HomeMy WebLinkAbout12-910 ^ ��,� CITY OF DIAMOND BAR � � ��� I 20�Z
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
��`°"' BUII.DING PERMIT APPLICATION FIRMLY
� JOBSITE APPUCATIO�f Q� PERMIT y�0 p/C/ �/
o ADDRESS I��QCL���I� DATE ` u •?� NUMBE�� ` g I�
� APN LOT TRACT ISSUE 7ypE
-7 / OCC
p OWNER� DATE C � � CONST. L ROUP
o ADDRESSL�_ �� ZONING SEfBACKS
FRONT
o CITY ZIP_ /`7EL�"TEL. RW ❑
APPLICA T TEL. REAR ❑
�d SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE �
ADDRES
� CIN ZIP TE PROPOSED USE �
oARCH/ENG/
z DESIGNER
a ADDRESS NO.DWEL NO.
NO:
� CITY Z�p �L UNITS STORIES BEDROOMS '
�
� DESCRIPTION SQ.Ff, FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLAAATION
p SFR/ADD/REM
p I HEAEBY AFFIRM UNDER PEtULTV OF PERJURV THAT 1 AM E%ENPT FROM THE CONTq�C7ppg l4 Gerege/Carport .
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.6BU5WESSANDPROFESSIONSCO0EAN1'�pTYOR (n
C1 CWHf'/NTi1CHREWIRESAPERMRTOCON3TRUCT,ALTER,tlAPROVE,DEAqLISH,ORREPAIRANYSTRUG W patfo/Deck
< TURE,PRqR TO RS ISSUANCE,AL50 REOUTAES THE MPLICAM WR 6UCH PERMR TO FlLE A SIONEO �w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO hiE PROVI570NS�OF THE�CONTpACTOR3 lF _
� CENSE UW(CHAPTER Y(COMHENCWO WfTH SECTION 7000)OF DMSION a OF T1E BUSINESS AND�PR6 . � POpVSPB
. � FESSIONSCOOE�ORTFIATHEORSHEISFJ(EAIPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMV• (�
V TqN.ANYVpL�T10NOFSECTION7o3t.6BYANYAPPLICANTFORAPERMI7SU&IECT37HEMPLICANTTO Z Re-Rool � � �
� ACIVR PENNJV OF NOT h10pE�T)IAN FIVE HUNDRED�OLLARS(fbaol.):
Z ❑I,ASOVlNEROFTMEVROPERTY,ORMYEMPLOVEESWfTNWAGE3A3THEIR50LECOMPENSATION, ' � (�`pmmBfC181 . ..
N7LL DO THE WORK,AND THE 9TRUCTURE IS NOT INTEHDED OR OFFEAED WR 9ALE(SEC.7W1,BU51- �J
� NESS AND PROFESSIONS COOE:THE CONTRAC70RS UCENSE�LAW DOES NOT MPLY TO AN OWNEp OF ? � - .
PROPEHTY NM1iO BU0.DS OR IMPROVES THEREON,AND WHO OOES SUCN WORK HIMSELF OR HERSELF OR
w 7TIROUGHHISORHEROWNEMVLOVEES.PROVIDEDTHATSUpiIMPROVEMEMSARENOTINTENDEDOR m �
Q UFFEAmFORSALEIF,HOWEVEq7HE8lALDWOORIM7ROVEMENfISSOLpN7rMp10NEYEAROFCONPLE
Z TIOI'1.THE OWNER�BUILDER WILL HAVE TFIE BURDEN OF.PFOVPlO THAT HE OR SHE DID NOT BUIID OR .
= IMPROVE FOR THE PURP0.SE OF SALE). � �
UJ ❑4�OMMEROF7HEPROPEHfY,'AMEJ(CW$IVELYCONTRACTINOWIfHLICEFJ$E�CONTRACTORS
� TO CONSTRUC7 TFfE�PHO.lEC7(SEC.7oN.BUSINESS AND PROFESSIONS COpE:THE COMMCTOq3 LI' VBIUBflOf1� � ADJ.AREA. � . ..
L11 CENSEUWDOESNo7APPLY70ANOWNEROFAPROPERTVWHOBUILD30RIMPROVESTHERC-0µAND . . �
� WFiOWNTAACTSFORSUCNPROJECTSWfTHACONTRACTOH(S)UCEN$EppURSUAMTOTHECONTqAO p�q�Ty DESCRIPT1pN �E .
� 70R5 LICENSE UW.).
0 ❑I Au E%EA1vT UNDER 6EC. B.i F.C.FOR TMIS REASON �
� U �� DATE OWNER - f�--
U r
�Q LICENSED CONTRACTORS DECLARATION � w� � -
2 I HEREBY AFFlRAI UNOER PENALTV OF PER.IURY TNAT IAM�LICENSED UNDEH PI70VISIONB OF CFIAFTER � � � � �
� p(COhMENCWO WITM SECTION 7000)OF DIVISqN J OF THE BUSMESS M!D PROFESSIONS COOE,AND Z �
��� MY LICEN9E IS W NLL FORCE AND EFFECT.
) K m
� LICENSE CIASS C�r1 D IIC.NO., T� �� .
WDATE 7 'r � �1 y CONTRACTOR d . .. .
� WORKERS'COMPENSATION DECtARATION � �� � ' � �
N� 1 HERFBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLlON7NG DECLARATqNS; V �
� � , . , Z � � .
� _I HAVE AND WILL M.VNTAW A CERTIFICATE OF CONSENT TO SELF-WSUqE FOR NOPo(EqS' g1 � -
� COMPENSATION,AS PROVIDED BY SECTION 37000F THE UBOR CppE,FOR THE pEqPoRMANCE V�
OF THE WORK FOR WHICH THIS PERMR IS ISSUED. �
� �1 HAVE AND N1LL MAIMAPI.WOR1(ER3'�COMpEN$A7pry IPISURANCE:AS REOUIRED BV SECTION � . . .
O 37000F�TiEUBORCODE,FORTHE�PERFORMANCEOFTHEWORNFORWHM31THI5PERMiTl9. /
ISSUFA-MYN�DRKFRS'COMPFNSATIONIl15URANCECAqRIERAND.POI.ICYNUMBERARE �CONSTRUCTION� �i�
� j caaRIER PUW REVIEW
0 VOIICY�NUMBER
�. ' � � EIECTRIC
p (�s���'pTe��ns�ma�T�a�iswaa��oouutsls�oo�oa�ss] PLUMBING � .
w
Z I CERTIFY 7HAT W TiE PERFOi1MANCE OF THE WORK FOR MlHICN THIS PERAIIT IS ISSUEO,1 MECHANICAL�
C7 SHALL NOT EMPLOY M!V pER50N W ANY MANNER SO AS TO BECOME SU&IECT TO THE- � � �
(n WORKERS COMPENSATqN I.AV/$OF CAUFORNIA,AND AOREE THAT IF I SHOVLD BECOME INSPECTION FEE �
S SUBJECTTOTHEWOPo(ERSCOMPENSATIDNPRpVISqN30FSECT10N37a00F7HEU80q �' �� '
cooe.i waTF+win�coua�v wini osE vaovisiorus, ISSUANCE
O —
p on�: �A��ca�rr:. � .SMIP ..
--� ' ENERGYP/C
J WARNINO:��FAILURE TO SECURE WORI(ERS' ENSATION CAVEMGE IS UNUWFUL,AND 9HALL BE �
�y SU8IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FWES UP TO ONE HUNDRED TNDUSMID ENERGY PERMIT
DOLURS(1100,00D),W ADDITION TO THE C0.ST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
J 6ECTION 31oe OF 7HE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. � � ' -
w RETEMION FEE: . O
O . CONSTRUCTION�LENDINGAGENCY � �p -AISFEE:
�. I HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT THERE�13 ACON$TRUGTION LENOWO A(iENCY J1
Z �FOR TME PEfiFORMANCE OF 7HE WORI(FOR WHIq1 TH15 VERMIT IS ISSUED(SEC.3087,CIV.G). �-�
W
�. LENDER'S NAME , . . , . .. . .
F— LENDER'SAODRE55 � - -
, � 'ICER7IFVTHATIHAVEREADTHISAPPLICATIONANDSTATETUTTHEABOVEINFOH►IATqN19WqiiECT. TOTALFEES ��.�3 � /O . ��
� I MiREE TO COMPLV M7Ti ALL CfTV AND CpUNT`/ORDpJANCES AND STATE UWS REUTMO TO BU0.01NO � �i
� CONSTqUCT{ON,AND HEREBV AUTHORIZE REPRESENTATNES OF 7H15 CWNTY TO ENTER UPON iHE '
Z �BOVE-MENTIONED VROPERTY FOR INSPECTqN VURP0.5ES. �COMMEN7S ��
� �� �O� C�l�
J
�
m PERMITTEE E(PRI1fn
N 7 f -rz �
� �SIONATU OFP pATE
� RECPT.NO. PAID BY VALIDATlO
WHITE—Depertrnent Copy,YELLOW--Finence Copy,PINK=Assessor Copy,pOLpENROD—Rle
Copy.GREEN—ApplkanYs Copy
CITI� O� DI/�MOND B�R
IfVSPECTION F�ECORD
.. ; . � : . h, o , ,. .� .
" ..�:
. .�
- � ,,� � � g a .�' e� � ..�, ,r,
, _ ,. _ ,
SET BACK j FLOORJOIST
FTGS/FORMS/STEEL __ �Fj HA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING �UNDER FLOOR CONDUIT
SLAB GRADE I FIREPIACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID NT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATIOfd FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC �ROUGH GRADING
ROUGH PLUMBING FINlSH 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.
5EPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CC}NST. FIRE DEPT,fltdAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FWAL PLANING
FINAL ENGINEERING • p �
COMMENTS
�� ,
SEPTICTANKSIZE
SEEP PIT/U SIZE —
� � ---
I
