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Home My WebLink AboutPR 12-1935L772 CITY OF DIAMOND BAR. DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITErADDRESSXdL360 / 60 id cy SheA/rit Zj APN LOT TRACT OWNER S 11 ADDRESS Sr oG i'nJ S Jd C G CITYIB e r 1 1c ( ZIP TEL. APPLICANT TEL6b9_ Up yl/g CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/ DESIGNER t t ADDRESS R CITY P vl-O ZIP 49ALMO TEL. f- OFd d OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7071.5 BUS W ESS AND PROFESSIONS CAGE ANY CITY ORCOUNTYWHICHREQUIRESAPERMITTOCONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUG TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LFCENSEUW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TOACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS (SSW).): - L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND. THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF HPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WO DOES SUCH WORK HIMSELF OR HERSELF ORTHROUGHHISORHEROWNEMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE BUILD WG OR IMPROVEMENT IS SOLD W"HW ONEYEAR OFCOMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORIMPROVEFORTHEPURPOSEOFSALE} O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TOCONSTRUCT THE PROJECT (SEC. 700, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U - CENSE UW DOES NOTAPPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, ANDWHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S) UCFNSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.} errZ EXEMPT UNDER SEC B. & P.C. FOR TFIIS REASON DATE OWNER ALP LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B ICOMMENC04G WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSEISINFULLFORCEANDEFFECT LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS; I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SET.FWSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 37W OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CAAAIER AND POLICY NUMBER ARE CARRIER C- l G POLICY NUMBER DOS SECTION NEED NOT BE COMPLETED OF THE PEPMT IS FOR ONE HUNDRED LDOLARS(5100)OR LESS} I CERTIFY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORXERS COMPENSATION LAWS OF CALIFORNIA, AND AG IEE THAT IF 1 SyQVID BECOME SUBJECT TO THE WORKERS' COMPENSATION PROM NS F SECTION fl OF THE LABORCODE, I SHA FO TH COMPLY WITH THOS OVIST NS. DATE: APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION GE UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CN%F S TO ONE HUNDRED THOUSANDDOLLARS (3100.000} W ADDITION TO THE COST OF COMPENS , DAMAGES A9 PRO FOR IN SECTION 370E OF THE LABOR CODS INTEREST, AND ATTOFN FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3087, CIV C} LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES, Po .j PERM EE (P NT) ryry 5 PE EE DATE V -nl I e-uepartment Copy, YELLOW -Finance Copy, PINI r PRESS FIRMI V APPLICATION PERMIT P/C . DATE -j I d/Z NUMBER o"1- \135# e \.G ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW Ci REAR SIDE/SIDE STREET RW p SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garaga/Carport W Patio/Deck LL Pool/Spa Z Re -Roof Commercial m Valuation _,o0'00&, 0 • — ADJ AREA QUANTITY DESCRIPTION FEE QU lLNUW W CDJ 2 0 m OL U Z @O'ftm m Oc 0 000'D CONSTRUCTION ( rps •,q PLAN REVIEW _ \ ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP , jQ ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: IW TOTAL FEES \ a • ' COMMENTS RECPT NO. 3g i PAID BY 'r Si. VALIDATION Vy. as nc 14-IJlICBT11 5 L.Opy cg,,r-*f OF DIAMOND SAA INSPECTiON REICORD yi 91 5 S"ET BACK FLOOR JOIST FIGS/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 I _ MID HT BOND BEAM ROOF SHEATHING 18 FT. BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING I FINISH GRADING SHOWER[TUBTEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTICTANK LANDSCAPEARRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING JENERGY FINAL PLANING F . INA.L ENGINEERING COMMENTS 4)z SEPTICTANKSIZE SEEP PIT/U SIZE CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITE rADDRESSiseL3Go / 60 i d F,j APN LOT TRACT OWN 004 9,AkS ADDRESS 6 S (got f j -S... V -C CITY DI eµ L ZIP -jLe21.,J'TEL. 5;bV-3raaq06 APPLICANT TELrII9eo W129 CONTRACTOR ADDRESS CITY ZIP TEL ARCFVENG/ DESIGNER Ai E It L r ADDRESS t.O-Cj TE CITY a w.LP d'j L- 0 ZIP TEL - 0 r- rc% OWNER -BUILDER DECLARATION' - I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AN EXEMPT FROM THE CONTRACTORS L4CENSELAWFORTHEFOLLOWINGREASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANI' CITY OR COUNTY WHICH REOUIRESA PEAMITTO CONS7gl1CTALTER. IMPROVE DEMOUSH, OR REPAIRANY STRUGTURF. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEDSTATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORSL4 CENSE LAW (CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS D(EMPTTHEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.4 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT TO A CML PENALTY OF NOT MORE THAN FIVE HONORED DOLLARS (SS001•): I7 L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS TMEIRSOLE COMP NSATION, WILL NESSTHE WORT( AND. THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. O BUSI- NESS AND PROFESSIONS COOS THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON AND WHO DOES SUCH WORK HIMSELF OR HERSELF ORTW-OUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OROFFEREDFORSALEIF, HOWEVER THE BUILDING OR W PROVEMEM IS SOLD WITHIN ONE YEAR OF COMPLE. TION, THE OWNER -BUILDER WILL. HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORIMPROVEFORTHEPURPOSEOFSALE. I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS - TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U - C ENSE LAW ODES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, ANDWHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ETTR,G EXEMPT UNDER SEG B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTERY (OOMMENCWO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSEISINFULLFORCEANDEFFECT. UCENSE CLASS UC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFWSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED. CG 1 HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS RECUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PER MT IS LSSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER - L-4 a .I POLICY NUMBER - AJI, i - Q Z rb GEIS SECTION NEE) NOT BE CCM'LE ED OFTHE PERMIT S FOR ONE H)NDRED ODLLARS Wm) OR uszS I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT is ISSUED, I SHALL NOT EMPLOY ANY PERSON W ANY MANNER SOAS TO BECOME SUBJECT TO THEWORKERSCOMPENSATIONLAWSOFIpROVIOAGREEIFISHOULDBECOME SUBJECT TO THE WORKERS COMPENIONS OFy C N 3700 OF THE LABORCODEISFOCOMPLYWOVISC.[) ATE APPLICANTWARNING: FAILURE TO SECURE WORKERS' COGE IS UNLAWFUL, AND SHALL BESUBJECTANEMPLOYERTOCRIMINALPENALTINESUPTOONEHUNDREDDIOUSANDDOLLARS(5100,000).WADDITION TO THE COSTATION. DAMAGES AS PROVIDED FOR IN SECTION 37" OF THE LABOR CODEINTERESTEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCYFORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3047, CIV. C.} LENDER'S NAME LENDERSAODRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORD WINCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES, ti 700 AJ e- PERM E (P e 1A 0/ .2- S R PE EE - DATE V WHITE—Department COpy, YELLOW—FinanCe Copy, PINK RESS FIRMLY APPLICATION PERMIT 'FkZ P/C DATE / (7/ NUMBERkQ.- \11?73q — ISSUE TYPE OCCDATE11IE-3 1 CONST S GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED USE•-( / 7 1 O NO. DWEL NO.v NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT .._ FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM' U) Garage/Carpon W Patio/Decic LL PooUSpa - Z Re -Roof Commercial m Valuation 0 AD,).AREA QUANTITY . DESCRIPTION FEE . QU ccH f3 EE? IRS UWJW CDZ DO a 0 JQ QZ¢ n o T anger ft the dava MWn CONSTRUCTION ] e- 9a PLAN REVIEW ELECTRIC PLUMBING MECHANICAL ' INSPECTION FEE ISSUANCE L} • ',', SMIP Sd ENERGY P/C ENERGY PERMIT RETENTION FEE: co PRE -ALT FEE:- EETOTALTOTALFEESla\ . q COMMENTS RECPT. NO. ` gC+ PAID BY cx SQ VALIDATION _ y, GOLDENROD—F le Copy, GREEN—ApplicanCs Copy MY OF DIANIOND BAR Ii',?SPECTJON RECORD n7?.de{ - i.,, y ^} -r. stY;,:'lr ll I' `',r.'1 rt a a+lJ o_ . `" m t ;+:• . M1gn YG.Y_'N u._!Lif''"+Cri hj,x: t. 11 J 1 ' fi 4t3 J—L, u. v'. t.y.,,} i 61. `L —1_ ,. _,z .... :' "i '' ! ' ni_y.,'. . r k. h SET BACK FLOOR JOIST FTGS/FORMS/STEEL -- - -- [FHAREOhATS-------------- -- 1- --------------- --.. - ----- ELECTRIC GROUND -- - _ UNDER, FLOOR DUCT _ GROUND PLUMBING - - UNDER FLOOR CONDUIT SLAB GRADE - FIREPLACE FOUNDATION TEMP POWER, FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 18 FT. BOND BEAM FRAMING/VENTILATION _ _ _ FINAL BOND BEAM_ ROOF COVER _ _ PRE -GRADING -- ROUGH HEATING BENCHING _ ROUGH ELECTRIC f ROUGH GRADING - ROUGH PLUMBING FINISH GRADING SHOYER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION I POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SES/ER --- _----- --- - ---- - FINAL ENG---___ -- SEPTICTANK LANDSCAPEARRIG _ SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING JENERGY FINAL PLANING FINAL ENGINEERING_ --` } --- -- COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE - - - CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITE ADDRESS Y St. O 1 (o/ O i d £-j APNLOT TRACT OWNER ,r ADDRESS C K2 G'o f J S Q/!!aj I_ G CITY D e & ZIP [;L(I TEL. 3Df6 ti06 APPLICANT TEL&ib9.8co wiw CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/ DESIGNER t ADDRESS a CITY ( w lP 444 It- A ZIP _ TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CCOE ANI' CITY OR COUNTY WHICH REOUIRESA PERMITTO CONSTRUCT ALTER IMPROVE, DEMOLISH, OR REPAIRANY STRUC- TURE- PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 0 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI. CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 By ANY APPUCANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).y: L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORT( AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 704, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK H W SELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORIMPROVEFORTHEPURPOSEOFSALE). 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TOCONSTRUCT THE PROJECT (SEC. 71)". BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A COWRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). eM'Z EXEMPT UNDER SEC. S. 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSEISINFULLFORCEANDEFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVEAND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS RECUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHISH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE-- CARRIER RECARRIER `C-- 4—It A L POLICY NUMBER Z- ,[ 2 " : 2LQ 7 DIS SECTION N® NOT BE OCKNtSEDOFT/E PERMIT IS FOR CNE HJNORED ODUARS MOD) OR LESS). I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I S777VVV DQUI ' BE SUBJECT TO THE WORKERS' COMPENSATON PROVISIONS OF SECTION 0 OF THE LABOR CODE, I FORTHWITH COMPLY WITH THOS R VISK)NS. DATE APPLICANT: WARNING: FAA -URE TO SECURE WORKERS' COMPENSATION COVERAG 5 U!1 WFUL ANO SHALL BE SUBJECT AN EMPLOYER To CRIMINAL PENALTIES AND CML FINES UP T ONE H NDRED THOUSAND DOLLARS (SI 011.000). IN ADDITION TO THE COST OF COMPENSATION, D ES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHIG/ THIS PERMIT IS ISSUED (SEC. 307, CM a). LENDERS NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURP/S S. c, it 0 1 c PERM EE ( NT) 0.2 S R PE EE DATE V WHITE—Department Copy, YELLOW—FInance Co;* PINI ESS FIRMI V APPLICATION PERMIT P/C - DATE l d/ NUMBERISSU DATE TYPE1) I II CONST L- GOCC ROUP ZONING SETBACKS FRONT RW REAR 0 SIDE/SIDE STREET RW p SIDE cc PROPOSED USE C - 04 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck LL Poovspa ZRe Root Commercial0 CIO Valuation iaOCT OO ADJ.AREA QUANTITY DESCRIPTION FEE QU UWJW C7Z m a_ JQ zgU Wg CONSTRUCT r PLAN REVIEb ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: FEE-- EEETOTAL LPI RRE--A...LwT TOTALFEES ales q COMMENTS RECPT. NO. PAID BY aS 's' VALIDATION i' N r,. ............. ......—r.,v wyy, iancur-nppucanu3 Lopy SETBACK FTGS;FORiVIS/STEEL ELECTRIC GROUND - GROUND PLUi'v1BiNG SLAB GRADE r TEMP POWER WATER SERVICE ROOF SHEATHING r FRAMING/VENTILATION ROOF COVER _ ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWER/TUB TEST EXT. LATH/SIDING WALL INSULATION CEILING INSULATION DRYWALL NAILING SEWER___ SEPTICTANK_ _ SEEP PIT/L.L. GAS AIR TEST FINAL CONST. FINAL HEATING FINAL ELECTRIC FINAL PLUMBING FINAL PLANING FINAL ENGINEERING COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE CITY OF DIAMOND BAR INSPECTION RECORD JFLOORJOIST _ _ - FHA REOMTS_ _ UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 8 FC BOND BEAM FINAL BOND BEAM PRE -GR ADING----_- BENCHING _ ROUGH GRADING -- FINISH GRADING POOL ELECTRIC POOL FENCING POOL FINAL OFF SITE IMPS. DEDICATIONS FINAL ENG----- LANDSCAPE/IRRIG. ON SITE IMPS. FINAL ZONING FIRE DEPT. FINAL HEALTH DEPT. FINAL DEV. FEES PAID ENERGY