HomeMy WebLinkAbout12-273 --�
_�F�_ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 P ESS
"�^'` BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE �$O N! �Ol,•�C. '�l J�C�� J��C, r� � � .�2� P/C
APPLICATI PERMIT
o ADDRESS � DATE NUMBE #
� ISSUE TYPE OCC
APN OT T DATE
p OWNER � �jl • CONST. GROUP
" ADDR ZONING SETBACKS
� FRONT RW O
Z CITY / ZIP TEL. '
� APPLICANT TEL. REAR p
� SIDE/SIDE STREET RW ❑
z
¢ CONTRACTOR � �(JG� SIDE p
ADDRESS PROPOSED USE �l�i�i
o CITY �iC. ZIP TEL. O - 7 � � �
o ARCWENG/ �Q(l�
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
p SFR/ADD/REM
p I HEREBY AFFIRM UNDER PENALTV OF PERIURV THA7 I AM E%EMP7 FROM THE CONTRAC70RS LI- GafegO/CefPOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANYCITYOR (n
U COUNTVWHICHREQUIRESAPEfiMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W Patio/Deck
W TURE,PRIOR TO ITS ISSUANCE,PL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMENT hiAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS ll� �
� CENSE UW(CHA7TER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
, O FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGE�EXEMP- (�
V TION.ANVVIOUTIONOFSECTION7o31.58YANYAPPLICANTFORAPERMITSUBJEC75THEAPPLICANTTO Z Re-Roof �
� A CIVIL PENALTV OF NOT MOFiE THAN FIVE HUNDRED DOLLARS(SSao).):
� ZOI,ASONRJEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIrtIBfClel '
WILL DO THE WORK,AND THE STfiUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70�a,BUSI- J
N NF55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
� PROPEHTYWHOBUILOSORIMPROVESTHEREON.ANDWHODOESSUCHWORKHIMSELFORHERSELFOR
2 TMROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NO7INTENDED OR m
w OFFEREDFORSALEIF,HOWEVER7HE6UILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
� TION,THE OWNER-BUILDEFi WILL HAVE TME BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOq 7HE PURPOSE OF SALE).
�_ ❑I,AS OWNER OF THE PROPERTY.AM E%CLUSIVELY CON7RACTING WITH LICENSED CONTMCTORS
TO CANSTRUCT THE PR0.1EC7(SEC.70��,BUSINESS AND PHOFESSIONS CODE:THE CONTRACTORS LI- V21U8t1Of1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� NMOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.).
� Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
� U
� ¢
DATE OWNER �
Z W
� LICENSED CONTRACTORS DECLARATION w
� 1 NEREBY AFFIRM UNOER PENALTV OF PERJURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d D(COMMENCING WITH SECTtON 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
X MV LICENSE IS IN FUIL FORCE AND EfFECT. m
� LICENSE CLASS � V LIC.NO. CJ / / / / / j ,
U DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARA ON a
� I HEREBV AFFIRM UNDEF PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELf�INSURE FOR WORKERS' _
Q COM7ENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
� Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w �HAVEAN�WILI MAINTAIN WORNERS'COMPENSATION INSUPANCE,AS REDUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORK MPEN TION INS ANCE CARRIER AN POLICV NUMBER ARE: CONSTRUCTION
Q
> cnaaiEa_ PLANREVIEW
ZPOIICV NUMBER ELECTRIC
, Q ✓ ��
0 (iHl55EClqNNE�NOTBECOMPLEfEDOFTHEPERMfTIS �RCNEHUI�DREDDOUAAS�SIOU)ORIESS� PLUMBING
Z I CER7IFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMFENSATIONLAWSOFCALIFORNIA,ANDAGREE7HA71FISHOULDBECOME INSPECTIONFEE
� SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR
� CODE,I SHALL F THWITH COMPLV WIT/H.�j1p5E P /S�`ION�S,./ /+ � ISSUANCE b u L
� ✓ '� �(/G !/G�/!'(/�� SMIP
p DATE: APPLICANT
J WARNING:FAILUf7E 70 SECURE WORKEfiS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(f100,000),IN A�DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABOflCODE,INTEREST,ANDATfORNEV'SFEES. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HERE6V AFFIRM UNDER PENALTY OF PERJURY THA7 7HERE IS A CONS7RUC710N LENDING AGENCY ,
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
W
i � LENDER'S NAME
F— LENDER'SADDRESS �-7
W ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES , ����•J
� I AGHEE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBY AUTHORIZE REPRESEN7A71VES OF 7HI5 COUNTY TO ENTER UPON THE
Z ABOVE�MENTIONED PROPER7V FOR INSPECTION PURPOSES. COMMENTS
� ���� ��
�
¢ PERMITTEE NAME(PRINT) � � �� �
�
� SIGNATURE OF PERMITTEE DA7E �
I = RECPT.NO. . PAID BY VALIDATION
~ WHITE—De aAment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—
P PX PX PY� PY� ApPlicant's CoPY
~ V �B�V �I� �0�6Vd��� ��ff� , .
��
B�J��[�����f� f�1���9��
0[�1�3pC�C�4�0a DQ4G Oa�pC�C�40G3 Oa�pLGQOOa DGJ4l� Oa�pC�C�`�G�
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. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
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 _ HEALTH DEPT. FINAL _ ________
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
—– - -- C�'1 �oQ.�, ---
COMMEiVTS
���� ��u�
�
���p� i u� ,
,���" '� I
� �jc��a � i
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I
a
i
I
i
C�J L — _ ---
