HomeMy WebLinkAbout12840 /y� �,r,�_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNI'I'Y&DEVELOPMENT SERVICES 21810 Copley Drive,Diamond Bar,CA 91765 � (909).839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS i �'°"'+ BUILDING PERMIT APPLICATION FIRMLY � � JOBSITE APPLICA PERMIT P/C �1 o ADDRESS�O�l� � ��� �/'� DATE ��3 `11 NUMBERIz � # �a- '�q.o 1 � APN o Z S�LOT D�� TRACT �W � zy D TEE l� CONST.�� GROUP p OWNER Te c jovi ,�2 C,-G�en ct o ADDRESS�Sc�a1� �S RL�i/'�- ZONING SEfBACKS � CITY�✓a ln��f' ZIP �9 �`89 ��.626-�4//-30�/ FRONT pyy � APPLICANT TEL. REAR p � SIDE/SIDE STREET Ryy p � CONTRACTOR ��O SaI�.✓ Fjtt_i'tu SIDE p o ADDRESS � PROPOSED US �O TE� (�L/1� Z "L o CITY L+R �/s�'h a.C ZIP qlS"�Z TEL�J�/-�Y�3'�&S o ARCWENG/ �z DESIGNER NO.DWEL NO. NO. a ADDRESS � CITY ZIP TEL UNffS STORIES BEDROOMS � � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� �OWNER-BUILDER DECIAAATION �� SFR/ADD/REM O Q I HEREBY AFFlRM UNDER PENALTV OF PERNRY THAT t AA1 EXEMPT FROA1 7NE CONTRACTORS L4 GflfB B/C9 Ii W CENSEUWFOR7HEFOLLOWINOREASON(SEC.7o31.60U5WE5SANDPROFESSIONSCOOEAM'p7VOR (n 9 � C1 COUHfVWHICHREOUIRE3APERMRTOCON$TAUCT.A�TER����E.DEMOUSH.ORREPAIAANVSTRUG W P8110/D9CI( �< 7URE,PRIOR TO fTS ISSUANCE ALSO REWIRES THE MPLICANT FOR SUCH PERMIT TO FlLE A SIONED w STATEMENf THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS�OF 7HE CONiMCTORS U- � CENSE UW(CMAPTEA B(COMMENCW(3 WITH SECTION)000)OF DMSION 3 OF h1E BUSWESS AND�PHO� � PooVSpe � _ � FESSIDN.4COO�ORTHATHEORSHEISEI(EMPTTHEREFROAIANDTHEBASISFORTHEALLEOEDEXEAIP- C7 V TqN.ANVVqLATIONOFSECT10N7031.68YANVAPV�ICANTFORAPERMITSU&IECTS7HEACPLICANTTO Z RaRoof - � ApVIL PEN/�LiV OF NOT MORE THAN.FIVE HUNDRED DOW1R3(f60D).): - � ❑4�.40WNEROFTHEPROPERTV,ORMVEId7LOYEESWfTHIVAGESASTHEIR50LECOMPENSA7qN, � � COrt1rtIBICl81 Z WILL DO THE WORI(AND THE S7RUCNRE IS NO7INTENDED.Ofi OFFERED FOR SALE(sEc.7a/,BU51• J ' � NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE LAW DOES NOT MPLV TO AN OWNEA OF ? �� PROPEFfTY WFq BUtl.0.4 OR IMPROVES THEREOIJ,ANO WIiO DOES SUCH NqRK HIMSELF OR HEASELF OR w iHROUGHHISORHEROWNEMVLOYEE3,7ROVIDmTHAT�SUCNWPROVEMEMSMENOTINTENDEDOR m - , . � OFFERmPDR3ALEIF,HOWEVERTNEBU9.CkNOORAIPROVEMENTISSOLOWRHWONEYEAROFCOMPLE- Z TION,7NE OWNER�BUILDER WILL HAVE TFIE BUROEN OF.PROVINO THAT HE OR SHE DID NOT BURD pq � IMPROVE FOR THE PUR705E OF SAIE): � w 04�.40NRJEROFTHEPROPERTV,AMEXCLUSNELYCANTMCTW�WfTHLICENSEDCOHTRACTORS Q 70 CONSTRUCT THE PRQIECT(9EC.7w1,BUSINESS M!D PROFESSIONS CODE;THE CONTRACTORS U- VBIUHIIOf1 qp,�,qpEq � � W CENSE LAW DOE9 No7APVLY TOAN OWNEA OFA PROPERTY WHO BULLDg OR IAIPROVES hiEREON,AND � NM1IOCONTAACTSFORSUCHPqQ1ECfSN7THACANTRACTOR(S)IICENSEDPURSUAMfTOTHECONT{UF pUANTITV �DESCRIP'f10N rau uc�sE uw.�. FEE . � ❑1 AM E7(EI.IPT UNDER SEC. B.8 G.C.FOR THIS REASON � . � . � U LL DATE OWNER � Z U � LICENSED CONTRACTORS DECLAAATION w - - ,- � - � � I HEREBV AFFIRH UNDEA PENALTY OF PERNHY TNAT IAM�LICENSm UNDER PROVISION9 OF CNAPTER � ' � � � Y(COMMENCPIO WITH SECTION 700D)OF DMSION 7 OF THE BUSWESS M�PROFESSIONS CODE,MA Z �� IAY LICENSE 19 P/FULL FORCEAND EFFECT. m � UCENSE C S> _ LI0.NO..