HomeMy WebLinkAbout12-575�i ^ J�� CTTY OF DIAMOND BAR � V
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES V
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(9({9)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'������W BUILDING PERMIT APPLICATION FIRMLY ,
I o DDRESS G(J k � $ �. APPLICA N n PERMIT P/C I
DATE �� ` NUMBER Z'✓�� # �2 \a-S�1
� ISSUE TYPE OCC
I .- APN LOT TR CT DATE CONST. GROUP
� OWNER
� ZONING SETBACKS
o ADDR SS FRONT RW ❑
oCITY Z� TE REAR ❑
o APPUCANT �CO e TEL. SIDE/SIDE STREET RW O I
¢ SIDE ❑
� CONTRACT R �C�
� ADDRESS PROPOSED USE
� CITY ZIP TEL �' � • S
w ARCH/ENG/.
z DESIGNER . NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES �BEDROOMS
� C(7y ZIP TEL.
N DESCRIPTION S�.FC FACTOR PSF ADJ.AREAlVALUATION
� �OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HER�V AFFlRM UNDEA GENAL7V UF GERAIRV THAT I M1 E%EMPT FROY THE CONTMCTO0.5 LF Gara9e/CarpoA
W CFNSEUWFORTHEFOLLOW�NaREA�ON(SEC.7N1.6BUSWESSM1��FiOFESSION5000E:�M'G7YOR (n .
C� COUNTYNMlUiRE9UlFYE3A9ERMR7000NSTRUCT.I�L7EA�PAOVE.OELtOL15H.ORREPNAAN'lSTfiUG W Pyti0/D9Ck
LL� NRE,PR10H TO�RS GSSUANCE.�LSO REOUIRE3 7HE APPLICMrT FOH SUC1i PERMI7 TO FRE A SIONED �w
� S7ATEYENT 7HAT HE OR SHE IS LICENSED PURSUANT 70 TFIE PROVISIDNS�UF TNE�CONTRACTOR9 LL LL ppOVSpB
� CEN9E UW(CHAP7ER Y(COMMENCwO WI'M SECiqN�oob)OF DIVISION 9 OG iHE BUSINE59 AND PR6
Q FESSIONSODD�OATHATHEORSHE�ISFJCEMPT7MEHEFFOMANDTHEBASISFORTHEALLEOEDE%EMP•
V 77pM.ANYVqLA710NOF5ECT10N7U31.eBVANYMPLICNfTFORAPEN.IIT$UBJECTSTHEMPlIC1NTT0 Z RgR00�
� A CML PENALI`/OF NOT MORE T}1AN FNE HUNDRED DOl.URS(_`+�)�):
O ❑I.ASOWNEROF.THEPROPERTV.ORYYENPLOVEESWITHlVA0E5ASTHEIRSOLECOMPENSATION. � (',pm/�BfCIaI �
Z V/ILL DO THE WOiYK.AND TNE 9THUCTUAE IS NOT INTENDEO OR OFFERED FOR 3ALE lSEC.7Du,BU51� J
� NESS ANO PROFESSIONS CODE THE CONTiUCTORS LICENSE UW pOES NOTMVLY 70 AN OWNER OF � .
P{qpE{If`/NM1pBUILDSOHIMPMVESTHEREON.ANDNMO00ES5Uq1WORKHIMSEIFORHERSELFOR m
Q 71UlOUGH WS OR MER OWN EMPLOYEES,PROVIDED 71iAi SUCH IMPROVENENTS ARE NOi RJTENDED OR �
W OFFEREDPoRSALEIF.HOWEVER7HEBUILDWOORWPROVEMFNTISSOLDWfT/11NONEYEAROFCOMPLE
0 TqN,THE�OWNEA�BUILDER WILI HAVE THE OUR�EN OF PROVW6 THAT HE OA SHE DIO NOT&IIID OR �
Z MPROV£FOR THE R1f1P0•`.E OF SALEI. .
_ ❑I,ASONMEROF7HEPROPEHfV.'IUIFXCLUSNEIYCONTFiACTWOWITH�K�NSEUCOAf1fUCTORS � � � �� •
� TO CONSTRUCT THE 9RAIECT(SEC.7oU,BUSINESS AN�PFtOFE5510NS CODE:iHE CONTRACSOFl.4 L�- V81UHl{ AD,I.AREA -
� CENSE LAW DOES NOTAPPLV.TO AN OWNER OFAPROPERTY WHD BULD$OR IM7ROVEs TMEREON,AND
W/qCOHfRACTSFOR9UCHPROJECTSWITIACOHTfiACTOR�SILICENSEDPURSUANfTOTHECONTAAG Q�J(NJ7�7y DESCRIPTION FEE .
70A5 UCEN50 LAW.).
O ❑1 MI E%EMCT UNDER SEC. B.6 P.C.FOR THIS REASON U �I
� � ��
� DATE � OWNER . . . . . . U +
Z . .. . LL� � . . . .
� UCENSED CONTflACTORS DECLARATION
Qd w
I HEREBV AFFIRM UNDER PENALTI'OF PERfURV TFIA7IAM LICENSED UNDEH PpO�ISIONS OF CHAPTER �
d Y(COAtldENCWO WITM SEGTION 700D)OF DNISION 7 OF THE&151NESS AND PROFESSIDNS ODDE,AND Z.
