HomeMy WebLinkAbout11-1305 ---_- -
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� ..�',�'� ,_.,.. CITY OF DIAMOND BAR �= : ( r J�f'j/15/IS
1 . '� DEPARTMENT OF COMMUNIT`l'&DEV�ELOPMENT SERVICES ��
_.� �_ _
- 21810 Copley Drive,Diamond Bar,CA 91765 PRESS
� (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
�'�''', BUILDING PERMIT APPLICATION
s JOB SITE ADDRESS APPLICATION DATE: P/C#
i ISSUE DATE: �/�/�'Fi�J PERMIT# �I� ��G�
z APN LOT TRACT
� OWNER D TYPE CONST. OCC GROUP:
J, ADDRE ZONING SETBACKS
J CITY ZIP c�/��TEL(.7I�I') �- —DZ1�2 FRONT RW ❑
� APPLICANT � TEL. REAR ❑
� ' SIDE/SIDE STREET RW ❑
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¢ CONTRACTOR SIDE ❑
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� ADDRESS PROPOSED USE ��tPJ�I�t�� � ��
� CITY ZIP TEL. ���a�� �J+n, QC �j�n
� ARCH/ENG/DESIGNER
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� ADDRESS #DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL. I
¢� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
¢ OWNEH-BUILDEH DECLAflATION I
z SFR/ADD/REM
= I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the r s)
� indicated below by the checkmark(s),I have placed nezt to the applicable item(s)[Section 7031, mess and Garage/CarpoR I
'� Professions Code:Any city or county that requires a permit to conshuct,alter,imprave,de sh,or repair,any
z structure,prior to its issuance,also reQuires the applicant for the permit to file a sign temerrt that he or she � Patio/Deck I
i is Ilcensed pursuant to the�provisions of the Contractor's Sfate License Law(Chap Commencing with Section w I
� 7000 oT Oivision 3 of the Busin and Professians Code]or that he or she is e t from licensure and the basis for LL Pool/Spa �
nthe alleged exemption.Any violation Section 7031.5 by any applicant for a pe subjects the applicant to a civil penalty Z Re-Roof I
of not more than five hundred dollars( 0�.
Y � I� (�I,as owner of the property,or my employ with wages as th ' le compensation,will do(,all of or(�portions � Commercial
y of the work,and the structure is notintended o ered fo e(Section 7044,Business and Professions Code:The m �
Z Contractors'State License Law does not apply to an ow f property who,through employees'or personal effort,builds
� or improves the pmperty,provided that the improv nts are �ntended or offered for sale.If however,the building or I
� improvement is sold within one year of com n,the Owner-Builde �I have the burden of proving that it was not built
jor improved for the purpose of sale.�. I
'� (,I,as owner of the prope exclusively contradi�g with licensed Con rs to consWct the project(Section
Z 7044,Business and Pr ions Code:The Contracmrs'State License Law does no ply to an owner of property who ValuatiOn: Adj.Afea: I
n buildsorimpro ereon,andwhocontractsiortheprojectswithalicensedContractor rsuanttotheContractors'State QUANTITY DESCRIPTfON FEE I
Y Licens, I
� (�I am exempt from licensure under the Contrac[or's State License law tor the following on(s): � I
�i 2
1 By my signature below I acknowledge that,except for my personal residence in which I must have 'ded for at least one w I
� year prior to completion of the improvements covered by this permit,l cannot legally sell a strudure tha av uilt as an w I
owner-builder if it has not been constructed in its entirety hy licensed contractors.I undersTand that a copy o licable
� law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at I
i the following Web site:http/www.leginfo.ca.gov/calaw.html, z I
= DATE: SIGN: �
— LICENSED CONTNACTOH'S DECLAFIATION � I
a
y I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000) I
� of Division 3 of the Business and Professions Code,and my license is in tull force and ettect. J I
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� LICENSE CLASS: LIC.NO.: Q I
� DATE: CONTRACTOR: = I
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¢ WOHKER'S COMPENSATION DECLAl1ATI0N � I
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS'
� �����
� I have a 'll maintain a Certificate of Consent to Self-Insure for Wo r's Compensation,as provided by CONSTRUCTION:
� Section 3700 o bor Code,for the pertormance of the work fo ich this permit is issued. p�,qN REVIEW:
> I have and will maintain r's Compensation Insuance,a uired 6y Section 3700 of the Labor Code,for ELECTRIC:
� the pertormance of the work fo 'ch this permit is issu . y Worker's Compensation Insu2nce Carrier and
¢ PolicyNum6erare: PLUMBING:
� CARRIER MECHANICAL: +1
� POLICYNUMBER INSPECTION FEE: I /I��
� (THIS SECIION NEED NOT BE CA IF1HE PfAMfT I ONE HUNDRFD DOLLPRS($100)OR LESS).
