HomeMy WebLinkAbout12-496 , — —
�.- _, _. �� CITY OF DIAMOND BAR �� ��� ��`
� DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES
�w . 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
\�'^"'� BUILDING PERMiT APPLICATION . FIRMLY
o� JOBSITE ( 2 Q�f S• l� n._• s�� DATE CATION C���i7� NUMB R � ' ` #/C �� L [
ADDRESS ✓U � �iGYrW �
� APN �y���� ��TRACT �` ISSUE � Z/ TYPE OCC
=�-H�� DATE CONST.� GROUP
p OWNER _C��VL �r.�,�K,1�.—��2j1/1
ADDRESS �3�� S L�MA-� ,�� ZONING SEfBACKS
Z ciTv D`- rtAR ZIP i TEL.��J�'�I"-5�`,?5�2. FRONT qyy �
, p APPLICANT J-�ItN i S�✓►�T� TEL. IZ� / REAR �
zd �/ SIDE/SIDE STREET RW. ❑
� CONTRACTOR I�RI'�CN T S 6'.t/{-3'� /E�J SIDE �
Q ADDRESS j 4'�� (����}►�/ ,���.
� CITY�p� ZIP 4l?.�'L TEL (�a"Les 9�,��75I PROPOSED USE i�
w ARCH/ENG/ l
z DESIGNER fi T ' ' ' -
►u ��., � w NO.DWEL. NO. NO.
a ADDRESS E�l�(,�.� `hi.
N C�TY '�iSi� ,��a� ZI TEL UNITS � STORIES � BEDROOMS
� �,.
� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATiON
Q OWNER-BUILDER DECLAAATION �� SFR/ADD/REM
O
p I HEREBV AFFlRM UNDER PENALTY OF PEA0.IRV 7HAT 1 AM EXEMPT FAOA1 T{E CONTMCTORS L4 Garage/Cerport
W CENSEUWFORTHEFOLLOWINOREASON(SEC.703t.5BU5WESSANDPROFESSIONSCODEN1YqTVOR . (n
C) OOUNTVNTi1CMREWWESAPERMITTOCONS7AUCT,ALTER,IMPROVE,DEMOlISH,ORRE7A7HANYSTRUG patt0/DBCI(
w TURE,PRIOR TO�RS ISSUANCE,AL50 REOUTAES THE APPLICAN�FOR SUCH PERMIT TO FlLE A&ONED w �
� STATfMENT THAT NE OR SHE IS LICENSED PURSUANT TO THE PROYISIONS OF THE CANfMCTOR3 L4 .. .
CENSE UW(CHAP7ER Y(COMMENCINa VATH SECTION 7Doo)OF DIVISION 3 OF T1E BUSiNESS AND�PHO� � Pool/Spa �
HO
_ � FESSIDNSCODE�ORTHA7HEORSHEISE%EMPTTHEREFROMAND7HEBASISFORTHEALLEOEDE%EMP- (�
V TKIN.ANY.VIOLA710NOFSECTION7o31.6BVANYMPLICANTFORAPERMI75U61ECT97HEAPPLICANT70 Z q�R00f �
A CML PENALiV oF NO7 AIORE TTIAN.FIVE HUNDRED DOLLAHS(iSOD).);
� ❑I,A40NMEROFTHE�PROPEHN,ORMYEMPLOVEESNTTHWAGESASTMEIRSOLECOMPENSATION, O COAIlfl8fCi8I�
Z WILL DO THE WOAK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,BU54 _J '
� NESS AND PROFESSIONS CODE TYIE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN ONTIER OF � - -
VROPEHfY W1i0 BUILD9 OR IMPROVES 7HEREON,M1D NM1io DOES SUq1 WOf1K HIMSELF OR HERSELF OR �
W� TIWOU(i11HISORHEROWNEMPLOYEES,VROVfDEDTHATSUCHIMPROVEMENTSARENOTpfTENDFDOR m
0 OFFERmPoR5ALEIF,HOWEVERTMEBU9.DINOORIMPROVEAIENTIS50LpWfTHINOryEVEAROFCOAIPLE-
z TION.THE�OWNERAUILDER WILL HAVE THE BURDEN oF PHOVIN(3 THA7 HE OR SHE DID NOT BUILD OR . . ,
� IMPROVE FOR THE RIRPOSE OF SALE).
