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HomeMy WebLinkAbout12-1355 (6) r _,. _��__ CITY OF DIAMOND BAR � • DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspect'son Notline(909)$39-7027 FIRM Y ��•��'� BUILDING PERM[T APPLICATION I � JOBSITE � I ,/n� C��n � APPLICATION , p �L �L PERMIT I�-(2�CP/C o ADDRESS `D1 DATE ^ NUMBER � •� �# `r APN LOT TRACT DATEE ` v �v t Z CONST.�D GROUF � OWNER � � _ ZONING SEfBACKS o ADDRE S � FRONT RW ❑ Z CITY ZIP TEL - REAR ❑ o APPLI ANT TEL. SIDFJSIDE STREET RW ❑ z SIDE ❑ � CONTRACTOR Q ADDRESS PROPOSED USE O ��-ry ZIP TEL Gl '� i�'1� w ARCWENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS S70RIES BEDROOMS � CITY ZIP TEL. N DESCAIPTION SO.FT. FACTOR PSF ADJ.AFiEANALUATION cr� � OWNER•BUILDER DECIARATION SFWADD/REM O 1 MEREBV AFFlRM UNDER PENALTV OF PERAIFY THAT I AN E%EMPT FROM THE CONTMCTORS Lb G8f390JC9fPOf1 �W CENSEUWFORTHEFOILOWIN�REA50N(SEC.7m1.58U51NE5SAN�PROFE5510N5CODEM1YC17YOR (n . ZCOUNryVMK]iqEq11RESAPEAMITTOCOW3TiiUCT.AITEAW➢ROVE.DEMOL15H,oRREPAIFANI'STRUG W P0110/DOCk w NRE,7RIOR TO RS ISSUANLE,AL50 AEOUIRES THE APPLICAM FOH 3UC11 PERMIT TO FlLE A SIONEO w � STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTiUCTOR9 l4 {L POOUS e � CENSE UW(CHMTER 0(COMMENqNG WfTN SEC'f10N 7D00)OF DIVISION 7 OF T1E BUS1NE55 ANO PRb � P O FESSqNS COOE)OP THAT HE OR SHE IS E%EMPTTHEREFROM AND THE BASiS FOR THEALLE6ED EXEMV- V TqN,�T10N OF SEC�ION 7oJt.s 8Y M7Y MPIICANT FOR A PERMiT SUalECTS THE APPLICNJT T0 'Z R0-ROOf � ACML TY OF NO7 MORE 7HAN FNE HUNDqED DOLUAS(S6ao).}. - Q ASOWNEROFTNEPROPEHTY.ORMYENPLOVEESWITHLVAGEShSTHE1R50LECOMPENSAi�ON. � COrtIRIBlCI21 Z yA DO THE WORK AND THE STRULNRE LS NOT fNTEN�ED OR OFFEREO FOR SALE�SEC.70�a,BU56 J � NE55/JJD FROFESSIONS CODE:TME WNTAACTOAS UCENSE UW OOES NOT A➢PLY TO AN ON�NER OF � PROPEHrI'M/IIOBUIL0.40NiM7FiOVE57HEREON,ANDWMODOESSUCHWONKHIMSELFORHERSELFOR m Q 71/fiOUGHH190RHEROWNFJ�I�LOYEES,PROVIDED7NATSUO/1MPROVEMENTSAREtJOTWTENDEDOR QOFFEREDibRSALEIF,HOWEVERTMEBUIDINCiORNIPROVEMENTIS50lDN1fTM�NONEYEAROFCqMPLE- Z TpN,THE OWNER$UfLDEFi Y(lLl1UVE TNE OUR�EN OF PROVWCl THAT ME OR SNE OIO NOT HURD OA = WPROVE FOR THE iVRP0.5E OF SALE} ❑I,AS OWHER OF TNE 7ROPEHTV,AA1 E%CLUSNELY CANTRACTINU WR77lICENSED CONiRACTOfLS Q TO CONSfRUCT THE PRQIELT(SEC.7os�,BUSINE55 AND PAOFESSIONS CODE:THE CONTAACTORS IJ- V81U3tI0f1 AQI.ARF1� � CENSE uW DOES NO7A7PLY TOAN OWNEA OFA PROVERTV WMO BUhDS OR IMPROVES THEREON,AND NM1qCONfRAGTSFORSUCNPRQIECT9WfTHACONTRACTOR(S)LICENSEDPURSUANTT07HECONTMG Qu,nNnTr DESCRIP7�ON FEE - TORS LICENSE UW.). J � D��E%EMPT UNDER 6EG 8.8 P.G FOR T195 REISON U � � � DATE ONRJER .