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Home My WebLink About10-842 . _ : —� ��_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' - 21825 Copley Drive,Diamond Bar,CA 91765 � � �. `, (I` (909)839-7020 Fax(909)861-3117 Building nsp o ��iUIM��839-7027 PRESS �'°^'� BUILDING PERMIT APPLICATION FIRMLY o DDRESS I�� Ll�l LL_OW V i� �� APPLICATION � 2� PERMIT p/C P �ci� -��•� DATE / �IO NUMBER (0�S`i2 #__�O— $�► � APN LOT TRACT ISSUE 7yPE �C DATE � CONST. GROUP p OWNE�Srj ►�,4L � 1-Il�N��AR� FAMILy TR K7 p ADDRESS 1 '� ZONING SETBA KS z CITY Lt)A�,n�UT ZIP 1 TEL.9u9_�i�{1 -06-7 FRONT Ryy � o APPLICANT �,,`Z�7 C F1 1 13 r�A n��7 A R i TEL. 9u9-!U i-nil,7y REAR � z / SIDE/SIDE STREET qyy p � TRACTOR�7�[� M A2T 1 SIDE Q 43u-9H - ADDRESS L�. o CITY t��LA AJ�I ZIP_s� TEL`%G4-$1�' �y PROPOSED USE �C7U/ — AR� z IGNE a ADDR S NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEfiEBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS U- G8f8 B/C8 Off W CENSELAWFORTHEFOILOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n C� COUNTVWHICHREOUIRESAPERMITTOCONSTFUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTqUC� P8�I0/DBCI( W TURE,PRqR TO ITS ISSUANCE,/LLSO REOUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIONED W --�� g STATEMENT TFU1T HE OR SHE IS LICENSED 7URSUANT TO THE PROVISIONS OF THE CANTRACTOHS LI- � CENSE LAW(CHAPTER o(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' POOUSPB FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT TMEREFROM AND TNE BA515 FOR THE ALlEOED EXEMP� � TION.ANYVIOLATIONOFSECTION7031.6BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof A CML�ENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(f600�.): Q ❑I.ASOMMEROFTHEPROPERTV,ORMYEM7LOVEESWITHWAQESASTHEIRSOLECOMPENSATqN, � COrt1f116lCIel Z N/1LL DO THE WOHIC,AND THE STRUCTUFE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701t,BUSI- J ' . � NESS AND PROFESSIONS CODE THE CONTMCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR w THROUQH HIS OR HER OWN EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER71iEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� Z TION,THE OWNEREUILDER WILL HAVE THE BURDEN OF 7ROVIN4 THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR TME PURPOSE OF SALE). �. W ❑I.AS OWNER OF THE PROPEHTY,AM E%CLUSIVELV CqNTRACTINO WITH LICENSED CONTRACTORS Q TO CANSTRUCT TME PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTAACTOHS U- V91U0l1Of1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONTJEROFAPPOPERTVWHOBUILDSOHIMPHOVE57HEREON,AND � NMOCONTRACTSFOFSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTMC- QUANTITY DESCRIPTION TORS LICENSE UW.). FEE � ❑I AM E%EMPT UNDEFi SEC. B,8 P.C.FOR THIS REASON Q � U � DATE � p � � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER PEN�LTY OF PERIUFV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEq � I � G(COMMENCING WITH SECTION 7oao)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFECT. m � UCENSE CLASS LIC.NO. � � V DATE CONTRACTOR d ' W i � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIRMUNDERPENALTVOFPERIURYONEOFTHEFOLLOWWGDECLARATqNS: V N Z �Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' a Q COMPENSATKKJ,AS PROVIDEO BV SECTION 3700 OF THE LABOR CADE.FOR THE PERFORMANCE U OF 7HE WORK FOR NM1iICH THIS PERMIT IS ISSUED. � � � _I FIAVE AND WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE-0UIRED BV SECTION Q 3700 0F THE UBOP CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS �A �� ISSUE�.MV WOFKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION `f� jCAARIER N REVIE �O 2 • �� POLICV NUMBER Zd ELECTRIC � (IHLSSECiqNNE�NpTBE�EfEDOFhEPERMT15FOppNEHIA�DqEpppli/�(f1pp10R�E55} PLUMBING W Z I CERTIFY 7HAT IN THE PERFORMANCE OF THE WOPo(FOH WHICM THIS PERMIT IS ISSUED,I MECHANICAL LJ SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE (/� WORKERS'COA/PENSATqNlAW50FCALIFORNIA�NDAGREETHA71FI5HOULDBECAME INSPECTIONFEE SU&JECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SECTION 37000F THE LABOR 25. a O COOE,I SHALL FORTHWITH COMPLY WIiH THOSE PROVISIONS. ISSUANCE p DATE: APPLICANT: SMIP �y O W � WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SUBJECTMIEMPLOVERTOCRIMINALPENALTIESAN�CNILFINESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT DOLURS(f1o0,o00�,IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN J SECTION 3'/aB OF THE LABOR CODE,INTEREST,AND ATTORNEVS FEES. � � � RETENTION FEE: OCONSTRUCTION LENDING AGENCY PR�A��: � � I HEREBV AFFIRM UNDER PENALTV OF PEFJURV THAT THEFE IS A CONSTRUCTION IENDINO AOENCV `� 'VQ FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.�. � � Z w �Z LENDER'S NAME i H LENDERSADORESS w I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE TTiAT THE ABOVE INFOqMATION IS OORRECT. TOTAL FE ES � 1 O Z •� � ��f��j� '��.�O � 1 AGREE TO COMPLY WITH ALL CITY AND CAUNTV ORDWMJCES AND STATE UWS FEUTWG TO BUILDING I �Y �� CONSTRUCTION,AND HEREBV AUTHORRE REPFESENTATNES OF THIS COUN7V TO ENTER UPON THE ' Z ABOVE-MENTqNED PROPERTV FOR INSPECTION PUFPOSES. COMMENTS Z A Y��Q C� ��•O� � -' �uK�i �HANOfIR � � m PERMfTTEE NAME(PRINT) - � � ,��Ce,� � Lia.v�u.l �3'9 z7 >o c K \3 P(�1 N SIOfM7IIqE OF PERMITTEE DATE �� ` � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Capy,60LDENROD—File Copy,GREEN—Appl{canYs Copy CB�Y OF DI�►iViOND BAR r � (,=�'�`,�;; �;I N?:5;��C Y E O N ff�E C O Fd D , „--. '��a�p�c�400a � t�� r �a��o�;; ��;_�' :.��p��oQa :��a�� i�. . o� 0, �,.. _ SET BACK FLOOR JOIST FTGS/FORMS/STEEL / ro ' FHA REQMTS ELECTRIC GROUND � UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOfdD BEAM WATER SERVICE - MID H'L 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 FINISH GRADING SHOWER/TUB TEST � ' POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL ' FINAL HEATING HEALTH QEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY . `�o � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a _ � Q f P � t�� CITY OF DIAMOND BAR v ---�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE ` ..._. 21825 Copley Drive,Diamond Bar,CA 91765 PRESS ^ '� (909)839-7020 F'ax(909)861-3117 Building Inspection Hotline(909)839-7027 ��9��W BUILDING PERMIT APPLICAT'ION FIRMLY N JOBSITE ' ' y � APPLICATION �/� PERMIT �, P/C o ADDRESS x � ��iS �/v 1 LZ-�� U� �^/R_ DATE X �O � I� NUMBER�Q g�'E 3# � ISSUE g 2 G O CONST. GROUP � APN LOT TRACT DATE p OWNER � � PAL �HANi)�1� I � � ZONING SETBACKS o ADDAESS n �S L1.�f U.tlw Qv/),/J�- FRONT RW ❑ ' Z CITY �1.!� . ZIP .