HomeMy WebLinkAbout12-566 ^ �� CPI'Y OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
t 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Notline(909)839-7027 PRESS
�'""', BUILDING PERMIT APPLICATION FIRMLY
o AD RIESS .�a 9�� �I U�/L� L� � � DATEICATION• 7 �Z NUMBEI��__C� �/C
� APN LOT TRACT DATEE Z CONST. GROUP
p OWNER _v I ��l�/ _ � � )��
p ADD SS Csi L� � E ZONING SETBACKS
z CITY J / D�rJ IP /�7 T TEL C�DCJ (�'7 FRONT pyy �
o APPLICANT TEL. SID SIDE STREET pyy p
� CONTRACTOR � OD'- SIDE �
� CITI'�N✓+'/'I"�l� Z p� L' - PROPOSED USE A�'�-OI-� '- 4��, J Q
oARCWENG/ (� - �--
z DESIGNER T
W NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIF TEL. • UNITS STORIES �_BEDROOMS
N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
O �OWNER-BUILDER DECLARATION SFR/ADD/REM
p I HER�Y AFFlRM UNDER PENALTY OF PERAIRY THAT I AM E%EMPi fROM THE CONTRACTORS ll- G0f8 0/C9
W CENSELAWFOqTHEFOILOWWOREASpN(SEC.70.11.6BIJ5WE5SMIDVROFESS10N9CODEMlYq7YOR (n �9 ��
� COUMYWHICMREWIAESAPERMtTTOCONSTRUCT,Al7ER,IMPROVE.DEMOLISH,ORREFAIRANYSTRUG W pefl0/DBCk
7URE,PRIOR TO RS ISSUANC�AlSO REpU�qE9 THE APP�ICAM FOR SUC!{pERMR TO F1LE A SIf3NED w
STATEYENT 7HAT HE Ofl SHE IS LICENSED PURSUANT TO 7HE VPOVISIONS�OF THE�CONTRACTORS LL
� CENSE UW(GHMTER Y(COMMENCWO WITH SECTION 7000)pF DIVISqN 7 OF THE BUSINESS AND PRO- � PooUSpa � �
. � FESSiONS COO�OR THAT HE OR SViE�15 EXEAIPT THEREFROM AND THE BA515 FOR 7HEALLEOED EXEMP- (�
TION.ANYVIO��TIONOFSECTION7U31.6BYANYAPV�ICANT�FORAPERMITSU&IECT$THEMPLICANTTO Z. Re-Root
� AClVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLtARS(i60o).):
Q ❑AASOWNEROFTHEGROPERTV,OqMYEMPLOVEESWITHI4AGE5A5THEIR50LECOMPENSATION, � COR1lflBfCiBI
Z WILL DO THE WORK AND 7HE 9TRUCTURE IS NOT INTEHDED OR OFFERE�FOR SALE(SEC.io�s,BU51- J '
� NESS AND PROFESSIONS CODE THE COHTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � '
�ROPEHfV VA10 BUIL0.9 OR IMPROVE9 THEREON,AND WHO DOES SUqi WORK HIMSELF OR HERSELF OR
Q iHROUGHHISORHEROWNEMPLOYEES.PROVIDEDTHATSUp/11APROVEMENTSARENOTPlTENDEDOR m '
Q OFFQiEDWq$ALEIF,HOWEVEqTHEBUILDPlOORIMPROVEMENTISSOLDWfTHWpNEyEAqpFCOMpL�-
Z T�ON.THE OWNER-BUILDER N7LL HAVE THE BURDEN OF PROVINCi THAT HE OR SHE DID NOT HUILD OR ,
= IMPROVE FOR 7HE RIRPOSE OF SALE). - .
W �4 N90WNER OFTHE PROPERfY;AM EXCLUSNELY CONTRACTINO WR71 tJCENSED COP/TRACTORS
[t TO CONS7RUCT THE PpQ1ECT(SEC.70N,�BUSINESS AND PROFESSIONS CODE THE COMMCTORB U- V01UHtlOf1 q�,q(.j� � •
L11 CENSE UW DOE9 NOT APPLV TOAN ONMER OFA VROPERTY WHO BULLpS 0R IMPqOVES THEREON,AND '- �
L• MN�OCONTRACTSFORSUCHPROJECfSWITNACOMRACTOR(S)UCENSEDPURSUAMTOTHECOHTRAG qUANTITY DESCRIPTION FEE �
�— 70RS LICENSE LAW.).
� ❑1 AM E7(EMPT UNDER SEC. B.8 P.C.FOR h115 REASON Q ,
� V
� DATE � ONMER H
Z V.
�Q LICENSEO CONTRACTORS DECLARATION W
CL 1 HEREBY AFFlRM UNDER PENALTY OF PERJURY 7NAT I AM UCENSED UNDER PRONSION9 OF CFIAPTER � � - -
� 9(COMMENCINGi WITH SECTION 7000)OF Dm310N 3 OF THE BUSINESS M1D PROFESSIONS COOE,AND Z
X" IIY LICEN9E IS W FULL FORCEAND EFFECT. m
�LLI _ � �
UCENSE CLASS (L._�_L �,�.No. c —3 � . .
