HomeMy WebLinkAbout10-1025 ��_ CITY OF DIAMOND BAR ���� f1,���
DEPARTMENT OF COMMUNITY&DEVELOPMENT S ES IT'�j-� �
� t 21825 Copley Drive,Diamond Bar,CA 91765 �,. ���
� (909)839-7020 Fax(909)861-3ll7 Buildi����� 9)839-7 � �$$
�'""', BUILDING PERMIT APPLICATION FIHMLY
y JOBSITE ��I �p � APPLICATION PERMIT /C
o ADDRESS i���GL1�v 1 Gv �- �
R DATE_ �O •I Z '� O NUMBER D' _ p
� APN LOT TRACT ISSUE �O�/ TYPE Y�,,� � OCC .
p OWNER Li2✓ .e�y� DATE /Zr�O CONST. ��(I�GfI� GROUP
" ADDRESS �I '�cl�t G .��r i v� ZONING SETBACKS
gCITY �• l�. ZIP ql�-�� TEL. ���7��ob FRONT qyy �
APPLICANT CQ.✓I a �WtAva TEL.g(➢r�3S7a?(o SID SIDE STREET qW ❑
� CONTRACTOR S ✓✓ _ _ w. dtOvi SIDE p
ADDRESS 22a I� �Gf V r �t-!�. /�c�,.E
� CITY r7 /�f✓l A Z�p PROPOSED USE �^� �V�9-C.
a��- TEL71 �? 777� �
oARCH/ NG/ �'r',� �i''�"'�K '
� DESIGNER NO.DWEL. NO. NO.
ADDRESS
u� UNITS STORIES BEDROOMS
N CITY ZIP TEL.
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/,4DD/REM
O
p I HEREBV AFFIRM UNOER PENALTV OF PE0.RIRV THAT I AA1 E%EMPT FROM THE CONTRACTORS ll• Gef99B/CBfpOR
W CENSEUWFOHTHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
C� COUNTYWHICNRC-0UIRESAPEHMITTOCONSTRUCT,PLTER,IMPROVE,DEMOUSN,ORREPAIRMlVSTRUC� w
W TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APVLICANT FOR SUCH PERMIT TO FILE A SIONED W P8110/DBCI(
� STATEMENT THAT HE OR SHE IS IJCENSEO PURSUANi 70 THE PROVISIONS OF 7HE CON7RAC70RS LI�
� CENSE LAW(CHAPTER D(COMMENCINO WITH SECTION�000)OF�NISqN 3 OF THE BUSINESS AND PRO� � POOUSPB
FESSIONS CODE)OR THAT HE OR SHE IS E%EMPTTHEREFROM/WD THE BA515 FOR THE ALLEGED EXEMP- (�
TION.ANY VIOLATKKJ OF SECTION 1031.5 BY ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Rool
� A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAAS(f50D)J:
� ❑I.ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSATION, COrt1rtIBfCl81
WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa�,BUSI- �
N NESS�flD PROFESSIONS CADE:THE CONTRACTORS LICENSE UW DOES NOT A7PLV TO AN OWNER OF �
PqOPEHTV WFIO BUILDS OR IMPROVES THERE-0N,AND WHO DOES SUCH WORK HIMSELF OR HEPSELF OR
w THROUGH HIS OR HER OWN EAIPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
Z iION,THE OWNER-BUIIAER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUItD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,AS OWNER OF THE PROPERTV,AM E%ClU51VELV CONTRACTINO WITH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.�OII,BUSINESS AND PHOFESSIONS CODE:THE CONTRACTORS LI� VBI110�iOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANONTJEROFAPROPERTYWHOBUILDSOFIMPROVESTHEREON,AND
� NM1IOCONTRACTSFORSUCFiPRQIECTSWITHACONTiUCTOR(S)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION
� roas ucENSE uw.�. FEE
Q O I AM E%EMVT UNDER SEC. B.8 P.C.FOR THIS REASON Q
?j U
� DATE ONTJER F-
Z U
� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRAI UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCINO WITH SECTION 7000)Of DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
