HomeMy WebLinkAbout14-4359 :'�:',.��� C1TY OF DIAMOND BAR ,� ?r���
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� � I I 1 l DEPARTn1ENT OF COn1N1UNITY&DEVEL�PMENT SERVICES �ZS�
� ~�, ���III i�:� `� ' 21810 Copley Drive,Diamond I3ar,CA 91765 PRE�� II
,.,� (909)839-7020 Fax:(909)861-3117 Building L�spection Hotline(909)839-7027 F�RMLY I
� '�ri"""" BUILD[NG PERMIT APYI.ICATION I
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i � �/�/� (� APPLICATION DATE: �I� a' t�'�" P/C# P� �4-�h3'S
¢ JOB SITE ADDRESS �� � T�� �N ISSUE DATE: ��/�Tdf/j� PERMIT# �y �,�J�
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z APN L T T T
o OWNER
TYPE CONST. OCC GROUP:
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� ADDR SS ZONING SETBACKS
� C17y ZIP TEL. FRONT RW R—
Q APPLICANT TEL. REAR �
o � SIDE/SIDE STREET RW ❑
Q CONTRACT SIDE �
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o� ADDRESS PROPOSED USE
� CITY ZIP TEL.
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`l ARCH/ENG/DESIGNER
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o ADDRESS !i DWEL.UNITS #STORIES #BEDROOMS
a CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BNLDffl DECLARATION
� i hereby aMrtn uMer penalry of perjury tha�I am exempt hom the Contractm's S[ate License Law for the reason(s) SFR/ADD/REM
� irbicatetl below by the checkmark(s).1 have placed next to the aDW��e item�s)[Sectlon 7U31S,Buslness and
o Garage/Carport
w Professlons Code:Any ciry ar courrty that requires a permit to construct,alter,lmprove,tlemolish,w repair,any
Z strucNre,Drior tn its issuance,also requires the aDP�icairt fm Ihe permit to file a signed slatement Nat Ae ar she t/l Patio/Deck
a is licensed Dursuant to ihe provislons ol ihe COMraclor's State License Law(Chapter 9)Commencing wtth SeCtion w
� 7000 of DlvFsion 3 0l the Business an0 Professions CodeJ or that he or she is exempt hom Iiceraure and Me basis for � P�USpa
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N the alleged exemptian.My violatian of Section 7031.5 by any applfcant for a permf�su6jecis the apD��t ro a civil penalty Z Re-Roof �
� of not more Uian five huntlretl tlollars(SSOD). p
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o (�I,as owner af the property,or my employees wIN wages as thelr sole compensation,wfll do U��of or(�portions � mmerc a
0 0l the woAe,arxt the struclure Is not intended or offered for sale(Sectlon 7044,Business and Pralessans Code:The �
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� Caitractnrs'Sfate License Law tices not apD�Y to an awner of property who,ihrough employees'or personal effwt,builds
w or improves the Droperty,P�ed Nat ihe Improvements are not intended or oflered lor sale.tt however,the building or
� improvnment is sold wlNin one year ol completlon,the Owner-Bullder wi11 have Ne buNen a1 proving Nat it was irot huilt
por improved fw tl�e purpose ol sale.).
� U I,as owner ol the property.am exdusNety contracGng witl�lice�ued Contraclors[o construd ihe RroJect(Section
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0 7p44,Business and Professions Cale:Tlie CoMractors'State License law does rwt appry to an owner of property who Valuation' dj. rea:
z buildsorimproveslhereon,andwhoconVxtstortheprojectswithallcensedContractwpursuanitotheContractors'State QUANTfTY DESCRIPTION FEE
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Y License Law.).
o (�I am exempl hom licensure under the ConVacior's Stale Llcense law�or ihe 1ollowi�re�son(s): �
� �
LL By my signature below t acknowletlge that,except for my personal resi0ence In wNch I must have resided lor al least one �
z year prior to completion of the imprwements cmered by this pertnit,l canrrot legalty sell a strucNre that I have buitt as an „�,
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a owner-builder il i��as not been consWctetl In its entirey�y licensed contractors.I understa�ttiai a copy of ihe appllcaDle
� law,Sectian 7044 of the Business and Professions Code is available upon request when ihis appl{cation fs submitted or at
d the tollowing Web sfle:Mtplwww.leginfo.ca.govlcalaw.himl. z
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�ATE: SIGN: �
� LICENSED CONTRACTOR'S DECLARATIOH a
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w I hereby a8irm untler penaYty fi perjury Ihal l am liceraed under provisioiu oi Chapter 9(commencing wil�Seclan 7W0)
� of Division 3 ot the Business and Professions Code,and my Ikense is in tull farce and effecl. �
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N L10EfdSE C. .N � Q
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o OATE: CONTRACTOR: w
�d WORNER'S COMPENSATION OECIARATION �
� I HEREBY AFFlRM UN�ER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
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¢ I have and will maintain a CenKple ot Consem tu Sett-Insure lor Worker's CompensatiaL as provided hy CONSTRUCTION:
� SecUon 3700 0l the Labor Code,(or Ihe erfwmance of ine warle for which this rmit fs issued. �7 . �'JQ
� v PQ PLAN REVIEW:
> I have and will mafntain Warker's Compensation Insura�e,as reQuireA by Section 370D oi the labor Code,for ELECTRIC: �?' 7-�
o the performance of ihe work for which this permit is issued.My Worker's Compensatfon Insurance Cartier and
¢ Po�iqNumberare: PLUMBING:
o �pµq�Eq MECHANICAL:
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z POLIGYNUMBER INSPECTION FEE: �/
� (T}flS$ECf10N Nffp NOT BE COM%FfED IFhIE PEM4fT lS FOR DNE FNNDRED DOLLMS(570�OR LESS7. ISSUANCE: � � � 7
� I cerifty thal(n tlie P�omcuice d Uce v.ak la whiG�ttiis Permit Is iawed,I stcill rot emObY�Y Person m any manner so as to +.�•.f'c f
ot�ecome suhject ro Ihe Worker§Comperuaiion Laws ot Califomia.Md agree Iha�If I shoultl becoma subjecl to the Worker's SMIP:
� Compen t ot Section 37W of La �e I shau coyiqy wiln •e v��s n57 ��� EtJERGY P/C:
� DATE������APPIICANT: �l/ ENERGY PERMIT.
LL 1
� wARNING failur to secure workers Compensauon cmerage is unlawful,and shall sub�ect an employer ro crlminal RETENTION FEE: 1�"Q�
w penalties and civil fines up ro one hundred thousand dollars(3100.000),in atldition to the cost ol the comperrsation,
� darnages as prmided for in sectfon 3706 01 the lahor code,interest,and attomey's fees. PAE-ALT FEE:
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� C�NSTRUCTION LENDING AGENCY BSAF: 'Q�—
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w I hereby affirm under penalty of per�ury ihat there is a Constmction Lending Agenq far ihe peAwmance ol 17ie work lor
= which this permil is issued iS¢c.3097,Civ.C.).
�
� LENDER'S NAME
� LENDFA'SADDRESS: p
a i cerfiry ihat I have read ihis apD�ication and sfate that�he above informalion is correcL I agree to compry vnN all city and TOTAL FEES 6,', , �j Q, y 01�6�
� counry ordinances and state laws relatlng ro buiidirg construction,antl hereby aumorize representatives of this county ro CpMMENTS:
Z enter upon Ne above-mentioned pmperry f inspection purposes. �
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a CPE E NAME�PRINn O ��� aC]C"S� �0�
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� RECEIPT N C.�!4� PAID BY:�[���_VALIDATION:
= SIGNATURE�F PEflM E DATE
�
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessa Copy.GOLDENROD—File Copy,GREEN—ApplicanYs Copy
CITY OF DIAMOND BAR �
INSPECT�ON F'�ECORD
. s � . a - • � , � '
�SETBACK!LETTER • . ,<,_ � .:s >°` TRACTAND LEDGER
FOOTINGS.FORMS � `' -` - SWtTCH GEAR
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- `� '� COMMERCIAL HOOD
SLAB�; ra - r - t,� ,�, ��E
'UG..PLUMBING:! ' " ' - ';r; �' T-BAR
UG.ELECTRICAL - � � ; �• ''r�` INTERCEPTER
' '` �.'' HOT MOP/SHOWERPAN
:UFER;GROUND:�' � ' :"-� $�� �„
SEWER LATERAL SEPTIClCESSPOOL
MAIN WATER LINE HERS REPORT RECENED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
SNEAR WALLS ING ROUGH CONDUIT
FLOOR SHEA
. :, _
'EXTERIOR. ' �� `� " �` ROOUSPA�' `_;' ; , � � �
SHEAR WALLS fNTERIOR;' "' ��. � ' ROUGH PLUMBING :� - t �e: a ,�° '` "°� '- `�
FHAMINGNENTING n ` " � � .� N } 5 , := s ROUGH ELECTRICAL'� �� ` � -� �^� r
ftOUGH MECHANICAL ,.k„ ,{� ' � � }�� � ROUGH MECHANICAL � � �� ""' �
�� „ ,. IS ^r 1 � F ,Y i,� ,U�,I� Y
RDUGH ELECTRICAL W(;�.)C( ) �`_- - �� , ` GAS T€ST ;� - - - �
ROUGHPLUMBING ;:':, ' ;", x � '`� ` ,..�j PREGUNITE° , '.A
�t r , ��
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INSULATION WALL �POOL PRE_DECK BO(�DING �_ �'' ' '�`, #� '�-
INSULATION CEIUNG P-�P � �� r � �
DRYWALL �FENCE/GQTEI AtARM � '
� �.
LATH(PR� FINAL POOL. r, -- ` - _ - ^ -�-'
LATH EXTERIOR WALLS:
LATH INTERIOR WALL FOOTING/STEEI
GAS TEST WALL STEEL 1�( )2N0( )LIFT
SCRATCH COAT � • WALL BOND BFAM
' WALL ORAIN/SEAL
ELECTRIC METER RELEASE �'2- t3- , � L YN�'�
GAS METER RELEASE � WALL FINAL
:: :: yF t ." Ftt ��
SPECIA�L INSPECTION � RO FRAMING PLANt�NGAPPROVAL a ' � - � � �
- � ' 1 , - ':�-� ROUGH FIRE APPfiOVAL `' `f 1'' �' �� _
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AE�BkifLDIW6 SV%.1r2.� , Z r J li`. t -. _ ` `
FINAL MECHANICAL ��; �� " �:'.�, ��� � ' FINAL FIR�DEPARTMENT '` _ � � ` � ' ��
= �FINAL PLAidNiNG '; �' ; "� � ' �� i , ;- - y '�.':
FINALELECTRICAL 1 L 3�+' 1� 7 �'
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FINP�L�ENGINEERING/PW �;. � ' `�
F.INAL PLUMBING�` ' �" l�'� � �
�T.C:'of OC�UFANCY, ' �:,, 7,> ��"�`: < �.�T, '. ;F1NAL COMMUNITY SERYICES r `- ' '` ` ' `
�-�'{ �FINAL�HEALTH DEP.T "
CEEtL of OCCUPANCV<�', ., ,��� � � �> �� . � `
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FINAL:INDUSTRIAL WASTE:: F ': ` -° � - --= t -`
COMMENTS:
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