HomeMy WebLinkAbout12-1455 (6) _!�` CTTY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITX&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765 PRESS
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702
�������� BUILDING PERMiT APPLICATION FIRMLY
o DDRESS���� S� � V����- DATEfCATION�'����Z^ NUMB R''`��`��A�/�J/�✓�
b
� ISSUE /�� �Z�- CONST.�_ GROUP
APN LOT TRACT OATE �
p OWNER .,����� �`iJ NS2y~/
`� o < �-1 S r L�J�}�r�i�K-- ZONING SETBACKS
o ADDRESS�� FRONT AW ❑
Z CITY ��A-�Ma.r+. g11^rZiIP TEL. REAR O
o APPLICANT TEL SIDE/SIDE STREET RW O
� CONTRACTOR � L 3S�IZV SIDE D
oADDRESS�.[„� ����V�— �'�- �
CfTY P 1��-r�_ Z�P ��EL71y '-SP�G'os PROPOSED USE
w ARCH/ENG/ ,
z DESIGNER NO.DWEL NO. NO.
0. ADDRESS � UNITS STORIES BEDROOMS
� CITY ZIP TEL
`n DESCRiPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
�
� OWNER•BUILDER DECIARATION SFR/ADO/REM �
O
0 I HEAEHY AFFlRM Il1IDER PENALT/OF PERAIRV THAT 1 AH IXBAPT FROA1 THE OOftTAACTOH.4 LF G8�800/CBfpDfl.
W CENSEUWFOR7HEFOLIOWWOREA50Nl8EC.7Wt.5Bi15WE5SINOPROFE5510N9CO0EANYCT'OR (n
U courmrm�wcn aFs�rowrrloca+srn�cLwiE0.u�vaovE.ovaoidsr+.oaaEv�mumsrnuo W Pa16aJDeck Z.
W TVRE.PRIOA TD RS ISSUANCE,AL50 REa1WES iHE APPLiCAM FOR�UCH PERM�T TO FlLE A SIONED W
� STATEMQlT TMAT HE OR S7E 19 UCENSED PUNSUANi TO THE FHOVISIONS Of THE CONfN�CTOR9 LL
R1 ,,1�,,
� CEN9E UW(CNA�TER o�COMAIENGNO�NTH SECTION 700u)OF DIVISION 7 OF THE BUSDlESS AND PRO- � PO.+..ayB .
� fES5�ON5000E1�7HATHEOR3HE150(EAI7TTHEHEFROMANOTHEB�SIS�ORTHEAlLE6mExEMP-
7qN.AttY YplAT10N OF SECTION 70�7.6 HV ANV APPL�CAM FOR A PER41T SU&lEGTS THE MPLICANT TO Z R9-ROOI
� AUVIL VENALiV OF NOT MORE i/1AN FIVE HUNDRED DOl1AR5(iw0�}. .
Q ❑4�SOWNEROF7I�EPROPERTY,OfiMYEMPLOVEE3INTHWAGESASTHEIR60LECOMPENSATION, � Cpmm8�C181
Z YALL DO TNE WORK AND THE BTRUC7URE q NOT IMEIIUED.OR OFFERID FOR]ALE(9EC.7oK BUSb _J
� NESS HdD PROFE5510N6 CODE:iHE COHTiUCTORS 110ENSE�Uw DOES NOT MttY 70 AH OYMER OF � .
VFi07EHTVWFiOBU40.90PfMFROVE9THEREIXIPNOWMO00E54UCM'NOfiNHUA3ELFORHERSELFOR m
Q THROU6H HIS OR HER UVM E1A7LOYEE3.PiqVIDED iHAT SUO/IMPROVEAIENTSARE NOT 117TENOED OA
W OFFEREDPORSAlES/10WEVE0.71fEBU0.DWOORMPROVFJdENTt3SOl.DWfT14NONEVEAROFCOAIPLE-
� T10N,THE OwWER�8U1lDER vALL FUVE TME BUAbEN OF�VPOYM6 7FU7 HE OR 6HE aD NOT BUILD OR �
= IMPROVE FOR THE PURP0.5E OF SALE} - ' . . , .
W OI�OVMEROFTMEPROPERTY.AMEXCLUSNELYCON�MCTINON?fNl1CBLSEDCOHfRAGTOR3
TO CONSTFIUCT THE PRO.IECT(SEG 7W�.BUSMESS AND VAOFE3570N5 CODE:7HE�UCTOR$U' Valuation ADJ.AREA.
W -CENSEUWO0E9NOTMPLY70ANON?lEROFAVROPERTYWFiOBUI1D80RWPROVE97HEREON,NlD ' - .
. � YA1pCOMRACT5FOi15U0/PROJEC�SN7fF1AGONtFlACTOR(S7UCENSEOPUFi6UNRTO7HEW�+TMG p�qN7ny DESCAIPTION FEE
� TOR4 UCENSE Uw.). /�,.
� ❑1 M1 E%EM9T UNDER SEC. . . . � H.i V.G FOR TWS ilEA5d1 � [v5 7_J
� s (v o�. �s
�'= o�Te . ovmea V �
Z � �
� LICENSED CONTRACTORS DECLARATION �
� W
CL i HEREBY AFFIRU UNDEN PEIULT'OF VERNRV 7NAT IAM LICENSm UNDER�ROVI510HS Of QiAVTER �
y�COMMENCPq YrtTN SECTION)aW)OF DMSiON�OF THE&151NESS ANO PROFESS�ONS ODDE N�D Z
� MY L�ENSE�s w Ful FORCE ANo EFFECi. m �--• S� aU
LLl
� UCEHSE CLASS R -r ���.�.�e����- �
� �
U DATE S �)—�p I.�J . CONTRACTOR Lj 1�L� S SrYU I LS�S d �
W
� WORKERS'COMPENSATION DECIARATION � �
� U
� I HEREBY AFFUiM UNDER PENALTY OF FERA/fi'/ONE OF TY/E FOlLON1N0 OEqJ�MT10NS: �
� _I HAVE M1D WILL NARITMN A GEATIFICATE Oi CONSENi TO SELF-INSUAE fOR WOR1(EFL . .
COAIPEN8AT10N.AS PROVID�BV&ECT10N 17o00F THE UI80R CODE.FOR 7ME PERFURMANCE W
OF TiE NIORK FOR WHICH THI9 PERWT 19136UED. �
� �j
_1 HAVE M1D WILI IAAVITAD7 WORKERS'COMPEN9ATION V+9l1MNCE AS REOUIRED BV SECTION C/I . [ �
Q a7oo OF THE LABOR GOOE.FOR 7HE PERFORMANCE OF THE WOPoC FOR WlOG1 TinS PERNIT IS
�m,Lry WpqKEf15'COIAVEN9A7pN INSURANCE CARfUER AND 70LKY NUMBEN ME: CONS(�iUCTION
j c�awEa PVJJ REVIEW �.
Z co��cv ranieEa ELEC7RIC
¢
Q RrassEcrior+rrEmwreeoatin�IDocnfveaMrsraaor�M�a�oau�R�mia+�sl PLUMBIN6
w MECHANICAL
. Z I CER7IFY TF1AY M 7HE PERFORAUNCE OF THE WOiIX FOR MlMC1i TIt15 PERMR 6 155UED.I
� s�wlrroroavior�arnEasonw,wreau+r+easo�sToaecanesuat�ciTonie. WSPEC710NFEE
� WORKEA+'COMPENSATpN UWS OF WIIFORNIA��REE THAT IF I SHOULD BECOME
� SUBJECiTOTF1EWOFIXERSCOMP@lSATIONPROVISIONSOFSECTION77a00FTHEUBOR ��UANCE � .
CODE.I SFULL FOHTIANTT�COAIRY N7TH T705E PRON4�DN5.
p DATE: APPUCANi: � �SMIP � O'�
W ENEROY P/C
� WARNINa:FAIWRE TO SECVRE WOFMER9'COMPENSATIdJ COVEMGE IS UMhN'FUL.ANO SNKl BE � �
�—y SUB.IECT AN EI/PLOYER TO CRMD7AL PEHALTIES AND CML FlNES VP TO ONE NUNDNED 71bU8�ND ENEROY PERMIT
DOlLAH3(S10U.00GI�N ADDITION TO THE C0.4T Of COMPENSATK7N.DMIA�ES AS PHOVIOED FOR W
¢ SFCTIQN 77a!Oi T1E IABOR CODE e1TEREST,ANO ATfORNEYS FEES. ' RETEM�ON FEE: � , ,
� CONSTiiUCT10N LENDING AGENCY PRE-ALT FE
O ��J Q
� I HEREBY AFFlRM UNDER PENAL7Y OF PERlUqY THAT TMERE 19 ACONSTRUC710N LENOWO AUENCY (�lF� �
Z FOR TME vERPoM�WCE OF T4E WOfIX FOH wHICM THR PERl1rt 19 tSSUED(SEG]Oot.CN.Gj. ��'-' ,
W .
� LENDER'S NAME . . .
F- LEMDERS AODRESS . . -
� �CFRTIF/iHA71 HAVE READ THI9 MflJCATION M7D STATE 1NATTHE I100VE WFORAIATION 19 COfiRECT. TOTAL FEES ��.��
W �A6REE TO COMPIY WIM Nl CfiY AND COUN�I'�ORDwJJiCES AND STATE UN9 HELAliNO TO BULON� ��
� CpNSTAUCTI0N.MIDHER�YAUfHOHIZEREPRESENTA71VE50GTW5COUNTYTOFNfERUYONTNE
Z /�BpVEAlEM10NE0 PROPEFiI'FOR tNSPEGTION WIRDOSE9. �MMEMS
0 �L�
J �!
�
(Y] p � ' � . � f ... � / /9 .
� p _ _)��
� � o�E RECPT.NO. ��a�� PAIO BY VALIDATION
� WHITE-Department Gapy.YELLOW—Flnence Copy.PINK=Assessa Copy.GOIOENR00--Ftle Copy�6REE1�-ApplicanYs Copy
�o�..i�s'�'i� �}: :j_'v�:''1�i't.'i�..'.�:i;�;�'._i,'3s;�
����5�:`'[�� i 7..t,.�'1��t y'!:{�,i^,vy Li:t�
{ ,,(�' �r�y'r'T�` r^.� .-- ' .. -._ _ . � .. , , i-,
��,.�_ ' IT�S � I c41 ���� i ��J� ��! µ �[j� ",� 9 w . � .�� .��1'�� �I F'11'�iKt,�2� n�Jd� 74{ r � ��.�,�i � 1 l f1� 1 F"f,'�.
c i � y r �3`,.�� ?_�l�^� � :n ��'a t�, � f > > �' � 3
,.. �,
_ "'___ .. . . :_. ._'_� _._._.;_.3_,...._.�.i_�,... __���..a�t,.:. ._..._y..,__ ._.._. __�._._�s�„_� _.._�,.._. . �..s v.,,._. y � - e� �„'T�'
5ET BA�K I _ i FLC)OR )n S I---. -_._._s�_ ._-__�
_ __ _.._
FT��lrORfv1�!iTFEL � • � ,FH.4 REQNITS
__ . __. I 2 _ . _ __ ; _ . _ . -.. ._. - -- -
ELKTI IC r,?�Ut�dD �_ �_l�_C/ --- - -------- 1 l iNDFR�I.00R DLICT_ _ --
-- -- -- -
I 4 -� �-- — - -
GRUUIJp PU.!i��iBlt�!G � IJNCicR FLGOR C0�lDUIT I
---------- ----
, --- -------� f-------------- -----
SIAf�GRAC��= '' I ;FIREPLACE FOUI�DATIO�I
-------- ------ ----
TEMP PC1bti�ER -----�--------------- -I `FIREP�ACE BOND BEANI---- ----
dVATER SERVICE '�MID HT.BOND BEAM
ROOF SHEATHIf�G tl I � ;3 FT.BOND BEAM
----- ;— —
FRAMI�IG/VENTILATION I 1� i FIP•IAL BOPdD BEAM
---...-----—..-------------- -- -- - --------- ----- :-------------.—.�-- --•-------
ROOF COVER 'PRE-GRADI�IG
----- -----------_ - ------ ___---- -----_—_.-- '• ------ --------
ROUGHHEATI�IG - ------ ---------- - +BEf•lC�i1NG
_ ----------------- �----- �--------------- —-------
ROUGH ELEC"fF;IC ;ROUGH GRADING
ROUGH PLUh461NG FIN15H GRADING
SHOWER�fU6 TEST I pOOL ELECTP,IC
EXf.LATH/SIDING POOL FENCIyG
bVALL IMSUI_ATION �POOL FINAL
CEILING It�.ISI)LATION �QF�SITE IMPS.
DR'lWA�L PJAILING i DEDICATIONS
---------------------- ---------------- ---- ... � -= -------
�EN/ER �FINAL ENG.
--------•--- ----- ----- --- - __---------__-- ' ---------- — _._.�.---
SEPTIC TANK I LANDSCAPE�IRR�G.
- __--- --- ------ -- -------- -----
SEEP PIT!L.L. ON SITE IMPS. ^
GAS AfR TEST �FINAL ZONING
FINAL CONST. I'FIRE OEPT.FINAL
- �HEA THL DEPT.FINAL
FINAL ELECTRIC j DEV.FEES PAID
FINAL PLUp/181NG I ENERGY .
FINAL PLANING '
FINAL_ENGI�IEERING ',�• �"�„�
connnnEr��rs
SEPTIC TANK SIZE "
SEER PIT/U SIZE
a
,