XL' MY UCENSE IS W NLL FOi7CE AND EFFECT. m
� UCENSE CLAS{S �� LIC.NO. "I�� �
V DATE 'IiD���I O CONTRACTOR ✓ �Zi d
'.'-' ��l"'l 4p(O�L j
� WORKERS'COMPENSATION DECL RATI N ¢ ✓�ALQ C{ �ST"V
� � L
N I HEREBY AFFIRM UNDER PENA�TV OF PERIURV ONE OFTHE FOLIOWING DECLARATqNS: Z )-�
Q �-rv
� I�HAVEANOWILLMAINTAINACERTIFICATEOFCANSENTTOSELF�INSUREFORWORNERS' _
Q COMPENSATION,AS PROVIOEO BV SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE U ` O•
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
� �
Qw _I HAVEAND WILL MAIMAIN WOW(ERS'COMPENSATION INSURANCE,AS REOUIqED BV SECTION
3700 OF THE UBOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MY WO�KERS'COMPENSATION INSl1RANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
� CARqIER ` UW�� _ PLAN REVIEW
Z POLICVNUMBER �L��Z-�I ELECTRIC
Q
0 (rFiLSSECiIONNE�NOTBECONIPLEfEDOFhiEPEFa.iriSFOqpNEFII�OFim00LWiS�t700)ORLESS} PLUMBING
w f�
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FO 5 PERMIT IS ISSUED,I ECHANI
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO TO BECOME SUBJECT TO THE .
(/� NKIRNERS'COMPENSATION LAWS OF CALIFORNIA D AOREE THAT IF I SHOULD BECAME INSPECTION FEE
S SUBJECT TO THE WORNERS'COM7ENSATION PRO ISIONS OF SE 70o OF THE LABOR �^ �
I SHALL FORTHWITH COMPLV WITH THOSE ROVISIONS. ISSU CE �•7
� n •
p DATE: l ✓T APPLICANP. SMIP
W
� WMNING:FAILURE TO SECURE WOH)(ERS'COMPENSATION CAV UNLAWFUL,AND SHALL BE ENERGY P/C �
�y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOILARS(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
w SECTION 37oE OF iHE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. AETENTION FEE' ���
O CONSTRUCTION IENDING AGENCY PRE-AL E:
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
a- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED(SEC.308�,CIV.C.),
Z
W
� LENDER'S NAME
F- LENDERSADDRESS
W I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES � /, �O
� I A6REE TO CqMPLV WITH ALL CITV ANO COUNTV ORDINANCES AND STATE UWS REUTING TO BU0.DING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER U70N THE
Z ABOVE-MENTIONE ROPERTV FOR INSPECTION FURPOSES. COMMENTS �
�
� � �
QPERMITTEE N PRI I ^ I��� �
(n V
� SIGNA7URE OF PERMI EE DA7E
� RECPT.NO. PAID B D VALIDATION
ITE—DepaRment Copy,YELLOW�inence Copy,PINK—Asaessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
�, ,,�� . `. .,s�?tQ��`t,'�� CITV O� D9e4iViOI�D �AR
T�y: �-,'��' 1.:i'�.'�3 LC7�i!r.tC7 0
�'�r,�:.i 1i ts'��'� p��c:iS�i �Itla7V'�����Otl Ill�'lr��� t � ' r
i�,?cs'C`,�f�'' ,
�� � i �.;,��� sr . ,fr ,
cC`��3��'��' .��. � .+ �ti� ���.1 �!`��1��'i •
.�= aa�p��400c� -o :�t}.. . o��p�c�4oa � aa�p�t�oc�a` � o ,��r � ,,.�� .e .,� � o o -
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. BUND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRAOING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING �� /c� HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
il �� �
COMMEIVTS �h—v�- � �� � ��
SEPTIC TANK SIZE '
SEEP PIT/U SIZE
a
e� �
�,� � ,
��:,