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HomeMy WebLinkAbout14371 (644) ^ _!� CITY OF DIAMOND BAR -f-'.`=,. DEPARTMENT OP COMMUNITY&DEVELOPMENT SERVICES � � w 21660 E.Copley Drive Suite 190 ' PRESS (909)860-3195 Fax(909)861-3117 �'�++�'��� BUII.DING PERMTI'APPLICATION FIRMLY � JOBSITE g� �., ��(f f � '��IIJ �.lV , ��� �Y�� # �'- ¢ ADDRESS�'(3��' �"�`'°�0 APPLICATI�N PERMIT P/C f��� �, � p � DATE�,�1�_NUMBER___� � ! � APN LOT TRACT . � ISSUE � TYPE 1 occ t DATE CONST.�_� \/ GROUP �_ p OWNER — o ADDRESS '� U ZONING SETBACKS .. � CITY IP�S�'TE ' � FRONT R�ly ❑ APPLICAN TEL �' REAR ❑ � • SIDE/SIDE STREET RW ❑ � CONTRACT R ' e-- SIDE ❑ Q CDDRESS� � U Z�P� TEL.�45�i,f��/'��.i� PROPOSED USE ��' � w ARCH/ENG/ z DESIGNER .C� G� w NO.DWEL. NO. NO. a, ADDRESS � y UNITS STORIES BEDROOMS � CITY �J ZIP c TEL� � � • v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O i HEREBY AFFiRM UNDEF PENALTY OF PERJUflY THAT!NA EXEMPT FROM THE CON7qACNflS LI- Gefe9B/C2fp0A W CENSEUWWpTFIEFOILOWINOflEASON(SEC7031.68USINESSANOPROFESSIONSCADE.ANYCITYOFi (n U COUNTYWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OqREPAIRANYS7RUC- W TURE,PRIOR TO RS ISSUANCE,AL50 HEDUIRES THE APPLICFNT FOR SUCFI PEHMIT TO FILE A SIGNED W Patio/Deck STATFMEM THAT HE OR SHE IS L�CENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS l4 � CENSE LAW(CHpPTER 9(COMMENCINO WITH SECTION 70D0)OF DIVISION 30FTHE BUSINESS ANO PRO- � POOVSP2 FESSpNSCODE)ORTHATHEOfl5HE15EXEMPTTHEREFROMANDTFIEBA515FORTF7EALLEOEDEXEMP- � TION.ANYVIOLATIONDFSECTION7091.5BYANYAPPLICANTFORAPERMITSU&IECTS7HEAPPLICANTTO z Re-Roof � ACMLVENALTYOFNOTMORE7HANFiVEHUNOqEDDOLIAFiS�SSOD)) � ❑I,ASOWNEROFTHEPHOPERTY,ORMYEMPLOYEESWITHWAGESASTNEIRSOLECOMPENSATION, � Commerciat WILL 00 THE WOAI(1WD THE STRUCTURE IS NOT INTENUED OR OFFERED FOR SALE(SEC 7044,BUSI- J � NESS RND PROFESSION3 CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNEH OF ? / � !/y7/ ` /}n PHOPERTYNRIOBUILDSORIMPflOVESTMEREON,ANDN770O0E55UCHWORKHIMSELFORMER50.FOR / (1 " ��" � THRdI(iHHISORHEHOWNEMPLOYEES,PROVIDEOTHATSl1CHIMPROVEMENTSARENOTINTENDEDOF m Q OFFERmFOHS11LE1F,HOWEVEfL7HEBUILOINGORIMPFOVEMENTISSOLDWRHINONEYEAROFCAMPLE- Z TqN,THE OWNER-0UIIDER WILL HAVE TF7E BUfl�EN OF PROVINO THAT HE OR SHE�IO NOT BUIID OR = IMPROVE FOR THE PURPOSEOF SALE). _ W ❑I.ASONRJEROFTHEPROPEHfV,AME%CLUSIVELVCOMRACTINOWITHLICENSWCONTMCTORS �i � � . Q TO CONSTRUCT l}1E PHOJECT(SEC.7D14,BUSINE55 AND PROFESSIONS CODE TNE CONTRACTORS LI- VBIIlaI10l1 ADJ AREA W CENSELAWDOESNO7APPLY70ANOWNEROFRPR4PER7YWHOBUILDSORIMPROVESTHEFEON,AN� � Nh1000NTIUCTSFORSUCHPR0.IECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTM0. QUANTITY /DESCRIPTION FEE � TORS UCENSE I,AW). � ❑IMIEXEMPTl1N�ERSEC. B APC FORTHISREASON Q 3 � � � D�TE OWNER V Z W � LICENSED CONTRACTOFS DECLARATION W � 1 HEREBYAFFIRM UNDER PENALTY OF PERIURYTHAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � d G(COMMENCINO WITH SECTION 7000)OF DIViSION 30F THE BUSWESS AND PROFFSSIONS CADE,AND Z L(Y LICENSE IS IN FULL FORCE AND EFFECT �1 � / m i.F' + ' �. 9 � UCENSECLASS LIG NO ��� � ' - - V DATE � G�? CONTMCTOR���� a - W � WORKERS'COMPENSATION DECLARATION Q - � IHEREBVAFFIqMUNDERPENAL7YOFPERIURYONEOFTHEFOLLOWING�ECLARATIONS Z ` � � _IHAVEIW�WILLMAINTAINACERTIFICATEOFCONSENTTOSELFdNSUREFOflWOflKERS' _ COMPENSAT�ON,AS7ROVIDEDBVSECTION370oOFTHELABORCOOE,FOqTHEPERFORMANCE W OF TT1E WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION .,.-�/`� Q 3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORK WR WHICH THIS PERMIT IS j� // ISSUED.MY WORKERS'COMPENSATION INSU`RA�NCE CARRIER AND POUCV NUMBER ARE CONSTRUCTION �� �r v � CAHRIER /r� PLAN REVIEW ��� � POLICVNUMBER �� _�� ELECTRIC 7 0 (IH455ECfpNNE�NOTBE00�.PLETmOFThEPERMIfISFORONEFUI�REOWUAFlS(S1a0)ORLESS) PLUMBING W I CERTIFY THAT IN THE PERiORMANCE OF THE WORN FOR W CH THIS PERMIT IS ISSUED,I MECHANICAL Z (} SHNLL NOT EMPLOYANY PERSON IN ANY MANNER 50 AS� ECO SUBJECT TO T � WORKERS'COMPENSATIONUWSOFCALIFORNIA,AJJ � E M INSPECTION FEE S SU&IECTTOTHEWbRKERS'COMPENSA�T P TIO 7ooOF ELA60R CWE,ISHALLFORTHWITMCOMPLYWIiH , P ISSUANCE � SMIP p DATE•I� APPLICANT WWAHNINO FAILURE TO SECURE WORKERS'COMP SATION COVERA(3E IS UNUWFUL, D HALLBE ENERGY P/C �y SU&IECTANEMPLOYEHTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAN� ENERGYPERMIT OOLLARS(f 10o,aoo�,IN ADDITION TO THE COST OF OOMPENSATION,DAM0.GE3 AS PROVIDEO FOR IN � SECTION 37oe OF THE LABOR GOOE,INTEflEST,AND ATTORNEY'S FEES RETENTION FEE: � CONSTFUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEFlEBV AFFIRM UNDEH PENAITY OF PERJUFY THAT THERE IS ACONSTRUCTON LENDING AGENCY FOR THE PEflFORMANCE OFiHE WORK WR WNICH THIS PERMIT IS ISSUED(SEC 3097,CIV C). 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DIAMOND BARI *--4* PRESS FIRM�Y CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190(909)860-3195 Fax(909)861-3117 BUILDING PERMIT APP�ICATION JAOD BD SRI TE sE s 7....6,S.�,...,,. IA/A40 ki'.Th4)AI i/Al,PA i APN LOT TRACT ......_ OWNER 11 it). 41.... ^ -.we l. ,Ot* ADDRESSIIWRII: a SIMMIIIM g P- MIMENEV CITY 'P 44J1w TE APPLICAN murnigit TE�. AU .--1...LIUMP!..11M, 411111/. CONTRACT, RAIL 1.0 A 4e,". . .Ad',iv.e 7..fa ADDRESS 1b2R-Wr.rSiOragIIAEZW.,3 CITY 6- .AUFAVE—ZIP.77.?.:>TE�.052-6)0,41-n38 ARCHJENG/ DESIGNER 4it,Ck t" ADDRESS -d..,A.A AI.: CITY P..—A,Wirig ZIP'0'T TE�. r FROM THE CONTRACTORS LI- CODE.ANY CITY OR OR REPAIR ANY STRUG OWNER-BUI�DER DECLARATION PERMIT TO FILE A SIGNED I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT t AM EXEMPT OF THE CONTRACTORS LI- CENSE I.AW FOR THE FOL�OWING REASON(SEC 7031.5 BUSINESS AND PROFESSIONS OF THE BUSINESS AND PRO- COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH, FOR THE AL�EGED EXEMP- TURE, PRIOR Tolls ISSUANCE,A�SO REQUIRES THE APP�ICANT FOR SUCH SUBJECTS THE APP�ICANT TO STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS THEIR SOLE COMPENSATION, CENSE�P,W(CHAPTER 9(COMMENCING WITH SECTION 7900)OF DIVISION 3 FOR SA�E(SEC 7044, BUSI- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS NOT APP�Y TO AN OWNER OF TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT HIMSELF OR HERSELF OR A CIVI�PENA�TY OF NOT MORE THAN FIVE HUNDRED DO�LARS($500)) ARE NOT INTENDED OR DI,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS WITHIN ONE YEAR OF COMPLE- WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED OR SHE DID NOT BUILD OR NESS AND PROFESSIONS THE CONTRP,CTORS LICENSED CONTRP,CTORS CODE: LICENSE LAW DOES PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO DOES SUCH WORK THROUGH HIS OR HER OWN EMP�OYEES,PROVIDED THAT SUCH IMPROVEMENTS OFFERED FOR SALE. IF, HOWEVER.THE BUILDING OR IMPROVEMENT IS SO�D TION,THE OWNER-BUI�DER WILL HAVE THE BURDEN OF PROVING THAT HE IMPROVE FOR THE PURPOSE OF SALE). 0 I.AS OWNER OF THE PROPERTY.AM EXCLUSIVE�Y CONTRACTING WITH TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CENSE�P,W DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS WHO CONTRACTS FOR SUCH PRO)ECTS WITH A CONTRACTOR(S) LICENSED TORS�ICENSE�AW). 0 I AM EXEMPT UNDER SEC. CODE THE CONTRACTORS LI- OR IMPROVES THEREON,AND PURSUANT TO THE CONTRAG B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEClr4RATION (HEREBY AFFIRM UNDER PENA�TY OF PER]URY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING INM-1 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY�ICENSE IS IN FUL�FORCE AND EFFECT LICENSE CLASS 8 LIC NO /2 DATE 0 q I 2,Oo 2 CONTRACTOR _i4g.e_4 DECLARP,TIONS FOR WORKERS' FOR THE PERFORMANCE WORKERS'COMPENSATION DECLARATION AS REQUIRED BY SECTION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FOLLOWING FOR WHICH THIS PERMIT IS I HAVE AND WIL�MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE POLICY NUMBER ARE COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE�ABOR CODE, OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WI��MAINTAIN WORKERS'COMPENSATION INSURANCE, 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND CARRIER A40 POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DO�LARS($100)OR�ESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W CH THIS PERMIT IS ISSUED,I SHAL�NOT EMPLOY ANY PERSON IN ANY MANNER SO AS ECO SUBJECT TO T WORKERS'COMPENSATION LAWS OF CALIFORNIA, %,a.., . M SUBJECT TO THE WORKERS'COMPENSAT,* • .:.p• ..,-,..,, 10 7500F 'E LABOR CODE,I SHALL FORTHWITH COMPLY WI T s, 1(7.• , DATE. i'zi/77f7 APP�ICANT WARNING FAILURE TO SECURE WORKERS'COMP•SATION COVERAGE IS UNLAWFU�, D HA��BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOLI�,RS(9100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PER]URY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C). LENDER'S NAME . LENDER'S ADDRESS , � � � . - . ... . ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES ...al . , , Aar ° d PERMI- 27 TUR,• . .51 DATE APP�ICATION DATE PERMIT 1 17(7"."="2 I CV I 1/?, NUMBER/137 P/C ISSUE DATE TYPE °C rt.. CONST.V GROUP Q R3 FRONT SETBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 17 0 PROPOSED N0. UNITS USE DWE�. 6A2-Eg V I 44"4Jr. _(_Ft6/..k4t1.14. 013,E--0 {-U5•E (IQ fn- N0. N0, STORIES BEDROOMS CO U-I Iil DESCRIPTION SQ, Ff. FACTOR PSF AD),AREA/VALUATION U- 0 z SFR/ADD/REM GarageJCarport Patio/Deck Pool/Spa Re-Roof E —1 Commercial co I,'64/7 /Y-/ /'0)--071- Ir7 ote.00 I ,](: , --- ' Valuation 1 ADJ AREA QUANTITY /DESCRIPTION FEE RI 0 IY I- C) L�I I til 0 Z 2 a. —i < 0 E < 6 Lj CONSTRUCTION PLAN REVIEW E�ECTRIC P�UMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PJC ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: I , 6 � � 9) (-77) I' ------k TOTAL F'S 53. d COMMENTS -1 (-e (-/\ RECPT. NO. PAID BY tdai4'—'Grt�IDATION 14/1 WRITE--Department Copy,YE��OW—Finance Copy, PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD -'n.),Q;;Mile.,"- .... :,i,P!ak'f.i::.h7„•titter, itn.rter..tarri,.,,4rtfrroaw,,.. . .0..44;4. ..s-.1.01,..wk,l,"...........::4.-tv,.-t-g.F-eria 4, ..0 'SET BACK: jl 'FLOOR JOIST FT-G-S/FORMS/STE.E�. 1 FHA REOMTS- ECTRIC GROUND i ----F i UNDER F�OOR DUCT UNEMie,Ish'�71;iNF UNDER FLOOR CONDUIT SlA6 GRP,DE FIREP�ACE FOUNDATION 1 TEMP POWER FIREP�ACE BOND BEAM WATER SERVICE MID HT. BOND BEAM- 7-2 ii-e5 ...2c2.--J-----'7--.-•. , • : .1.. ;l;J...., FRAMING/VENTILIATION 1 FINAL BOND BEAM ROOF COVER PRE-GRADING IBENCHING ROUGH HEATING ROUGH E�ECTRIC ROUGH GRADING ROUGH P�UMBING FINISH GRADING POOL E�ECTRIC -S-11-0-WER'f-TU B TEST EXT. IA-1-14,1S;DING P00�FENCING WAL�; N-STRAT I ON P00�FINAL CEI�ING INSU�P,TION j OFF SITE IMPS. DRYWAL�NAI�ING DEDICATIONS EWER I FINA�ENG. SEPTIC TANK I LANDSCAPORRIG. SEE-P.-PIT/LI. 2777--' ON SITE IMPS. GAS AIR*Ic FINAL ZONING FiNTA�CONST. FIRE DEPT. FINAL • FINA�I IEATING 1-HEA�TH DEPT,FINAL _ FINAL E�ECTRIC DEV,FEES PAID- --I- FINAL P�UMBING ENERGY _ cli,e,2111 I -O I�---------- ----- �� GOM MENT'S r-z ot. pAct Thire-4- SEPTIC TANK SIZE SEEP PITP]SIZE � 14.