�_�� r • Z W � LICENSED CONTRACTORS DECLARATION -� � � W 1 MER£BY AFFlRM UNDER PENALTY OF PEFUURY THAT 1 AM LICENSED UkDER PROVISlONS OF CHAPTER � d G(COMMENGWOW1IHSECTION'lOOD)OFOMSIONJOFTHE9VSINESSANDPROFESSIONSCODE,AND � X W LICENSE IS W FULL FOPCE AND EFFECT. . m u� � � UCENSE CL4SS IIC.NO. � V OATE CON7RACTOR d W � WORKERS'COMPENSATION DECtARATION -� � U � I HER�V AFFIRM UNDER PENAIN�F GERNflY ONE OF T1iE FOLLOW WG DECIAAATIONS: � ZQ . 0 I/UYEANDWILLMAINTAIHACfATIFICATEOFCONSEMTOSELF�INSUREFORMARf(ERS �S � COMPENSATION.AS PROVIDED BY SECTION 77000F THE UHOR COD�FOA THE PERFCRA/ANCE W . OF TNE WOiiK FOR WHICH THIS PERAtlT IS ISSUED. � g O w 1 FUYE AND WILL IM�NTAIN WON(EAS'COMPENSATION�NSUHANCE�AEWIRED BY SECTION h Q ]70o OF TME LABOA CODE,FOfi THE pERfORM/�NCE OF THE wOPo(FOR VtH10111i15 PEFMit�S ��V� tSSUED.MY WOH!(ERS COA/PFJ�SATI�N�NSUfVNCE CARRIER AI�POIK:Y NUMBER ME: CONSTRUCTION jCAA{UER PLAN REVIEW � P0�1Cv NUMBER ELECTRIC "'�3 (IF�45ECfqNt�NOTBE00APlEfEpOFhIEpER�,t�ISFOqp�EFU�Di7Epp�If+�lOqlE551 PLUMBING � � � a �- l 1 W I CERTIFV THAT W THE 7ERFOHMANCE OF TFiE WOfU(FOH WMICM 7H1S PERMIT IS ISSUED.1 MECHANICAL — Z L•} SNA(1lqT EMPLOY MfY PERSON W AM'MANNER SO AS TO BECOME SV&lEC7 TO tNE �NSPECTION FEE � YNDRNERS CAMPENSATION U'NS OF CAIIFORNIA AND AGREE THA7IF I SMOULD BECWaE 9 � SUBIECTTOTHEWORKERS'CO�A7ENSAiIONPROVISIONSOF5ECT10N97WOFTHELABOR �SSUAHCE �� � ` � - � COOE 1 SHNl FORTHYVITH CO�PIY WITN'iHOSE PROVISION5. • � O SMIP p DATE: APPIICANT�. . � w ENERGY P/C � WARNIN(3:FALLRE TO SECURE WOHKERS f:0A1PEN5ATpN COVERAGE IS UNUWFUL.AND SFUIL BE � SUBJEC7 AN EMPLOVEH 70 CAU/WAL PENALlIES ANO C7ViL FlNES UP TO ONE HUNDRED TTIOUSMID FJdERGY PERMIT DOLUFiS(S1ao.000),W ADDI710N TO THE C0.5T OF COMPENSATION,DMUGES AS PROVIDED FOR IN O J 6ECT10N 3T0!OF THE 1I80R CODE lNTEiiEST,ANO ATTORNEYS FEES. ' RETENTION FEE: � � O . CONSTRUCTION LENDING AGENCY �E-ALT • y � �� 1 � 1 HEREBY AFFIRM UNDEN VENtl'fY OF PEKIURV 7NA7 THERE IS A CONSTRUCTION LENDIN6 AOQlCY �7 , z FOR TME PERWMNNCE�f THE'NOHK FOR MMlp/TM�B PERIA�T IS ISSUEO(SEC.7CY7.C�V.G.I� W �Z IENDEHSN.WE r F-� IENDER'SAD�RESS � � .SI � ICERTIFVTHATIHAVEREAD7HISAVPIIGATIONANDSTATETYUTTHE�BOVEINiORMATIONISCORRECT. TOTAL FEES � w I AGREE 70 COMPLY WIM ALL Cf1Y AND COUNTV ORDWANCES MlO 57A7E UWS REUTR76 