�.t_�°L TEL.904'6411 -OC�7 REAR ❑ o APPLICANT TEL. � SIDE/SIDE STREET RW O � CONTRACTOR O11� EI� V�L! L SIDE ❑ o ADDRESS PROPOSED USE �GM� I�'7iJ CO VGR CITY ZIP TEL. I w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HERE9Y AFFIRM UNDER PENALT'/OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G0l09B/CBfPOR W CENSE LAW FOR THE FOLLOW WG REASON(SEC.7031.6 BUSINESSAND PROFESSIONS COOE:ANV CITV OR (n U COUNT'YWHIq7RE�UIRESAPEFlMITTOCAN57RUCT.ALTER.IMPNOYE,DEMOLISN,ORREPAIRANY9TRUG W Patlo/Deck wTURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIONED W � STATEMENT 7}lAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� � PpOUSPB � CENSE LAW(CHAPTER e(COMMENCWO WffM SECTION 7000)OF DIVi510N 3 OF THE BUSINE55 AND PRO- rt ^ FESSpNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROAI AND THE BA515 FOR THE ALLEOEO E%EMP� v Re-Roof L} TION.N!1'VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z � A CML PENALTV OF NOT MORE i/1M1 FIVE HUNDRED DOLI.ARS(5500).�: 0 XLASOWNEROFTHEPROPERTV.ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, � CORIrt1BfC18I Z VASDO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFEftED FOR SALE(SEC.701�,Bi151- J � NE55 AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPtV TO AN OWNER OF � PqOPER'h'M�FIOBUILOSORIMPROVESTMEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR m [t TMROUGH NIS OR HER OWN EMPLOVEES,PROVI�ED THAT SUCN IMPROVEMEMS ARE NOT MTENDED OR QOFFEAEDFORSALEIF,HOWEVERTNEBUILDINGORIMPROVEAIENTISSOLDW�THINONEVEAROFCOMPLE� Z TION.THE OWNER�BUILAER WILL HAVE TME 9URDEN OF PROVINO THAT HE OR SNE DID NOT BUIID OR � IMPROVE FOR THE PURP0.5E OF SALE). ❑I,AS OWNER 6F THE PROPEHTV.AM EXCLUSIVELV CONTRACTINO W ITH LICENSED CONTFUCTORS � TO CONSTRVCT THE PROJECT(SEC.7W�,eUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U011Or1� ADJ.AREA _W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSOHIMPROVES7HEREON,AND Z W1qCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE 70HS IICENSE LAW.). Y _J O ❑1 AM EXEMPT UNDEH SEC. B.8 P.C.FOfl THIS REASON � � Q � DATE u OWNER i"�pLV+ �L�' � Z W � LICENSED CONTqACTORS DECLAAATION -� � W 1 NEREBV AFFIFM UNOER PENALTI'OF PERJURV THAT I AM LICENSED UNDEF PROVISIONS�F CHAPTER Vr d G(COMMENCIN(3 WITN SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AN�PROFESSIONS CODE.AND Z X MY UCENSE IS W FULL FORCE AND EFFECT. m i L1J � , � LIGENSE CLASS LI0.NO. J � V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q = U � �HEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWMG DECLARATIONS: N Z Q � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELFINSURE FOR WORNERS' S Q COA/PENSATION,AS PROVIDED B�SECTION 3700 OF THE LABOR CODE.FOR THE PERFORMANCE w OF 7HE WORK FOR WHICH TFIIS 7ERMIT IS ISSUED. � 0 I HAVE AND WILL MAINTlJN WORKERS'COMPENSATbN INSURANCE,AS REOUIREO BV SECTION QQ 3�00 OF THE IABOR CAOE,FOR THE PERFOiiMANCE OF THE WORN FOR WHICH TNIS PERMIT IS ISSUED.MV WOF7KER5'COMPENSATION INSUFA7JCE CAARIER AND POLICV NUMBERAAE: GONSTRUCTIO O .O O � CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q � (1HISSEcroMNE�No78EC01.a.E7moFn+EPEaMtlSwaa�EFiU�DREooalntaS(Etao)oaLEssl PI.UMBING W MECHANICAL Z I CERTIFY THAT M 7HE PERFOFiMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I �} SHALL NOT EMPLOV ANY PERSON IN M!V MANNER SO AS TO BECAME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE /� SSU&IECTTOTHEWORKERS'COMFEN5ATIONPROVISIONSOFSECTION37000FTHEUBOR SUANC LS .00 O COOE.1 SHALI FORTHWITH CAMPIY VJI�OSE PROVIS10N5. /��LJ I .