HomeMy WebLinkAbout12-978 i �
�F�_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765
' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 SS
��'""". BUII..DING PERMIT APPLICATION FIRMLY
I o D RIESS v Gl I I-C I �C DATE CATION Q� /� PERMIT J�7 . �7 P) P/C
�� � NUMBER ( �� /1S �.
� APN LOT TRACT D TEE � Z � 2i CONST. � GROUP
p OWNER .
o ADDRESS ZONING SETBACKS
z CITY ZIP TEL. FRONT Ryy � .
� APPLICANT TEL. • REAR �
¢ , SIDE/SIDE STREET pVy p
� CONTRACTORL_!�I'1PlOs t3r��11�n�S ��LI'h '�q /n� SIDE �
Q ADDRESS �� ,
� CITY�PSe Pr;N ZIP 9'2�4t! TEL O SSZ� S PROPOSED USE I
w ARCWENG/T- i
z DESIGNER
a ADDRESS NO.DWEL NO. NO.
� C� ZIP TEL UNRS STORIES BEDROOMS
�
� DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION
Q . OWNER-BUILDER DECLARATION
p SFR/ADD/REM
Q 1 HEREBY AFFlRAI UNOFA PENALTY OF PERNRV THAT I AM FXEMPT FROM THE CONTRACTORS U- GaragelCarport � �
W (�7d5ELAWFORTHEFOLLOWWaREA50N(SEC.7ai1.6BU5P1ESSANDPROFESSqNSCODEANYClTYOR , (n
C� COUNTYNTi1G1RE0UIRE5APERMI7TOCONSTAUC7.ALTER,UAPROVE.DEMOLISH.ORREP�IAANYS7RUG W P8ti0/DBCk � .
�V NRE.PRIOR TD RS ISSUANCE,ALSO REOUIRES THE APPLICANT WR SUCH PEAMIT TO fILE A SIONED w
� STATEMENT 7HAT NE OR SHE IS LICENSED PURSUANT TO THE PqOVI510Ng�OF THE�CONTMCT0179 LL , _
� CENSE UW(CHAPTER e(COMMENCWO WITH SEC710N 7000)OF OIVISqN]OF 7HE BUSME59 AND PR6 . V" POOV$p8 �
. Q FESSIONSCOD�OqTHATHEORSHE�ISEXEMPTTHEREFROMAND7HEBASISFORTHEALIEOEDE%EMP• C7
V 710N.ANY V101�T10N OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SUBJECT9 THE AFPLICANi T0 . Z. R9-ROp( � . . .. . .
� A CML PENALiV OF NOT MOFE 7HAN FIVE HUNDRED DOLURS(t50o).): .
Z ❑I,ASOVMEROFTHEPHOPERTY,ORAIYEMPLOVEESWfTHWA6E5ASTHEIRSOLECOMPEN$ATIpN, � 0 (',pmlfl8fLM81 , _
N7LL DO THE WORI(AND THE 37RUCTURE IS NOT INTENDED OR OFFEAEU FOR SALE(SEC.7os/,BU54 J
� NESS AND PROFESS{ONS CODE THE CONTRACTORS LICENSE UW OOES NOT APPLY TO AN OWNEfl OF j ' - .
PHOPEHTY WFiO BUILDS OR IMPROVES THEREON,M1D WHO DOES SUCH WOqK FpA15ELF OR HERSELF OR �
W TH71LN10HHISORHEROWNEMPIOVEES,PfiOVIDEDTHAT5Up/11APROVEAlEN7SARENOTINTENDEDOR . m � .
� OFFEREDWRSALEIF,HOWEVER731EBUILDW�ORIMPROVEMQJTISSOLpVrtTlpNpryEYEAROFOWJPLE
Z TIDN.7HE ONTJER�BUIIDER WILL HAVE 7HE BURDEN OF PROVIN6 7HAT HE OR SHE DID NOT&1RD OR
� WPROVEFORTHEPURP0.5EOFSALE} � . . .
W ❑4�40WNEROFTHEPROPEHfV,AMEJ(CIUSNE�YCONTRACTWOWfTHUCHISEDOONTRACTORS
� TO CONSTRUCT THE PRQlECT(SEC.70��,BUSINE55 AND PROFESSIONS CODE THE CON7qACTOR3 LI- V8IU8�{Ofl� (��,(�R� '
CENSE LAW DOES NOTAPPLy TOAN OWNER OFA VROPERTV WViO BUD.DS Oq IMPROVE$7}�EREON,AND
WMOCONTRAC75FORSUCHPRO,IECTSWfTYIACONiMC70H(S)LICENSEDPURSUANfTOTHECONTRAG (��f�,JnTi DESCRIPTIDN �E
TORS LICENSE LAW.).
p ❑1 MI E%EMPT UNDER 6EC. B.1 P.C.FOq T){IS REASON �
� ' U
� DATE oNMER �F
� �
F, UCENSED CONTRACTORS DECLARATION � W� � � - � - - . �
� I HEREBY AFFlfW UNDER PENALiY OF PERJURY 7HA71 AM LICENSED UNDER 7ROVISION9 OF GV PTER � � � -- -
p� Y(COAIMENCWO W17H SECTION 7000)OF DMSION a OF THE @USINESS M1D PROFESSIONS CODE,IND Z . . '
X MY UCENSE IS M FULL FORCE AND EFFECT. � . � a v �
� IICENSE CLASS ` �� LIC.NO.:_O(� 7�7S �. w . .
Ww� ���f�i z corrraacroa Ei1 n�caS' (�ra��' a
� WORKERS'COMPENSAT�ON DECLARATION � � � - � � �� � �
� I HER�Y AFFIRM UNDER PENALTV OF VERJURY ONE OF THE FOLLOWWG OECIARAT10N5: U
� �
� _IHAVE�ANDWILLMAINTAINACERTIFlCA7EOFCONSENT703ELFaNSUREFORHqRKERS' . . . .
C0IAPENSATION,AS PROVIDED BY SECTION 370o OF 7HE LABOR CODE FOq THE PERPoFiMANCE �U�
OF THE WORK FOR NM111CH THIS VERMIT 5 ISSUED. �
�
_I HAVEAND WILL MAIMAW WORI(ERS'C�MVENSATION WgUqANCE A4 qEWqiED BY SECTiON
Q 370o OF THE LABOR COOE,WH 7HE PERFORMANCE�OF THE WORK WR WHICH TH15 7EHAlIT IS.
�SSUED.MY WORKERS'COMPFNSATION INSURANCE CAqpIER'AND POI,ICY I�qJ►1BER ME �CONSTRUCTION
jc�FlAiEa��pin�P/( PUNI REVIEW � _ . . .
�Z ao��cv r�eEq�_I�I S.3�I I 7� . ELECTRIC
Q
0 (irussFcnoNr+�r�meFoon�tFrIDacn�a�atirr�5waa�Msn�+mocuutspioo)oa�ssy �PLUMBING � .. �� . � .
w
� Z 1 CEHTIFV THAT IN THE�ERFOHMANCE OF THE WORK FOfi WFIICli 711I5 pERAIIT IS ISSUED,1 �MECHANICAL�
CJ SNN.L NO7 EMPLOV ANY PERSON W ANV MPNNER SOAS 70 BECOME SUB.IECT 70 THE� �- � �
(/) WORKERS'CAMPENSATION UWS OF CALIWiWIA,AND AGREE THAT IF I S/iOULD BECOME INSPECTION FEE -
S , SUB.IECT TO THE WORKERS COMPENSATION PROy1510NS OF S CTION 7o00F THE IABOR ' -' � ��
cooE•���n+ca+air�wnr��1�1�PRpVISqNS . � ISSUANCE
p DATE / APPLICANi: �rf �SMIP . . . . .� . .
W
J ENERGY P/C �
J WARNWO:FAILURE705EWREWORI(ERS'COMPENSA710NCOVEMOEISUNUWFU�,ANp9lML�BE
� SU&IECTANEMPIOYERTOCRIMWALPENALTIESANDCMLFWESUPTOONEHUNDREDTV�USMID - ENEROYPERMIT �
DOLLARS,(f t oo,000),W ADDI710N TO 7HE COS7 OF COMPENSATION,DAMA6E5 AS PROVIDED FOR IN
J SECTION 37oE OF THE LABOR CODE,INTEREST,ANDATTORNEV'S FEES. � ' '- � � -
� RETENTION FEEi �
w.
� . CONSTRUCTION�LENDING AGENCY � PqE-ALT FEE:
� 1 HEREBY AFFlRAI UNDER PENALTV OF PERIURY THAT THERE IS A Cd�$TRUCTION LENDINO A�ENCY
zn-' FOR 7ME PERFORMANCE OF 7HE WOPoC FOR WHtt]I7HIS PERAUT IS ISSUED�SEC.3oW,pV.C.).
W
��, LENDER'SNAME � �
F— LENDERSADDRESS - -
� ICEfRIFYTHATIHAVEREADTMI9APPLICAT10NµDSTA7ETHATTHEABOVEIHFORMATIpN19CORRECT. TOTAL FEES � -�'-f�Z.
� I A(iREE TO CqMPIV WI7H A�L CITV AND COIRfTY ORDMANCEg AND STATE UWS REUTWO TO
CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HIS COUN7Y TO ENTER U�OH �
ABOVE-MENTbNED PROPEF7Y FOR INSPECTION PURPQSES. � '
p COM.E TS '
-' A-1.� .� G���71.�
� PE E NM1E(PRltfn � ' . . . .
¢ .� �/YI � //z
v�
N SIO iU PERMIITEE —� DAT -
- RECPT.NO. P/UD B VNJDATION
WHITE-Depertment Copy,YELLOW—Flnance ,PINK—Assessor Copy,GpLpENROD—File Copy,OqEEµ—qppl{canra Copy
ClTY OF DIAMUND �AR
1NSPECTION RECORD �
� � g • • �; ' e ��'`' s-� • g <{~;� ` • �r�
�.
SET BACK � 'FLOQR JOIST .
FTGS/FQRMS/STEEL ' �FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUIJD PLUMBING i UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATIOId
TEMP POWER FIREPL,4CE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGN ELECTRiC ROUGH GRADING
ROUGH PLUMBING FINISN GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL IN5ULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEOICATIONS
SEWER FINAL ENG.
SEPTICTANK LAN05CAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST j FINAL ZONING
FINAL�ONST. �FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FlNAL
RNAL ELECTRIC i' � DEV,FEES PAID
FINAL PLUMBING -1 �� ,• y}�•' ENERGY
FINAL PLANING
FINAL ENGINEERING • � e
COMMENTS
SEPTIC TANK SIZE ;
SEEP PIT/U SIZE
,�, t ,
� �I r"