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Home My WebLink About17481 i � • '� CITY OF DIAMOND BAR ---��'--- DEPARTMENT OF COMMLJNTTY&DEVELOPMENT SERVICES 21825 E.Copley Drive �.X,p•��,� PRESS (909)860-3195 Fa�c(909)861-3117 F{RMLY "'';;:;�'"' gUILDING PERMIT APPLICATION � JOBSITE f n /� APPLICATION PEAMIT P/C oADDRESS ��.17 `/�ilL'C G��r�� DATE �Z � O NUMBER�,��— # � ISSUE TYPE OCC APN LOT T�RACT DATE CONST. GROUP °C OWNER i� �£�O: `�'� � o' Z A� ZONWG SETBACKS II ADDRESS FRONT RW ❑ Z CITY•(J�ANtWvi4 .�9.C. ZIP TEL9o9 fi-'Ll�Z3 REAR ❑ � o APPLICANT TEL SIDE(SIDE STREET RW ❑ I � CONTRACTOR SIDE � � ADDRESS PROPOSED USE U o C�Ty Z{p TEL. w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCAIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEf7 DECLAAA710N SFR(ADO/REM O I HERE9V AFFIRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FROM THE CONTMCTOAS LI- G8f8Q0/CBfpOR � W CENSEUWFORTHEFOIIOWIt1CiREAS�N(SEC.7037.6HUSINESSMIDPROFESSI�NSCO�E:PNYCITYOR (n ZCWNTVWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRPNYSTRUG W patio/Deck w NRE,PRqR TO ITS ISSUANCE.�L50 REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w � S7A7EMENT THA7 HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRAC70R5 LI- � CENSE UW(GIAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS MlD PRO� � POOUSPB � FESSIONSCOOE�ORTHA7HEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (� 710N.ANV VIOLATION OF SECTION 7031.6 BY ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof A CIVIL PENAL7V OF NOT MORE THAN FIVE HUNDRED DOlURS(f500).): �� []I,ASOYMEROF�}IEPROPERTY,ORMYEMPIOYEESWICHWAGE5A57HE1RSOlECOMGENSATI�N, � CO/fi�flBlcial " �� +WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OfFERED FOR SALE(SEC.70u,BUSI- J � NESS AND PROFESSIONS CODE:7HE CAN7RAC70RS LICENSE LAW DOES NO7 AP Lv TO AN OWNER OF � 7ROFERTVNRiOBUILDSORIMpROVESTNEPEON,ANDWHODOE55UCHWORI(HI SELFORHEFSELFOR m [C THROU�HHISORHEROVMEMPLOVEES,PNOVIDEDTHATSUCHIMPR MEMS RENOTINTENDEDOR W OFFEREDFORSPLE.IF,FIOWEVERTMEBUIL�INGORIMPROVEMENTISS6 WfTHI ONEVEAROFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ 7FIA HE OH HE DID NOT BUILD OR Z IMPROVE FOF TME PURPOSE OF SALE). I _ ❑I,ASOYMEROFTHEPROPEHTY,NAEXCLUSNELYCONTRACTIN WITHLI ENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.70a1,BUSINESS AND PROFES510 5 CODE THE GONTRACTONS LI� V81U8t10l1 ADJ.AREA W CENSEIAWWESNOTMPLVTOANOWNEROFAPROPERTVWFIOBUI SORI PROVESTHEREON,AND S yyr{pCpry7qJ�CTSFOIiSUCHPRQIECTSWITNACONTRACTOR�S) ICE EDPUR UANTIOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS UCENSE UW.). � O ❑I AM E%EMPT UNDER SEC. 8 P.C.FOR THIS REASON U � I / � u' DATE � �� ON?JER U Z J � LICENSED CONTRACTORS DECLARATION ��7 �¢ / w CL I HEREBY AFFIRM 11N0ER PENALTV OF PERIURV THAT I AM LICENSE�UNDER PROVISIONS OF C/J � � 7 Z 0 � e(COMMENCINO WI7H SECTION 7000)OF DIVISION 70F THE BUSINE55AND PROFES�CODE,AND Z X MY�ICENSE IS IN FUIL FORCE IMO EGFEGT. m Sl` • �' /� � � LICENSE CLAS U LIC.NO.