HomeMy WebLinkAbout12-277� _�� CITY OF DIAMOND BAR ��� �����
DEPARTMENT OF COMMUNITY�&DEVELOPMENT R
• " ti � 2I810 Copley Drive,Diamond Bar,CA 91765 ��������$$
(909)839-7020 Fax(909)861-3117 Building Inspection otline( 0 39-
'�����'���W BUII.DING PERMIT APPLICATION MLY
} JOBSITE�y 2t� S ���/ APPLICATION`���� PERMIT /�7_���P/C ��
o ADDRESS� � DATE NUMBER G t�
ISSUE ����/� TYPE 1'"�� OCC
=-° APN LOT TRACT DATE CONST. GROUP
p OWNERX � � '��/
ADDRESS OG �tr✓' ZONING SE7BACKS
ZciTv jZ. � ,o-�- ZIP "- TEL. �� I REAR RW ❑
p APPUCANT TEL. SIDEJSIDE STREET RW O
SIDE ❑
� CONTRACT ^ ��' ^
Q ADDRE S - PROPOSED USE
� CITY � ZIP �j 7�/ TEL "'d�
w ARCH/ENG/
z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNEH-BUILDER DECLARATION SFR/ADD/REM i
O
� 1 HEREBY AFF{RM UNDER PEfULTY OF PE0.NHY THAT t Nd EXFl�P7 FROA1 THE CONTMCTOi1u L4 G929B/CBfPOR
W (�NSEUWFORTHEFOLLOWINQREAu�N(SEC.7031.68USP1ESSANDPROFESSION9COOEANI'Cl7VOR (n � . _
U CpUNfYWHK]1REOUIRESAPERMITTOCONSTRUCT.ALTER�PROVE.DEAfOLISH.OPREPNR/�M'STRUG W P0li0IDeLI( i
� TURE,PRqR TD RS ISSUANCE,ALSO RE-0UIRES THE APPLICANT FOR SUCH PERMR TO F1LE A SIONEO
STATEMEHf THA7 HE OR 51�E IS L�CENSED PURSUANT 70 THE PRONSIDNS�OF 7HE CONiMCTORS LF LL pppVS
� CENSE lAW(CHAGTER V(CAMMENpNd WITH SECTION 7000)OF DMSIOM 7 OF TME BUSINE55 AND PRO Pe
0 fESSpN5CO0E�ORTHATHEORSHEI5IXEA1PT7NEREFROMAND7HEBAS15FORTHEALLEOEDEXEMP•
V 710N,/JIYVplA710NOFSECTION7031.6BYANYAPVLICANTFORAPEHMITSU&IEGTSTNEAPPLICAN770 Z R8-ROOI
� A CML PENALTY OF NOT MORE THAN FIVE HUNDRED OOlLARS(S6o0)J:
0 ❑I,ASOWNEROFTHEPROPEHTY.ORMVEMPLOVEESWfTY1M'AOESASTMEIRSOLECOMPENSATION, � �mercial
Z NALL DO THE WORK AND THE 9TRUCTURE IS rlOT INTFNDED OR OFFEREO FOR S�LE(SEC.7au,BUSF �J
� NESS AND PROFESSIONS CODE TME CON7MCTOHS LICENSE lAW DOES NOT MVLV TO AN OWNER OF ?
PROPER7YNRiOBU�LDSONIMPROVESTHEREON,ANDWHODOE55UCFiWORKHWSELFORHERSELFOR m
� THROUCiHHI30RHEROWNEMFIOYEE9,PRDYIOEDTHATSUCHIMPROVEMENT3�RENOTINTENDEDOR
QOfFEAEDPDR9ALE�F.N�N�EVERTMEBUILDWOORIMPROVEMFHTISSqDWIT19NONEYF�IROFCOMPIE•
Z TqN,THE�OWNER-BIIIIDER WILL HAVE THE BUf7DEN OF.VROVINa THAT NE�N SHE DID NOT BUIID OR
� QAPROYE FOR THE PURPOSE OF SALE).
w OI,ASONMEROF�THEPROPERTY,AUEXCLUSNE�YCANTRACTINOWITHUCENSEDCONTW�CTORS
� TO LONSTRUCT THE PRQIECT(9EC.7al/,BUSWESS ANO PROFESSIONS CODE:THE C01fTRAC70R9 LI- V01U91I0f1 AD.I.AREA'
� CENSEUWOOESNOTAPVIYTOANdIM�EROFAPROPERT'WHOBUM1DSORIMVROVEBTMEREON,AND . ��
MM110CpMRACTSFORSUCHPROJECfSWfTHACONTRACTOR(5)LICENSEDPUABUANTTOTHECONTMC pUAN71TY DESCRIPTION FEE �
� TOi15 UCENSE IAW.�.
� O I AM D(EMPT UNDER SEC. 8.8 P.C.FOR THIS R ° �
U
� �
� pq7E . . . . ONMER �V .
� UCENSED CONTRACTORS DECLARATION W �
� I HEREBY AFFlRAI UNDER PENALiY OF PERIURY 71U71AM�LICENSED UNDEH 7RONS10NS OF CHAPTER Ur
p, a�COMMENCWO Yn7M SEGTION 7oao)OF DM810N]OF 7HE BVStNESS M10 PHOFESS�ONS CODE,uJ0 Z
\IY LICENSE IS W FULL FORCE AND EFFECT, m
7�p �
� ENSE C S �r/ —v LIC.NO. � / � J
V �p� �L/ CONTAACTO .� L�S S -
W
� WORKERS'COMPENSATION DECIARATION Q � (�u� 2
�. U �
� I HEREBV AFFIRM UNDER PENALTV OF PERNi1Y ONE OF THE FOLLOWWO DECLARATIONS: Z ^�/� r .
