HomeMy WebLinkAbout13-1360 _----�_ ___
.: _,�__�_'�:._�;� .�r, CITY OF DIAMOND BAR . . � ���/I�'j i5
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: ___;, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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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
g APPLICATION DATE: P/C# I
i JOBSITEADDRESS 7�Iy/a.(j/J PERMIT# �^ ���a _
z APN LOT TRACT ISSUE DATE:
� OWNER �,�'�, �E=i I .P��iL � _ TYPE CONST. OCC GROUP:
� ADDRESS w 4'X �1�W
n CITY � '+ ZI TEL. ZONING F ONTCKS RW ❑
s APPLICANT fP�� � TEL. REAR ❑
� SIDE/SIDE STREEf RW ❑
� II
� CONTRACTOR SIDE ❑
� ADDRESS
PROPOSED USE
s CITY ZIP TEL.
�
� ARCH/ENG/DESIGNER
� ADDRESS �
#DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL.
7O OWNEH-BUILDEN DEClAHA710N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION j
= I hereby aftirm under penalty of perjury that I am exempt from the ConVador's State License Law for the reason(s) SFR/ADD/REM I
L� I
indicated below by the checkmark(s),I have placed ne�R to the applicable item(s)[Section 7031.5,Business and Garage/Carport
� Professions Code:My city or county that requires a permit to construct,alter,improve,demolish,or repair,any
z structure,prior to its issuance,also requires the applicant for the permit tn file a signed statemeM that he or she � Patio/Deck I
i is licensed pursuant ta the provisions of the Contractor's STate License Law(Chapter 9)Commencing with Section W
n70W of Division 3 of the Business and Professians Code]or that he or she is exempt from licensure and the basis for � Pool/Spa I
� the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjecLS the applicant to a civil penalty Z Re-Roof
T of not more than five hundred dollars($500). � �
� (�I,as owner of the property,or my employees with wages as iheir sole compensation,will do U all of or(�portions � Commercial I
y of the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The m I
� Contractors'State License Law does not apply to an owner of property who,through employees'or personal effort,builds
L or improves the property,provided that the improvements are not intended or oftered for sale.If however,the building or I
� improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not built
� or improved for the purpose of sale.�. I
�
()I,as owner of the property,am exclusively cont2cting with licensed Contractnrs So construct the project(Section
Z 7044,Business and Professions Code:The Contractors'Staffi License Law does not apply to an owner of property who Valuation: Adj.Area: I
� buildsorimprovesthereon,andwhocontractsfortheprojecLswithalicensedContradorpursuanttotheContractors'State OUANTIIY DESCRIPTION FEE I
Y License Law.). I
� (J I am exempt from licensure under the Contractor's State License law for the following reason(s): �
� � �
1 By my signature below I acknowledge that,ezcept for my personal residence in which I must have resided for at least one w
� year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an W
owner-6uilder if it has not been constructed in its entirery by licensed contractors.I understand that a copy of the applicable I
� law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at I
� the following Web site:http/www.leginfo.ca.gov/calaw.html. Z
= DATE: SIGN: � I
— LICENSED CONTHACTOfl'S DECLAHATION � I
a
' I hereby aftirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000) �
� of Division 3 of the Business and Professions Code,and my license is in full force and effed. J I
� Q
� U
n LICENSE CLASS: LIC.NO.: z I
I
Z DATE: CONTRACTOR: �
a WOHI�H'S COMPENSATION OECLAflATION � �
y I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: �
� I have and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION: I
a Section 3700 of the Labor Code,for the pertormance of the work for which this permit is issued. p�qN REVIEW:
� I have and will mainTain Worker's Compensation Insu2nce,as required by SecUon 3700 of the Labor Code,for
� the performance of the work for which this permit is issued.My Worker's Compensation Insu2nce Carrier and ELECTRIC: T—��
¢ PoIi�yNumberare: PLUMBING: EkTP�1J rP� d�_Q.�p��/'e �Q/'rl���,p-
Z CARRIER MECHANICAL:
;� POLICY NUMBER
INSPECTION FEE: I
n (THIS SECTION NEED NOT BE COMPLETED IFhIE PFAMR IS FOR ONE HUNDRm DOLLARS($100)OR LESS).