ISSUANCE:
� I:ertify ihat in the performance of rk for which ihis permit is issued,I s ot employ any person in any manner so as to . ,
�
become subject to me Wo mpensation Laws of Califomia.Md agree that hould 6ecome subject to the Worker"s SMIP:
� Compensation pro'' oi Section 3700 of the Labor Code,I shall foNnvith comply with rovisions. ENERGY P/C:
i DA7E: � APPLICAN7: ENERGY PERMIT:
� WARNING:Failure to secure Worker's Compensation coverage is unlawful,and shall subject an employer to criminal RETENTION FEE:
y penalties and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of the compensation,
i damages as pmvided for in section 3708 of the labor code,interest,and attorney's fees. PRE-ALT FEE:
�
i CONSTHUCTION LENDING AGENCY BSAF:
y I hereby affirm under penalty of perjury that the2 is a Construction Lending Agen�y for the pertormance of the work for
= which this permit is issued(Sec.3097,Civ.C.).
�
IENDER'S NAME:
,s LENDER'SADDRESS: � �
i I certify that I have read this application and state that me above information is correct.I agree to comply with all city and TOTAL FEES ' 1 L/
� county ordinances and state laws relating to 6uildin consWction,and hereb authorize re resentatives of this coun to P.• '
z 9 Y P ry COMMENTS:
� enter upon the above-mentioned property for inspection purposes.
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a PERMITTEE NAME(PRINT)
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� a-?Dy� PAID BY:�
= SIGNAlURE OF PERMITTEE DATE RECEIPT# ��/ 7 VALIDATION:
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
CITY OF D�AMO,ND BAR '� '�
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�UFER��ROIlND , ��- €, ��� °-' � ��: = �` � , � ` ' ��r �� HOT MOPISHOWERPAN �
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
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SHE1�R°WALLS EX�TERIOR��' ' � °� "�`�` ' " .'. �' �; ` �� �- � '' POOUSPA ' `� � -�
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RO�UGFI�LU�161NG�. ���� , ,��� ���: ,� � � � � � .� � �� ,. PRE GUNITE
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INSULATION WALL POOL PRE DECK BONDING a. � � � °
INSl1LATI0N CEILING P-TRAP �
DRYWALL FENCE 7 GATE/AI1aRM ` � "
IATH(PRE) � FINAL F�OL � � �
LATH EXTERIOR I WALLS: x � �
LATH INTERIOR WALL F�OTING/STEEL
GAS TEST WALL STEEL 1 sT( )2Ne( )LIFT
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE ; WALL DRAIN/SEAL
GAS METER RELEASE WALL fINAL
SP�CIAL INSPEGTION ! R0.FRAMING PLANNINGAPPROVAL � � � � � ° _
FINAl,:BUILDING��,..:�� _ � �
, ..��. _ „ ;� . P � � � , , ROUGH=FIREAPPROVAL . 9 � �. ��, _
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F1�1;4L�ELECTEtICAL ��� ., ��,-� � `� .. . �.;�: .& »�,�,�..� � � "� ��° FINAL PLANNiNG� � �` � �� ��.
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FINltL�PLf1M61N�� � ° `�� �� �'"'�`�" � � � � � . �` � �FINAL�NGINEERING/PW
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� FiNAL GOMMUNITY 56RVIGES �• � � - � � � � �
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CERT�of QCCUPANCY ,�, ��� � � � , a � � , FlNAL NEALTH DEPT. ` � � � �
FINAk.INQUSTRIAL WASTE g
COMMENTS:
� ' _' ` `_�,`_ CITY OF DIAMOND BAR V/�P� �� l`
1 � DEPARTMENT OF COMMUN;TY&DEVELOPMENT SERVICES �/L6/��
� 21825 Copley Drive,Diamond Bar,CA 91765
' � (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-702 PRESS
�'H�' BUILDING PERMIT APPLICATION J� FIRMLY
QJOBSITE —/�,� ���J��/� �„ DATE NUMBER /I30J #
¢ ADDRESS �/"/�Z .�f� , L`-�I('�, /Q( APPLICATION PERMIT p/C
� ISSUE j TYPE �'.` OCC /'�
APN L T TRACT DATE � 3 / CONS . •� C/�Y/���p (lTe/
p OWNER �L�L. G�� ��
o ADDRESS �— ZONIN SETBA KS
Z CITY ZIP TEL. FRONT qyy p
� APPLICANT TEL. REAR p
QSIDE/SIDE STREET AW ❑
a� CONTRACTOR < '17�5 C- '(�, SIDE p
ADDRE S 7-C�>( t
� CITY Y . ZIP ��75'LTEL 'c -- PROPOSED USE i�
oARCH/ENG/ �
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTV OF PE0.IURV 7HAT I AIA EXEMPT FROM THE CONTRAC70RS LI� Gefe9B/CBfpOft �
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSAN�PROFESSIONSCODE:ANYCITYOq (n
U COUNTyWH�CHRE�UIRESAPERMITTOCONSTRUCT,ALtER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
W NRE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRAC70R5 LI- �
