The URL can be used to link to this page

Home My WebLink About26443.pdfCITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS BUILDING PERMIT APPLICATION FIRMLY o JOBSITE APPLICATION PERMIT '/ (i P/C GADDRESSDATENUMBER '` p ISSUE TYPE OCCAPNLOTTRACTDATE p OWNER S'P\YP (^ t'P CONST. GROUP p ADDRESS I`C a nn n r ZONING SEfBACKS z CITY ,Annin[;Z ZIP 5 TEL. FRONT Ryy I APPLICANT TEL. REAR p SIDE/SIDE STREET RW CONTRACTOR C SIDE p ADDRESS 2 CITY alnlnclF ZIP(j TEL. rY./7S{/J PROPOSED USE Q Y(b[1 UlbOd n• o ARCWENG/ p}-n-f'+<PYC z DESIGNER NO.DWEL. NO.NO.a ADDRESS CITY ZIP TEL. UNITS STORIES BEDROOMS DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REMO p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FPOM THE CONTRACTORS LI G8f8 B/C9 RWCENSEUWFORTHEFOLLOWINQREASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:PNV CITV OR (n g ZCAUNTVWHICHREOUIqESAPEfiMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREFAIRANVSTRUC- W P8t10/DBCk 1WNRE.PRIOR TO RS ISSUANCE,AL50 RE UIRES hiE APPLICANT FOR SUCH PERMIT TO FILE A SIONE wSTATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORSLI CENSE LAW(GIAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- PooUSpa FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOP 7HE ALLEOED E%EMP- TION.ANY VIOLATION OF SECTION 7031.6 BV ANV AVPLICANT FOH A PERMIT SU&IECTS THE APPLICANT TO Z Re-RoofACMLPENALTYOFNOTMORETHANFIVEHUNDREODOIURS(f5a0).): 0 I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSATION, CORIRIBfC18IZWILIDOTHEWORI(ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701,BUSI J N NESS AND PROFESSIONS CODE:TNE CONTRACTORS LICENSE LAW OOES NOT APPLV TO AN OWNER OF PROPEHTV WNO BUIIDS OR IMPROVES THEREON,AND Nh10 OOES SUCH WORK HIMSELF OR HERSELF Oq w THRDUGH HIS OR HER OWN EMPLOVEES,FROVIDED THAT SUp11MPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREAPoRSALEIF,FIOWEVER7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAAOFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN(3 THAT HE OR SIiE DID NOT BUIID OF IMPROVE FOR THE PURPOSE OF S LE). w I,ASOWNEROfTHEPROPERTV,AME%CLUSNELYCONTRACTINaWfTHLICENSEDCONTRACTORS TO CONSTRUCT THE PRQIECT(SEC.7W1,BUSINESS AND PROFESSIONS CODE TNE CONTRACTOR9 LI- V8IU0fI0f1 ; qp.qqE,qWCENSEUWDOESNOTAPPLVTOANOWNEROFAPROPEHTVWHOBUILDSORIMPROVESTHEREON.AND WMOCONTRACTSFORSUCMPRQlECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS LICENSE LAWJ.FEE I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON U LL DATE ONMER Z U Q LICENSED CONTRACTORS DECLARATION W CC I REBV AFFIRAI UNDER PENALTV OF PE0.IURV THAT I AM LICENSED UNDER PROVI510N5 OF CHAPTER COMMENCINO WITH SECTION 7000)OF DIVISbN OF THE BUSINE55 AND PROFESSIONS CODE,AND Z LLJ Y LICENSE IS IN FULL FORCE AND EFFECT. j' UCENSE CLASS LIC.NO. " / 'I 1 DATE OR.Y CONTRACTOR L'C. WORKERS'COMPENSATION DECLARATION 1 HEREBV AFFIRM UNDER PENALTV OF PERriJRV ONE OF THE FOLLOWING DECLAAATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIF INSURE FOR WORNERS' Q COMVENSATION,AS PROVIDED BY SECTION 370o OG THE LABOq CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS VERMIT IS ISSUED. Qw I HAVE AND WILL MNNTAIN WOR)(ERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION 370a OF 7HE LABOq CODE,FOR THE PERWRMANCE OF THE WORK FOR WHICN THIS PERMIT IS A' ISSUED.MV WORKEFS'COMPENSATION INSUFANCE CARRIER AND POLICV NUMBERME: CONSTRUCTION i_ x CARRIER IC:PLAN REVIEW ' , POIICYNUMBER y2 ELECTRIC 0 (iHISSECi%NJNEmNOTBEWAFLEfEDOFhIEPEAMiISFORONEHIy DilmpqlMS(1tpp pqLESS} PLUMBING WZ I CEHTIFY TiAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C SHAIL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE V/ORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE S SUBJECT TO THE M/ORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOF CO E.I SHALL FORTHWITH COMPLV WITH THOSE PFOVISIONS. ISSUANCE J , l bpDATE:APPLICANT: SMIP WJ WAANINO:FAILURE TO SECUPE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,M!D SHALLBE ENERGY P/CJ SU&IECTMIEMPLOVERTOCRIMINALPENALTIESANDCMLFWESUPTOONEHUNDREDT}fOUSAN ENERGYPERMITDOLLA{iS(S10o,000J,IN ADDITION TO THE COST OF CAMPENSATKKJ,DMAA ES AS PROVIDED FOR INJSECTION3708OFTHELABORCADE,INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I HEREBY AFFIqM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFOFMANCE OF THE WOFK FOR WHICH iHIS PERMIT IS ISSUED(SEC.70G7,CIV.C.). ZW LENDER'S NAME F— LENDER'SADDRE55 w I CERTIFY THAT I HAVE READ 7HI5 APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CARRECT. TOTAL FE ES 1 3 D• I1AGREETOCOMPLVWITHALLqTYANDCOUNTYOqDINANCESANDSTATEUWSREUTIN(3 TO BULLOINO V CONSTRUCTION,AND FIEFEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON TH Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS ' nur s ra a PE E, z9/oa SIONA F PERMIT7EE E RECPT.NO. PAID BY VALIDATIONH WHITE-0epaAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO File C opy,GREEN—Appllcant's Copy CIYV O DIA OI D AR I SPI C 90ft9 ff CORD G' 0 o[ , °' bGJ'l C ostl[} t I}O i.. r, ., SET BACK FLO R 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 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.d Q FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY o COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE G] NF' l ' ` „f'§ r';, I,.;