ISSUANCE:
� I certiry that in me perfortnance of the work for which this permd is issued,I shall not employ any person in any manner so as to
� become subject to the Worker's Compensation Lavrs of Califomia.Md agree that if I should become subject tn the Worker's SMIP:
� Compensatlon provisions of Sedion 3700 of the Labor Code,I shall forthwith comply wim mose provisions. ENERGY P/C:
J
i DATE: APPLICANT: ENERGY PERMIT:
� WARNING Failure to secure Worker's Compensation coverage is unlavrful,and shall subject an employer to criminal
y penalties and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of the compensation, RETENTION FEE:
i damages as provided for in section 3708 of the labor code,interest,and attorney's fees. PRE-ALT FEE:
�
i CONSTHUCTION LENDING AGENCY BSAF:
y I hereby aRirm under penalty of perjury that there is a Construction Lending Agen�y for the performance of the work for
= which this permit is issued(Sec.3097,Civ.C.).
�
LENDER'S NAME:
r LENDER'SADDRESS:
i I certiTy that I have read this application and state that the above information is correct.I agree to comply with all cily and TOTAL FEES � '7��
� county ordinances and state laws relating to building construction,and here6y authorize representatives of this counTy to COMMENTS:
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� enter upo e above-mentioned property for inspecGon purposes.
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¢ PERFAI EE N (PRI
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n --��,�� I !� VALIDATION:
x SIGNAlUR OF PERMITTEE DA7f RECEIPT# '� PAID BY:
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WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
. CITY OF DIAMOND BAR "'�
IiVSPECTION RECORD M .
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SETBAGKiLETTER TRACT AN�LEDGER �
�FOQTINGS FORMS ���. SWITCH GEAR �
'�SL�AB`�` � '��` � � � � COMMERCIAL HOOD
UG..PLUMBING , . ;;,; �. � T-BAR
UG'.,ELECTRICAL _,� r��m INTEflCEPTER
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U�ER�ROU,ND � �g v HOT MOP/SHOWERPAN ;
SEWER LATERAL SEPTIC/CESSPOOL I
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLQOR SHEATHING ROUGH CONDUIT
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�SHEAR WALLS EXTERIOR '' � � ��' ��: . ` POOUSPA � " � � � =�
.
,SHFARWALLS INTERIOR ���, ROUGH PLUIVIBING
R�MING/VENTING '��;�: ROUGH ELECTRICAL
AROUGH MECHANICAL ROUGH MECHANICAI
�ROIJGH EIECTRICAL W� }C( y � � GASTEST
RQUGH P
LUMBING PRE GUNITE
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INSULATION WALL POOL PRE DECK BONDING
INSULATION CEILING P-T�P
DRYWAIL FENCE/GATE/ALARM
LATH(PREI FINAL POOL
LATH EXTERIOR WALLS:
LATH INTERIOR WALL FOOTING/STEEL
6AS TEST WALL STEEI 1S�( )2N°( )LIFT
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION R0.FRAMINGFLANNINGAPPROV1�iL
FI� ` .' _ �����
��NAL�,BUILOIN� � �-� :F,�, ROUGH FIREAPPROUAL
FINAL�MECHANICAC , FINAL FIRE DEPARTMENT
FiMAL ELECTRIGAL �� FINAL PLANNING
FINAL PLUMBIN6� .1��7-/,f ���. FINAL ENGINEERING/PW
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�7:G:of OCCUPANCY FINAL COMMUNITY SERVICES
GERT of'OCCUPdNCY ,,�ds ; FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
COMMENTS:
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' _ ''. �� _ CITY OF DIAMOND BAR � �•
� ' � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)8G1-3117 Building Inspection Hotline(909)839-7027 Pf;ESS ,
� '^�', BUILDING PERMIT APPLICATION ' FIRMLY
} JOBSITE �/ /�� `—/' (� APPLICATI PEF4MIT p� �3 p/C
o ADDRESS���% � �`��in lC�-+� �C:►' DATE �� 9 ��3 NUMBER 13�0 #
`r APN LOT TAACT ISSUE .-� ' � �\� TYPE p�C
—�� ��_ � DATE CONST. GROUP
p OWNER �"'C!�-�+-1 U2a �j��
ADDRESS C'Gti� 01 ZONING SETBACKS
Z CITY � •C�,.-c ZIP 1�T TEL�C�(- I l S 7 FRONT RW ❑
o APPLICANT TEL. REAR p
Z SIDE/SIDE STREET RW ❑
m CONTRACTOR � ( ; SIDE ❑
Q ADDRESS v10��� ll.2ct+,Q�6 �a-
� CITY � �- ZIP�� TEL PROPOSED USE
w ARCWENG/
z DESIGNER
w NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNEA-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UN�EN PENAL7V OF PERNRY THA7 1 AA1 E%EMPT FROM THE CONTMC70R5 LI- Gdffl9B/CBIPOfI
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7NI.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNryWHICHREWIRESAPERMITTOCON57R11C7,ALTER,IMPROVE,DEMOUSH,ORREPAIRANYSTRUG - �
w TUHE.PRIOR iD RS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W PatidDeck �
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF THE CONTMCTORS LI- � .
� CENSE UW(CHA7TEfl G�COMMENCING WITH SECTION 7000)OF DIVISION]OF THE BUSINESS AND PRO POOUSPB
� FESS10N5 COOE�ORTHAT HE OR SHE IS EXEMPT THEFiEFROM AND THE BtiS15 FOR THEALLEGED E%EMP- (�
V TION.ANVVpLATIONOFSECTION7o77.58VANYAPPLIGWTFOqAPERMITSU&IECTSTHEA7PLICANTTO Z Re-Roof
� ACIVIL PEWLLiV OF NOT MORE THAN FIVE HUNORED DOLLARS(fSOD).):
Z ❑I,ASONRJEROFTHEPPOPERTY,OFMYEAIPLOYEESWITHIVAGESASTHEIRSOLECOMPENSA710N, 0 COrtIl118fCidl -
WILL DO THE WORK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7o�i,BU51- J
� NESS PN�PROFESSIONS COOE:TME CON7fUC70R5 LICENSE LAW OOES NOT APPLY 70 AN OWNEfl OF �
VROPERfI'LMiO BUILOS OR IMPROVES TiEREON,AND WHO DOES SUCH WOPK HI/ASELf OR HEHSELF OR
CC THROUGHHISORNERONMEMPLOVEES.PROVIDEDTHA75UCNIMVfiOVEMENTSARENO7INTENDEDOR m
O OFFERmPoRSALEIF,HOWEVER111E8U1LDINGORIMPROVEMENTI550LDWfTHINONEYEAROFCOMGLE-
Z TION.7HE OWNERAUIIDER N7LL HAVE THE BUROEN OF PROVING THA7 HE OR SHE DID NO7 BULLD OR
� IMPFiOVE FOfl THE PURPOSE OF SALE� '
w ❑1,AS ONRIER OFTNE PROPER7Y,AM EXQUSNELY CAMRACTIN�WRH LICENSED COMHAC70R5
� TO CONSTRUC�THE PRQIEC7(SEC.7oa�.BUSINE55 AND PROFESSIONS CODE:h1E COMMCiORS LI- V81U8flOn ADJ.AflEA
W CENSE UW DOES NOTMPLYTO AN OWNER OFA PflOPFATY WHO BUILDS OR IMPROVES THEREON,AND
� W1iOCONiMCTSFORSUCNPRQIECT5WfT11ACOMM(.TOq(S)LICENSEDPURSUANTTO7HECONTRAG (�UANTITY DESCRIPTION FEE
Y TORS 110ENSE UWJ. �
0 ❑I AM E%EMPT UNDER SEC. B.8 V.C.FOR THIS REASON Q �
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� .. ¢
DATE OYMER H
O . .____ _. W �
, �Q LICENSED CONTRACTORS DECLAFlATION W
CC 1 HEREBY AFFIRM UNDER PENILTY OF PE0.IURY 7HAT IAM LICENSED UNDEA PFOVISIONS OF CHAP7ER � , ( �
d D(COMMENCINO WITM SECTION 7000)OF DIVISION]OF THE B4SINESS M!D PROFESSIONS OOOE,AND Z W
�� MY LICENSE IS W FULL FORCE AND EFFECT. m
� LICENSE CLAQSS C �J l� LIC.NO. ` �`O�� �
wOATE ��-/�r� CONTRACTOR d
� WORKERS'COMPENSATION DECLARATION a
� IHEREBYAFFIRMUNDERPENAITYOFPERlURYONEOFTHEWLLOWINGDECLARATIONS: Z '
� _I HAVE ANO WILL MAINTAIN ACEHfIFICATE OF CpNSENT TO SELF-INSUAE FOR HR7RKER5' _ ,
Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR COD�FOR THE PERFORMANCE `U
Q OF THE WORN FOR HM1iICH THIS PEflM1T IS ISSUED. � ' �
w _1 HAVEANU WILL MAINTAIN WORKERS'COMPENSA710N INSUMNCE,AS REOUIRED BY SECTION
Q �70o OF THE LABOR COOE,FOR THE PERFORMANCE OF THE WORN FOR WHICii 7HI5 PERMrt IS
ISSUED.MY W0(9..1C�ER/5'COMPENSATION INSURpAN/C�^E CA1ARIER AND POIIC NUMBER ARE: CONSTRUCTION
j CAARIER_ l�'V.e��� /V(�d--t fl�� PLAN REVIEW
Z POLICY NUMBER �j �_,�� fl�'( ELECTRIC
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o (n+ssEcror�NeIDwreEmns�r�oFn��trrsroqor+Et�x�oau�u�simloatFss1 PLUMBING Sq . a5
