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HomeMy WebLinkAbout12-1129 „��' CITY OF DIAMOND BAR �---1��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �r' 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 a I � JOBSITE � , ' � / APPLICATION G�/ PERMIT �� !l�q p/� o ADDRESS �� DATE [ � �Z NUMBER � q � ISSUE TYPE OCC APN LOT TRACT DATE �� CONST.�,.�4 Q� GROUP p OWNER o ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT q�/y � o APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL PROPOSED USE � o ARCH/ENG/ �z DESIGNER . NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL UNITS STORIES BEDROOMS cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � �OWNER-BUILDER DECLARATION - p SFR/ADD/REM p I HEAEBV AFFlRM UNDER'PE/UL7Y OF PERAIRY THAT I A/d E%EMVT FROM T7{E�pryTqACTp{L5 L�. Garege/Carport . W (�NSEUWFORTHEFOLLOWINCiREASON(SEC.7o31.6BUSINE55ANDPROFESSIONSOOOE:ANYCITYOR � (n � C� COUMYWHICHREIXIIHESAPERMRTOCON97RUCT,ALTEf�UAPROVE,DEMOUSH,ORREPAIRANYSTRUG W P8fi0/DBCk � TURE,PRIOR TO RS�SSUANC�AlSO REOUIRE9 7HE MPLICANT FOR SUGi PERMIT TO FfLE A SIONED w � 3TATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO T7E�PROVISIONS�OF THE COMRACTORS L4 . � CENSE UW(CHAPTER Y(COMMENCW6 WITH SECTION 7000)OF OIVISqN 3 OF THE BUSINESS AND�PRO- . � POOUSPO , � FESSIONS COO�OA 7HAT HE OR SNE IS E7(EMPTTHEREFROM AND 7HE BA515 FOR THEAU,EOED EXEAIP- (� TION. VIOLA710NOFSEC710N7o3t.68YANYAPPUCANTFORAPERMI7SUBJECT3THEAVPLICANTTO Z� R�ROOf � A NALTY OF NOT MORE TMAN FIVE HUNDRED DOLLARS({500).r . � C��SOWNEROFTHEPROPERT',ORAIYEM7LOYEE3WI7HlVM1ESASiHE1RSO�ECOMPEN3AT1pN, � � CORIfI1BlC181� Z N7LL E WORI(AND THE STRUCTURE IS NOT IN7ENDED OR OFFERE�FOR 9ALE(SEC.7a4,BUSI- J ' � NESS D PROFESSIONS COOE THE CONTRACTORS LICENSE LAW DOES NOT APVIY 70 AN OVlNEH OF j � � PROPERTY VhiO BU0.D9 OR IMPROVE9 THEREON.AND VMO DOES SUG1 NpRN/qA15ELF OR HERSELF OR wTHROUGH H1S OR HER OWN EMPLOYEES,CROVIDED THAT SUdI IMPROVEAIENTS ARE NOT PlTENDm OR . m � Q OFFFA�FORSALEIF,HOWEVER7NEBUNDINOORUAPROVEMENTISSOLDWfTMNONEVEAROFCONPLE . Z 710N..THE OWNERAUILDEA WILL HAVE TNE BURDEN OF.PROVWO 7HAT HE OR 6HE DIO NOT BUIID OR � qdPROVE FOR THE PURP0.SE OF SALE} � - W ❑I,ASOWNEROF7HEPROPEHTY,-AME%q.USNELYCANTMCTWOWfTHLICENSEDCONTRACTORS Q TO CONSTRUCT THE PRQIECT(SEC.70N,�BUSINE35 AND PROFESSIONS CODE:THE�CONTRACTORS LI- V0IU8�IOf1' (�p,J.(�R�� ' � CENSE UW DOES NOTAP7LY TOAN OWNEA pFA VROPERTY WFq BUiD3 OH IMPROVE9 THEAEpN,IWp - Mn1000NfRACiSFOReUCHPR0.1EC7SWIhIA00NTRACTOR�S7UCEtrSEDPURSUANfTOTHECONTMP qUq�17Y DESCRIPT1pN roAs ucEruE uw.�. FEE o ❑1 AM DfEMP7 UNDER SEC. �B.8 P.C.FOR THIS REASON � � � U LL DATE � ” � � OWNER ~ Z U �Q UCENSED CONTRACTORS DECLARATION W CL I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT IAM'LICENSED UNDEA PROVISION9 OF CHAPTER � �� � � 9(COMMENCWO W17H SECTION.7000)OF OMSION 7 0F THE BUSINESS AND PROFESSIONS CODE,ANU Z ��� MY LICENSE IS W FULL FORCE AND EFFECT. m � UCENSE CLASS LIC.NO.. �� - . � (~j �TE CONTRACTOR d . . W � WORKERS'COMPENSATION DECLARATION �� �� � � � � I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOW WG DECLARATqN$; V � C!