HomeMy WebLinkAbout12-1275 _�,� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUIVITY&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
y JOBSITE �6�"�� ��p� APPLICATIONy � 1Z PERMIT���{�7�p/C
o ADDRESS Z2.��.LJ CAIG LU/111� �3�T/LU�� ,3 C�� DATE NUMBE � � q
� APN LOT TRACT �SSUE � f/ � TypE p�C
DATE �� CONST.� GROUP
p OWNER ��AwAO�.J/� rI1A�L rT-�J.�iS�L�I
�p ADDRESS�'�j,f�,��-r_� jV� �O ZONING SEfBACKS
FRONT
Z CITY ZIP TEL� RW ❑ .
Q APPLICANT TEL. REAR �
¢ SIDE/SIDE STREET pyy p
� CONTRACTOR / SIDE �
ADDRESS `
� CITY �Pr�,(G'S� ZIP� TEL p Q PROPOSED USE �F ('.¢J�'1'
w ARCH/ENG/. � �
z DESIGNER S1� �' ' ��
a ADDRESS NO.DWEL NO. NO.
, � CITY . ZIP �L UNITS STORIES BEDROOMS
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEAEBV AFFl{iAI UNDER PENALiY OF PERAIRV THAT I A/d EXEMPT FAOY T}�E CONTMCTORS LL GefB B/CB Ii
W CENSEUWFOR7HEFOLLOWINOREASON(SEC.7ai1.6BUSINE55ANDPROFESSIONgOppEANypTypq (n 9 �
� COUHTYNTiIp1RE0UIRESAPERMITTOCON3TAUCi.AL7ER,DAPROVE,DEMOLISH.ORREPAIAANY57RUG W PefiOJDBCI(
NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE MPLICANT FOR SUpi PERMIT TO FlLE A SIONED �w
� STATEYENT THAT HE OR SNE IS LICENSED PURSUANi TO hIE PROVISIONS OF 7HE COtfTRACTORS LL .
� CENSE UW(qUDTEA e(COMMENCING WI7H SEC7�ION 7oDD)OF DIVISION 3 OF THE BUSINE59 AND PR6 . u' POOUSpB
. � FESSIONSCODt�OftTHATHEORSHEISEXEMP77HEREFROMANDTHEBA515FORTHEALLEOEDE%EMP• C7
V TK1ti.ANYVqL�TpNOFSECTION703t.6BVANYMPLICMJTFORAPERMITSUBJECT3THEAPPL�CANTTO Z RaAoof � .
A CNR GENALTV OF NO7 MORE THAN.FIVE HUNDRED DOlURS(f5ao).r
Z ❑4�SON7JEROFTTIEPROPERTY,ORAIYEMPIOVEESWI7H14A(3ESASTHEIRSOLECOMPENSAT%'7N, 0 Cwnmeroial .. � �
N7LL D0 7NE WORK AND hIE STRIKNRE IS NOT INTENDEO OR OFFERED FOR 9ALE(SEC.�7ou,BUSI- _J
� NESS AND FROFESSIONS CODE THE CONTMCTORS LICENSE LAW UOES NOT MVIY TO AN OWNEp OF j � .
PROVEHTY WHO BUILDS OR fMPROVES THEREON,M1D WHO DOES SUpi NOHK HU.ISELF OR HERSELF OR
CC iHROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUp/IIAPROVEMENTS ARE NOT plTENDED OR m .
Q OFFERIDFORSALEIF,/iOWEVERTHEBULLDINOORIMPROVEMEHT1550LDWRlUNONEYEAHOFWMPIE. .
Z T�ON,hfE ONRJER-BUILDER WILL HAVE TME BURDEN OF PHOVING THAT HE OR SHE DID NOT BUItD OR ,
� pdPROVE FOR THE PURP0.SE OF SALE� . . .
O 4�OMMER OF THE PROPERT;AM E%CLUSNELV CONT{UCTINO M/fTH UCENSED COPITRACTORS
� TO CONSTRUCT THE PROJECT(SEC.70s1.BUSINE55 AND PROFESSIONS CODE:THE.CONTMCTDRS�II' VelUatlon ADJ.AREA �
� CENSE UW DOES NOTMPLV TOAN ONTlER OFA PROPERTV WHO BUIlD3 OR IMPiiOVES 7HEREON,AND - � '
WHOCOMRACTSFORSUCHPRQIECfSWITHACONTRACTOR(S)LiCENSEDPURSUANTTOTHECONTRAQ qurwnrr DESCRIPl10N
Tqi�LICENSEUWJ. FEE �
� ❑�AA1 E%EAIVT UNDER SEC. �8.8 P.C.FOR TiIS REASON �
� U
u' o�re OWNER H
�Q UCENSED CONTRACTORS DECLARATION � w - - - �
CL I HEREBY AFFlRM UNDER PENALTY OF PERJURV THAT I AM�LICENSED UHDER PROVISION9 OF GIAPTER � ' � -
� D(COAIMENCWO WfTH SECTION 7000)OF DMSqN 70F THE BUSINESS M1D PROFESSIONS CODE,AND Z '
�� W LICENSE IS W FULL FORCE AND EFFECT. m
� UCENSE CLASS � C�� LIC.NO. (07 R�OI� � ' ..
wDATE�_Z �"�� CONTRACTOR d . . . .