Q
� _I NAVE AND VALL MNNTAIN A CERTiFICATE OF CONSEM TO SELF-WSURE FOR WOPo(EFCS' Z
Q COtAPENSltT10N.AS PROVIDED BY SECTKK!770o OF TNE UBOH CODE.WR TME VERFORMANLE �U.
OF THE WORK FOR WHN�I THIS PERMIT IS.ISSUED. , , �
�
_I HAVE AND N�LL MAINTAIN�MlORKERS'COMPENSATION MSURANCE.AS FEWIRED BV SECTKIN
Q a7oo OF�THE LABOH COOE.FOP THE PERFORMANCE OF 7HE WOPo(FOR NM111pi iHIS GERMIT IS
1$SVEp.MY WOPo(EAS'C01dPENSATtON�NSURANCE C1IHRIER AND VOUGY NUMBER ME CONSTRUCTION-
�j c,uwER . . . PLAN REVIEW
Z X po��cvrmiMeER ELECTRIC
¢ �ressEcnor+r�r+oraE�rIDOFn�a�rsroaa+E�oauasR�mloa�ssl PLUMBING . ..
Z 1 CERTIFV THA7 M THE PERFO{UTANLE OF THE WORN FOR WMICH THIS PERM�T IS ISSUEO,1 MECHANICAL � �
� srr,uLrwr�Piovarrvveasa+w,u+vNa�rNeaso�sToeeca.�Esus�ecrroniE INSPECTIONFEE
� YpRXEPS'COMPENSA7�OM lA`NS OF C.�LIFORT11q AND�OREE h/AT IF I SHOVLD BECAME . .
SUB.IECTTOTHEWORKERS'�COM7ENSATIDN�PROVISJONSpF ECTION37ooOFTHEUBOR ISSUANCE f�
OCqpE, 5 wrrr�+win�couc�r win+r E PROVI for+s. // � �T�
O
DATE S I�APPLICA!^/ f,aC•.���� .SMIP .
u1 ENERGV PtC
� WMNINO:�FALLUR TOSECUREWOR)(ERS'Cf�MPEN5ATIONCOVERAGEISUNUWFUL.ANDSHN.lBE � � ' -
� SUB.IEC7ANFlAPLOYERTOCRIMINALPENALTIESANDCMLFWESUPTOONEHUNDREDTHWSAND ENERGY�PEAMIT
ppU,/W9(f1po,000),W ADAITION TO THE COST OF COAiPEflSATION.DAMAOES AS PRONDED fOR IN
J SECTION 37oe OF 7HE UBOR CODE.RJ'TEREST,AND ATfOflNEYS FEES. ' RETENTION FEE: r .
�
w CONSTRU,CTION LENDING AGENCY PRE-A�T FEE
a
O
� 1 NEREBY AFFlRM UNDER VENALN OF PERIURV iHAT THERE 19 ACONSTRUCTION LENDW(�A(3ENCY
�FOR THE PERFORMANCE OF TME WORK FOR NM1i1CH THIS PERMIT IS ISSUED(SEC:3087,CN.CJ.
Z
W
�� LETIDERS NAME . . . . .
� LENDER'SAODF7E55 � ��y/�
� �I CERTIFV THAT I HAVE READ TH13 APPL�CATIONAND STATE TNATTHE ABOVE WFORMATION 19 CdViECT. TOTAL FEES � /�// 9,
� w I AOAEE 70 COMPLV WfTH ALL CIT'MIO COUNTY ORDWANCES AND STA7E UWS FEUTWCs TO BULWNO� L/
� CONSTRUC710N. DHEREBYAUTHORIZEqEPRESENTATIVE50FTMSCWNTYTQEH�EA11Y0HTHfi
AgpyE-MEN,JYJN PROPERiY FORINSPECTION VURP05ES.
Z .� �� COMMENTS �
o x ; �-S�
_
QP Itt AA1E(� ` . . . . . .
v, Q�'�--- . /Z
uj StaNAN OFPERMIITEE D TE
RECPT.NO. PAID BY VALIDATION
� WHITE—Department CoPy,YELLOW—Flnence CoPy.PINK—Assessor Copy,GOLDENROD--Ffle Copy:GREEN—Applkk;anYs Capy
{. . . . , ., j�.,• �,-, _ . ,l
; . � <, - ". .. _� . r= �� CITY OF DIAMOfVD �AR ; ,
_. ` " � � � ,, �:.� � ; INSPECTIOPI REC4RQ .
��� .. �:.�_ . .: . . ,��, ,., �
., ,. � .. ; � . ..� .� ,_ . � � � � _ .�.. x-' �. , ,. � � � � �.
. . � � � � .. . ���
SET BACK FLOOR JOIST
FTGSJFORMS/STEEL ;FHA REQh/1T5
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PlUM61NG UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING j 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM____
ROOF CQVER PRE-GRAQING
ROUGH HEATING I BENCHIldG
ROUGH ELECTRIC ROUGH GRADING �
ROUGH PLUMBING �FINISH GRADING
SHOWER/TUBTEST PdOL ELECTRIC
EXT.LATH/SIDING PQOL FENCING
WALI INSULATION POOL FINAL
CEILING ItJSULATION OFF SITE IPAPS.
DRYWALL NAIUNG �DEDICATIONS
SEWER FINAL ENG. _ ________._
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. Otd SITE IMPS.
GAS AIRTEST FINAL ZOPJING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.F�NAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING E(dERGY
FINAL PLANING
FINAL ENGINEERING • m e
COMMENTS G/N 9��" ��� �
c.vru:tq�,2�,�
SEPTICTANKSIZE
SEEP PITIU SIZE
�
x�.a
� �"t� j ��
�� I
.��
��
— ------ /
'
1