G ---�--------- ------------------I ��UNDcRFLGORCONDUIT
SLA6 GRAC�c ----------_�— -----__-_ j FIPE?LACE FOU��IDATI0�1 _- _--_--
TENiP PO�VER -' ----- - — ----------- - (FIREPLACE BOND BEANI
�VATER SERVICE I,'vIID Hl".BOND BEAM
ROOF SHEATHING _ _ ;8 FT.BOND BEAM __
FRAMING/VENTILATION j FINAL BOND BEAM_ ____ ________
--------------------------- --------------—_.__..—.
ROOF COVCR __ j PRE-GRAdING --_----------
ROUGH HEATING _ ____� _ _ _ _____________.____ �BENCHING ______
- '---�------------ —
ROUGH ELECTRIC i ROUGH GRADING
ROUGH PLUMBI�IG FINISH GRADING
SHOWER/TUBTEST I POOL ELECTRIC _
EXT.LATHlSIDING POOL FENCWG
WAL�I�15U1_ATION �POOL FINAL
CEILING I�•ISULATION �OFf-SITE IMPS.
DRYV+JALL P•1,41LIPJG i DEDICATIONS
------------ --_,.----------------------- -----
�EN/ER !FINAL ENG.
------- --- -- -------------— �-._..___.__.
SEPTICTANK ILANDSCAPE/IRRIG. ____ _______
SEEP PIT;L.L. ' �OhJ SITE IiV1P5.
GAS AIRTEST FINAL ZONING
FINlaL CONST. ��i I FIRE DEPT,FINAL _
�INAL I-IEATING HEAL�Fi DEPT.FI�dAL - —
FINAL ELECTRIC QEV.FEES PAID
FINAL PLUMBING E(dERGY
FINAL PLANING
FINAL ENGIi�IEERING ° m � ��' _____
COMMENTS
SEPTIC TANK SIZE '
SEEP PIT/U SIZE
— ,°� � .
d