HomeMy WebLinkAbout13-626 ��� _ CITY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES �
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
Q DDAIESS �� $� r �� APPLICATI N PERMIT i'r!.-� p/C
o DATE � � NUMBER #
� ISSUE TYPE ,� OCC
APN LOT TRACT OATE CONST. � �L� GROUP
p OWNER G(Q'
p ADDRESS a .� ZONING SETBACKS
w L�'P ZIP / TEL�� - FRONT RW ❑ �
- o APPLICANT ' v�• TEL. REAR ❑
Z SIDE/SIDE STREE7 RW ❑
¢ CONTRACTOR C� O�/T Ia .T�P��Q �« , SIDE ❑
o CDORE SC f� Z Z�P ,�C TEL O ' .. PROPOSED USE GQ CL . .S
a ARCH/ENG/ �00� �
'W DESIGNER NO.DWEL NO. NO.
a ADDRESS
� CITY ZIP TEL UNffS STORIES BEDROOMS
cn ,,
� DESCAIPTION SQ_FT. FACTOR PSF ADJ.AREANALUATION
¢ OWNER-BUILDER DECIARATION SFR/ADO/REM
O
p I MEREBY AFFIRAI UNOEA PENALTY OF PEARIRY TUT 1 AY E](EMPT FROY hIE COHTRACT0R4 L4 GaregelCarport
W CFNSELAWFOFlh1EFOlLOWWaREA50N(SEC7m1.59U5WE55MlOPROFESSIONSCAOEANYQTYOR (�
U COUNTI'NTIICHREOUIHESAPFAMITTOCONSTHUCf,ALTER���VE,OEAlOU51�ORREFNANiY9TRUG W
w NRE.PHIOR TO RS 155UANCE,hL50 REOUTAE9 TiE A➢PIICANT FOR SUCH PENUT TO pLE A SICNEO W Patio/Deck
� STATEMEHT THAT HE OR SHE LS 11GENSED PUqSU.Wr TO hIE PIiOVL510N5 OF 731E COHTHACTOqS Ll- �
CENSE UW(OiAPTER o�CONMENGTN6 vATH SECTION TooO)OF OIVI4ION�OF THE BUSWE55 ANO PFO- PooUSpa
0 FESSqNS COOE�OR THAT ME Ofl SHE IS EXFJAPTTHEREFROM ANO THE BA515 FOH THEAI,LEG�E7�YP- �
U TION.MIY VId�TION OF SECTION 7oat.5 BY AHY APPIJCAHi FOR APERMIT SUBJECTS THE MPUC/J!T TO Z RaRool
A tlVIL PENAl,7Y OF NOT NORE T1VN FIVE HUNORED OOlUpS(SSoo),}
� ❑1A50MMEROFTHE7flOPEHTY.ORAIYENPLOYEESWITHYVAGESASTH�RSOLECOMPFj1y�7�pN, � (`,pmmefCial ��
Z YALL OO THE WOHI(ANO THE STRUCTURE IS NOT INTENOED Oq OFFEAED FOR SALE(SE4 7aa,BU54 J
� NE55 M10 PROFESSIONS CAOE'THE COHTRACTOf75 UCFNSE LAw OOES NOT AP7lY To AN OWNER OF ? '
— PqOPERIY NTIO BU4.OS QR IMPROVES THEAEON.PN�VA1000E5 SUp1 WOFK HUASELF OR MFASEIF Oq
�w THROUGH WS OR HEA OMM EMPIOYEES.7ROV10EO THA7 5UfJ11YPROVEMEMS ME NOT PfiEHOED OR m
� OFFEPmPoRSKEIF.HOWEVERTME8U4DWGOFWFROVEA1FNTt5501DW(TNWpNEYF�1qOFCOMPIE
Z iION.THE OWNER-BUttDER WILL HAVE TNE BUFOEN OF PROW�O TY7AT HE OR SME DI�NpT BUIlO OR
� IAIPROVE FOF hIE WFPQSE OF SAIE� '
w �I�OWNEROFTHEPROPEATY,AA/IXClUSNELYCOMFlACiW6VrtfY1UCEN5EDGOH�RACTORS
[[ 70 CANSTiAICT 7HE PROJECT(SEG 7va�,�9U51NE55 ANO vROFE55lON5 CODE THE COMRAGTOqS L4 ValUdf�W1 qpJ.qREq
W CENSE UW DOES NOTAPPLYTOAN OWNEA OFA PROPEATY WHO BU0.DS Oq IMPROVE9 THEAEON,µD
� 1»1000NTAACiSFORSUCHPRQIECT9WR11ACOMMCTOfi(S)LICEHSEp7Uq5UAM7p717ECpt!{q�G qUANTffY DESCRIPTION FEE
Y T00.5110ENSE UW.).