� ` v+ �� �. . .. . U QATE Z(� �•)Z . COHiRACTOR d . . W � WORKERS'COMPENSATION DECLARATION Q � � � � � � I HEA�YAFFIRM UNDER PENALiY OF PERNRY ONE OF THE FOILOWWO DEQAAAT10N5: � ' - 4J Z � _I HAVE AND.WILL MAINTAW A CERTIFlCATE OF CONSEM TO SELF-INSURE FOfi 140iU(ERS' � - Q COMPENSATION.AS PROVIDm BV SECTION 3)OOOF THE LABOR CODE,FOq T}/E pERFORMANCE U- OF 7HE WOHIC FOR WHICH THI3 PERMIT IS ISSUED. W � � W �I HAVEMID WILL MAIMAIN.WORKERg'�COMPENSATION INSURANCE,AS REWIqED BV SECTION Q J7000F�7HE LABOR COpE,FOR THE�PERFORMANCE OF THE WOPo(FOR WHIq1 iH15 PERMIT IS ��� - � LASUE0.MV WORKERS'COMPENSATION INSUFiANCE CMRIER Al1D.POLiC/NUMBER ARE �CONSTRUCTION j CAARIER Guprect Zn<vs AnGt PUW REVIEW ��J t , O S Z aaicr r�eEa�.�ODO���S y- 1 at 1 ELECTRIC ¢ p OTess�cnor�r�IDraTe�oonq�rIDa�n��rrs�oaowE�rn�000u�ls�oqaa�sy �PLUMBING ' w Z 1 CERTIFYTHAT W THE PERFORMANCE OF TME.WORN FOR WHICH THI9 PERMIT IS ISSUED,I �MECHANICAL " C:J SHALL NO7 ENVIOY ANY PERSON W ANV MANNER 50 AS 70 BECOME SUBJECT 70 THE' � � N 1WRKENS'COMPENSATIONLAW$OFCALIFORNItiANDAGREETHATIFISHW BECOME INSPECTIONFEE SUBJECT TO THE Vl�D/iKERS'COM7ENSATION PROVI�S OF SEC ON 3700 i THE UBOR � - - � -�j E.I FORTHWI7M CpA/pLY WITH SE PRO qNS. � ISSUANCE � .. p DA1E: L Z I L APPLICAM: �SMIP ,. O O ' w � ENERGY P/C � WANAN6:FA0..URE TO SECURE WOfU(ERS'COMPENSATION COVERAGE IS UNUWGUL,AND SHALL BE � � SUBJEC�ANEMPLOYERTOCRIMfNAl,PENALTIESANDqVILFWESUPTOONEHUNDREDTHOUSAND ENEROY�PERMIT DOLURS(ftao.oao),�IN ADDITION TO THE CQST OF COMVENSATION,DAMA�ES AS PqOVIDED FOR W J 6ECTqN 370!OF THE UBOR CODE,INTEREST;ANDATfORNEYS FEES. � - � w RETENTION FEE: �' . O� O . CONSTRUCTION LENDING AGENCY PRE-ALT/]F�E � I HEREBY AFFlRM UNDER�PENALTY OF PERIURV THAT THERE 19 A CONSTRUCTION LENDINO A6ENCY �j!j /�'� t �� � f-0R THE PERFORMlNCE OF�THE WOR1C FOR WHIp17HIS VERMR IS ISSUED(SEC.3oo7,qV.C.} Z W ��. LENDER'SNAME - . . . . . . � F-� LEI�ERSADORESS � - /� . W' �ICEHTIFYTHATIHAVEREADTHISAP7LICATIONANDSTATE7HATTiEABOVEPlFORMATqNISCORAECT. TOTAL FEES �� 1 � �� y / � rf-�3 � 1 A(iREE T0 COMPLY Wlhl ALL CRV AND(pIR�RV O{1pW/JdCES AND STATE UWS RELATWG TO BUILDIN6 � // � CONSTRUCf10N,ANp HEA�V AUTHORRE REPRESENTATNES OF THIS COUNTV 70 EMER UPON 7HE " � Z ABOVE-MEMKNJED 7ROPERTY FOR INSPECTION VURPOSES. �COMMEN7S �� - � BI�NuI�iV SvLL���N _ m FE 7TEE NAA/E(QRI/!T) �A � ' (� � ¢ _1 �..J /�[ /� = V `-'���v � U� ` vj 51 TU OFF'ERMfTTE DATE - . � ' RECPT.NO. I PAIDBY VALIDATION WHITE-Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy.GREEN—Applk;anCs Copy _ ' . Ca�'Y OF DIAMOND BAR -�'��—� 9i�SPECTl0�1 REG�RD . _ . . �1; � �, ,�_:` B ' '_, ' � +'� ys��_ .. • :,y� � ,a�` e' � �'�,, , � . 1, . , . ,, �, , .;r' � : � . r � `, � SETBACK FLOORJOIST ' t FTGS/FORMS/STEEL -- — FNA REQMTS — -- — � EIECTRIC GROUNd UNDER FLOOR OUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER �FIREPLACE BOND BEAM WATER SERVICE MID HT.BOND BEAM ROOF SHEATNING 8 FT.BOND BEAM FRAMINGlVENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRlC EXT.LATHISIDING POOL FENCING WALL INSULATIOhI POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTICTAtdK LANOSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIRTEST FINAL ZONING FINAL CONST. F(RE DEPT.FINAL FINAL HEATING � �HEALTH DEPL FINAL fINAL ELECTRIC DEV.FEES PAID FIN,4l PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING . � e COMMENTS SEPTICTANKSIZE SEEP PIT/U SIZE � ,�. - :� _. �;_ _�::