�� J O� �— 'tp•;O V DATE CONTpACTOR ��J�/��- a W � � WORKERS'COMPENSA710N DECLARATION J � a N _ U N I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING OECURATIONS: Z Q Z _I HAVE AND N�LL M/UNTAIN A CERTIFICATE OF CONSEIdT TO SELF�INSURE FOR WORKERS' 2 Q COMPENSATION,AS PROVIDED BY SECTION J700 OF THE LA80R CODE.FOR THE PERFORMANCE W OF THE WORN FOH WNICFI THIS PERMIT 151SSUED. � � � IHAYEANDWILLMNNTNNWORKERS'CAMPENSATIONINSURANCE,ASREWIREDBYSECTION Q 3700 OF THE LABOR CODE,FOR THE PERFOR/AANCE OF TNE N�ORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE CONSTRUCTION j c,�RRIER PLAN REVIEW ZPOLICY NUMBER ELECTFIC Q _ � (i}�SECi1qJNE9�NO78ECO�.iPLEIEDOFT1fPEPoATI.SFOFiONE4i.X�ORED00U13Slstao)OFtLESS? PIUMBING w I CEATIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICN THIS PEqMIT I5155UED,l MECHANICAL I��,'�� \\�I �- -"_�� Z (,�J SHALL N01 EMPLOV ANV VERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE � N WORNERS'COMCENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SFIOULD BEGOME INSPECTION FEE � � SU&IECTTOTHEWORNERS'COMPENSATIONPROVISI�NSOFSECTION37WOFTHELAHOR ISSUANCE � ,' � � CODE,I SHALL FORTHWITH COMPLV WITH THOSE PqOVI510NS. O SMIP I D� � � DATE: APPLICANT. . i J 'ENERGY P/C ��'�' � J WAflNIN6:FAIIURE TO SECURE M10RKER5'CAMPENSATKKJ CAVERAGE IS UNLAWFUL,AND SHhll BE L ! . _ �y SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HIXISAND ENERGY PERMIT DOLLARS(f100,000).IN/�DDITION TO THE COST Of COMPENSATION,DAMAGES AS PROhDED FOR IN s � SECTION 3708 OF THE LP.BOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �� W CONSTFUCTION LENDING AGENCY PRE-ALT FEE: d O CC I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE�S A CONSTRUCTION LENDING AGENCY d FORTHE PERFORMANCE OFTHE WORK FOR WMICH THIS PEFMIT IS ISSUED(SEC.308�,CIV.C.�. ' , Z W � LENDER'S NAME F_— LENDER'SADDRESS . - � � � � TOTAL FEES ��d. �� 1 CERTIFY THA7 I HAVE READ 7H APPLICATI AND�STA 7HA77HE ABOVE INFORMATION IS CORRECT. w I AOREE i0 COMPL��4'ITH ALL C AND COUN ORDINAN S AND STATE UWS RELATING TO BUILDING � CANSTRUCTION,AND HEREBV AUT RIZE R PR NTATIVE OF THIS CWN71'TO ENTER UPON THE ZABOVE-MENTIONED PROPEHN FOR SPEC io PosEs. COMMENTS � \ J •� � m PERMITTEE NM/E(PRIM) ¢ � � UJ -7 � S1GtUNRE OF PERMITTEE � ATE RECPT.NO. l�I� PAID BY S VAIIDATION 2 �" WHITE=DepeAmenl Copy,YELLOW—Finence Copy,PINK—Assessor Copy.GOLDENRO�File Copy,GREEN—ApplicenYs Copy �, ��'�'l �IF �81d6l�1�1�9� iE��ff� �� • �6l��I�f�CC�'9�[� ff$[��If�i�D , -�-�� (y� �r ��., ��.�-W��:.1'�l.s!4/uv ° �.!.. ' :wtih.:�4 y Q 4 ` :�,::. ��J'`�.J�JUV .,.� �� D Q � ,'t. „ —.._r..�F.`,_� " '�. ` '. ��.,_.. � � {$ .:...:. ,"%.. . ., , . �:... ��:�.'.... SE7 BACK � �� 1 �LOOR JOIST � FTGS/FORMS/STEEL I FHA REQMTS ELECTRIC GROUNb UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CU�IDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIF�EPLACE BC7lVd EiEAM WATER SERVICE MID HT. BdND BEAM ROOF SHEATHING 8 FT. B�ND BEAM FRAMINGNENTILIATION FlNAL BOfVD BEAM FIOOF COVER PRE-GRADIl�tG ROUGF-t HEA7tNG BENGHlNG FtOUGH ELECTRIC � ROUGH GRADING ROUGH PLUNiBlNG FINISH uRADING ^ SHOWEFUfU6 TEST POOL ELECTRIC EXT. LATH/SiDiNG PUOL FENCING WALL.INSULATION , POOL FINAL CEILING IN�ULATION QFF SITE IMP6. DRYWALL NAI�ING DEDICATIONS SEWER FINA�ENG. SEPTfC TAPlK LANOSCAPEltRRIG. SEEP PtT/L.L. OtV SITE tMPS. GAS AIR TEST FtNAL ZONlNG FINAL CQNST. GIRE DEPT. FlNAL FINAL HEATlNG HEALTH DEPT. FINA� � FINAL ELECl"RIC DEV. FEES PAID FINAL PLUMBING ENERGY � , �.."'JII� Q. �p:,_ .. COMii�E�lTS SEPTIC TA(UK SIZE SEEP PIT/U SIZE � � F� � � m � �� - � , � . � . �� . �� . � . �� - > r�.� �� ` . � � , ,� ------- , , , _,_�., _ . -� '��;,�;, � CITY OF DIAMOND BAR DEPARTIR4ENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 • ,, (909)860-3195 Fax(909)861-3117 PRESS �"^�. BUII.DING PERMIT APPLICATION �� FIRMLY �' JOBSITE ,. APPLICATION PERMIT P/C ]�J/l 0 ADDRESS ��2s GL�'�� Gl��'K LAJ, DATE � NUMBER # �� I I V � ISSUE TYPE OCC � APN LOT TRACT DATE CQNST. GROUP ' � OWNER W� � ADDRESS � ZONING SEBACKS � CITY YI111`�'�O�D �A�LZIP TEL.,{/OGI��-G REART RW ❑ APPLICANT TEL. SIDE/SIDE STREET , RW ❑ � CONTRACTOR SIDE ❑ Q ADDRESS � CITY ZIP TEL PROPOSED USE B AACH/ENG/ � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALU TION p� OWNER-BUILDER DECLARATION SFR/ADD/REM S S C/ -UU O I HER�V AFFlRM UHDER PENAL2Y OF PE0.AIRY THA7 I AM E%EMP7 FROM THE CONTRACTORS L4 G8fHg6✓CBfPOR /�� W CBiSELAWFORTHEFOLLOWINOqEA.90H(SEC.7IXf1.6BUSWE55M1DPROFESSIONSCODEANYCfTVOR (f� �O •Ol/ C.7 �rWH�REOUIRE3APERMRTOCONSTFUCT.ALTERIMPROVE,DEMOIlSH.ORREPAIRANYSTRUG W I LL TURE.VRIOR TO IT8 ISSUANCE ALSO REDUIRES 7HE M�LICAP1i FOR SUCH FEfU1R TO FILE A SIONED w Pa�� t� i� STATEMEHf THAT HE OR 9HE IS L7CENSED PURSUANT TO 7HE PROVt510NS OF THE CONiRACTOR3 LI� � CENSE UW(CHAPTER Y(COMMENCMO VATH SECTION 7000)OF DIVISIDN 7 OF THE BUSINESS AND PRO- � PooUSpa FE&9qHSCOO�ORTHATHEOR5HEISE](EMP77HEREFROMAND7HEBASISFORTHEALLEOEDE%EMP- (� TION.ANYVIOLATIONOFSECTION7091.6BVMIVAPPLICANTFORAPERMIT9UBIECTSTHEAPPLICANTTO Z Re-Root F, A CML PENALTV OF HOT MORE TMAN FNE MUNDRED DOIURS(t6oD)J: . ❑1,/�40NlNEROFTHEPROPERTY,ORMYEAIPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 COmffIB/C101 � �i WILL DO THE WOFiI(AND THE STAUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7ou,8US4 J � � � NE59 AND PROFE3910N3 CODE THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPEHfY 1Mp BULDS OR IYFROVES THEREON,ANO WHO DOES SUCH WORK HIMSELF OR HERSELF Oq � TNiqUOM MS OR MER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � I OfFERED FOR SALE IF IqN�EVER 7HE BUILDWOOR IAIVHOVEMB�IT IS SOLD WfTTAN ONE VEAR OFCOMPLE- ,Z �iION,iHE OWNERSUILOER WILL HAVE THE BUFDEN OF PROVINO THA7 HE OR SHE DID NO7 BUILD OR � W PROVE FOR THE PURPQSE OF BALE� _ � 01hROW17EROFTHEPROPEHfV,AMIXCLUSNELVCOMRACTWOWITHLICENSEDCONTRACTORS TO CONSTRUCT THE VR61EC7(SEC.7oU.BUSINESS AND PROFESSIONS COOE 7HE CONiRACTOiiS LI- V01uHtbn ADJ.AREA CEN9E LAW DOES NOTMPIY TO AN 01MIER OF A PROPER7Y NM1ID BUILOS OR pAPROVES TIEREON,M1D � 1NIOCOHT�RACT8Fdi8UCHPHWEC73WITHACOHTRACTOR(5)LICENSEDPURSUAN7TO7HECONTRAG pUANTITY DESCRIPTION FEE � � iOq3 LICBfSE UW.). .. . ' ❑I AM D(OIFT UNDEA SEC. B.8 P.C.FOR THIS REASON � 3 c> � � DATE OWNER U J � � UCENSED CONTRACTORS DECUIRATION w OC 1 HEREBY AFFlRN UNDER PENALTY OF PE0.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ' � a(COYAIEMCMU WfTH SEC7qN 7000)OF OMSqM a OF THE BUSINE55 NdD PROFESSIONS CODE,IwD Z ' X W LICEMSE IS P/FUl FORCE AND EFFECT. , L1J m 0 LICENSE CLASS LIC.NO. � � � J V o�� corrrnncroa a. w � WORKERS'COMPENSATION DECLARATION � � I HER�Y AFFlRIA UNDER PEHALTY OF VERIURY ONE OF THE FOLLOWfNO DECLAM710N5: Z - � _IHAVEANDWILLMAINTNNACEHfIFICATEOFCONSENTTOSELHNSUREFORVIOHKERS' _ ` Q COMPENSATqN,AS PROVIDED BV SECTION 970o OFT71E LA80R CODE,FOR THE PERFORMANCE U Q OF hIE WORK FOR WHICH THIS PERMIT 19 ISSUED. � + � Q _I HAVE AND WILL WVNTAIN WORKERS'COMPENSATION INSURANCE,A9 RC-0UIRED BV SECTION 37ao OF 7HE LABOR ODDE,f-0R THE PERFORMANCE OF THE WORK FOR NMlqi 7HI5 PEqMR IS ' _ . � ISSUED.MY WORKERS'COAIPENSATIOH INSURANCE CARRIER AND POLICY NUMBER ME: CO STRUCTION -�---�-, � GIRRIER � PLA EVIEW i � POLICV MAABER � ELECTRIC � (1FY6sECilp�lE�NOTBEoOAPLEfIDaFnEPER.�isPoHa+Et+U�pi�oatAfLS(Stao)oaLESs} PLUMBING Z I CERTIFY THAT M THE PERFOHMANCE OF THE WORN FOR WMICH THIS PERMIT IS ISSUED,I MECHANICAL C} SH/�LL NOT EMPLOV ANY PERSON W ANY MMINER SO AS TO BECOME SU&IECT TO THE � � � WORKERS'COMPENSATION LAWS OF GWFORNI/�AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECTTO7HE WORKERS'COMPENSATION PROVISIONS OF SEC710N 3700 OF THE LABOR • ~j cao�,i sriui FORmm�n�co�aP�r wini n�ase aaohsaNs. ISSUANCE � SMIP p DATE: � APPLICANP. W ENERGY P/C � WARMNO:FAIIURE TO SECURE WORKERS'COMPENSAT�ON COVEMOE IS UNLAWFl1L,AND SHAI.L BE � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDGVI�FWESUPTOONEHUNDREDTHOU9AND ENERGYPERMIT DOLLAFiS(f7oo,000),IN PDDI710N TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOH IN ¢ SECTION 3708 OF 7HE LABOR CODE,IHTEREST,AND A7'fORNEYS FEES. - RETENTION FEE: � OCONSTRUCTION LENDING AGENCY PpE-ALT FEE: � � I HER�Y AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDIN�AOENCV Z FOR THE PERFORMANCE OF THE WORK FOR NM1iICi1 THIS PERMIT IS ISSUED(SEC.3007,CIV.C.). � W � LENDERSNA►IE H LENDEftSMDRESS //��....yy � I CERTIFY TMAT I HAVE READ hilS MFLICATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL F o ' / � w I AOREE TO COMPLV N77H/LLL CT'AND COUNTY ORDINANCES AND STATE UN5 RELATMO TO BU0.DIN6 � � COH57AUCTION,AND MEREBV AUTHORIZE REPRESENTA71VE5 OF 7HI5 COUN7Y TO ENTER UPON 7HE � / //�� ZABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. � COMMENTS ' l'! J � m PERMfTTEENAME(PWNn � Q � y BqNA7UREOFPERMfTTEE DATE RECPT.N0. PAID BV VALJDATION � VYFIITE—Depertment Copy,YELLOW�Inence Copy.PINK—Assessa Copy,GOLDENROD--File Copy,GREEN--Applicant's Copy . ( �9'9'� (�f� �DA�OR9� ��6� �� • � o��c��o¢�� Q� �Q�l�i�� U a � �Q� �f � p o SET BACK FLOOR JOIST FTGS/FORMS/STEEL � � FHA REQMTS ELECTRIC GROUND ' - UNDER �LOOR DUCT ' - GROU�lD PLUMBI(�IG • UNDER FLOOR COt�IDUIT!. � ' � SLAB GRADE - FIF�EPLAC�FOUNDATION - � • _. TEf1NP POWER FIREPLACE BOND BEAM ' WMTER SERVICE MID HT. BOND BEAM ROOF SHEATHii�lG 8 FT. BOND BEAM � FRAMIfVGNEiVTILIATIQN FINAL BOND BEAM ROOF COVER PRE-GRADING ' ROUGH HEATING �ENCHING ROUGH EL�CTRIG - � � ROUGH GRADING ' RUUGH PLUPJIBIfVG - F!NlSH GRADING. SHOWER/TUB TEST - -' PdOL EIECTRIC • ` EXT. LATH/S1D1NG � . . POOI FENCING . W�4LL INSULATION �POO�FINAL CEILIiVG INSULATION , . OFF SITE IMPS. � DRYVIIALL NAI�ING DEDICATIONS � ` SEWER FINA�ENG. ' ' , _�: SEPTIC 7AP�K . i. : . .. L.ANDSCAPE/IRRIG. • - SEEP P17JL.L. ' _ ' Of�StTE IMPS. �AS A(R�7EST - FINAL ZONiNG ' FiNAL COf`i5T. - • FIFiE DEPT. FlNAl. � •� FI�dAL HE�4TI�lG ' HERLTH DEPT. FlNAL • FIPlAL ELECTRIC ' DEV. FEES PAID FIiVAL PLUMSING , � � ENERGY • ��o � - , Cl��l��s � . , � S�PTIC TAfVK SI�E SEEP PITIU SIZ� . � . � f� • � � . `[� ' , � ` . �� -- -_J�`— CTTY OF DIAMOND BAR DEPARTIvIENT OF CONIIvIUNITY 8c DEVELOPMENT SERVICES 21825 E.Copley Drive '~ (909)860-3195 Fax(909)861-3117 ��,,� �] PRESS . �`%AM�� BUILDING PER11�T APPLICATION ��` �--y� FIRMLY oJOBSITE z�25 Clear Creek Ln. ��'�1 ��q�,� � APPLICATION PERMIT P/C ADDRESS DATE NUMBER # � ISSUE TYPE OCC � APN LOT HO TRACT DATE CONST. GROUP p OWNER Rita Medirate p ADDRE S 22HO7 a2 TYaI ZONING SETBACKS Z C�Ty ��amon ar ZIP TEL. Z FRONT qyy p g APPLICANT TEL. REAR p � SIDE/SIDE STAEET RW ❑ � CONTRACTOR SIDE p I ADDRESS � CITY ZIP TEL. PROPOSED USE o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS u� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDEADECLARATION 5972 $'rj.rjQ SFR/ADD/REM p I HEREBV AFFIRM UNDEF 7ENALTV OF PERri1RV THAT I N.1 E%EMPT FpOM 7HE COMRACTORS LI� � Garege/Cerport. 84O 2 7 �O W CENSEUWFORTHEFOLLOWINQFEASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCI7YOR C r, U �p�JrJTYyh11CHREWIRESAPERMI77000N5TRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVSTRUG �V�y �2�OO w TUFE,PFqR TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO w Pa�io/Deck � STATEMEM THAT HE OR SHE IS IJCENSED PURSUAM TO THE PROVISIONS OF THE CONTMCTORS LI- � CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AN�PRO- PooUSpe � FESSIONSCODE)ORTHATHEORSHEISEJ(EMPTTHEREFROMANOTHEBASISFORTHEAILEGEDE%EMP- (� U TION.ANVVIOLATIONOFSECTION7091.SBVANVAPPLICANTFORAPERMITSU&lECTSTHEAPPUCANTTO Z Re-Roof A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(t600).): � ❑I,ASOWNEFOF7HEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCiBI Z WILL DO THE WOR1C,AND THE STRUC7URE IS NOT INTENDED OR OFFERED f-0R SALE(SEC.70a�,BU51- J � � NESS AND PROFESSIONS COOE:7HE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � PqOPERTV WHO BUILDS OR IMPROVES THEREON,M1D VAiO DOES SUCH WORK HIMSELF OR HERSELF OR CL THflOU�H HIS OR HER OWN E1APlOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFC0.NPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR = IMPROVE FOR THE PURPOSE OF SALE). w ❑I.ASOWNEROFTHEPROPEFTY,AMEXCLUSNELYCONTRACTINOWfTHUCENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.70a6,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS L6 V81U8�1Of1 5 ADJ.AREA W CENSEUWDOESNOTAPPLVTOMlOWNEROFAPROPERTYWViOBUILD50RIMPROVESTHEHEON,AND � WFIOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � 9�1'AM EXEM T UNDE SEC. B.d P.C.F F 7 REASON Q � � U � DATE OWNER F— Z U � LICENSED CONTRACTORS DECLARATION W � a , �c I HEREBY AFFIRM NDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PflOVISKKJS OF CHAPTER � � e(COMMENCINO WITH SECTKKJ 7000)OF DIVISION J OF THE BUSINESSAND PROFESSIONS CODE,AND Z XL, MV LICENSE IS M FULL FORCE AND EFFEC7. m _ LL1 � LICENSE CLASS LIC.NO. � �. ~ DATE CONTRACTOR � � ' �d W � � WORKERS'COMPENSATION DECLARATION Q � � I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWINQ DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' ¢ (�(� Q COMPENSATpN,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U 1� OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. w W � I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION r � Q 3700 OF iHE LABOR CODE.FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS (� y� J ' ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION 2�9 9 3.7O V�/' jCARHIER PLAN REVIEW �i 374��2 • ZPOLICV NUMBER� ELECTRIC Q p (1H5SECTONNE�NO78EOOMR.Ff�OFTHEPERMfISFORONE1ill�DqEDpOLLqq3(5100JORLESSy PLUMBING W Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � �} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE � SU&IECTTOTHEWORI(ERS'COMPENSATIONPROVISIONSOFSECTIPY37000FTHEUBOR O• � CODE,I SHALL FOR77iWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE Z S.OO � � � p DATE: APPLICANT. SMIP �� w ENERGY P/C ��/.�.\ , I �J J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATKKJ COVERAGE IS UNLAWFUL,AND SHALL BE J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESlWDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT � DOLLARS(f100.000).IN ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ��I r �. � �n n� � �O.O O w RETENTION FEE: f � O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ! � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENOINO AGENCV i FOR THE PERFORAIANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.308�,CIV.C.). W �'..s.�•--'''=-�"I � LENDER'S NAME � LEN�ERSADDRESS w ICERTIFYTHATIHAVEREADTHISAPPLICATIONlWDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES z��,$2 3� 154.30 � I AOREE TO COMPLV WITH ALL CITY AND CWNTV ORDINANCES AND STATE UWS RELATING TO BUI�DING � V � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ' Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS 0 J � m PERMITTEE NAME(PRINn J � �� Q w 0/ u� � SIGNATUFEOFPERMITTEE O E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Depariment Copy, ELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy —f o-�c�� 5�J2q • �'� , . . . ., .. .. . . . . .. . � ,. _ ...._ ,,��. .�, . , _ . .. �C9�'�f �(r ICDO�Na�Bf��D l�l�l6� '` ' � ��SL�[c(C"i1'8�� ff�[��If��D � ` °`�C�UII� o ' � U � � � � . a .`� p . op SET BACK . � • FLOOR JOIST FTGS/FORMS/STEEL FHA REC�MTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING � UNQER FLOOR CU�IDUIT � SLAB GRADE FIREPLACE FOUNDATION � TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM _ ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTII_IATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING ' BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNISING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING lNSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L..L. ON SITE IMPS. GAS AIR 7EST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEA�TH DEPT. FINAL FlNAL E�ECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY � o � � �. , ,�, -' ---- P � P . CONIfViIENTS , SEPTIC TANK SIZE SEEP PiTIl1 SIZE , ,,� �� v. �,. �� '.t. ,��a� � �" a � � � _ , � � � o 0 9 I � o p-, . � � r I ) / � � • CITY OF DIAMOND BAR -----��`— DEPARTMENT OF COMMUNiTY&DEVELOPMENT SERVICES 21825 E.Copiey Drive PRESS �'" (909)860.3195 Faz(909)861-3117 FIRMLY � `':�;�''' BUILDING PERNIIT APPLXCATION . � JOBSITE �-- APPLICATION .,,U PERMIT � /C i o ADDRESS ,�� ZJ e� i Y C�12'�L� � DATE v' � MBER � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER � ZONING SEfBACKS o ADDRESS FRONT RW ❑ Z G�Ty Z!P TEL. REAR � o APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR l/ �.�'t-�: C=✓��-'� 0 SIDE � oADDRESS ��+ y�/�'K''""� CJ� pROPOSED USE S�i T< <-- l �'7'J� " � S�iL' �i ! CITY Rs�k! GiT!- ZIP �r 2so i TEL. 1-26 "i-�17��j w ARCWENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFlRM UNDER�ENALTY OF PERIUHV THAT I AM EXEMPT FROM THE COMRACTOfiS LI- G8l89B/GOfPOR � � W CENSELAWFORTHEFOILOWIN4REASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITVOR zCOUNTYWHICHREOUIHESAPEAMITTOCONSTAUCT,ALTER.IMPROVE,DEMOL�SH.ORREPAIRANVSTRUC- W P8110/DBCk w NRE.PRIOR TO ITS ISSUANCE,�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FI�E A SIGNED w � STATEMEM S}1AT HE OR SHE IS LICENSED PURSUANi TO THE PROVISIONS OF THE CANTRACTORS Ll� � pooUS a � CENSE UW(CMAP7ER o(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF TME BUSINESS AND PRP � P O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFflOMANDTHEBASISFOF7THEALLEOEDEXEMP� V TION.ANYVIOLATIONOFSECTION7031.5BYANVAPPLICANTFORAPERMITSU&IECTSTNEAPPLICANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE 7HM1 FIVE HUNDRED DOLLARS(f500).): O ❑I,ASOMMERaFiHEPR�PER7Y,ORMYEMPIOYEESWITHWA�E5A5THEIRSOLECOMPENSATION, 0 COrt11710fC18I Z WILL D�TME WORK�D THE S7RUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a�,BUSI� J � NESS AND PROFESSIONS CODE:TNE CONTRP.CTORS LICENSE UW DOES NOT APPLV TO M!OWNER OF � VAOPEFiTYNMOBU1lASORIMPROVESTHEREON,M1DYhiODOESSUCNWORNHiMSELFOHHERSEIFOR m Q THRIXIGH HIS OR HER OWN EMPLOYEES,PROVIOED 7HAT SUCH IMPROVEMENTS AqE NOT INTENDED OR w OFFEREDFORS/�LEIF,FIDWEVER.THEBUIIDINQOFIMPFOVEMENTISSOLDWITHINONEYEAAOFCOMPLE- � TION,7HE OWNER-BUILDEH WILL HAVE THE BURDEN OF PROVWG LHAT HE OR SHE D�D NOT BUILD OR Z IMPROVE FOR hIE PURPOSE OF SALE). _ ❑1,AS OMlNEROF THE PROPERTY.P1A EXCLUSIYELY CONTPACTIN�WITH UCENSED CQNTfUCTORS W � TO CONSTRUCT TiE PRQIECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:TFIE CONTfUCTOqS LI- V8IU8�1Of1 AD .AR W GENSE UW DOES NOTAPPLV TOAN OVMEfl OF A PROPERTY WFIO BUILDS OR IMPROVES THEREON.AND Z y�{p�pMqACTSFORSUCHPROlECTSWITHACANTMCTOR(5)LICENSEDWflSUANTTOlHECOMRAG QUANTITY DESCRIPTION FEE F- TORS UCENSELAWJ. � J � O I AM IXEMPT UN�ER SEC. B.b P.C.FOR THIS REASON U � � � DATE ' ��ER U Z J � LICENSED CONTRACTORS DECLARATION � w I HEREBY AFFIiiM UNDER PENALTV OF PERIURY THAT I AM LICENSEO UNDER PRO�ISKKJS OF CHAPTER � d B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS M FUIL FORCE AND EFFECT. m LU r/� � � UCENSE CLASS LIC.NO. � '^ L� �M �f � . V DATE CONTMCTOR IyI I 7< G�•W O a W � WORKERS'COMPENSATION DECLARATION Q ' N U � I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OG THE FOLLOWING OECURATIONS: Z Q � _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 Q COMPENSATION,AS PROVIDED BY SEC710N 37000F THE LABOH CADE,FOR THE PERFORMANCE W OF hiE WOPK FOR WHICM THIS PEf1M1T IS ISSUED. � � w !I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED 8V SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WOR/CERS'COMPENSATION INSUPANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CARiiIER PLAN REVIEW � ZPOLICV NUMBER ELECTRIC ¢ � Z"' � (�-assEc�qNNE�aoreEooMR.EfEoaFn+erEar.�tsFataNElR�moounlug�mlai�6s} PLUMBING w MECHANICAL Z 1 CERTIFV THAT IN THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I �} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE � WORNERS'COMPENSATIONUWSOFCALIFORNIA,AN�AGREETHATIFISHWLDBECOME INSPEC710NFEE �� S SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTqN 37000f THE LABOR ISSUANCE �_ CODE,I SHALL FORTHWI7H COMPLV WITH THOSE PROVISIONS. O SMIP p DATE: APPUCANT: . J ENERGY P/C � WARNM(�:FNLURE T�SECURE M1�RKERS'COMPENSATION COYERAGE IS UNLAWFUL,AN�SHALLBE �y SU&IECTANEMPLOVEFTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT OOLURS(5100.000).IN ADDITION TO 7HE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOH IN 1 /y� J SECTION 3708 OF THE LABOR CODE,INTEAEST,AND ATTORNEY'S FEES. RETENTION FEE: "��" � w CONSTRUCTtON LENDING AGENCY PRE-ALT FEE: d O � I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CANSTRUCTION LENDING A(3ENCV d FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS�SSUED(SEC.3087.CIV.CJ. Z W � LENDER'S NAME F- LENDER'S ADDRE55 /yJ� � ICERTIFYTNATIHAVEREADTHISAPPLICATION DSTATE � T7HEA80VEINFORMATIONISCORFECT. TOTAL FEES r �+ � W I AGREE TO COMPL�WITH ALL CITY AND CWNT ORDINANC AND STATE UWS RELATING TO BUILDING � CON5IRUCTION,AND HEREBV AUTHORIZE,AE ESENTATI S OF THIS CWNTV TO ENTER UPON THE w � AgOYE�MENTIONE�PROPERTlFOR�EC PURPO S. Z COMMENTS � � _ ¢ PERMITTEENAME�PHINn, �, � / o a � S16NATURE�FPEFMITfE AT RECPT.NO. PAID BY VALIDATION � WHITE—Department Copy.YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy l �9�'�Y �� [�Q��6�R� �1�16� '" � � 0�xf�C�t�u C�P� �I�C�[�� c�� , a�� a �� a�. � �� : � � �; SE7 BACK FLOQR JC�IST FTGS/FOAMS/STEEL FNA REQMTS � ELECTRIC GROUND UNDER FLOOR DUCT � GROUND PLUMBING UNDER FLOOR CUhIDUIT SLAB GRADE FIREPLACE FOUPUpATION 7EMP POWER �IREPLACE BOND BEAM WATER SERVICE Mib HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM __� FRAMfNGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGti HEATING BENCHlNG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINiSH GRADING � SHOWEFUTUB TEST POOL ELECTRIC �` � EXT. LATH/SIDING POOL FENCING WALL ItdSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWA�L NAILlNG DEDICATIONS SEWER FIhIAL ENG. SEPT(C TANK �r� /�� ,,� �"�—=� LANDSCAPE/IfiRIG. SEEP PIT/LL. �� 1�/�_ � ON SITE IMPS. GAS AIR TEST FINAL ZONlNG FINAL CONST. FlRE DEPT. F1NA� F1NA�HEA7lNG HEALTH DEPT. FINAL � FlNAL ELECTRIC DEV. FEES PAID , FINAL PLUMBING ENERGY � . . _ � � � � �;`: co��Ts . . _ _ . . . SEPTIC TANK SIZE SEEP PITlU SIZE 1�i m � � A � . � � ° � � � �� , , .. WALNiJ'T VALLEY UNIF�D SCHOOL DISTRICT 880 SOUTH LEMON AVENUE WALNUT CA 91789 i CERTIFTCATE OF COMPLIANCE ' With Fee Provisions of . Government Code Section 65996 , DEVELOPER/OWNER Rite Medirata (�`�^-�`� ADDRESS 2725 Clear Creek Ln Signature of Applicant CITY/ZIP Diamond Bar 91765 The person signing represents that he/she is au�llorized �TELEPHONE 909.861 .0023 to sign on behalf of the owner/de��:loper and that the information provided is true and accurate*o the be�t of his/her lmowledge. NEW LOT ADDRESS USE OF BUILDING TOTAL SQ. FT. 2725 Clear Creek Ln NSFR 5g72 Diamond Bar Residential/Commercial/Industrial C lty . . HOME IMPROVEMENT OR REMODELING PROJECT I ADDRESS DESCRIP'TION TOTAL SQ. FT. . -a� Diamond Bar Walnut Bedroom, Family Rm., Kitchen, etc.) • � � Signature of Superintendent af Buildings � Date � -�v • � ' TO BE COMPLETED BY SCHUOL DISTRICT ' < FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE �- School District under provision of Government Code §65995 $ //� $a2,5', 9� are: (EFF. 8/17/98) Residential Development $1.93/sq. ft. Receipt# • Commercial/Industrial $0.31/sq. ft. Date � p/ Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects QVER 500 sq. feet (eliminating garage or uncovered patio). • � This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may t�e issued. This is to certify that the above described development has been detemuned to be EXEMPT from the development fees of Government Code Section 65995 and a building permit may be issued. ` Exemption Justification: 3°ROJECT IS 500 OR LESS SQUARE FEET � OTHER W� )��9C1��3.td�».e.[�> /lK.�J �'.H3eia-� �" " �-- Assistant Superintendent Fiscal and Facilities Management 1/87 Rev. 2/88; 6/88; 8/89; 1/90; 8/90; 10/90; 8/92; 6/93; 11/93; 8/94; 6/96; 1/97; 8/98 PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROT�:ST OF FEES ON REVERSE SIDE _ , - ,, ; l - , } �,� '� � � , \ NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES Section 66Q20 of the Government Code enacted as Assembly Bill 3091, set forth as Chapter 5�9, Statutes of the- State of California, 1996 effective January l, 1997, requires that this school district provide a written notice to the project applicant at the time of payment of school fees, mitigation payznents or other exactions. This notice is to advise you that any protest in regard to such amou:2ts or the validity thereof in accordance with Section 66020 of the Governrr.ent Code and other applicable law, commences with such payment or performance of any other requirement as described in Section 66020 of the Government Code. Additionally, this notice advises that the protest thereof must occur within �0 calendar days thereafter. . . _ . _ .- , _ , , . ;; :. �