X MY LICEN9E IS W FUL.L FORCE AND EFFECT. m
W p
� UCENSE CLApSS$�d/�L_ LIC.NO..� o�� �� � �
V DATE��O��Z . CONTRACT d - �
W
� WORKERS'COMPENSATION DECLARATION � �
� U
N 1 H£ii��AFFIA►i WiDER PENAL7V OF PERNRV ONE Of TF1E FOLIOVJWG DECLAMTIONS: Z
� _1 HAVE AND WILL WUNTPIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR W WiKEfIS' �
Q CpIdpENSATION,AS PROV�ED BV 6ECT10N 3700OF THE LABUF CODE.FOR THE PERFORMANCE W�
pF 1}(E WORK FOR WHK]i THIS PERMIT 19 ISSUFA. �
� �/�
w ��/(HpV6 ANp WILL MAINTAIN wORKEii3'�COMPENSATqN MSURANCE.AS REOUIRED BV SECTION
Q Z ]700 OF THE L180R CODE,fON THE PERWHMANCE OF 11iE WORK FOR WHId1 THIS VERMIT IS S�S a��
0 ISSUED.M�VW1ORNEA�S'�GOAIPENSAT INSUFiANCEC�MFiIER�AND.POLICYNUMBERME: CONSTRUCTION�. . . . . � -.
� c�wEa'�•e.I[.� G lf �Q.�IG0.Y1 PLAN REVIEW 4'`,�.� S
>
Z vo��cr rai�aeEa d� ELECTRIC ��•�e } ��'
Q PLUMBING
� (IHI9SECtioNN�No7BE00MPtEr�OFi1$aFf0Art6FORONEF#x�oR�OoluRsRlooloqlEssl , . ,
W I CERiIFY THAT M THE PERFOfU1ANCE OF iHE.WOW(FOR WHICM 7HI9 PERMfT IS ISSUED,I MECHANICAL
Z
� SHALLNOTEAI7LOYANYPERSONWANYMANNERSOAST06EWME5UeJECTTOTHE iNSPECTIONFEE
� WORKERS COM7ENSATION LAWS oF CALIFORNI AGREE THAT IF I SHOULQ BECDME . . . . .
S 6UBJEC7TO7HEWONCERS'COMPENSATION V�5 OFSECT10N37WOF�ELABOR � �
CO�E.151uLLFORTM`ATHCW�PLY�n n1 EPROVIS 5. ISSUANCE
G / f
p oa�.�d����2 nP�tcarlr��..�Y .SMIP
w ENERGY�P/C
� WAANINO:�FAILURE TO SECURE WOAKEAS'COMPENSATIbN COVEMGE IS UNUWFUL.AND.SHN1 BE '
� � S110.lECTIJ�EMPIOYERTOCPoNWALPENALTIESANDGVILFlNE3UPTOONEHIAl�REDTFKKJSAND ENERGY PERMIT
DOlLAR3(t10D.00D).�N ADD�TION TO THE COST OF COMPENSATION.DAMAQES AS PRONDED FOR IN � � �
� 6ECTION 37oe OF 7HE LA90F7 CODE IMEfiEST,ANO ATfORNEYS FEES. ' RETENTION FEE: .
a' CONSTRUCTION LENDING AGENCY P6F�h-AL��
� I'/
� 1 HEREBY AFFlRM UNDER OENALTV OF PERIUflY THAT THERE IS ACONSTRUCTION LENDINO AOENCY
�FOR 7HE PERFORMANCE OF�TNE WORK FOP N?i1CH i/H9 DERMR IS ISSUED(SEC.10c7,QV.C.�.
Z '
W
�� IENDERS NAME . .. . . .
� LENDEWSADDRE53 . �S � •
� �ICEHTIFYTHATIHAVEREADTHI9APPLICATIONANDSTATEh1ATTHE�BOVEINFOM/AT1ON19CORRECT. TOTAL FEES `}', � � •�
w IA4REETOCOMPLVWITHALLCRYIWDCAUHTVORDWANCE5�11DSUTEUW9HEUTWOTOBURDWO �
�" CONST1iUCf10N,AND HEREBV AUh10H�ZE REPRESENTATNES OF THLS COUNTV TO ENTER UPON iHE 1� • O�
Z /�BOVE�►�ENT�DNEDPROPER7YFORINSPECTIONWRPOSEB � COMMENTS '
0
J � Ez�cc=r \\ ��-'s- ��q�t..o �_
PERM NAME�P '
�' g•�Z P(� �o �o ��- - .
vj NANREOFPEPMITTEE �TE
RECPT.NO. I I � � PAID BY VALIDATION
� "WRITE--Deperdnent Copy,YELLOW—Flnence CoPY.PINK—Asseua Copy.GOLDENROD--FfIe Copy.GREEM—AppllcanYs Copy
cir�r o� �iannor�� �aR
INSPECTIOM RECORD
., y . .
..1 � e . . e � '� ; p � -o �,, ` er Q ,,�,,, e„� p .
} e
. . � . ,
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL _ • _ � ^___ � FHA REQMTS . .
E�ECTRlC GROEIND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUIJOATION
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-GRAOING
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC ROUGH GRAD(NG
ROUGH PLUMBING FINISH GRRDING
SHOWERlTUB TEST AOOL ELECTRIC
EXT.LATH/SIDlNG POOL FENCIPlG
' WALL INSULATI�N POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
" SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L ON SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEAITH DEPT.FINAL
FINAL ELECTRIC DEV.fEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING ' � p _ �
COMMENTS Ccti+s s • ��
�.
i _
��
�. -��e,� �`
SEPTlCTANKSIZE
SEEP PIT/U SlZE --
7
`�� ,�. `{
_r' � � f}^2 .d __
��� =Y�r;�� �4*.
l
3
�
I