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Z 1 CERTIFV THAT IN THE PERFOFiMANCE OF THE WORIC FOR WHICH TNIS PERAIIT IS ISSUED,1 �MECHANICAL
�' SHALL NOT EMFLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE �
� WORKERSCAMPENSATIOf1LAW50FCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE
� SU&IECTTO THE WOHKERS'COMPENSA7qN PROVISIONS OF SECTION 7700 OF THE LABOR �, l a
� CADE.I SHALL FORfHWITH COMPLY VJ17H THOSE PROVISIONS. ISSUANCE o�
�
p DATE: qPPLICANT. �SMIP
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� WARNING:FAIWRE TO SECVRE WORICERS'COMPENSATION CAYEMGE IS UNUWFUL,AND SHALL BE ENERGY P/C
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� SUBJECTANEMPLOYERTOCRIMINALCENALTIESANUCIVILFlNESUPTOONEHUNDREDh10U5AND ENERGYPERMIT
DOLLAHS(f1ao.0oo�,IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 370D OF THE LABOR CODE WTEREST,AND ATfORNEYS FEES.
¢ RETENTION FEE: -- ' C�O
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1HERE8YAFFIRMUNDERPENALiYOFPERIURV7HATh1EREISACANSTRUCTIONIENOWOAGENCY �
f-0R TME PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED�SEC.3097,CIV.G).
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� LENDERSNAME -
F- LENDER'S AODRESS
w I CERTIFY THAT I HAVE READ THIS MPLICATION AND STATE hUT TiE ABOVE INFORMATION IS CORRECT. TOTAL F E E S �(lo� `�
� 1 AGREE TO CAMPLY N7hi ALL CITY AND COUNT`/ORDINANCES AND STATE UWS REUTING TO BUILDING
� CONSTRUCTION,MIDHEREBYAIJhIORIZEREPRESENTATNE50F7HISCWNTYTOENfERUPONTHE
Z ABOV ENiIONED PROPERTY FOR INSPEC710N PURPOSES. COMMENTS
� � '-�V�-
�
m PERMITTEE N E RI �
¢ � q 3
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� sicruTu E EE DATE RECPT.NO. PAID BY J ��o��3 VALIDATiON
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WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assassor Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy
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GRGUI�!D PLUMBING __ , i �UhDER FLOOR CONDUIT_ � _ _ _
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SI_AEs"Rr1DE � FIREPLACE FOUhDATION �
--- ----------�__...-----..--— ---------------- — — —--
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ROOF COVER , , PRE-GRADING
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ROUGH HEATING �
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ROUGH ELECTRIC � I '_ I�OUGH GRADING
ROUGH PLUME31�1G � �FINISI-I GRADING I
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FINAL CONST. FIRE DEPT.FINAL
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FINr1L ELECTRIC I �DFV.FEES PAID
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