HomeMy WebLinkAbout10-1073 ��� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 ����� PRESS
'� (909)839-7020 Fax{909)861-3117 Building Inspe-
�<9�'��W BUILDING PERM[T APPLICATION FIRMLY
� JOBSITE ���{ �, • � APPLICATION PERMfT P/C
o ADDRESS 'YTT � ��-L�Si II�� �• DATE NUMBEF�D"� O � �
� APN LOT TRACT D TEEI��(�(O "' / O CONST.'� � Q�"C`,ROUP
°C OWNER
� ZONING SETBACKS
o ADDRESS FRONT RW ❑
ZIP TEL.
o APPLICANT TEL.f3lB.3d3•�i^ SIDFJSIDE STREET RW ❑
� CONTRACTOR Cr SIDE �
o ADDRESS � � PROPOSED USE
CITY���I�dLl�`� ZIP9l��. TEL.'
w ARCWENG/'f
z DESIGNER�� NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
� OWNEF-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRM UNDER 7ENAL7Y OF PERRIRV THAT I AM EXEMPT FROM THE CONTRACTOqS LI- GHf89B/CB�Of(
W CENSEUWFOHTHEFOLLOWINQREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
U COUNTYWH1CHfYE-0UIqESAPEFlMITTOCONSTFUCT,ALTEA,IMPROVE,OEMOIISH,ORREPAIRANYSTRUG w P8�10/DBCK 9��
Z TURE,PRIOR TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMI770 FILE A SIONED
W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO TiE PROVISIONS OF THE CANiRACTOiiS LI�
� CENSE U`N(CHAPTEii��CAMMENCING WITH SECTION 7 W6)OF DIVISION 3 OF THE BUSINE55 AND PFO� n POOVSPB
� FESSIONS CODE)OR 7HA7 HE OR SHE IS E%EMP77NEREFROAI AN�THE BASIS FOR THE A4.lE0ED E%EMP•
7�pN./JJY VIOl.AT10N OF SECTION 7031.6 BV ANV APPLICNIT FOR A PEAMIT SUBJECTS THE APPUCMIT T0 Z Re-Roof
� A CML VENAL7Y OF NOT MORE T11AN FNE HUNDRED OIXlARS(f50o).):
O ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAQESASTHEIRSOLECOMPENSATION. C� CORIRIBfCl31
Z VALL DO THE WORK�NO 7HE STRUCTUftE IS NOT�NTEN�ED OR OFFEFED fOR SALE(SEC.7a1,BUSI� J
N NESS AND PROFESSIONS CODE:TNE CONTRACTORS IJCENSE LAW DOES NOT APPLV TO AN OWNEH OF ?
PfiOPERTYWHOBUIIDSORIMPROVESTHEREON,ANDWHODOE55UCHWORKHIMSELFORHERSELFOR m
Q 7NROUGH HIS OR MER OYJN EMPLOYEES,PROVIDED THAT SUpf IMPROVEMENTS ARE NOT INTENDED OR ,
QOFFEREDFORSALEIF,HOWEVERTNEBUILAINGOFIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE-
Z TqN,THE OWNEfl�BUILOER WILL HAVE TF1E BUFiDEN OF PROVINO THAT HE OR SHE DID NOT 9UILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS OWNER OF THE PROPEHTV.AA1 EXClUSNEIY COMRACTINO WfTH LICENSED CONtfiACTORS
� TO CANSTRUCT TME PR0.JECT(SEC.70a1,BUSINESS AND PROFESSIONS CODE:THE CON�RACTORS ll- VfiIU8110f1 ADJ.AFEA
� CENSE LAW DOES NOTAP7LV TO AN OWNER OF A PROPERTY WHO BUILD9 OR IMPROVES THEREON,AND
WIIOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHEGONTRAC� QUANTITY DESCRIPTION FEE
TOHS UCENSE UW.).
O ❑I AM E%EMPT UNDEf7 SEC. B.8 P.C.FOH iH15 REASON �
� Q
� � D�TE OWNER V
Z W
� LICENSED CONTRACTORS DECLAFATION -�
OC W
1 HEREBY AFFIHM UNOER PENAL7Y OF PERJURV TFiAT I AM LICENSED UNDEF 7qOVISIONS OF CHAPTEH Ur � ��
� Y(COMAIENCINGWfTNSECTION7000)OFDIVISION3OFTHEBUSINESSAND7ROFESSIONSCADE,AND Z
X A/V LICENSE IS IN FULL FORCE AND EFFECT. m S
� LIGENSE CLASS�r'Z'7�b��D LIG.NO. � � '
J
V DATE� �•�� CONTRAGTOOR �- .
