HomeMy WebLinkAbout10-1048 ��,� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 $$
'°�'� BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE �^�y
>- �� APPLICATION / PERMIT p/C
o ADDRESS�) N. r rc.�.,���-'�C rC�.,�- �1n DATE IQ %���O NUMBER f0-f0�#
� ISSUE � �! v�` TYPE��fC1_, _„�� OCC
APN LOT TRACT DATE O� � U �� CONS �1 �
p OWNER ��r.r'�.� :c�. �G����- � �� ROUP
o ADDRESS�.n,�_��,���,��� 1.=+.� ZONING SETBACKS
Z CITY �:n.�. �.n.1� t7ir`�ZIP TEE�'l!G�37�`14 FRONT qyy �
o APPUCANT �zra TEL.���� _��c�� REAR �
� SIDE/SIDE STREET RW ❑
�
� CONTRACTOR '�' � w SIDE p
ADDRESS '� �
� CITY �..(il-- ZIP�r� TEL.�,?�"�S���C � PROPOSED USE
o ARCH/ENG/ ��- ` �
z DESIGNER
a ADDRESS NO.DWEL. NO.
NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRAI UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f88B/C9fPOR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.68USWESSANDPROFESSIONSCODE:ANVCITVOR (n
U COUN7yWH�CNREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANVSTRUG W
w NRE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES hiE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck
� STATEMENT TFUT HE OR SHE IS LICENSED WHSUANT TO THE PPOVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHMTER B(COMMENCINO WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � PooUSpe
, Q FESSIONS CODE�OR THAT HE OR SHE IS EXEAIPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- C7
V TION.ANY VIOLATqN OF SECTION 7N1.5 BV ANY APPLICANT FOR A PERMIT 5U&IECTS 7HE APPLICANT T0 Z Re-Foof
A CML VENAL7Y OF NOT MORE 7HAN FNE HUNDRED DOLURS(5500).):
Q ❑lASOWNEROFTHEPROPEHTV,ORMVEMPLOYEESWITHWAGESASTHEIR50LECAMPENSATION, � COf1'IrtIBfCI01
Z WILL DO THE WOiil(,AND THE STRUCTURE IS NOT INTENDED OR OFfERED FOR SALE(SEC.7Wa,WSI- J
� NE59 AND PROFESSIONS CODE THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j
PROPER7Y NMO BUILAS OR IMPROVES TMEHEON,AND N?10 DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROU(iH HIS OR HER OMM EMPIOVEES,PROVIDED THAT SUq1 IMPROVEMENTS ARE NOT WTENDED OR m
0 OFFEREDWRSALEIF,FiOWEVER7}1EBUILDINOORIMPROVEMENTISSOI.DWI7HINONEYEAqOFCOMPIE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIIA OR
� IMPROVE FOR THE PURPOSE OF SALE). -
w ❑I.AS OWNER OF THE PROPEHTY,AM E%ClUSNELV CANTRACTIN�WfTH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7WI,BUSINESS AND PROFESSIONS CODE THE CONTMCTOqS LI- V81U9�1Of1 qp�.qpEq
W CENSE UW DOES NOTAPPLV TO AN OWNER OFA PROPERTV WHO BUILDS OR IMPHOVE9 THERE-0N,M!D
� WMOCANTRACTSFORSUpiPRQ1ECTSWITHACONTMCTOq(5)LICENSEDPURSUANTTOTHECONTRAG ounNnTv DESCRIPTION
Y TORS LICENSE LAW.). FEE
Q ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q '
� U
LL DATE ON?JEF �
Z U
� LICENSED CONTRACTORS OECLARATION w .
� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAGTER � %�J , �^ +
� 8(COMMENCIN(3 WI7H SECTbN 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CODE,AND Z � I � ♦
�� MV IJCENSE IS W FULL FORCE AND EFFECT. m
� LICENSE CLASS__G' o l�_ UC.NO. ` -1 1��� �
V DATE r CONTRACTOR - d
W
� ` WORKERS'COMPENSATION DECLA 10 I / �
� U
N I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLAAATIONS: Z
O _�NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELf�INSURE FOR WORI(ERS' ¢ '
2
Q COMPENSATION,AS PROVIDED BV SECTION 3]OOOF THE LABOR CODE,FOR TME PE{iFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
� �
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REWIRED BV SECTION
Q 3700 OF THE LAHOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WOR/ RS'COMPENSAT INSURANCE CARRIER AND POLICV NUMBER AAE: CONSTRUCTION
jCARRIER J��-����.�-{��[1�j LL��� PLANREVIEW
0 POLICY NUMBER L�.1� �7 •9 C���L'7 ELECTRIC
� 2r- .�
� (iHI55ECiqNNE�NOTBECOA�LETEDOFTiEPEPMTISFORONEHINi%1�Dp1l�RS(t10U)OiiLESS} M N �
W
Z I CERTIFV hlpT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
�} SH/LLL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
[n WORNERS'CAMPENSATION LAWS OF CALIFORNIq AND AGHEE THA71F I SHOULD BECAME INSPECTION FEE
SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION o00FTHELABOR
O CODE,I SHALL FORTHWITH COMPLY WITH THOSE P ISIDNS. S NC _ �S D,�
p �ATE.�O 1 APPLICANTCC�u�l� � SMIP
W ENERGY P/C
J WARNINO: LURE O SECURE WORKERS' NSA VEqAOE IS UNLAWFUL,AND SHN.L BE
J
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT
DOLLAflS(5700,000),IN�DDITION TO THE COST OF CAMPENSATION,DAMNOES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEI"S FEES. NTIO FEE: ��(,� �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFIRM UNDEF PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AOENCY
� FOR 7HE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
W
�T LENDER'S NAME
i
� LENDER'SADORESS
� TOTAL FEES �p rJ, ',(7
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT hIE ABOVE INFORAIATqN IS CORRECT.
w I AGREE TO CAMPIV WITH ALL CfTY AND COUNTV ORDINANCES AND STATE LAWS PEUTIN6 TO BUILDINO
d
� CONSTRUCTION,AND HEREBV AUhiORIZE REPFESENTATNES OF THIS CWNTY TO ENTER UPON THE '
Z ABOVE-MEMIONED PROPE TY FOR INS�ECTqN PURPOSES. COMMENTS '
0
J ��
f
�
m FERMITTEE N (PRINn ,^ -
¢ l �
Cn �/
{, � SKiNANRE OF PERMI7T DA
� RECPT.NO. PAID BY VAUDATION
WHITE—Depertment Copy,YELLOW�Inance Copy,PINK—Assessor Copy,OOLDENRO�File Copy,(3REEN—Applicant's Copy
c�rv o� ����o�� ��� _ -
INS�EC1'B�i� R�CORD
x:��r�p�c�4�a � �����r ��c�t�oc�:� F. oa�p�c�ooa . �a�c�:�� � aa�p���� ,_`
SET BACK '� FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATI�N
TEMP POWER FIREPL,4CE 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 ''O FINISH GRADING
b
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDWG POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/�RRIG.
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 %�'iv ENERGY
C�OG o
COMMEIVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a
� �
�-�� d