� CENSE UW(CHAP7ER D(CAMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- POOUSp2
. Q FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEFEFROM AND THE BASIS FOR 7HEALLEGED E7CEMP• (�
V 710N.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICAN7 FOR A PERMIT SUBJECTS 7HE APPLICANT TO Z R0-ROOI
�, A CIVIL VENALTY OF NO7 MORE THAN FIVE HUNDRED DOLURS(SSao).):
Z �I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIq50LECOMPENSA710N, � Commercia�
WILL DO THE WORK,AN�THE STRUCTURE IS NOT IN7ENDED OR OFfEREO FOR SALE(SEC.70/1,BUSI� J
� NESS AND VROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPERTY WHO BUILOS OR IMPROVES THEREON,AND VAiO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THA7 SUCH IMPROVEMEN75 ARE NOT INTENDED OR m
Q OFFEREDWRSALEIF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
= IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCANTRACTORS
� TO CANS7RUC7 7HE PR0.1EC7(SEC,7ou,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� V01U2t1Of1 ADJ.AREA
W CENSEUWDOESNOTAPPLY70ANOWNEROFAPROPER7VWHOBUIIDSORIMPROVES7HEREON,AND
� NM1IOCONTRACTSFORSUCHPROJECTSWITHACONTFiACTOR(5)LICENSEDPURSUANTTOTHECANT{UC- QUANTITY� DESCRIPTION FEE
Y TORS LICENSE LAW.).
� O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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LL DATE OWNEF H
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�¢ LICENSED CONTRACTORS DECLARATION w
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I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA71 AM IICENSED UNDER 7FOVISIONS OF CHAPTEH �
� Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z �
��� AIY UCENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS ^� LIC.NO.��v`"'/f'/ �
V DATE �< � CONTRACTOCR�—� d .
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� WOFiKERS'COMPENSATION rt LARATION Q
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� I HEREBY AFFIRM UNDER PENALTY OF PE0.IURV ONE OF THE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
Z COMPENSATION,AS PROVIOED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR VJFiICH THIS 7EFMIT IS ISSUED. �
F �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q3700 OF THE LABOR CODE,FOR THE PERFOpMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��`_f��
ISSUE�.MV WORKE�S,$'_c�APENSATION INSURpNCE CARRIERAND POLICV NUMBERARE: CONSTRUCTION lP
—� /tl' T" �/
j CARRIER �7-t�6Lt /i[�i+.,vl PLAN REVIEW
QPOUCV NUMBER � ���� .����_ ELECTRIC
� (iHISSECiqNNE�NDTBE�METEDOFhIEPERMfTISFORONEHUPDREDDOLLApS(5100)ORLESS} PLUMBING
W
Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE VlOHN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C� SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE
N WORKERS'COMPENSATION LAWS OP CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR / /O
CADE,I SHALL FORTHWITH COMPLV WITH TH PROVISIONS. ISSUANCE L
0 �
p DATE:�� qPPLICANT: SMIP _
W
J WARNING:FAILURE TO SECURE WORKERS'C SATION COV E IS LAWFUL,AND SHALL BE ENERGY P/C �
J
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES P TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(5100.000�.IN ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,WTEREST,AND ATTORNEYS FEES. ��
w RETENTION FEE:
O CONSTRUCTION LENDING AGENCY pqp_q�❑.
� I HEREBYAFFIRM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY B �/ `
n- FOR THE PERFORMANCE OF THE WORN FOP WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
� /
� TOTAL FEES
� I CERTIFV THAT I HAVE fiEAD THIS AP7LICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALL CIN AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING �
� CANSTPUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
� ABOVE-MENTIONED Pq07ERTV FOR INSPECTION PURPOSES.
Z COMMENTS
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m PE{iMI77EE NAME T) / �
C/) `�� ^/
� SIGNATURE ITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL g�l(( FHA REQMTS I
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE ��'a„(p u FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK . LANDSCAPE/IRRIG.
SEEP PIT/L.L. �N SITE IMPS.
GAS AIR TEST FINAL ZONING
FINALCONST. >0 �—�� � FIRE DEPT. FINAL
FINAL HEATING l HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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