W
� WORKERS'COMPENSATION DE LARATION �
� U
� I HEREBV AFFIRM VNDER 7ENALTY OF PERJURY ONE OF THE FOLLOWING DECUMTtONS:
� Z
Q
� _I HAVE AND WILL MAINTAIN A CERT�FICATE OF CANSENT 70 SEIF�INSURE FOR WORKERS' _
COMPENSATION,AS PROVIDEO BY SECTION 370o OF THE IABOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PEPFOHIA.4NCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSUqANCE CAFRIER AND POLICV NUMBERARE: CONSTRUCTION
� �uiR�ER — PLAN REVIEW
� POLICYNUMBER�G� L �I ELECTRIC
Q (fY+LSSEcnoNME�NoreEO]MFI-Er�oFniEaEw�.frsFOaaNEr+tXi�R�ooU.Pas(f�mloaLEss} BIN
w MECHANICAL
Z I CERTIFV THAT W THE PERFOPMANCE Of THE WORK FOF WH�CH THIS PERMIT IS ISSUED,I
�} SHALLNOTEMPLOVANVPERSONW MPNNERSOASTOBECAMESU&IECTTOTHE 1NSPECTIONFE£
� WORNERS'COMPENSATION LAWS OF IFORNI0.AND AGREE THAT IF I SHOULD BECOME �
SU&IECTTOTHEWORNERS'CAMPEN TIONPROVIS OFS N37o00FTHE R �pNrF/ _'LcJf�
S CD�E.ISHI.I.IFOFTHWITHCOMPLY TH0.5EPft0 N �J
O /�� ��i��r� �,I� � SMIP
p OATE:7.•�•l�+ APPLICANT. . �
W � �NERGY P/C
J WARNINO:FAILURE TO SECUFE WOR NSATION COi ERAGE UNLAWFUL,AND SHALL BE
J
� SlfO.fEC7ANEMPLOYERTOCRIMINALPENALTI DCIVILFIN SUPTO NEHUNOREDTHWSMIO ENERGYPERMIT
DOLLARS(f10D.oao),INADDITIONTOTHECO5T0 COMPENSATI GESASGROVIDEDFOFi�N � ��`�
J SECTpN 3�OB OF THE LABOH COOE.INTEREST,AN�ATTORNEV'9 FEES. RETENTION FEE: � v�� .
�
w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
a
O
Q I HEREBY AFFIPAI UNDER PENALTY OF PERJURV THAT THERE IS A CANSTRUCTION LENDING AOENCV
' � FOR THE PERFOHMANCE OF THE WORK FOF N�HICH THIS PERMIT IS ISSUED(SEC.7ao7.CIV.C.). '
Z
W
� LENDER'S NAME
� LENDER'SADDRESS � ��
� ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHAT7HEABOVEINFORMATIONISCARRECT. TOTAL FEES
w I AGREE TO COMPLY WITH ALL CfTY AND COUNTV ORDINANCES AND STATE UWS REUTIM6 TO BUILUIN�
� CONSTRUCTION,AND HEREBV AU7HORIZE REPRESENTATNES OF THIS COUNTV TO EMER UPON THE
� /$OVE-MEMIONED PROPERTV FOR INSPECTION PURPOSES. .
Z COMMENTS
0
J �
�
m RMfTTEE N RINT) .
Q
� �.
TUREOFPE DATE
� RECPT.NO. � PAID BY � VALJDAT{ON
�"' WHITE—Department Copy,YELLOW—Finence Copy,PINK—Aesessor Copy,GOLDENROD--FlIe Copy,GREEN—Appllcant's Copy
C9�V O� DIAMOI�� �AR
Ift�SPEC�l06\! RECORD
_.�.�� ; � ,�,,,
.
, -.
�`-� ��;i� 5l,>;ir�i ��S�i
w., . . .
o � .' � ���� DGrI�P�C�400[�l' : ; o` ,� G`��� � �I �''C� o
� �
,}I��G?f�C�4D0[�l = : o ��.. � ,O�I�I�C��? . . �,,�,
�SET BACK FLOOR JOIST � �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE 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
SHOWER/TUB TEST ` POOL ELECTRIC
EXT. LATH/SIDING POOL FENCIfJG
WALL INSULATION POOL FINAL
CEILING INSULATIOPJ OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PITlL.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING Z3 1O ENERGY
C��"l �o c
COMMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a
c� �
.�
� � ��: