Loading...
HomeMy WebLinkAbout12-826 ^ _��_ CTTY OF DIAMOND BAR +f--�( � DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES �T�� 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020. Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ��'°"'� BUILDING PERMIT APPLICATION FIRMLY i JOBSITE APPLICATION�`� /� PERMIT � � p/C � o ADDRESS DATE ( NUMBER # � OCC ^ APN LOT TRACT DA EE � ONST. U�� GROUP p OWNER p DDRESS ZONING SETBACKS CITY ZIP TEL FRONT qyy � . APPUCANT Tt/�G_t TEL. -�']�p, , � REAR � � SIDE/S�DE STREET qyy p CONTRACTOR � � SIDE � i ADDRESS ti CITY ZIP EL POSED USE � , 0 CFi/ENG/. r� -� —�; � � /� ' a ADDR N S NO.DWEL. NO. NO. � CITY Z�P �� UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION -0WNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBV AFFlRM UNDER�VENALTY OF PERAIHV TNA7 I AM EXEMPT FROM THE CONTRACTORS LI. G9fegB/CBfPOfI W CENSEUWFOR7HEFOLLOWINOREASON(SEC.70.11.68USP1ESSANDPROFESSpN9COpEANYClTYOR � (n � COIJNTYNMICMREOUIRESAPERMITTOCONSTRUCT.AL7ER,IMPROVE.DEMOIISH.ORHEFAIRANYSTRUG W PetiO/DBCk � ' � TURE,PRIOR TO RS ISSUANCE,AlSO qEWIqE6 hIE APPLICANT FOR 6UCH PERMR TO FILE A SIONED �W � STATEMEN7 7HAT HE OR bHE IS LJCENSED PURSUANT TO hiE�PROVISIONS OF THE CONTRACTORS L4 , . � CENSE LAW(GiAPTER D(COMMENpNO VATH SECTIOtJ 7000)OF DMSION�OF iHE BUS(NE59 AND PR6 � POOUSP9 � FESSIONSCOO�ON7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP- C7 V T10N.ANYVIOLATIONOF�SECTION7U31.68VANVAPPLICANTFORAPERMITSU&IECT9THEAPPIICANTTO Z� R8-ROO� � A CML VENALTY OF NO7 AqRE TMAN FNE HUNDRED DOLIaRS(i600).): 0 ❑4�SOH7JEROFTHEPROPERTY,OqMYEMPLOVEESWfTHYJAGE3ASTHEIRSOLECOMPENSATION, 0 CpmmBfCj81 Z WILL DO THE WORK,AND THE 9TqUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.�7041,BUSF J � � � � NESS AND FROFESSIONS COOE:7HE CON7RACTORS UCEN3E LAW DOES NOT APPLV TO AN OVlNER OF ? - PROPEHTY WFiO BUIL0.9 OR IMPROVE9 THEREON,AND WHO OpES SUG1 WORK HIAISELF OR HERSELF OR w THROUOlIHI50RHEROWNEMVLOVEES,CROVIDmTHATSUp/tli1PROVEMENTSARENOTINTENDmOR m - . Q OFFERmPORSALEIF,HOWEVER7YIEBULDBdOORWPROVEMENTIS50LDN7T1{p.�pNEVEMOFCOMPLE- Z T10N.7HE OWNER-BUIIDER WILL HAVE T7E BUR�EN OF.PROVIN6 7HAT�HE OR SHE DID NOT BUILD OR , � MPROVE FOR THE PURPOSE OF SALE} � W �4��wNEROF7HEPROPEATY,AMFj(CLUSIVaYCONTMCTPlliWrt7iliCENSEDCONTMCTORS Q TOCONSTAUCTTHEP(iWECT(SEC.70N,�BUSINESSANDPROFESSIONSCOOE:THE�CONTMCTbRS�IJ• V81Uetf0fl� /�.qR� ' � CENSELAWDOESNOTAPVLYTOANOWNEROFAPROPERTYNM11D9U0.DSORIMPROVESTHEREON,AND � '� N'FrOCONTRACTSFORSUCHPROJECTSWTIACONTRACTOR�S7L10EN5EDPURSUANfTOTHECONTRAC Q�J(V,JT�'�/ DESCRIPTION rau ucErasE uw.�. FEE � � ❑��EXFAIPT UNDER SEC. �B.8 P.C.FOR THIS REASON � U � DATE � ONRJER �� � U � UCENSED CONTRACTORS DECLAAATION � � - - - � I HEREBYAFFIRN UNDER PENALTY OF PERIUHY MAT I AM'UCENSED UNDER PROVISIONS OF CHAPTER � ' � Y(COMMENCIN(i�WITH SECTION.7000)OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS OODE,AND Z, ' xx W LICENSE IS W FULL FOR D EFFECT. m � UCENSE LASS C �� IIC,NO..���� ��CJ � � �.