(yJ ❑4�ONMER OFTHE PROPERTY,AM E%CLUSNELV CANTRACTINQ WffH�ICENSED COHTRACTORS
CC TO CONSTRUC7 THE PRQ1ECf(SEC.7oN,BUSINESS AND PHOFESSIONS CODE THE CONTMCTbR9 LI- V01U8tIOf1 ADJ.AREA. �
��� CENSE LAW OOES NOTAPPI.V TOAN ONTlER OFA PROPERT'WH0 6ULDS OR WPROVES THEREON,M!D ' �
� NTIOCONTMCTSFORSUCHPR0.IECTSWITHACONTMCTOR�S)UCENSEDPURSUANTTOTHECONTMG q�qN7�7Y DESCRIP'fION
roas uc�sE uw.�. �E .
� ❑1 AM IXEAIP7 UNDER SEC. B.8 F.C.FOR THIS REASON Q C.j I� J • �
U
� DATE ONMER ' �H
Z . � . � � („)� I`
�Q LICENSED CONTRACTORS DECLARATION � w � � -
2 �•
1 HEREBY AFFIFiM UNDER PENPLTV OF PERIUFY THAT IAM'LICENSED UNDER PqOVIS10N5 OF CHAPTER
� i(COMMENGNO WIiH SECTION 7000)OF DIVISION 7 OF THE BUSINESS MID PROFESSION.4 OODE,AND Z ��
��� MY LICENSE IS M FUl FORCE AND EFFECT. �
� UCENSE CLASS �_ LIC.NO. ����)�� , ,
U �T� I��� ' �fCI� CONTRACTOR �P�1 I'S�Vr�''S LI� d . . .
W .
� WORKERS'COMPENSATION DECLARATION � � -� � - �
� 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF iHE FOLLOW WG DECIAAAT10N5: V -
C� �� Z
� '�' I HAVE AND WILL MAINT/UN A C6RTIFICATE OF CWJ$EM TO SELF-INSURE FOR W'ORKERS = � - -
CONPENSATION,AS PROVIDED BY SECTION 37000F TME LABOR CODE,FOR T}IE 7ERFORAIANCE W�
OF THE WORK FOR WHICFI TMS PERMR IS ISSUED. � �
�
� _I HAVE AND WILL 1.WNTAW.WORKER3'COMPENSATION INSURANCE;0.5 pEpUqiED BV 5ECT10N . .
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHipi THIS PERNR IS �r'C�p
ISSUED.MY WORKEAS'C1OMPENSATION INSURANCE CARRIER-AND POLICY NUMBER ME: �CONSTRUCTION�. � U
j CAARIER�S� T�CD PU1N REVIEW
� POLICV NUMBER OU.2�, ,�� - . . /,�
Zd. ELECTRIC �,�
o (n�sEcrqrir+�wreeoon�rmocnfvaurrswaa��oou.wsls�oo)oatFssl PLUMBING _ - �j
w
Z 1 CERTIFV T1iA7 M THE PERFORMANCE OF THE WORK FOR W1UCli THI9 PERA/R LS ISSUED,1 MECHANICAL
CS SHALL NO7 E/A7LOV ANY PERSON W ANV MANNER 50 AS TO BECOME SU&IECT TO THE � �
(/J WORKERS'COMPENSA710N UWS OF CALIFORN10.M1D AOREE THAT IF I SHOULD BECOME �NSPECTION FEE
S SUAIECT TO THE WOPoCER5 COMPENSATION PROVISqNS OF SECTION�7o00F THE UBOR - -'- ' �
COOE,1 SHALL FORTHWlTH COAIPLY WITH 7HOSE PROVISIONS. ISSUANCE
� �� �/�1��'-�1 �
p ��: APPLICANL /� �SMIP f
W
� WARNINO:�FA4LRE TO SECURE WORKEiiS'COMPENSATION COVEMGE IS UNUWFUL,AND SMALL BE ENERGY�P/C . �
� SUB.IECT AN EMPLOYER TO CRtM WAL PENALTIES AND CMl FW ES UP TO ONE HUNDRED h10U5AN� EryERGY-PERMIT
JDOLLMS(t10o,0a0j,W ADDIT70N 70THE COS70F CAMPENSATION,DAMAOES AS PROVIDED PoR IN I
SECTION 37aE OF TNE LABOR COD�INTEREST.AND ATfORNEY'S FEES. � � '
W RETENTION FEE: C�
� CONSTFtUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFlRM UNDER PENALTY OF PE0.IURV THAT THERE IS ACON3TRUCTION LENDINO AOENCY ��,��j
-FOR TME PERFORMANCE OF THE WORK FOR WHICH THIS PEPoAR IS ISSUED(SEC.3087,CIV.C,�. J�
Z
W
�� LENDERSNAME , . . . . .
