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HomeMy WebLinkAbout11-574 �„`_ CITY OF DIAMOND BAR �� � �I DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES t 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS y'""' BUILDING PERMIT APPLICATION FIRMLY Q DDRIESS �r� ����'��Q.�r� R d . � APPLICATION PERMIT /l_ �� P/C o —T DATE NUMBER � # OCC � APN LOT TRACT D TEE O �� ONST. �L���GROUP p OWNER TP�� PnP��-L o ADDR`ESS 41�Q-LtnC�,l,rl�� ZONING SETBACKS z CITY I11Q,h'�or�l� ?iGr,� ZIP 9�]�0 TEL.909 Zy�� FRONT p�y � g APPLICANT TEL. REAR � zd SIDE/SIDE STREET qyy p � CONTRACTOR _T�OI�-'r ELEGT7C-I G SIDE p � ADDRESS `� o CITY �(�-/N`O ZIP qn rV TEL. O - PROPOSED USE o ARCWENG/ z DESIGNER a ADDRESS � NO.DWEL. NO. NO. N UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEAIPT FROM THE CANTRACTORS LI� GafB B/C8 OA W CENSEUWFOqTHEFOLLOWINOREA50N(SEC.703t.66U5ME5SANDPROFESS10N5CODE:ANYCITVOF (n 9 � ZCOUNTYWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W P82I0/DBCI( w 7URE,PRpR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STATEA/ENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CANTRACTORS LI� � CENSE UW(CHAPTER 0(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa , � FESSIONS CODE)OR T}IAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED E%EM7- (� TION.ANVVIOLATIONOFSECTION7o31.5BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICMITTO Z RB-Roof A CIVIL PENALTY OF NOT MORE hIAN FfVE HUNDRED DOLURS(t500�.): Z ❑LASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COR1R18fC18I . I WILL DO THE WORKµD THE S7RUCTURE IS NO7 INTENDED oq OFFEPED FOR SALE(SEC.7ou,BU51- J � NESS AND PROFESSIONS CODE:TNE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PqOPEHTY NM110 BUILOS OR IMPROVES THEREON,AND NM110 DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED Oq m Q OFFEREDFORSALEIF,HOWEVERTNEBUILDINGORIMPROVEMENLISSOIDWITHINONEVEAROFCAMPLE� Z 7�ON,TME OWNER�BUILDER WILL MAVE THE OURDEN OF PROVING THAT FIE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). � ❑I,AS OWNER OF THE PROPEHTV,AA1 EXQUSIVELY CAMRACTING WRH LICENSED fqNTRACTORS � TO CqNSTRUCT THE PRQIECT(SEC.70��,BUSINESS AND PROFESSFONS CADE:TFIE CONTRACTOqS LI- V8IU6f10l1 ADJ.AREA � CENSE UW DOES NOTAPPLV TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND NM1IOCAMRACTSFORSUq1Pq0.1ECTSWITHACONTRACTOR(S)IICENSEDPl1R5UANTTOTHECONTRAG OUANTITY DESCRIPTION FEE TORS LICENSE LAW.). � ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOq THIS REASON � � U LL DATE OWNER ¢ O U ¢� LICENSED CONTRACTORS DECLARATION W ,2 I HEREBY AFFIRM UNDER PENALTY OF PERIUiiV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �� i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �L� W LICENSE IS IN FUL�FORCE AND EFFECT. /�_� � � UCENSE CI.A �I `�' IIC.NO. / '-"7 7��T' � w 7KQ�vtT E l?�L -' DATE I CONTRACTOR � WOFKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: U � Z Z0 _I HAVE AND WILL MAINTAIN A GERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ Q COMP SATpN,AS PROVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE w OF E WORK FOR WHICH THIS PERAIIT IS ISSUED. � � � I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOIJIRED BV SECTION Q 370a OF 7HE LA80q CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS . � ISSUED.MV WORKERS'CqMPEN5AT10N INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ] CARRIER L PLAN REVIEW ¢ voucv NuueER ,�7 Z 1'7 a ELECTRIC .fj��p� _- � � 0 (iHI55EC�qNNEIDNOT�BE00MREfEDOFTI-IEPERMfTISFOqpNEFR,WREpppl/{LS(f�pp�ppLF$$� PLUMBING W Z I CERTIFV THAT IN THE PERFORMAtJCE OF TNE WOFiK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ' ' C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE [/� WORKERS'COMPENSATIONIAWSOFCALIFORNI0.�NDA�REETHATIFISHWLD8EC0 INSPECTIONFEE SU&lE TOT EVIORKERS'COMPENSATIONPROVISIONSOF ECTION37000FTHE �� �� ~ COD SH FORTHWITHCOMPLVWITHTHO P EVISI ISSUANCE � � 1 p DATE: I • qPPLICANT: SMIP W � WARNIN(3: AILURE TO SECURE WORKEFS'CAMP SATION COVERAGE IS UNLA UL,AN SHALL BE ENERGY P/C � � SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDREO TFpUSAND ENERGY PERMIT OOLLARS(f100,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � w SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEI^S FEES. RETENTION FEE: �_ O COIJSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV f-0R THE PERFORMANCE OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED(SEC.70G7,CIV.C.�. Z W � LENDER'S NAME � LEN�EH'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE TIiAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES O �J"' ��� � I AGREE TO COMPLV N7TH ALL CRV AND CAUNTV ORDINANCES AND STATE LAWS REUTINO TO BUILDINO � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UPON THE � Z ABOVE-MENTIOtJED PROPERTY FOR INSPECTION PURPOSES. COMMENTS ' 0 J � m PERMITTEE NAME(PRINn ' _ . Q � � SIGNANRE OF PERMITTEE DATE � RECPT.NO. P/UD BY VALIDATION WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessar Copy,GOIDENROD--FIIe Copy,GREEN—Applicant's Copy � c�-rv o� �a�,�o�� ��,� �����'��� i�s����-ao� ��co�� ;:� oa�p��400a :�a�� oa���c��oa '' ` oa�p�c5�oo� o � � f� =�� DGa`ir� ��'� O�I�I�G(� r o[���° ��� SET BACK FLOOR JOIST FTGS/FORMS/STEEL � � � FHA REQMTS ELECTRIC GROUND UNQER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT � SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FfREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM RO�F SHEATHING 8 FT BOND BEAM ,. FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBIPIG FINISH GRADING SHOWERlTUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATIOh! OFF S1TE IMPS. DRYWALL fJAILiNG DEDiCATIOMS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP P1T/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC L DEV. FEES PAID . FINAL PLUMBING ENERGY C��o � � , - COMMENTS . , SEPTIC TANK SIZE SEEP PiT/U SIZE G�l � Q ��h � �