�r � V DATE I�_Z� — I / CpNTRpCTOR d , W � WORKERS'COMPENSATION DECLARATION � -�� � � � � I HEREBYAFFIRM UNDER PFNALTV OF PERJUHY ONE OF THE FOLLOWMO DECLMATIONS: V ' ' C/� . . . , . , Z � � . � _I HAVE�AND WILL WUNTNN A CFHfIFlCATE OF CONSEN7 TO SELF-INSURE FOR 14oR10ER5' � - � CONVENSATION.ASPROVIDEDBYSECTION37000FTIIEUBORCODE,Fpq7�/EPERWRMAHCE U F THE WORK FOR WHICH THI3 PERMIT IS ISSUED. w � � 1 WNE ANo WI�L MAINTAIN.WOR)(EAg'�CpA1PEN5AT10N WSUqANCE;Ag REWIRED BY SECTION . . . Q 37000E-THE LABOR CODE,FOR THE PERFORM/JJCE OF THE WOPK FOR WF9C1i THIS PERMIT IS ISSUED.MY WOPo(ERS COi�ENSATION INSURANCE CARRIER�MID.POLIC'/NUMBER ARE: �CONSTRUCTION� � > �^��� � PLlW REVIEW � POLICY.MIIABER ' �� I����7. . ELECTRIC .. . . 0 (nissFcitaar+eIDw7eE�rmoFn+E�ar.trswaa+eM+a�ocuu�sls+oolor�� �.PLUMBING � . 2 w v Z �CERTIFYT1iATINTHEPERFOR1dANCEOF7HE.WORKFORWHICHTF119PERAlITI515SUE0,1 �MECHANICAL� C} SFiALL NOT EM%.OV M7Y VERupN W ANy MµNER 50 AS TO BECOME SUBJECT 70 THE ' � � (n WORI(ERS'fAMPENSATqN UW$OF CAIIFORNl1 AND AGREE THAT IF I SHOUI.D BECDME INSPECTION FEE� SUBJECTTOTHEVIORKERS'COMPENSATIONPROVISqN50F5ECTION � 5{s1gBq-- � � � �j co e�,i s}wiu wRr�ni cw�aiv Hnn� os ov o s. ISSUANCE p DA7E: - C� FLICM7i�. .SMIP • • W WARNINO:��FA0..URE TO SECURE WORKERS COMPENSATION COVEMpE I5 UNLAWFUL,ANp SHALL BE ENERGY�P/C � � SUB.IECT AN EMPLOVER 70 CRtldPIAL VENAITIES AND CML FRJES UP TO ONE HUNDRED TFqUSAND EAJERC3Y�PERMIT DOlLARB.(S1ao,aoo).M ADDI710N 70 THE COST OF COMPENSA710N,DAMA(iE5 AS PROVIDED'FOR IN J SECTION 370E OF 7HE LABOR CODE,INTEREST,AND ATfORNEYS FEE3. �� � � � � RETEN"fION FEE: w. O . CONSTRUCTION LENDING AGENCY �pRE-ALT FEE: � 1 HEREBYAFFIRM UNDER PEN�LTY OF PERJURY THAT THERE 13 A CONSTRUCTION LENDINO AOENCV nZ-' �FOR TNE PERFORMlWCE OF THE WOPoC fOp NM1ilpt THIS VERA/1T IS ISSUED(SEC:�U87,qV.C,J, W �, LENDERS NAME � ' F—� LENDER'SADDRESS -- - - �� 'ICERTiFY7HATI�FIAVEREADTHI9MPLICA71pNANDSTATETUTTHEA00VEWFORAlAT10NISCORqECL TO 1'AL FEES � �3 ' I A(iREE TO COMPLY W17H ALL CITV AND CAUNTY Oqp W/JdCFS AND STATE UVlS REIAT W p TO BUILDINO � � CONSTRUCTION,AND HEREBY AIJ�HOq12E REPRESENTATNES OF TNIS COUNTY TO EMER UPON iHE � ABOVE�MINfIONED PROPER7Y FOR INSPECTION PURPOSES. Z o s ,� � �O COMMENTS ' � � m PE � EE � V � � � � � Z Uj OFPERM DATE � RECPT..NO. PAID B VALIDATION WHITE—Depailment Copy.YELLOW—Flnence Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—App�IcanYa Copy - CITY �F DIAMQfVD BAR �� INSPECTION RECORD , . ,. , _�, . � �, :,nn . #� � � �. .p ` � . � � _� � � � . 4 � � � {�.P t- �� A� _ . _ � � Ly, o � �. SET BACK FLOOR JOIST ` FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR OUCT GROUND PLUMBING UNDER fLOOR CONDUIT SLAB GRADE F�REPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT.BOPlD BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION __ FINAL BOND BEAM_ ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROI�GH PLUMBING i FINISH GRADlNG SHOWER/TUB TEST POOL ELECTRIC EXT.LATH/SIDWG POOL FENQNG WALL INSULATION. POOL FINAL CEILING ItJSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. ' SEPTICTANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ' ON SITE IMPS. GAS AIR TEST FINAL ZONfNG FINAL CONST. fIRE DEPT.FINAL FINAI HEATING HEALTH DEPT.FINAL FlNAL ELECTRIC DEV.FEES PAID FINAL PLUMBING EMERGY FWAL PLANING FINAL ENGINEERING p �OMMENTS SEPTICTANKSIZE SEEP PITIU SIZE � �ii�� _ �'�y� � �