HomeMy WebLinkAbout12-540 _�,�,`_ CTTY OF DIAMOND BAR /
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I�
„ � 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
��'""'. BULLDING PERMIT APPLICATION FIRMLY
� JOBSITE
� o ADDRESS � T• DATE CATION / I ?� PERMIT � 2 /C
NUMBER q
� ISSUE /- TyPE pCC
APN LOT TRACT DATE ✓ � �� CONST. GROUP
p OWNER `
p ADDRESS Z .i� ZONING SEfBACKS
z CITY ZIP �17/.�STEL. FRONT q�y � .
� APPLICANT TEL. R�`R O
�� SIDE/SIDE STREET RW O
CONTRACTOR +G�1� SIDE �
o CDDRESS" `Z TE 9��J-�s -��1� pROPOSED USE G� � `
o ARC NG/ 1' -
�z DESIGNER NO.DWEL. NO. NO:
n� ADDRESS
� CITY ZIP �L UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNEF-BUILDER DECLARATION SFR/ADO/REM
O
. 0 I HER�V AFFlRM UN�ER PENALTY,OF GERNRV THA7 1 AM E%E1APT FqOM TryE CANTRACTORS�4 Garege/Cerport
W CENSEUWFORTHEFOLLOWINIiREASON(SEC.7031.6BUSWESSANDPROFESSION9COOENJYGTYOR (n
� COUNNWHIC7IREOUWESAPERM177000NS7AUCT,ALTER,IMPROVE.DEAIOlISH;ORRE7NRANYSTRUG W P81i0lDeCk
TURE.PRIOR TD RS ISSUANCE,ALSO q[-0UIRES THE APPUCAN{Fpp SUGi PERMIT TO FlLE A SqNEO W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 hVE PROVISIONS�OF THE COMRACTORS LF ,
� CENSE LAW(CHAPTER Y(COMMENClNO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINE59 AND�PRb �- PooUSpe
. � FESSIDNSCOOE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALlEOEOEXEMP• C7
TION.AM'.VIOIATIONOFSECTION7o31.6BYANYAPPLIC/VITFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� ACIVIL VENALTY OF NOT MORE TYiAN FNE HUNDRED DOLLARS(f50D).r
� ❑4�^OWNEROF7HEPROPERTY,OqMYEMPLOVEESWI7HYJAGESASTHE1R50LECOMPENSATION, � � CpmmBfCial
Z N7LL DO THE WORI(AND TNE STRUCNRE IS NOT INTENDED Ofi OFFERED FOR 9AI.E(SEC.70u,BU51- ��J ""
� NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE�LAW DOES NOT A7PLY TO AN.OWNER OF j -
PROPEHTY NTip BUIL0.4 OR IMPROVES 7HEREON,M1D WHO DOES SUCH NpRK HIMSELF OR HERSELF OR
w iHROUGHWSORHEROWNEMPLOYEES,PROVIDEDTHATSUpiIMPROVEMENTSARENOTINTENDEDOR m � - ,
Q OFFERmFORSALE1F,/qWEVER7ME8UILDWOORWPROVEMENTIS50�pWfJMNONEYEAROFG�DM7LE
Z T�ON,h1E OWNEH-BUILDER WILL HAVE THE BURDEN OF PROVING THAT'HE OR SHE DID NOT BURp pq .
� PdPROVEFORTHEPURPOSEOFSAIE). �
w ❑I,ASOWNEROFTHEPROPEfiT1;AME%CLUSNELYCANTRACTWOWRHI�CENSEDCONiRACTOR3
� TO CONS7RUCT h1E FROJECT(SEC.701�,BUSINE53 ANO PROFESSIONS CODE THE.CONTMCTORB�U- V81U9t(Ofl� q�,q fj�- '
CENSE UW DOES NOTMVLY 70AN ONTIER OFA VROPER7Y WHO BUILDS OR IMPROVES 7HEREON,AND � �
� WHOCOMAACTSFORSUCHPRO,IECTSWfTFIACONTRAGTpq�S)LICENSEDPURSUAMTOTMECONTRAG Q�J(��,JT�TM DESCRIPTION --
TORS LICENSE UW.). �E .
Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR TWS REASON � � C
� U
� DATE ONMER H
Z U
� LICENSED CONTRACTORS DECLARATION �w - �
. � I HEREBY AFFlRAI UNDER PENAL7V OF PERIURY TH�T I AAI'LICENSED UNDER PROVISIONS Of CMAPTER Z � ��� j �� �w L?
� p I���p��TM SECTION 7000)OG DMSION 30F THE BUSINESS M1O PROFESSIONS COOE,AND
�X AIYLICEHSE IS M FUIL FORCEAND EFFECT. m �� �• v�,
� UCENSE CU1SS� LIC.NO.. �I �77i.3 A�� � � �
U DATE v I I�L . CONTRACTOR �,��. is C✓I / ' d . .
�W (�n..},�.- L - .
WORKERS'COMPENSATION DECLARATIOItl I'V Gr�rs� Q . _. _ ..