` p OATE:�� APPLICANT: �, ��i� �Wi 1/Ll/(L L o •5� w ENERGY P/C J WARNIN4:FPJLURE TO SECURE W�RKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE J SU6IECT AN EMPLOYER 70 CRIMINAL PENALTIES AN�CIVIL FINES UP TO ONE HUN�RED THWSMID � DOLLARS(S10o,o00).IN ADDITION TO TME COST OF GOMPENSATION.DAMAGES AS FROVIDED FOR W ENERGY PERMIT � J SECTION 3708 OF THE LABOR COOE.INTEREST.ANO ATTORNEV'S FEES. FYETENTION FEE: 1 '�O . Q w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a O �/� � I HEREBYAFFIRM UNDER PENALTY OF PERIURV THAT THERE IS ACONSTRUCTION LENDING A6ENCY �g�� '-"�" d FOR THE 7ERFORMANCE OF THE WORK FOR WHICN THIS PERA/1T IS ISSUED(SEC.108�,CIV.C.). Z W � LENDERS NAME � LENDER'SADDRE55 � I CERTIFV TNAT I HAVE READ THIS APPUCATION PND STATE THAT THE ABOVE INFORMATpN IS CARRECT. TOTAL FE ES � �� , S� W I AdREE TO COMPLV WITH AlL CITV ANO COUNTV OROINANCES AND STATE UM'S REIATINO TO BUI�DINC � CpNSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTV TO EMER UPON THE Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS - � � JkNv�NOZ/( H nJ �2 m PE ITTEE N (PPINT) ¢ ��u.1r.L,,�,,.�vLc-v �/.,L�v,�ic'' �� 5 NATURE OF PERMITfEE DATE qECPT.NO. PAID BY G 1 VALlDAT10N�Q� _ �"" WHITE—DepeRment Copy,YELLOW�inance Copy,PINK—Assessor Copy.GOLDENROD—Flle Copy,GREEN—Applir.anPs Copy CIT'V O� DI�►4Vi0�[� �AR I�S�ECT'BO� B��COIRD ` � � _:. ,� :��Q�� "� '��" "�� U � r�i �..�.t,'; .:; Da��ll��' -'' � '� � r�'��' SET BACK � FLOOR JOIST FTGS/FORMS/STEEL FNA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT -" SLAB GR,4DE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BONO BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHlNG 8 Fr BOND BEAM FRAMINGNENTILATION FlNAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATiNG BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�T'UB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRR1G. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL F►NAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY _ C��o � , —� " COMMEfVTS��L� �� rz� °� SEPTIC TANK SIZE SEEP PIT/U SIZE a ��r � � � a. :�. j�^ Q ' l� Atfachment A � , � Form for Non-Franchise Fiaulers for Construction and Demolition Debris Company and Project Info: Name of licensed demolition contractor hauler or self hauling company Address of Company City Zip Code Phone Number Address and Name of Project Site � ��J l,(�1/�9_ou� d7v�� r`��l�. . �• ,Q. Type of recycleable material or waste material to be transported for this project (,t'cro 1� ' Report Information: Please submit this information prior to fmal building inspection. A report reflecting the following information: • The estimated volume or weight of construction and demolition debris,listed for each material; , • The estimated volume or weight of cons�-uction and demolition debris that can be diverted listed for each material; • The estimated volume or weight of construction and demolition debris that will be � landfilled as waste; and � Identification of the vendor or facility that will collect or receive the construction or demolition debris. AB 939 Fee Payment: Pay AB939 fee of$12.00 per bin and$50 per roll off for all non-franchise hauler containers Type of Container number of container Paid date(office use only) (revenue code CD Waste) Agreement and Signature: The property owner agrees to submit documentation to demonstrate compliance with the 50%diversion. requirement for construction debris and shall indemnify and hold harniless the City for damage and liability, including any financial liability, fines and penalties, associated with using a non-City franchised hauler and failing to satisfy diversion requirements. � ' � �.;-�aLl..�J !q�`j,��%,a�LGt� Jf(MVinJ/�� M./,! Q ��26 /� Property Owner Signature Print Name Date Self Hauler Signature Print Name Date � Last updated June 26,2008