HomeMy WebLinkAbout12-596 _��_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY�&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765 ��
(909)839-7020 Fax(909)861-3117 Buildiag Inspection Hotline(909)839-7027 � PRESS
��''""� BUII.DING PERMIT APPLICATION � FIRMLY
'o N JOBSITE APPLICATION �J� t � PERMIT �� P/C
ADDRES � �• DATE NUMBER 1i
� ISSUE / TyPE p�C
APN LOT TR T DATE LJ CONST. GROUP
p OWNER
o ADDRESS C ZONING SETBACKS
Z CITY ZIP TEL. FRONT RW ❑
g APPLICANT TEL. C�• (,+ REAR 0
zd, SIDE/SIDE STREET RW ❑ -
� CONTRACT I' SIDE p
ADDR S � k D
� CIN ZIP TEL PROPOSED USE
o ARCFi/ENG/
z DESIGNER
� ADDRESS NO.DWEL. NO. NO.
� CITY ZIP 7EL UNRS STORIES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� �OWNER-BUILDER DECLARATION � SFR/ADD/REM �
O
Q 1 HEREBY AFFlRM UNDEA PEWLTY,OF PERIURV THAT I AM EXENPT FROM THE CONTMCTORS LL Garege/Carport
W CQISEUWFORTHEFOILOWINOREASON(SEC.703t.6BU51NE5SANDPROFE5S10N5CODEMh'CfTYOR (f�
V COUNiYWHIp1RE0UIRESAPERMIT7000NSTiiUC7,ALTER,I/JVROVE,DEMOLJSH:ORREPAIRANYSTRUC W
Z TURE.PRqR TO RS ISSUANCE,ALSO REOUIRES THE APPIICANT FOR SUCH PERMR TO FlLE A SIONED w P8[l0/DBGk '
w STATE4EHT TFIAT HE OR SNE IS IJCENSED PURSl1ANT TO THE PROVISlONS OF THE CONTRACTORS ll-
, �� CENSE UW(CNMTER Y(COMMENCWG WITH SECTIDN 70DO)OF DMSION 7 0F THE BUSVJESS AND�PR6 u- PooUSpe ' �
FESSIONSCOOt�ORiHATMEORSHEISIXEMPT7NEREFROMAt�THEBASISFORTHEALLEOEDE%EMP- (7
TIDN.ANYVIOLATIONOFSECTION7031.SBYANYAP7LIGNTFORAPERMITSU&IECT37HEAPPLtCANTTO Z. RaRool
� ACIVI�PENALTY OF NOT MORE TMAN FNE HUNDRED DOLLARS(i6ao)J: �
� ❑4�U^OWNEROFTHEVROPERTY,ORMYEMPLOYEESWlTHWAGESASTHEIRSOLECOMPENSATION, � (`,pmmBfClal
z WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.�7ou,BUSF J �
� NE53 AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT MVLY TO AN OWNER OF j
PfiOVEATY WIiD 9Uq,pg pq IMPROVES THEREON,AND NTiO DOES SUCi1 WpRI(H WSELF OR HERSELF OR
WTHAOUdHHI50RNEROWNEMttOVEES,PROVIDEDTHATSUCHIIAPROVE�IENT3ARENOTINTENDEDOR m �
0 OFFERIDFORSALEIF,IiOWEVER7MEBlALDWUORDAPROVEMENTISSOIDWfT19NONEVEAROFCOMPIE•
Z TION,THE�OWNER�BUILDER WILL HAVE TFIE BURDEN OF PROVIN(3 THAT HE OR SHE DtD NOT BUILD OR ,
� W PROVE FOR THE PURP0.SE OF SALE� , ' .
W ❑�,ASOWNEROFTHEPROPERTV,AME%CLUSNE�VCONTRACTINO�WffliIICENSEDCONiRACTOR3
CC TO CONSTRUCT TME Pi1WECT(SEC.7WA,BUSINESS AND PROFESSIONS COpE 711E CONTAACTORS ll- V81UatfOfl' (�a.qq� '
LlJ CENSE LAW DOE9 NOTAPVlv70AN OWNER OFA VROPERTV NM110 BUILDS OR IMPROVE9 THEREON,M!D ' �
� M'IiOCONTRACT5FOA5UCHPRQ1ECfSWfTHACONTRACTOR�S7L10EN5EDVURSUAMTOTHEGONTfUO QUANTITY DESCRIPTION
Toas ucFNSE uw.�. • FEE �
O ❑I IX 3EC. B.8 P.C.FOR TWS REASON �
� U
� DATE ONMER f-
z U
Q� UCENSED CONTRACTORS DECLARATION � �W � - � �
CC �HEREBY AFFlRAI UNDER PENALTV OF PEiiIU{iY 7HAT I AM�LICENSm UNDER PROVISIONS OF CHAFTEfi �
� Y�COMMENCPKi WIT}I SECTION 7000)OF DMSION]Of THE BUSlNESS AND PROFESSIONS CODE,M1D Z � �
XL� MY LICENSE IS W FULL FORCE AND EFFECi. m
LLI �� UCENSE CLASS LIC.NO. � � - .