� � . .. . , Z � , � _I HAVE�AND WILL MAINTAIN A CEqTIFlCATE OF CONSEM TO SELF-INSURE FOR MqRI(ERS s1 � COMVENuNT�DN,AS PROVIDED BV SECTION 3700 OF h1E LABOR CODE,Fpq 7}IE PERWRMMICE lJ OF THE WORK FOR NM1iICH 7}{q PERMIT IS ISSUED. W . � � � _IHAVEANDWILLMAUlTAWWORKER$'CpMPENSATqNINSUHM7CE;/SqEWIREDBV5ECT10N � - Q a7oo OF 7HE LABOR CADE,FOR THE PERFORMANCE�OF THE WORK FOR WHICH THIS PERMR IS. �SSUFD.Mv WORKERS'CAMPENSATqN IHSURAIJCE CARAIER AND POLtCY IJUMBERARE �CONSTRUCTION� jCAHRIER PLAN REVIEW � POLICY�NUMBER . � zd., � . . ELECTfiIC p (1}OssEcfIONNF.�M07BEIX'MRE7IDOFngPEPoyTtSFOaa+EfAR�DR�Oouwas�ftoo)oalFS�, �P,LUMBING � . . W Z I CERTIF/THAT M THE PERFO{iMANCE OF THE.WORK FOR WMCH TNI9 PERIAIT IS ISSUED,1 MECHANICAL C7 SHIu1NOT EMGLOV ANV 7ERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE�. � (n WORKERSCOMPENSATIONIAWSOFCt�tFORNItiANDAGREETHA7�15HOVLDBEWME INSPECTIONFEE SUBJECTTO7HEWOHKERS'�COMPENSATIONPROVISION30FSECTION37o00FTHEUBOR '' - S cooE,i sfuu FOAr�nn'tH coua�r win�nwse aaov�saNs. ISSUANCE O p DA7E: APPLICAN7:. .SMIP W --� WARNINO:�FAAAIRE TO SECURE WOR)(ERS'COAIPENSATION cOVEMGE IS UNUWFUI.AND SHALL BE ENERGY�P/C � J �L SU&IECTANEMPLOYER70CRIMWALPENAL7IESAN�CMLFlNESWTOONEMUNDREDTHOUSAND ENEROYPERMIT DOlLAR9(5100.00D),W ADDITION TO THE C0.5T OF COMVENSATqN,OMIA�ES AS PROVIOED FOR IN J SECTION 370E Of THE U100R CODE,IMEREST,AND ATfORNEV'S FEE3. � ' - w RETENTION FEE: O . CONSTRUCTION LENOING AGENCY � PRE-ALT FEE: � 1 HEREBY AFFIRM UNDER PENK7Y OF PERIURY THAT THERE IS ACONSTRUC710N LENDWa ACiENCY �z� �WR THE PERFORNANCE OF THE WORK FOR WHICH hu5 PERMR IS ISSUED(SEC.9oD7,qV.C.). W �, LENDER'SNMIE . . ., . ' . .. � . . • F-� LENDER'SADDRESS � TOTAL FEES S. Z� ¢ �ICERTIFY7IUTI�HAVEREADTHI9MPL7CATIONANDSTA7E7}1ATTHEABOVEINFORAIATqNISODRRECT. w I AGREE TO COMPLY N7TH ALL CT'AND COUNTV ORDINANCES AND STATE UWS qEU7W�70 BUILDU70 d � CONSTRUCTIqy AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTy TO EMfER UPON 7HE - z ABOVE-MEN710NED PROPERTY FOR INSPECTION PURppSES. COM $ ` �' . � ���� r � PERMITTEE NM1E(V —� � Q � �J--�� � �IONANRE OF P ITTEE DATE 1 � RECPL NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Appl{canCs Copy �F* � c��v oF o��nno�va ��R . ,,�,f INSPECTIOPV RECOFiD o " D. � ' ;� ,o � o �, ,� �� 0 °;�' �p'�,� Q ;,' � �,,,� SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR�ONDUIT 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 HEATING BENCHItdG _ _ _ ROUGH ELECTRIC ;� ROUGH GRADING ROUGH PLUMBING � FINISH GRADING SHOWER/TUBTEST � POOL ELECTRIC EXT.LATHlSIDING POOL FENCING WALL INSULAT10N POOL FINAL � CEILING INSULATION OFF SITE IMPS. DRYWALL NAILIIdG DEDICATIONS ____ SEWER _ FINAL ENG. _ _ SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT.FINA� FINAL HEATING HEALTH DEPT.FINAL FINAL ELECTRIC DEV.FEES PAID FINAL PLUMBING ENERGY FINAL PLANING __. FINAL ENGINEERING � � � COMMENTS '� -- � � � � �-�''v � 5���1--- ' . '' -r � � � SEPTICTANKSIZE SEEP PITlU SIZE i I