� I HEREBYAFFIRM UNDEA PENALTY Of GERJURY ONE OF THE PoLLOWWG DEG:ARATIONS: U - '
� �
O _IHAVE�ANDWILLI.WNiAINACERTIFlCATEOFCONSENT70SELF•INSUREFORWORKFAS � � �
Q COMPENSATION,AS VROVIDEU BV SECTION 37UD OF THE UBOR CODE,Fpq 7HE PERPoqMANCE U'
OF THE WORN FOR WHHXi 7HI5 CERMI7 IS ISSUED. W
� �
� �I HAVE AND WILL AUIMAIN WORKERS'COMpENSATION WSURANCE.A9 REOUTAED BV SECTION � � �
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH h115 PERMIT IS � '
ISSUED.MY WORKER5 COMPENSATION INSURANCE CA(iRJ1EA�AND.�POLICY IdUMBER ARE CONSTRUCTION -
jCARRIER .S'�'U.T� �'✓�-U - PLAN REVIEW
� POIICY�NUMBER -
� ELECTRIC
o (nessEcnoNr�IDwreE�rmoFn+eaEw.rtswaor+EMaot�ooti�tstt�m)oa�ss' PLUMBING
w
Z �CER7IFV T1iAT IN THE PERFORMANCE OF THE WORK FOR W WCH THIS PEPod1T IS ISSUED,I MECHANICAL `�
C'} SHALL NOT EM7LOV ANY PERSON W ANY!AMlNER SOAS TO BECOME SU&IECT TO THE� � �
(,/� WORKERS'COAAPENSATION LAWS OF CA�IWRNIA,AND AGREE 7HAT IF I SHOUID BECOME INSPECTION FEE
S SUBIECT TO THE WORKERS�COMPENSATION 7ROVISIONS OF SECTION 77o00F THE UBOP ' � � � �
cooe,i sw�u.FOAr�vnni corav�r win� sE aao!v�swr�s. ISSUANCE �
O - ��p DATB APPLICANT: CJ �SMIP _
� ENERGY P/C
WAHNINO:�FALURE TO SECURE WORKERS'COMPENSATtON CAVEMGE IS UNUWFIA,AND SHALL BE
� SU&IECTANEMPIOYERTOCRfMWALPENALTIESANDGVILFWESUPTOONEHUNDREDTMOUSMID ENEROYPERMIT
DOL1NiS(S10D,000),W ADDITON TOTHE COST OF COMPENSA710N.DAM/lGES AS PROVIDED FOR IN
J SECTION 37oe OF hIE LABOft COOE,INTEREST,ANDATTORNEY9 FEES. � � � � ' �
w RETENTION FEE: � •
O CONSTRUCTION LENDING AGENCY �-ALT F�
�. 1 HEREBY AFFIRM UNDER�PENN.7Y OF PERIURV THAT TNERE IS ACONSTRUCTION LENDWO AOENCY �C � •
Z fOR THE PERFORMANCE OF iNE WORK FOR WHICH 7HI5 PERMI7IS ISSUFD(SEC:3087,CIV.G). -��
W
�. LENDEHS NAME . . . . . ,
h- LENDER'SADDRESS � � �
�� 'ICEfRIFY7HATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEWFOR1AATpN19CORR 7 TOTAL FEES� . �/�)
� IA(iREETOCOMPI.VWITHALLCITVANDCOIRlTYORDPlM10ESANDSTATEUWSREU7WOTOBU �I. � {� �
� ,CONS7RUCTION,AND HEREBV AUTHORIZE REPRESEN7ATNES OF TToS COUNTV TO EHfER UPON THE "
ABO MEMIONED PROPERTY FOR INSPECT N PURPOSES. .
COMMENTS '
J'
�
m PE I NAME(PR1Nn .
Q �
�
' ONA RE OF P RTEE DA
RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy.YELLOW--Finar�ce Copy.PINK—Assessor Copy.GOLDENROD—File Copy.6REEN—Applfcant's Copy
CITY �F DIA►MOND BAR
INSP�C1'IOP� RECORD
� ,
.�;�.
-�� 43 ""���°,-` D � "'+�',�Y.,-� ° A "_�,�,� 0 0 � p , �
. . ... , . . � , _ . , .. ..�_ Y.
SET BACK _ j FLOOR JOIST
FTGS/FORMS/STEEL fHA REQMTS �
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING U�lDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNOATlON
TEMP P�WER FIREPL�CE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FItdAL BOND BEAM
ROOF COVER_ PRE-GRADING
ROUGH HEATING BENCHING - �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FtNiSH GRADING
SHOWER/TUB TEST PpOL ELE�TRIC
EXT.LATH/SIDING POOL FENCING
WALL lNSULATION I POOL FINAL
CEILING INSULATION OFF SITE'IMPS.
DRYWALL NA�LING I DEDICATIONS
5EWER fINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. Ofd SITE IMPS.
GAS AIRTEST � FINAL ZONING
FINAL CQNST. FIRE DEPT.FINAL
FINAI HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING E(VERGY
FINAL PLANING
FINAL ENGWEERING • o 0
C�MMENTS
4 a���
SEPTICTANK 51ZE
SEEP PIT/U SIZE ,
�
�, ���' —
{��„�,�
`
r � _
.,a;_<