� LENDERS ADDRE55 - � �
� TOTAL FEES yS �• 7 l Q�'� �
� �1 CERTfFY THAT I HAVE qEAD THIS MPLICATION AND STATE THAThiEA80VE P7FORMATION IS CORRECT.
w 1 AQREE TO COMPLY N7iH/il.l,CITY AND COUNTV OqDWANCES AND STATE UW$REUTINO TO BUILDINO
� CONS7RUCflq{ANp HEREBV AUTHOWZE REPRESENTATIVFS OF THIS COUHTV 70 ENTEH UPON iHE
Z ABOVE-MEN710NED 7i�PERTY FOR INSPECTION 7URP0.SES �
o COMMENTS
J
�
m PEAMI7TEE NAME(PRI/(T) '
Q
�
�J SIONAiURE OF PERMRTEE DATE
� RECPT.NO. PAID BY VALiDATION
WHITE-0epenmenl Copy,YELL0IN--Finence Copy,PINK—Assessor Copy,GOLDENROD—Fle Copy,GREEt�Appl(canYs Copy
ciTv oF �sanno�� BaR � �-1 .
Ii11SPECTl011! Rf COR�
� � v
'� � � 0 � " Ct � 1 ;o __ '> � ��� ` :� p: - � �„�,o �• � � � � _� - �
, ,�,_�,�:
_ ��. , . _ , o , a
SET BACK FLOOR JOIST
fTGS/FORMS/STEEL ��
_______� __ FHA REQPATS
ELECTRIC GROUND UNDER FLOOR DUCT •
GROUND PLUMBING UN�ER FLOOR CONDUIT
SLAB GRADE S� �Z FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM.
WATER SERVICE MID HT.BOND BEAM � .
ROOF SHEATHING I 2 d�r2 8 FT.BOND BEAM
FRAMING/VENTILATION �?.o I L fINAL BOND BEAM �
ROOF COVER PRE-GRAQING �
ROUGH HEATING ,r BENCHING
ROUGN ELECTRIC Z ,, ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION ' POOL FINAL
CEILING IlJSULATION j OFF SITE IMPS.
DRYWALL NAIUNG I.� l2, �DEDICATIONS
SEWER �FINAL ENG. `
5EPTIC TANK LA-NDSCAPEII RRIG.
SEEP PIT/L.L. OI N SITE IMPS.
GAS AIR TEST .r`, FINAI ZONfNG
FII`!AL CONST. �,� fIRE DEPT.F�PJAL
FINAL HEATING • HEALTH DEPT.FINAL
fINAL ELECTRIC � � � DEV.FEES PAID
FINAL PLUMBING /2 ' � . ;'^' EMERGY
FINAL PLANING �
FINAL ENGINEERING . `� B
�
�OMMENTS —c�� ��, '�� ��= �; ! �__; a 2 �'�
�2 � c� ���4��
t ' �
., 1;.
SEPTICTANK SIZE
SEEP�PIT/U SIZE -
t