70 BUILD�N(7 � CONSTHUCTION.AND HEA�YAUT110A�ZE REPRESENTATNES OF iHiS COUMV TO ENTEH UPON THE ZABOVEM EO ROPERTY FOR I P crqea vuavosEs. COMMENTS . � y� V � m VERMI7TE (PRINn . . � . ¢ '� � � � � SIQNATUq�OF PEFOAlTTEE �A7E RECPT.NO. PAID BY VALIDATION � WMITE--0epartmen[Copy.YELLOW—Flnanee CopY.PtNK—Assessor Copy.GOLDENROD—Ff1e Copy.GREEN—Appl{canCs Copy �� s �6� `�.,�9" 5"��31�,9�i i?�a j:i�1 5:i s�1 e`3 � � .r' 91l7�:3�"��4„�i � 9��jif a:;r't�'.'.�y�'j'�t"�'��✓� u;._ I�f .a � ., . .y..'�xy�'a+'rrL`,� r.�- �i �._"�'��y'zb r -� . � �:� �—.F- . :.�w? i .�vt�..� �-0 �-.—s..--�..✓. . . .? -Y..' - r�.; � ''e. I{1 o- � �y ='-.�.'fi` ln".i o 21`e. : .'�ii� 1 -�. fj''�` t � A � � �._� { �� �t�f�:-, �� ���;(�-- rI i� s Ya< i �`�, �lt�a�';y,� {1,�s�`'�,�,{J�I`���-'��."� � N r.yy� �,�4 f} � �. ��f 7 ._u_:;..�_ .__.� .i'i`�.� �a��.t.��i�::.=�,^d.4L�:.a,..���i::...'.r'..c,.���:-..''_. r re i �-�_.��3�.`t t��"..:,.,�C'�..,� :���.._._,.z..� ��.., ..�t�A�.` �-t7't"1�"rtl.�R 1�-G.�i` . .�.: ,..r . _� ,., ._'__.� ._..�_�,.__. SET BACI< I � FL�)OR JOIST I - - -- - F7�S/rORfvl�lSTF.EL � _ _ _ _ _._ . __ . I ---. --- - - -- .. - --- -- _ --.. _ __ _ .. _ _ I_._.._ _.__. ._..---- --..___ .__. __- , FN4 RFOfvf fS--- `_-- - - ------I EIECTi?IC GROUtJ� , I ,Uf�DFR i I.OUR Dl ICT C�RC)UIV�PLl!iv1P,I�IG � i U�Ifi-R FLOOR CO�IDUIT I —--------- -- - - SLA6GRADc ------- � �� � �FI�E?LACE FOU��lDATION ----- -------- - ------ ------------------ '----------- --- ------ TENiP PO�VER r FIREPLACE BOND BEAM ��lATER SERVICE �MID HT.BON�BEAM ROOF SHEATHit�dG ;8 FT.BOND BEAM ----- •— — FRAMINC,/VENTILATION ----------------- I FINAL BQND BEAM�---- `_..___..__ ----------_--------------- ROdF CO�/ER _ _ � __ ;PRE-GRADING — -------- ----------- ROUGH HEATING 'BEfdCHING -------------------- ------ -- , ----�----------- ROUGH ELECTRIC i ROUGH GRADI�lG ROUGH PLUMBING �FINISN GRADING SHOWER/TUBTEST I POOL ELECTP,IC EXT.LATH/SIOING �POOL FENCING bVALL INSUI=ATION j POOL FINAL CEILING R�ISUlA110N ;OF�SITE IMPS. DR'fbh/ALL P�lAILING--------,--- -----------__------ �DICATIONS -------- SEWER i FINAL ENG. SEPIICTANK ---------- ----- -- ----�-�---- ILANDSCAPE/IRRIG _. ._._---- SEEP PIT/LL. --- --------- --^----- OPJ SITE INIPS. GAS AIR7EST ;FINAL ZONING FINAL CONST. �FIRE DEPT.FINAL FINAL FIEATING i HEA�pT.FINAL — FINAL ELECTRI� DEV.FEES PAID . FINAL PLUMBING ENERGY . FINAL PLANING FINAL ENGI�IEERING P > �� '� COMMENTS 1 a SEPTICTANK SIZE � SEEP PIT/U SIZE 'ff i }' .f,t