'^ �
U DATE,_y�'7'� �� CONTqqCTOR I V d .
W '
� WORKERS'COMPENSATION DECLARATION � --� - - � -
� I AFFIRM UNDER PENALTY OF PERJUFV ONE OF THE FOLIOWING DEG:ARATIONS: V �
� Z
� _I HAVE AND YALI MAINiNN A CERTIFlCATE OF CONSEN!TO SElFaNSURE FOR WORICERS' � �
� COM7ENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERF-0RMANCE U
�F THE WORK FOR NM1i1CH 7//�g pERM1T IS ISSUED. W
� �
_I HAVE AND WILL MAIMANI WORKEiIg•�COMPENSAiION INSURANCE;q5 qEOUIHEO BV SECTION
Q J70o OF�THE LABOH CODE,FOR THE PERFORMANCE OF THE WOPo(FOR WHip/iHIS PERMIT IS �•��- /�I.� .
�SSUED.MY WONCERS'COMPENSA710N INSURANCE CARRIER AND POLiCY MIMBER ME: �CONSTRUCTION� `f'
> CARRIER g TGs �✓NS�
Q PLAN.REVIEW
� POLICY�NUMBER 7 � � I �I . .
ELECTRIC
� (n+�ssEcnor�N�wraEoonatr�oFir�a�rswaor��noaululsioolon�ssl PLUMBING
w
� Z I CER7IFV.THAT W TiE PERFORAIANCE Of THE.WOHI(FOR WHIp1 TFVI$PERA/1T lSISSUEO,I MECHANICAL
CS SHALL NOT EMPLOY ANY PERSON W ANY NANNER 50 AS TO BECAME�SU&IECT TO THE�
(n WORKERS'COMPENSATION lAW$OF CAIIFOFWI�NiD MiREE THAT IF I SViOULD BECOME INSPECTION FEE�
SUBJEC7 TO THE WOPotERS COMVENSATION PROVISIONS OF�SECTION 37a0 OF THE UBOR � �� - �
O caoE.i s+uu watriwin�coMa�r win�n�osE rpoviswus. ISSUANCE -
p DATE APPLICANP.. .SMIP
W
� WARNINQ FA0.URE TO SECURE WO/iKERS COMPENSATtON COVERA(iE IS UNLAWFVL,AND SHALL BE ENERGY P/C �
�y SU&IECTAN EMPLOYER 7o CRIMPUL PENAL7IES AND CM�FlNES UP TOONE HUNDPED TYqUSAND ENERCiY PERMIT
DOLLAHS.(f100,000),'W ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIDED FOR IN
J SECTION 370!OF TiE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. � " �
W RETENTION FEE:
O , CONSTRU,CTION�LENDING AGENCY � p - T FEE•
� 1 HER�Y AFFlRM UNDER FENALTV pF PERfURV THAT THERE IS ACONSTRUCTOH LENDINO AOENCY
Z� FOR THE PERFORMANCE OF hIE WORK FOR WHIq1 THIS PERMI7IS ISSUED(SEC.7oW,qV.C.).
W
� LENDERS NAME . . . _ - . . . . •
� IENDEH5A0DRE55 -
� ICERTIFYhIATIHAVEREADTHI9MPLIGT10NM1DSTATE�THATTHEABOVEINFORMATIONISCORqECT. TOTAL FEES -
� 1 A6REE TO COMPLY M7TH ALl CfTYAND COUNTY pppWpJ.�CFS AND STATE UWS RELATWG TO BU4.DIN6
� CONSTRUCTION,AND HEREBv AUTTiORIZE qEPRESENTA7IVES OF T1tlS COUNTY TO EHTER UPON iHE '
. Z ABOVE-MEMIONED PROPERTY FOR INSPECTION VURPOSES. COMMENTS ' �
�
J
�
m PFAMITTEE NMIE(PRI1Jn ' .
Q
� . . . . . . . . , .
Uj �SIONA7UREOFPERMRTEE DA7E
� RECPT..NO. PAID BY VALIDATION
WHITE-Depaitment Capy,YELLOW—Finence Copy,PINK—Assessor Copy.GOLDENHO�Ie Copy.GREEI�
. Applicam's Copy
� CITY OF DIAl1AOND BAR �
INSPECTIOFV REC4RD
, ,_ . _ .
< , - .
. � -� . � - - ��
. . -= � � <.��� � �� m � �� � o�
� .,
n p .
� . v _ 8 = � � s x
s � �: d • ,�-a€� . � i �
., _ �,. . .. . , � _ _ .
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT �
GROUMD PLUMBING UNDER FLOOR CONDUiT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER �FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHItJG � 8 FT.BOND BEAM
FRAMING/VENTILATION FItdAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING �BENCHING
ROUGH ELECTRIC ROUGH GRADING'
ROUGH PLUMBING �FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING ____ DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FIN,4L PLUMBING ENERGY
FINAL PLANING _______
fINAI ENGINEERING • o e
�
COMMENTS
� �
SEPTICTANKSIZE
SEEP PIUU SIZE
:s ''i
��J �
�
