HomeMy WebLinkAbout12-641 ` , _��� CTTY OF DIAMOND BAR v
DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES �
21810 Copley Drive,Diamond Bar,CA 91765 �� PRESS
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70
'�'%+����W BUII.DING PERMIT APPLICATION FIRMLY
� JOBSITE �J� '` �,{/ APPLICATION� � �� NUMB R�� #/C I
o ADDRESS l7`� � I� �V�� 1--� ��r - DATE �
� ISSUE TYPE OCC
� APN LOT TRAC7 DATE CONST. GROUP
p OWNER
ADDR SS � L- � - � � ZONING SEBACKS
o FRONT RW ❑
Z C�Ty ' ZIP TEL� � � REAR ❑
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTO � � P SIDE ❑
� ADDRESS � PROPOSED USE
� CITY d ZIP TEL �
w ARCH/ENG/.
z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF AW.AREANALUATION
i �
� OWNER-BUILDER DECLARATION SFR/ADD/REM
I, O
1 HER�V AFFlPod UNpEA PENALTY OF VERRIRV THAT 1 AM EXEMP'T FROA1 THE CONTMCTORS LI- Garage/Carport
W CENSEUWFOR7HEFOlLOW�N(1HEA+OIJ(SEC.7031.6BUStNESSAND7ROFESS10N9CODEMfYClIYOR .
� U COUHTYWHICMREOUWESAPFAMRTOCOMSTRUC7.At7ERwPi10VE.DEMOLISH.ORREPAtAM1Y5TFlU6 W Pa[tolDeck a
Z 7URE,VRIOR TO�RS 55UM10E,ALSO REWIRES THE APGLICANT FOH SUC11 PEF».11T To FlLE A SIONED
W STATEMQlT THAT HE OR SME 4S LICENSED PURSU�NT TO THE PHOVISION,4�OF THE�CONTRACTORS L4
� CENSE UW ICFUP7ER a(COMMENCINc3 WI7H SECTION ToOoj Of DiVt510N 3 Oi TME BUSlNESS AND PHP . � POOUSpO
� FESSIDNSCOO�ORTHATNEOFSMEISE7(EMPT7HEREFiiOMANDTHEBASISFORTHEM.LEOEUE%EMP- (� - �
� 7qN.ANY.V101AT10NOFSECTION7031.6BYANYADPLICANT�FORAPERMITSUAIECTSTHEAPPLICANTTO Z� q�Root
, F A CML VEN�LLTV OF NOT MORE TNAN FIVE HUNDRED DOlLARS If5�0).Y J
Q ❑�ASOWNEROFTHEPROPEHTV.ORMYEMPLOVEESWfTH1VAQE5ASTHEIR60LECOMPENSATION, Q COfI1ff10fC18I
Z VJIIL 00 THE WORK�ND TME 9TRUCTURE 19 NOT�NTF1'�DED OR OFFEAE�FOR SALE tSEC.-7�,BU51• �I
� NESS'AND PROFESSiON3 COOE TME CANTRAC70RS UCENSE UW DOES NOT A7PLY TO AN OWNER OF �
PROPEHTYNRiOBUiLDSOHIMVROVESTHEREON,ANDWHODOESSUp1WOANHW3ELFORHERSELFOR m
[L TYiH01J(iHHI50RHERQWNEMPLOYEES,7ROViDEDTHATSU0111APROVEMENTSAFENOTiMENDEDOH �
� OFFEREDFOR3ALEIF,FiOWEVER111E8UILDW�ORWPROVEMENT�55�1DN�71qNONEVEAROfCOMPLE-
Z TpN,.THE ON7JER-BUILDEN WILL MAVE TME BURDFN OF PROVVKi THAT�HE OR SNE DID NOT 9UIlD OR
� pAPROVE FOR 7NE R1FP0.aE OF SALE}
w O l�S OWNEROFTHE PROPERtV,-AA1 E%CLUSNELV fANTMCTINo WITH LICENSED CONTRIICTORS
� 7p CpIJ57RUCT T/IE FRQIECT(SEC.70�1.&151NESS ANO PROFESSION9 CODE:THE�CONTRACTOR9 LJ- VBluflt{Ofl NDJ•AHFA
� CElISELAWDOESNOTMPLYTOANOWNEROiA7ROPER7YWIiO8U0.D30RIMPROVESTHEAEON,ANO
W/qCOMMCT5FOR5UGHPROJECTSWITHACOHTRACIOR(S7LICENSEDPURBUMRTOTHECONTfUG Q�J/Ufj�� ESCRIPTION � FEE .
TOqS LICENSE UW.).
J /
� O ❑1 AM E%EMPT 11NDEN SEG �B.8 P.C.FOR T/95 REASON U `
� �
� DA7E OWNEH ~
W
� UCENSED CONTRACTORS DECLARATION �w
� �
1 HEREBV AFFlHM UNDER PENALTY OF PERIURV iHAT I AM LICENSED UNDER P OF CFIAPTER Ur s
d Y(COMMENCWOYATHSECTION7000)OFDIVISIONJOFTHEBVSWESSANDPROF ID ODDE,AND Z. , .
X 1,(Y UCENSE IS P!NLL�RCE/�qD EFFECT. � m
LtJ �;/� �
� UCEraSE cLqsS � LIC.NO., � J '
V DATE_� r_�.��..,� CONfRACTOR d .
W
� WOflKERS'COMPENSATfON DECLARATI N � �
� U
� IHEREBYAFFWIAUNOERPENALIYOFVERJU0.YONEOFTHEFOLLOWW60ECLAMT�OMS: Z
� _IM�jYE�ANDWILLMNNTAINACERT�FlCA7EOFCONSEMTOSELF-�NSUREFORWORNERs 2
jJQNPENSATION,AS PROVIOED BY SECTION 370D OF TNE UBOR CODE,FOR iHE PERFORMMICE w'
�pF T7(E WORX FOR NM1i1CH 77��3 PERMIT IS ISSUEO. �
� y
_I NAVE AND N1�LL MAIMAW�WOPxLRS'COMPENSATION INSURANCE;AS RE�UIRED BY SECTION ��"7 �S
Q 370o OF 7HE LABOR COOE,FOR THE PERFORMANCE OF THE WORK FOR WHK711'M�s PERMIT IS G�
�55Um,�,ry WpqK � 'CpMPEN5AT10N IN CE CM R'AND POI�CY NUMBER ARE CONSTRUCTION��
juaaEa PLAN REVIEW �I .� �
Z po��cr raun+sEa ELECTRIC
¢
o �vsFcr�wr�IDrq7eEooMrtE7EuoF swa �ooau�R��l��? PLUMBING
w MECHANICAL
Z 1 CER7IFV TMAT IN 7HE PERFOfUAANCE O E FOR ICH THIS PEN.�R IS ISSUED,1
(r} 91/�LLNOTEMPLOYPNVVERSONINANV ER AST EcoMe�sue:iEciTonie � INSPECTIONFEE
UJ WOR%ER5 COMPENSATION lA`NS OF C IA D A E 7HAT IF i SHOU�D E ... .
SUBJECTTOTHEWORKEFIS'COAI7ENSA PRO SqN SECTION E�ABOR ISSUANCE I � I � �
S �I SHAIl�F/ORT TH COMPLv VIITH � � �VI� . . ..
0 v
p DATE o f • � �icAHr. . . . �SMIP
� WAHNIN(3:�FA1WRE70SEWREWOFi1(ERS' P IONCOVEMGEISUNLAWFUL.ANDSHALLBE ENERGYP/C . .
� SUBJECT AN EMPLOYER TO CAIMWAL PENALTIE3 AND pNL FWES UP TO ONE HUNbREO THOUSAMI ENERQY PEAMIT
DOLLAHS(f100,000),��t1 ADD�TION TO THE COST OF COMPEN5AT10N.DMfAQES A3 VROVIDED FON M � � �
¢ SECTION Y70!OF 7HE LABOR COOE.W'fEREST,AND ATTORNEYS FEES. ' FjE7ENTION FEE: � .
O CONSTRUCTION LENOING AGENCY p ALT FEE:�,
.._r� , �
� 1 HER�Y AFFIRM UNDER'PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AOENCY 'iT'1 --
d �FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS CE(iMfr IS ISSUED(SEG��OG7,CAV.G). rt° 'T .
Z '
W
��. LEUDERS NAME _ . . . . .
� LENDER'SADDRE . �' ��y
�' 'ICERTtFYTHATIHA a�on+is�rvuc�ria+u+osr�rEn�rn+e�eovEwFoiw�riowisooar+Ecr: TOTAL FEES ///� D���
� 1 A(iAEE 70 COMP,LV 7H ALL CITYANO COUNTY OFt[I�NANCEB AND STATE UWS REU7W6 TO&/1LDW0 , " �
.� CONSTRUCTION,AND EREBV AllTHORI2E REPRESENTATNES OF T115 COUNTYTO EHTER UPON 7HE
Z qgOVE-NE P PERTY,FOR WSPECTION 7URPOSES. COMMENTS �
o � � �
m PERMfTTEE NMIE �t � J � . . �
Q
N
Uj SKiNATURE OF PERMfTT DATE
RECPT.NO. PAID BY VALIDATION
� WHITE—Departrnent Copy.YELLOW—Finance CopY.PINK—Assessar Copy,GOLDENHOD—Ft1a Copy;6REEN—Applicant's Copy
CITV OF DIl�MONC? B�►R ' �'
IiVSPECTION RECORD
�, , . � 8 � : . D,, , �. .-
.
_
- � ,. , ��" ' � ' ��' .. ''� � � ` ��'�' p � ,�9!.a�' r � � ���:_
�
0
. . .. ._.:.; . . ._.. , r.
SET BACK FLOOR JOIST ^
FTGS/FORMS/STEEL FHA REQMTS
ELECTRlC GROUND ' UNDER FLOOR DUCT
GR�UND PLUMBING •UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOfVD BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHItVG 8 FT.BOND BEAM
FRAA4ING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRAQING
ROUGH HEATING BENCHING
ROUGH ELECTRIC �ROU H GRADING
ROUGH PLUMBING �FlNISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENtItdG
WALL INSULATION POOL FINAL
CEILItJG INSULATION OFF SITE IMPS.
DRYWALL NAILItdG DEDICATIONS
SEWER FINAL ENG.
SEPTI C TANK LAN DSCAPE/I RRIG.
SEEP PIT/L.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 PLUNIBING ENERGY
FINAL PLANING
FINAL ENGINEERING • .p m
COMMENTS �
n
;
�
SEPTIC TANK SIZE
SEEP PIT/U SIZE `-
I 'IV.
I Y 'Ii