HomeMy WebLinkAbout10-1103 �___�_�___-- ----�-- _ �' �
_�,,�_ CITY OF DIAMQNI�BAR y'
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES G
21825 Capiey Drive,Diamand Bar,CA 91765
{909}839-7420 Fax{949)$61-3117 Buiiding Inspection Hotiine{909)839-?027 PRESS
���' BUILDING PERMIT APPLICATION FIRMLY
o ADDRIESS� ��� W�a'� �. (�'��YV �'t• APPLICATION PERMIT J}� �� �!C
DATE NUMBER i�
� t�SU� ���.O�2--/D nP� /� �C�
APN LOT TRACT DATE CQNST. �-J CJ GROUP
p OWNER LZUV\c:�-� LL'7.
p ApDRESS ��1�� ��+�-�� ��T� "�+'�' ZONING SETBACKS
�'� ��Ty i4... 'd�fLIP �1._��$ TEL.'�LJ�I �470^3 �{ FRONT RW ❑
� APPIICAMT ' ?-s�t.t+ P.Qt�uOZ.a TEl")til t�5"-�t3�G, REAFi ❑
SIDE/SIDE STREET RW O
� CQNTRAG70R p(i] v\tn.Pi�- ��, Nnbitp� SIDE ❑
ADQRESS.��(3 ,�- ��"� ]f_�1 •
o —'�'� PROPOSED USE �'�-��D i..,.��t:�.4-i.✓ �.�C.�.+�-4.� - �c-y�.�Q.
cirv _ 8��.���_ ziP 23o�2Te�.'l/Y 6~tC'-5�26
w ARCHlENGI ��a C c:���-�"—`'t--
� DESIGNER
a ADDRESS NO.DWEI. NO. NO.
UNITS STORIES BEDRdOMS
� G17Y 2EP TEL.
� DESCFtIPTION SQ.FT. FAC7QR PSF ADJ.AREANALUATION
�
� OWNER-BUILDER DECLARATtON SFWADD/FiEM
O
� !H£RESY AFF7RM UHpER PENl�iTY OF PERIURY TFUT i AM EXEMPT FROAi 7NE COMfRACTORS Li- G8f806/C8(�JOA
W CENSEUWFORTHEFOLLOWINOREAS4N(SEC.7037.5BUSINESSANDCROFESSIONSCODE:MIVCITV4R (/�
U COUMYYM{CHREQUIRESAPERMIT7000NSTPUCT.ALTER.IMPpOYE.DEMOliSH,ORREPAtRANYS7AUG UJ patiotDeck
Z TURE.OR�OR TSY 1T5 iSSUANCE.ALSO RE4UIRES iHE APAI.iCANT FOfl SUCH PERMIT TO KILE A SiGN6D W
W STATEMENT THAT HE pR SNE IS f.10ENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
�S CENSE UW{CHAPTEH 9{CUAiMENCW{3 WiTH SECTION 7000)OF QIVISiOtt 3 OF TNE HUSW ESS AND PRQ- u- PooVSpa �
7C FESSWNSCODE)ORTHATHEORSHEISEXEMP7THEREFpOMANDTMEBASISFORTHEALLE6EDEXEMP�
�j 710N.ANVVIOIATIONOFSECTION703t.58YAN1'APPLICMITFORAPERMI75UBJECTSTHEMPLICANTT� Z �'{{g-RbQ!
� A C{y��pENAL7Y OF tiUT MORE THAM FNE HUNOREO DOLIARS(f506}.):
� ❑4�.SON?JERpF7HEPROPER7v,4RMYEMPLOVEESWITHWAOESASTHEIRSpLECOMPENSATION, � C,pmrfi9fti81
Wlt.l.DO THE WOAlS,AND THE STRUCTURE!S NOF tNTENOED OR OFFEHED FQR SAIE(SEG.70Aa,0US4 �.!
� NESS AND PROFESSFONS C06E:THE CtlNTRACTORS IiCENSE LAW D6E5 NOT APPI.V TO AN OWNER OF �
PROVERTV N?It?BUILp5 OR IMPRf7VE5 THEREON,ANb Vh10 DOES SUCFI WOHK HIMSELF OR HERSELF OR
[L 7tiAQtJtiFiHi50Rl1ERONTJEMPIOYEES,PAOY@E6'TttAT5UCHlMRAOVEMENTSARENOTIHTENDEDOR �
W OFFEHEDFOASALEIF,HOWkVERTNEBUILDINtlORUAPROVEMEN715504AVMHINONEVEAROFGOMPLE�
0 TK?N,THE OWNER-BUILDEFl WILL HAVE TME BURDEN OF PROVINq 71iAT HE QR SHE OID NOT 9UILD OR
Z IMPROYE FORTHE PUfiPOSE OF SALES.
_ ❑I,ASOWNER4FTHEPROPEHTV.AMExCWSNELVCOMRACTINOWfTHLICENSEDqONTRAC70R5
� TO' STflUC7 THE PRWEGT(SEC.T04A,9USINESS/J+ID PAOFESSIONS CODE:THE CANIRACTOAS l!- V8{UBtiOn AC}J.AREA
W CENSE tAW 90ES NOT'MPLV TO AN OWNER OF A PROVERTY WHO BUILDS Op IMPpOVES THEREON,AND
� WFN?CONTRACTSFORSUCHPROJECTSWITHACON7MCTOR(5)LICENSEDPURSUANTTO7HECAN7RAG Q�J/{NTITY DESCRfPTlON FEE
Y TORSLtCENSEiAW,).
� ❑I AM EXEMPT UNDEfi SEC. 6,8 P,Q F00.7H15 REASON �
� �
�
� DATE OWNER E"
Z W
� � LICENSED Ct?NTRAC7QRS QECtAFiATlOtJ �j
� I H6REBV AFFIqM UNDER PENALTV OF PERIURV THAT I AM I.ICENSED UNDER PROVISIUNS OF CMAPTER � S 1 fJ�,�� j �_ ` �}�
� Y{COMiAENqNtd WfT}i SECT70N 70qk}OF DIVtSN3N 3 QF THE Bt7StNE55 AND PROFESStONS CODE.AND Z. j v�4ti�'�
LLI w�'�ENSE IS IN NLl FORCE ANO EFFECT.
f �yri`_ G�+ �
� LICENSE CLASS ,d V�.,�.�lo �}LIC.NO. `��i� / (,a � �
� DATE �S+'T� ��'��' �'GONTAACTOR "�" n•
W
� WORKERS'CpMFENSATION DECLARATION � �
_ �
� i HEREBY AKfiRM UNDER PENALTY OF PEfUURY ONE OF 7NE F4ltOWiMG DECLARATIONS
Ct) a
K� IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENT105ELF�INSUftEFORWORKERS' _
� COMPENSA7FON,AS PflOYtDEO 8Y SECTtON 37000FTHE Lil86R CODE,FOR TNE PERFOflMANCE W
OF TNE WORK FOP WFIICH THIS PEFMIT IS ISSUED. �
�
W _,.,.�I HAVE AND WILL MAINTAIN WORKERS'CAMPfiNSATIQN INSURANCE,AS REOUIFED BV SECTION
� 31tl0 OF THE LABOR CQDE.FOF THE PERFORMANCE OF THE WORK FbF1 WHICH TNIS PERMlT IS
ISSUED.MY WrQRKERS'COMPENSATION iNSUAAF7CE CARRIER ANO PO4�CY NUMBER ARE GONSTRUGT�ON
� CARRIER 11Q�+f�� PI.ANREVIEW
� POLICV NUMBER Zl�S��DO y 3S(�/^c�f ELECTRIC
d
� (fl'6SSECTIOfJNE�NJTBEf,'�Mi'I.EfED4FT1�i+EW.NTISFORONEI�ANiXiEDDOLIPASf=t00)4RLESS} UM � •�
Z i CERTIFV THAT IN THE PERFO(iMANCE OF THE WORK FOR WHICH THIS PERMIT IS�SSUEO,I MECHANICAL
�J SHALL Nt?T EMPLOV ANV PEASON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
� WC7AK£RS'C4MPENSAT�OH IAWS OF CALtFORNiA N�D A4REE TNAT iF i SHOULD BECAME ��1SPECTION FEE
� SU&IECT TO THE W4RKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F TNE LABI?R � UANC ��-'
� COpE,I 5�N}ALL FORTHWITN COMPLY WITH TNpSE PftOYIS70NS.