� WORKERS'COMPENSATION DECLARATION Q � � - � � �
� � I HEREBVAFFIRM UNDER PENALtt OF PERNRY ONE OF THE FOLLOWWG OEQ:ARATIONS: � �
N . . . . . .. . . Z .
� � _IHAVE�AND.WILLMAINTAWACERTIFICA7EOFCON5EM70SELF-INSUREFORWOPo(ER5 � �
COMPENSATION,AS PROVIDED BY SECTION 3700OF THE UBOR QOOE,FOq TIIE PERPoRMAHCE U
OF T/¢WOqK FOR NM1iN:Li THIS PERMlT IS ISSUED. W .
� �
IHAVEANDWIILMAIMAWWORI(ER$'�COMpEN$AT�qdM3URANCE.ti^+REWIREDBYSECTION ��� /�
Q 37000F�THE 1A80R CODE,FOR THE PERFORAIANCE OF THE WOPo(WR WHICN THIS PERMR IS
�SSU�.MY�MDRKEAS'COMPENSA7IONINSUfiANCECMfUERMID.PQICVMIMBERAAE: CONSTRUCTION�
j c�wAiEa G�I P '� C /v ti/�A�(�� PLAN REVIEW
0Z ao��cr�eEa T� lnftY� S'l'��l.� L�_ ELECTRIC
¢
p" (n+ss�cita�N�rpTeE�TIDo�n�v�.+rsr�oaor+E�oavas(siao�oq� PLUMBING �
w
Z I CERTIFV.THAT IN TiE PERFORMAN O E WOPK FOR WHlpi 7HI9 PERMIT IS ISSUED,1 MECHANICAL
C7 SHALL NOT EMVLOY ANY 7ERSOH ANv Efi SO AS TO BECAME SU&IECT 70 THE �
(/� WDRKERSCOMPENSATIONLAWS CA� NIA�AIDA(iREETHATIFISHOUIDBECAME INSPECTIONFEE-
SUBJECT TO THE VlORKERS'COM ENSA7 I I PROVISIONS OF SECTION�7000F THE UBOH - -
O COOE,ISHALLFORTHWI7HCAM YWI� �OSEPROVSIONS. ISSUANCE � � ��
`p DATE: ��ZS'i I ZAPPIIC � �SMIP ��' .
i
� WARNINO:�FAILURE TO SECURE NfORKE PENSATqN COVEMGE 15 UNLAWFUL,AND.SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FP1E5 UP TO ONE HUNDRED 7i1WSAND ENERGY PERMIT
DOlUR3(t10D,000J,W AD01710N TOTHE CQST OF COMPENSATION,DAMAGES AS PFOVIDED FOR W O.
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYB FEES. �
w - RETENTION FEE:
o CONSTRUCTION LENDING AGENCY PRE-ALT FEE
� 1 HER�YAFFlRM UNDER PENALTY OF PERIURV 7HA7 THERE IS A CONSTRUC710N LENDWO A6ENCY �
Z �FOR TME PERFORMANCE OFTNE WOR)(FOR WHlq1 THIS PERAIR IS ISSUED�SEC.�30Y�,CIV.C.}
W •
� ��. LENDERBNAME . .. . . -.
1— LENDEfY$ADDRE55
�
W icErrr�vnuriw�veaawrHis�ra�ic,vror�,wosr�renurnie.�sovEwFoaM�raN�scor�ecT. TOTAL FEES � ��'1
� I A6REE TO COMPLV WITH ALL CT'AND COUNTY OROWANCES AND STATE UWS REUTW6 TO BUILDINO '
� CONSTRUCTION,AND HEREBY AUT1iOR1ZE REpqE5EN7ATIVES OF THIS COUH7Y TO EMER UPON iHE ' .
Z ABOVE-MEMqNEDPR07ERTYfORINSPECTIONPURPOSES. �COMMENTS �
� � �
_
m VERMI E NAM PRINn . � ( .
c� �[� ��Z
�/j �SIONA REOF ITT � DATE
� RECPT..NO. PAID BY VAUDATION
WHITE—Depanment Copy,YELLOW—Fmence Copy,PINK—Assessor Copy,GOLpENROD—F!e Copy,GREEN—Appl�anYa Copy
� . �:,.�
c��-v o� �i�nnon�o:B��: �:� ::.:.�:--�
INSPEC7'10�l�,��GB(Fi�1 '��`-'�. � -- `':'
ho � . � , z : . w _
� � , �, . ;_ . p, . � � D
„
e �° .v � o -• � o • : .�F;,� o o .�..
SET BACK 'FLOORJOIST 4
FTGS/FORMS/STEEL FHA REQMTS �
ELECTRIC GROUND UNDER FLQOR OUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE i FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING - 8 FT.BONQ BEAM
FRAMINGNENTILATION FIPIAL BOND BEAM
ROOF COVER �PRE-GRAOING
ROUGH HEA7ING I BENCHING _
ROUGH ELECTRIC �ROUGH GRADING
ROUGH PLUMBI�lG - FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SlDING �POOL FENCING
WALL INSULAT)ON �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. - -�z FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FINA�PLANING
FINAL E�IGINEERING . � `�
con�ME�vTs
SEPTICTANKSIZE
SEEP PITIU SIZE -
Y'
ri
i.
m k�, � . _
`�5 + 1'Y� _
�'���� - e — _
u
w r
`5� 'z .u.