HomeMy WebLinkAbout11-1489 CITY OF DIAMOND BAR ��r����
�-"--�F'',''�'— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVIC
�ti .
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'�'9^' BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE APPUCATION� I PERMIT1 L� p/C >J�.�
ADDRESS ��7� UD� � �/� DATE �� �� `'/ NUMBEAT�'���/v ' # 6!• < ���
� ISSUE TYPE OCC
r APN LOT TRACT DATE CONST. GROUP
p OWNER
� ADDRESS ZONING SETBACKS
0
Z CITY ZIP TEL. FRONT qyy p
� APPLICANT TEL. REAR p
� SIDE/SIDE STREET RW ❑
¢
a� CONTRACTOR SIDE ❑
I O ADDRESS PROPOSED USE n D��i, A �_. .�1...�
o CITY ZIP� TEL �n, T r�/ /'L( .r �U
w ARC NG
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA7 I AM EXEMP7 FROM THE CONTRAC70RS LI- G3feQB/CeIPOlI
W CENSE UW FOR THE FOILOWING REASON(SEC.7o37.5 BUSINESSAND PROFESSIONS CADE:ANY CI7V OR (n
U COUNTyWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOIISH,ORREPAIRANYSTRUC- W patio/Deck ?/
w TURE,PRIOR TO ITS ISSUANCE.AL50 HEQUIHES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W
STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAP7ER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND FRO- � POOUSPe
Q FESSIONSCOOE)ORTHA7HEOPSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
V TION.ANYVIOLATIONOFSECTION7o31.58YANYAPPLICANTFORAPERMI7SU&IECTSTHEAPPLICANTTO Z Re-Roo(
A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f500).):
Z ❑I,ASOVMEROFTHEPROPERTY,OHMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COrt1ff18fClel
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF j .
PROPERTV WHO BUILOS OR IMPHOVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HEHSELF Oq
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN7S ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVEf�7HEBUIL0INGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE-
Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEJ.
w ❑I,AS OWNER OF 7HE PROPER7V,AM EXCLUSIVELY CANTMCTING WITH LICENSED CONTRAC70RS
� TO CONSTRUCT THE PRQIECT(SEC.70�/,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8f10 ADJ.AREA
W CENSELAWDOESNOTAPPLY70ANOWNEROFAPROPERTVWHOBUILOSORIMPROVES7HEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY ESCRIPTION FEE
Y 70R5 LICENSE LAW.�.
Q ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
� � " C c_�\\� ' �
� DATE OWNER
o � � � � .
� LICENSED CONTRACTORS DECLARATION �
� ��, � 1 - 13�
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
d B(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINE55 AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
LLl �� m
� LICENSE CIASS LIC.NO. j
J
U DATE �� Z CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
� I HERE AFFIRM UNDER PENALIY OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z
ZI HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUPE FOR WORKERS' 2
Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE IABOR CODE.FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q370o OF THE LABOR CODE,FO THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS
ISSUED.MV WORNERS' OMP NSATION IN U ANCE CA RIER AND POLICV NUMBER ARE: CONSTRUCTION
Q r
� CARRIER � PLAN REVIEW __ I����i
Z POIICY NUMBER �G�`�"��[� ELECTRIC
Q
� (fHLSSECTIONNEmNOTBECOMREfEDOFTI¢PEW.Q�ISFORONEIM1N�DREDDOUARS�S700)ORLESS� PLUMBING
W
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICM THIS GERMIT IS ISSUED,I MECHANICAL
�}' SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONlAW50FCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE
� SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF 7HE LABOR
� CADE,1 SHA FORTHWITH COMPLY WITH THOSE OVISION ISSUANCE
� SMIP
p DATE: Q'� APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 370B OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PFE-ALT FEE:
O
� 1 HEREBV AFFIRM UNDEF PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERF-0RMANCE OF THE WORN FOF WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES •b�
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CARRECT.
w 1 AGREE TO COMPLV WITH ALL CI7V AND COUNTY ORDINANCES AND STATE UWS REl.A71NG TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTY FOR INSPECTION 7URPOSES.
Z COMMENTS �
�
J
I
m PEHMITTEE NAME(PRI ) �
i � /��
I � SIGNATUREOFPERMI ATE �
_ � RECPT.NO. PAID BY - VALIDATION
I ~ WHITE—De artment Co YELLOW�inance Co PINK—Assessor Co GOLDENROD—File Co GREEN—
P PY. PY� PY� PY. ApPlicanfs CoPy
�B�lf �� D9�@/iOh�l� �ArR
If�S(�l�C�'9�� ff�IE�C��B�
Oa�pC�C�400G�] DG�4G: Oa�3pGC�40G3 Oa�pC C�400a fla4�' . pa�a���a�. �
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE 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 FINISH GRADING
SHOWERlTUB 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 � FINA�ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING NEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING - ------------------ ENERGY----- - -----------
����
COMMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a
� r�
