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HomeMy WebLinkAbout10-1144 �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE5 21825 Copley Drive,Diamond Bar,CA 9176�(�[�f]��(���� PRESS T' (909)839-7020 Fax(909)861-3117 Buildi g Y�Is�j c 'f`�hir 09)839-7 �<9���w BUILDING PERMIT APPLICATION FIRMLY o D R'ESS �� � � ��l'n���� G� • � � DATE CATION NUMBEFj� / #C � ISSUE �/�,� O TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � t v�m t,T' � ZONING SEfBACKS Z CITY�A�a���,n.i��lr ZIP� TEL.�14,.�'�lI��7 FRONT RW ❑ REAR ❑ o APPLICANT � TEL.�y��_�� SIDE/SIDE STREET RW ❑ � CONTRACTOR ,� , SIDE ❑ Q ADDRESS �0 � �' PROPOSED USE ��'�''e�`� 1f2 N�n e ��1� • � CITY .�_ TEL q I l� � � w ARCH/ENG/ z DESIGNER NL N �` NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CIN ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/FiEM O � I HEREBY AFFlRM UNDER 7ENALT'OF PERri1RV THAT I AM EXEMPT FROM THE CONTMGTOPS LI� Gefe9B/CBfpOf1 I W CENSE UW FORTHE FOLLOWINO REASON(SEC.7031.6 BUSINESS AND PROFESSION9 CODE:ANY CITV OR (n U COUNTYNhI1CHREQlJ1RESAPEFMITTOCONSTRUCT.ALTERIIAPROVE,flEMOLISH,ORREPAtRANYSTRUG w petlo/Deck ' Z TURE,PR�OR TO RS�SSUANCE,AL50 FiEOUIRES THE APPLICANT FOR SUp1 PERMIT TO FILE A SIONED w STATEMEN7 TMAT HE OR SHE IS IJCENSE�PURSUANT TO THE PROVISIONS OF lNE CANTqACTORS LI- � CENSE UW(CNAP7ER 8(COMMENqNo wI7H SEC710N 7000)OF DiVISiON 3 oF THE BUSINE55 AND PRO- � POOVSpB � FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND TME Bh515 FOR THE ALLEGED EXEMP� ' � TION.AN�VIOUTION OF SECTION 7031.5 BY ANV APPLICPNT FOR A PERIAR SU&lECTS THE APPUCANT TO Z R@-R00� � A CML PENALTY OF NOT MORE h7AN FIVE HUNDRED DOLUNS(f500�.): � ❑I,ASOWNEROFTHEPROPERTY.ORMVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � CORIf1'IBfCIeI � WILL DO THE WORK.hND T}1E STRUC7UFE IS NO7 INTENOED Ofl OFFERED FOR SALE(SEC.7ou,6U51� J � NESS AND PROFESSIONS CODE'fHE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WF10 BU0.�5 OF IMPROVES TMEREON.AND WHO DOES SUCH WORK HIMSELF OR HEFlSELF OR (t �iNROUaHH150RMEROWNEMPLOYEES,7ROVIDEDTNA75UCNIAIPROVEMENTSARENOTINTENDEDOR m W pFFEqEpFORSALEIF,HOWEVER7HE8UILDINGORIMPROVEMENTISSOLDNnTMINONEYEAROFCOMPLE� � TqN,THE OWNERbUILDER WILL NAVE TME BUR�EN OF PqOVIN6 TFUT HE OR SHE DID NOT BUI4D OR z IMPROVE FOR THE PURPOSE OF SALE). � _ ❑I,ASOWNEROFTHEPROPEHTV.AME%CWSIVELVCONTMCTINdWfTHLICENSEDCONTRACTORS Q TO CONSTRUCT THE PR0.IECT(SEC.7ou,BUSINE55 AND PROFESSfONS CODE:THE CONTMCTORS LI- V8IU01iOf1 ADJ.AREA W CENSE UW DOES NOTAPPLV TO AN OVMER OFA PROPERTV NM1iD BUILDS OR IMPROVE9 THEREON,AND F NTIOCANTRACTSFORSUCHPR0.IECTSWITHACONTMCTOR(S)LICENSEDPURSUANTTOTHECONTiUG QUANTITY DESCRIPTION FEE TOiiS UCENSE LAW.�. ` O ❑I AM E7(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON � I J �� ��4 C.i�L`U � � Q � DATE OWNER U � J � UCENSED CONTRACTORS DECLARATION w � I NEHEBV AFFIRAI UNOER PENALT'OF PERIUiiV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �� Q a N d D(' MENCING WITN SECTION 7000)OF DIVIS�ON 3 OF 7HE BUSINE55 AND PROFESSIONS CODE.AND Z X W L�CENSE IS IN FULL FORCE AND EFFECT. m LLI ' ^� p Q � � LIGENSE CLASS �'�J LIC.NO. G i b � �"Ci � . �— �7�I CONTRACTOR � J V DATE I�'�\ � J T� a W � WORKERS'COMPENSATION DECLARATION Q � U N 1 HEAEBY AFFIRM UNDER PENALTV OF PERIUAV ONE OF THE FOIIOWINO DECLARATIONS: Z Q � _I NAVE AND W�LLMAMTAIN A CERTIFICATE OF CONSENT 70 SEIF�INSURE FOR WOHKERS' S Q COMPENSATION,AS PFOVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE w OF THE WORK FOR WNICH THIS PERMIT IS ISSUEO. � � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSUPANCE,AS REOUIRED BV SECTION Q 3790 OF THE IABOil COOE�FOR THE PERFOHMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED.MV W�RKERS'COAIPENSATION INSURANCE CARRIEH AND POLICV NUMBERAAE: CONSTRUCTION � CMRIER PLAN REVIEW ZPOLICV NUMBER E T � �� Q t��. �D � �russEcitaarl�No76EcaASY.E7FnaFn�EPEriMrISFORa+EF�D��sK��I��`�} PLUMBI W MECHANIGAL Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I � SHAIL NOT EMPLOV ANV PERSON IN ANV M?NNER SOAS TO BECAME SU&IECT TO THE INSPECTION FEE � WORNERS'COMPENSATION LAWS OF CALIFORN10.�D�GREE THAT IF I SFiOULD BECAME �/-�7 S SUBJEGTT07HEV10RKER5'fAMPENSATIONPROVISIONSOF5ECT10N37o00FTNEUBOR SSU CE ( � J COOE.I SHALL fOHTH'MTH COMPLY W ITH TNOSE PROVISlOHS. O ` P p DATE:���,'NI �PPLICANT. ��1+ �`,L�.�y�— � W �� ENERGY P/C --� WARNIN�:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE J � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANOCNILFNESUPTOONEHUNOAEDTHW5MID ENERGYPERMIT DOlURS(f100.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN O J SECTION 3708 OF THE LPBOR COOE.INTEREST,ANO ATTOANEVS FEES. RETENTION FEE: F!--- 2 w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a O � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING ACENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED�SEC.SOG7.CIV.CJ. Z W � LENDEF'S NAME F_- LENDER'SADORE55 /I�� wI CERTIFY THAT I HAVE READ TMIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES �r�� �� � I AGqEE TO COMPLV WITH ALL CITV ANO CAUNTV ORDINANCES AND STATE lAWS REUTINO TO BUILDINO CONSTRUCTION,AND HEREBV AUTHOR2E REPRESENTATNES OF THIS COUNNTO ENTEH U70N THE Z ABOVE-MEMpNED PROPERTV FOR INSPECTION PURPOSES. COMMENTS ' � �f-�/V 1� � �W�� Z�f m PERMI E NAME(PRINT� ' � ' - iS 'h�10 � SI()NAN E OF PERM� E DATE / RECPT.NO. PAID BY P VALIDATION � WHITE—Department Copy,YELLOW�inence Copy.PINK—Assessa Copy.GOLDENR06--File Copy,GREEN—Applfcanfs Copy CIYY O� DI�►i1�OND ��,0� r''�4`r�i :�.: Ih�1SP,�C�@O� �[ECOE�D . • ���1 7;� ,}G��l.^�\t I�I'� . ., ., .. . . .. . ��. ,..� . oa�p�c�400a o �� � oa�p���a oa�Q�c�400a . �����'�� �� ���r� �, .. .� 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-GRAOING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST � � r.o 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 PITlL.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 ?.,� o ENERGY C�G�U�o � COIV1MEfVTS �-c,..�-",•T' _ `�-__,`/cj�e � SEPTIC TANK SIZE SEEP PIT/U SIZE a e� a � �