� ❑I AA1 D(EAIv7 UNOEA SEG B.i 7.C.FOA THIS REASON Q �i
� U
� �ATE _ OWNER H
Z U
� UCETJSED CONTRACTORS DECIAFIATION � w
� 1 HEREBY AFFiRM UNUER PENALTY OF PE0.AlqY 7)1AT I AM LICF1f5m UNOEA VqOVI5qN5 OF CNAPTEA �
' d, i�mMMF1lCt1q WI7}�SECTIOH 7000)OF OMSION]OF THE WSWESS.WD PROFESSIONS C06E,/�ND Z
�c 1dY LICENSE IS W FULL FaRCE AND^EFFECT.
� LICENSE C SS �r�"� �IC.NO. �l I I I �
U DATE� �� COMMGTOR d
W
� WORKEAS'COMPENSATION DEC TION Q � ,
� U
� I HFA�Y AFFIRAI UNDEN PENALTY Of 7EAJUpY ONE OF TNE WLLOW WG DEal�RA710N5: Z .
� _I HAVE AND WILL NNNTAPI A CEATIFlCATE OF CANSEHT TO SEtF-INSURE FOR WORKEHS' a
� COYPEN4A770N,A$VFOVIUm BY SECTION]]Oa OF 7HE UBOH COOE FORTHE PERFOqIdMICE U
�//'QF THE WOPoC FOR WMIq171U5 PElW7T IS ISSUED. W .
0 /L�'-'�/ �
Qw V i T J HAVE AND WILL MAIHTAfN WORKEFlS'COMVQ15ATqN INSVfLNC�ti5 REOUIRED BY SECT%N!
�700 oF TI1E UBOH CoOE.Foq 7HE EAFOFAtANCE OF THE WOPoC FOR WH10/THLS VEAtAT t5 �
ISSUED.MY WO YPEN INSUqA_N/S E CAARIER Ml0 POUG7 MJM9ER ARE CONSTRUCTION
j c�awea �¢ PUW REVIEW
o voucvr+uMSEa �
Zd ELECT W C
0 (RaSSEcilor+NE�wieE¢AFl.FfIDOFnEaEPo��rswaor+EYAXUR�0alKslsto0f��"+s} PLUMBING L _
W
Z 1 CERTIFY THA7 PI 7ME PEPFOPAWICE OF hIE WORx FOH WMU1 ixl5 PERMrt IS L55UED,1 MECHANICAL
C'S SM.V1 NOT EAIPl07 M1Y GERSON W M!Y IIAMIER SpAS TO BECOME SU&IECT TO T1fE
(,/) WORI(ERS COMPENSATiCN!UWS OF CALIFORNI�ANO Af3REE THA7 IF I SHOUID 6ECAME INSPECTION FEE
= SU&lEClTOTHEWON(E0.4COMFENSA71DNPqpV�510N50F5EGTION]7aoOFiHEIABOR
coo i coari+Nnn�caur�r wrnr nas6 aao io . ISSUANCE �
O
p On7E I I �pp���qN7; SMIP
W
� WARNW6:FM11qE TO SEGLRE WOFKFA9' SATqN CAVE GE IS VNLAVlFI�ANO SHILL BE �1EFGY P/C
� SUalECf AN EMPLOVER TO CAIMUlIL PENALTIES M10 CML FRlES UV TO ONE HUNDHED 7FIOUSAI� �ERGY PEAMIT
DOI.LAAS(iloo,000�PI PDDI710N T07HE COST OF CCMPENSATON,OM1t�GE5/S PROVIDED FOR W �
J SECTION S/OE OF THE LA80R COpE WTERES�ANO ATfORNEY'S FEE9.
Q FiETENTION FEE: .�
OCONSTFiUCT10N LENDING AGENCY pFiE-p,�T FEE �
� I HERE9Y AFFlRM UNOER PENl�LTY OF PEFWRY THAT THERE IS A CONSTAUGTON L£NOWU AGENCY '
Z FOi1 THE PEAFORMANCE OF 7HE WOHI(FOR WHICH 7YY9 PERwT IS t55UED(5EG wn.cN.C4 .