� DATE: �`� �+��� APPIICANT. �""'�-'F-J��� Q.�r�.r��S SMIP
C�
� ENERGY P/C
� W/�RNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE 15 UNIAWFUL,ANO SHALL BE
� SU&lECT AN EMPLOYER TO CAIMfNAL PENAL7IES AND CML FINES UP TOONE HUNDRED Tt10USAND ENERGY PE
O6ltAR5(S1oo,OW),IN RDD17ION TO THE COST OF COMPEN5ATION.DAMAQES AS PR4ViDED FOR tN
� SEC710N 37oe OF THE I.ABOR CODE,INTEREST,AND ATTORNEV'S FEES. ENTI N FEE:
� CONSTFUCTIpN LENDING AGENGY PpE-AIS FEE:
O
� i HEREBY AFF�RM UNDER PENALTY 4F PERJi1ftV TNAT TMER6 iS�CONS7RUCiION LENOINQ AGENCV '
�- FOR THE PERFpRMANCE OF THE WbRK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
2
[tJ
� LEN�ER'S NAME
F— IENDER'SADDRESS
� i CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT iHE ABQVE INFORMA7pN IS CARRECT. TlJ 1 AL FEE�
W I AGIiEE Tp COA/PLV WITH Al.l.CITV AND CqUNTY ORDINANCES ANO STATE LAWS RE4ATING TO BUILOIN6
� GONSTRUCTEON,AND NEREBY AUtHOii2E�EPRESENTATIY65 OF THIS COUNTY TO ENTER UPON THE �
ZABOVE-MEMTIONED PROPERTV FOR INSPECTION PURPOSES. CQMMENTS �
p �'� (p�..PA/"n 2a
� PERMt7TE£NMiE(ARiNT} .G�s.~��
"d �..a-�."
C1)
,�/� SIONATURE OF P6RMITTEE DATE
� AECPT.N4. PAID BY� VALIDATION
WHITE—Department Copy,VELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENpQ ile Copy,GREEN—Applicent's Copy
� Ci1fV �V� IDIA�t>i\fC3 �AR
IM�S�°EC1'IC��! RECt3RCD
� : oa�p��4aoa oa4c� aa��c��►oQ �a�pc�c�400a oa� Da�p�t���, �� :
SET BACK FLO(7R JOlST
FTGSlFORMSlSTEEL FHA REQMTS
ELECTRIC GRqUND UhJDER FLOOR DUCT
GROUND PLUMBING UNDER FLC70R Cf�NDUl7
SLAB GRADE FiREPLACE FpUNDATION
TEMP POWER FIREPLACE BQND BEAM
WATER SERVICE MID N'T. BC1ND BEAM
ROt3F SHEATNING 8 FT. BOND BEAM
FRAMCNGJVENTILATIQN FiNAL BOND BEAM
RQOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGN E�ECTRIC ROUGH GRADING
ROUGH PLUMBWG FINISH GRADIfJG
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINA�
CEI�iNG INSULATiON CiFF S#TE IMPS.
DRYWALL NAILlNG DEDICA`(fC}NS
SEWER F{NAL ENG.
SEPTIG TANK �ANC}SCAPElIRRIG.
SEEP P(TIL..L. � ON SlTE lMPS.
GAS AIR TEST �lNAL ZONWG
�INAL CONST. - FIRE DEPT. F�NAL
FINAL HEATING HEALTM DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING �,�j �,'`-�� ENERGY �
� ��� ' .�
COMMEiVTS
SEPTIC TANK S�ZE ,
SEEP PiT/U SIZE
a
� � —
�.�� �