U DATE '�' CONTRACTOR P d .
W
� WORKERS'COMPENSATION DECLARATION � �� � � �
� 1 HEqEBYAFFlpM UNDER PENALTY Of PERJURV ONE OF THE FOLLONRNG DECURATIONS: V �
C� Z
� �I HAVE�AND WILL MAINiAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' �
COMPENSATION,AS PROVIDED BY SECTION 3700OF THE UBOR CODE,FOR THE PERFORMMICE U'
OF 7HE WORK FOR WHICN THIg pERMIi IS ISSUED. W
� �
� _1 HAVEAND WILL MNMAIN WORKERS'�COMPENSATION WSURANCE;A$qEdUIRED BV SECTION � � �
Q37000F THE LABOFi CODE,FOR THE PERFORAIANCE OF THE WORK FOR WHlq/THIS PERMIT�3
LSSUED.MY WORKEAS'COMPENSATION INSURANCE CARRIER AND POLILY NUMBER ARE: CONSTRUCTION
jCAARIER PLAN REVIEW
� POIICV NUMBER . . . .
�d.. ELECTRIC
p (rwss��T�or+r�IDwis�oo�.�Tmo�n�a�rswaa��moawrsK+rolo�+�ss1 PLUMBING 6
w
Z 1 CERTIFY THAi IN THE PERFOPMANCE OF THE.WORK fOR WHICM THIS PERAIR IS ISSUED,1 MECHANICAL�
Cr} SFULL NOT EM7LOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT 70 THE� �
(/� WORKERS COA7PENSATqN LANS OF CALIFORNI �wn�oaEE nuT�i sHoucn eecoMe 'INSPECTION FEE�
S SUBIECT TO THE WOW(ERS'COM7ENSATION V NSIONS OF SECT70 3700 OF TNE tABOR � �
CODE,I SHALL i'OH7MNiH COUP�V WITIi � pqOVIS10N5. ISSUANCE
�
p DA7E�� pppl;ICq1dP. �SMIP
W
� WARNINO:FA9LRETOSECUREWOHKERS'COMPENSAT VE GEISUNLAWFUL,AND.SHALLBE ENERGY�P/C �
� SU&IECTAN EMPLOVER TO CRIMINAL PEN/�71E3 AND GVIL UP TO ONE HUNDRED 7HOUSAND �JEROY PERMIT
DOLLAA3(5100.000),IN ADDITION TO THE COST OF COMPENSATqN,DAMA6E5 AS PROVIDED FOR W
J SECipN37olOFTHELABOR CODE,INTEREST,ANDATfORNEYSFEES. � ' O
w RETEMION FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDER PENALN OF PERIURY iHAT THERE IS A CONSTRUCTION LENDWO AOENCY
�- FOR THE PERFORAIANCE OF hIE WORK FOR WHICN 7MIS PERMIT IS ISSUED�SEC.3ou7,CIV.CJ,
Z
W
LENDERSNAME __ '
�
� LENDER'SADDRE55 � -
�� ICER7IFYTHATIHAVEREADTFIISAPPLICATIONANDSTATE7HAT7HEA80VEINFORMA710N19CORRECT. TOTAL FEES� �� ��
w 1 AIiREE TO COMPLV WITH ALL qT'AND COlN1iY ORDWANCES AND STATE UWS RELA7IN�Tp BU¢.DINO
� CONSTRUCTION,AND HEREBV AU7HOARE FEPRESENTATIVES OF 7HI5 COUNTV TO ENTEH UPON THE -
� ABOVE-MENTIONED PROPERTY FOR INSPECTION WRPQSES.
Z
o � COMMENTS "
J'
�
m PE NAME(P ' .
Q
� �
(/� O P DATE
� RECPT.NO. O pq�p gy VALIDAl10N
WHITE-Deparpnent Copy,YELLOW--Finarae Copy,pINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Appl{caM's Copy
CI�Y OF DI�►IUIOND B�►R
IIVSPECTION REC4RD
�,� ���� � �, �-�� p ��� �;�� � p � � p � �. • 0�'s
r-
SEf BACK FLOORJOIST
FTGS/FORMS/STEEL FHA REQPATS
ELECTRIC GROUND UNDER FLOOR DUCT • • �
GR�UND PLUMBING UNDER FLOOR CONUUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM __ _
ROOF COVER PRE-GRADING
ROUGH HE,4TING BENCHIIdG _
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SNOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOI FINAL
CEILING INSUTATION �OFF SITE IPAPS.
DRYWALL NAILIPIG I DEDICATIONS
SEWER FINAL ENG. __
SEPTICTANK ' ' LANDSCAPE/IRRIG.
SEEP PIT/L.L. Otd SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL C�NST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC .+ ;' j DEV.FEES PAID
FINAL PLUMBING � � + � � ,� �� ��� ENERGY
FINAL PLANING ' i �`'�.. — —
FINAL ENGINEERING ' • � _._
COMME�lTS
SEPTICTANKSIZE
SEEP PIT/U SIZE
�,
�� �� �