W
� IENOEH'S N�LE
F— IENOEft5A0DRE95
w 10EATIFY7HATIHAVEREAOTFUSAPPUCA770NM10S7ATEn1ATTHEABOVEwFORMA710Nt3CAtiqECT. TOTAL FEES . �i�p
� � I ACREE TO CO►IP�Y WITH Al1 ClTY ANO COUNiY ORpP1ANCE4 AN�STATE UWS RElATWO TO BULLDNlG _
� COHSTPUCT10N.lJA7NERE8Y.Wi1%7fiREREPRESENiATIVE50FTHlSCOVNTYTOEMERU70Ni}IE
Z ABOVE-AIEMXJNED PROPERTY FOR INSPECT70N PVRPOSES.
� � � COMMENTS
_ �S' �c.- c�.
m GER�nTiEE NMIE(PRWTI I /
Q
�
� SIaNATUqEOFP DATE
� RECPT.NO. PAID 8Y VALIDAT70N
� WHRE-0epartment Copy.YELLOVJ—Finanee Copy.PINIhAssessar Copy.GOLDENR�Ia Copy.G^`.,rs�.—ApPGcanCs Copy . .
���`�'�° �::��" ��a��1��f>.i�3 �=��i9==
���3��=kaz..;���3� �a�.����
r 7 y� �. r'-r� � � r .-��=-,�.^^�'"mz?;,'�-am��d �'.� .�-„5�i_-��� ,,��..,r -x- �. . }S`".� - ..�
`�1i. .I � � 7 �. ? t}� 1 1'N l� �t�`1' �!4 y-�-(`� ���� v� �-s� � � � �F '{ .
, 'l , �' l�� �� ��y a9� ������ �! �.� � v+ v������s�.�"���L,,�t�� �,$;�S �� ;��,.,r.���5s��l,s- �,� �e �
���...a.—.��..._. .__1�`�x!E�,�_..a �w�.:��;����� �'�.�c-��"�.�,r..��,�r,,.F���y.,s.�...-.-�..�m�=K :�...,,,:"_?�`��}r���a3 � . �.i �.-u"/' �v4�r r,;Cl't,.. - — -
�•^ �.m.�—:s'i' '��c,.. -ti.s.-
. . ,. .. � .: . �.. ; .
..E�B�tCK � , j I rL00R JGIST ,
----- ---�------ ---�---- -- ---- ----------- — ---- --� ---- ------�--- -- -
F7:;:;;��J�ivL.:�TEEL (--- --- - �
------ - -�-� ------- -- _I FH�F,EQ�,1T;
----- -- ---------�------- -, ------- ------ ---_ --- —-- ---..__._.... .-----
;LECfRIC GROU'rJQ � ! � l)PJDEP,�LOOR OUCT
GR01)idpFl_Ufv121N1i ----�_..----�—� ---- ----� Uhd� C�ERFL��OnC��NL�UIT--
SL55 Gf,^,DE —-------�-- _� -----� FIREPLACE FnUf•dOATIU�d —
�(L-tii°PO4�!CR. � � �FIREFLACE�OtvD EE;;h�
V!ATtR=ERVICE � IAID HT.BOf�1D BEAM
ROOF SHEATHIhdG � � �3 FT.BO�dD BcP.hS
FRANIIf•IG!�JE(�I I ILA.TION _ _ ___ I FINAL BOND BcP.NI__ __
ROOF COVER _ __ _ PF.E- RADING _ ___
ROUGH HEATING BEfJCF�If•!G _ __
ROUGH cLECTRfC � �--- r�.OUGH GR;DINCi
P,OUGH PLUi`�1f31PdG FINISH G�ADING
SH04dER/TU6 TEST I PGOL ELECTRIC
EXT.LATH;SIDING POOL FENCINv
+,VALL INSULATIO�I FOOL FIrJAL
CEILI�dG f�aSULAT101`! j CFF SITE IMFS.
GRY�/ALL PIAILING DEDICA.TIOhlS
SENlER FINAL ENG
SEPIIC TANK IANDSCAPEiIRRIG _
SEEP PIT;'L.L. � ON SIT�I�1PS. �
GAS AiR TEST FINAL ZONING
FINAL CONST. FIRE DEPT.FIP•JAL
FINAL HEATI�IG HEP,LTH DEPT.FINAL
Fli�f\L ELECTRIC DEV.FEES PAID
FINP,L PLUNISING (ti) E�,IERGY �
FINA.L PLANIfJG --^--� -- ----- -- -- --
FINA.L ENGINEERIPdG___ _� __ __ _ _ �g � � ____ ________
COMMENTS _..__. __.�—_—_. —.— — —
SEPTICTAfVKSIZE ,
SEEP PIT/U SIZE