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Home My WebLink About21744ll1,1lIO�D DJlli ii CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 869ONS-Fax (909) 961-3117 6 39 7 fl a o BUILDING PERMIT APPLICATION JOBSITE ADDRESS 21110 SlL-O:n Ce 01> APN LOT TRACT OWNER M /kE` /462 J&X A,-/ �Z�LZT ADDRESS :2ll/S/(.v1lYL CITY DIAMa94(L ZIP 9/7 TEL -2j0i APPLICANT TEL CONTRACTOR PIC11,64 WIh ADDRESS CITY L4:: ZIP -0TEL. 73 ARCN/ENG/ `13 y'y DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS u CENSE LAW FORTHE FOLLOWING REASON (SEC.7031.6 BUSINESSAND PROFESSIONS ODDS ANYCFrY OR COUNTY WHICH REOURESAPERWTTOCONSTRUCT,ALTER IMPROVE, DEMOU3H2OR REPNRANY STRUG TURF, 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 LF CEDE LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATK)N OF SECTION 7031.f6a6 BY ANY APPLICANT FOR A PEFNR SUBJECTS THE APPLICANT TO ACMLPENALTYOF NOT MORE THAN FIVE HUNDRED DOLLARS(M: ❑ 1, ASOWNEROFTHE PROPERTY,OR MYEMPLOYEES WITHWAGESAS THEIR SOLECOMPENSATION, WILL DO THE WORK AND THE STRUCTURE M NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI. NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOESSUCH WORK HEMSELFOR HERSELFOR THROUGH HISOR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR ED SALE OFFERFORIF.HOWEVERTHEBUILDING OR MPROVEMENTIS SOLD WITHIN ONEYEARDFCOMPLE- TION, THE ONMERAUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE). ❑ L AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITHUCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC- 7W BUSINESS AND PROFESSIONS CODE THE CONTRACTORS ll- CEFSE LAW DOES NOTAPPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND NON) CONTRA, SUCH PRO.IECTS WITHACONTRACTOR(S)LICENSED PURSUANT TO THE CONTMC- TORS LICENSE LAW) 0 1 AM EXEMPT UNDER SEC B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7000) OF DMSIN 3OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASSA,_ LTC. NO. 2-39 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 t6SUEM I HAVE AND WLL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37DD OF THE LABOR CODE. FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THISSECTION NE®NOTBE fYMF ET®OFTHE PEAMT1S FORCNE HIAOREDDCUARS(31Do)ORLESS} 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA,AND AGREE TFyTdf Is BECOME SUBJECT TOTHE WORKERS'COMPENSATNkI PR �I* gSOFs i 3700 OF THE LABOR COD IS FORTHMATH COMPLY WTDI THE PR ISION DATE ! APPLICANT. WARNING: FAILURE TO SECURE WORKERS' OOMPEN ERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES L FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SIW.WOL IN ADDITION TO THE COST OF PENSATION. DAMAGES AS PROVIDED FORM SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. SW, CIV. C.). LENDER'S NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORI2E REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOR INSPECTION PURPOSES. [ ('"" w( L PERNITTEE N SIGNATURE OF PERMITT DATE o PRESS FIRMLY CATION/, // 6 � / P - /� DATE IT P/C s �- "7` NUM "7 # ISSUE TYPE OCC lillll DATE �� CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE o % NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT I FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM to Garaga/Carport W Patio/Deck LL PooVSpa Z Re -Roof 0 Commercial - 5 CD Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U F U W J W C7 Z CO J 4 U_ Z Q U W CONSTRUCTION PLAN REVIEW ELECTRIC / PLUMBING MECHANICAL INSPECTION FEE ISSUANCE_ (f�) SMIP ENERGY P/C ENERGY PERMIT �7 RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO, D PAID BY VALIDATION WHITE —Department Copy, YELLOW--Fhance Copy, PINK —Assessor Copy. GOLDENROD —File Copy, GREEN —Applicant's Copy 41 !&i� j464& SETBACK FLOOR JOIST FTGS,-'FORMS/STEEL FHA REQtATS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE POUNDATION TEMPPOWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 F7, BOND BEAM FRAMING/VENTILATION FINAL BOND BEAK ROOF COVER �-R-G ADING ROUGH IDEATING BENCHING ROUGH ELECTRIC *ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST :POOL ELECTRIC EXT. LATH;'SIDING POOL FENCING WALL INSULATION POOL �INAL CEILING INSULATION OFF SITE !MPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENO SEPTIC TANK LANDSCAPE!IRRIG SEEP PITIL.L. ON SITE IMPS GAS AIR TEST FINAL CONST. FINAL ZONING F!RE DEPT, FINAL FINAL HEATING HEALTH DEPT, FINAL FINAL ELECTRIC DEV. FEES PAID 'ENERGY ............ X COMMENTS . . .. ..... ....... SEPTIC TANK SIZE SEEPPIT/USIZE- DIAMOND HAD a CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 1------- 21 FIRMLY 39 c) PRESS ri (909) 86044'95-Fax (909) 861-3117 BUILDING PERMIT AI'PLICA1 APPLICATIOW/Voq DATE P MIT P/ ...••^•••"" NUM iii C , 'I # ISSUE DATE TYPE OCC A.)/// h - y CONST GROUP FRONT SETBACKS ZONING REAR SIDE RW 0 u) ui 14- 0 z 5 -J 5 o3 n SIDE/SIDE 0 PROPOSED NO. UNITS USE DWEL. -14/ geo / gesA / ro ; Zet ( --T---- STREET RW 0 NO. NO. STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF SFR/ADD/REM Garage/Carport al-1-1 P do/Deck Pool/Spa Re -Roof Commercial Valuation c-2, ovo ADJ.AREA QUANTITY DESCRIPTION FEE ADJ. AREANALUATION 0 z cT3 m / D _s EL -5hatit / 7701ZI- _I 2° x 0 2LLI CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SM1P ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: 52,-00 Lit 0 6.0„ 0,1 5,3 Q-0-0 TOTAL FEES COMMENTS I RECPT. NO. 0 PAID BY dri_17, VAUDAT10N WHITE —Department Copy, YELLOW —Finance Copy, PINK py„ cant s ,ii JOBSITE n ADDRESS 21//61 SIL-14:2'1.- C144)1> r D n y z ,t r D D Al M m JJ n D 13 II r D m LI Z JJ E E D r ..,./.1 Z La r 1.1 r he D J Z D ,— APN LOT TRACT 2 5 AJ B n 0 V) Ca Ci LAI I-- CI ci Z Ci LU Z (.9 CO I = M 0 C) 11.1 --I —J CC I.33 CI- 0 CS Z 1.11 I-- M LU t =1 CO ..4C Co OWNER it/i /KC 4n,y) e4rrot-yA/&-z:1- ADDRESS awl S/Lvvrt cc_otA) CITY 0 iA/Ind Air, 131A. ZIP q/74c-- TEL "r6 V I ST if -21 07 APPLICANT gIca 1"w) 144-4.-41-0-4444./TEL CONTRACTOR i c * kri I- a • ... ADDRESS 'Mir CITY I4 ' --144"it= ZIP 9 > 7 S. -0 T E L.. 909 1 3 2., ARCH/ENG/ 93 Vy DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I NA EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOUDWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT. ALTER, IMPROVE, DEMOUSH2OR REPAIRANY STRUC- TURE, 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 LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AN) PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROIA AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): 0 t. AS OWNER OFTHE PROPERTY,OR MY EMPLOYEES WITHWAGES AS THEIR SOLE COMPENSATION, WU DO THE WOW, AND THE STRUCTLIRE 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 PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IE HOWEVER, THE BUILDING OR RIPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION, THE OWNER -BUILDER IMU. HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOFI THE P(JRPOSE OF SALE). 0 I, AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTFIACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR NAPROVES THEFIEON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B. & 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 DMSION 3 OF TIE BUSINESS AND PROFESSIONS CODE, AND DAY UCENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS 73 LIC. NO. g 2,341SY DATE /0/510 y CONTRACTOR _40-1A.4-14F744V 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. I HAVE AND WIII MAINTAIN WORKERS' COMPENSATION INSURANCE AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORIAANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (IHS SECTION NF_EDNOTBE CONFUTED °FIFE PERMIT'S FOR CNE FUFDRED DOLLARS ($100)OR LESS). I CERTIFY THAT IN 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 1NORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION P • • SIONS OF S. 3700 OF THE LABOR CODE) SH.L FORTHIMTH COMPLY WITH •Aly • .• i 6/ 0-11 DATE: APPLicANT. Ar• wiLrAr WARNING: FAILURE TO SECURE WORKERS' COWEN RAGE IS UNLAINFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES I FINES UP TO ONE HUNDRED THOUSAND DOLLAFIS ($100000)., IN ADDMON TO THE COST OF • .. PENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LAI3OR CODE, INTEREST, AND ATTORNEYS 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. 3097, CIV. C.). LENDER'S NAME LENDEFrS ADDRESS I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WM4 ALL CITY AND COUNTY OFIDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSE& e CIANAA3 Nkri. G AA-41) PERMIT -FEE N .," AL. ib/S-10y SIGNATU - OF PERMITT 91 DATE ON CITY OF DIAMOND BAR INSPECTION RECORD I ., ,1... V,141.14,4% zity,•2 r- SET BACK : FLOOR JOIST FTGSIFORMS/STEEL *FHA REQMTS _-LECTRIC GROUND _ - _ _ I GROUN-D. PLUMBING * _ UNDER FLOOR DUCT UNDER FLOOR. CONDUIT SLAB GRADE _ TEMP- P-OWER WA-T-ER SERVICE i FIREPLACEFOUNDATION FIREPLACE BOND BEAM MID HT BOND BEAM ROOF SHEATHING .8 F-, BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING - . BENCHING ROUGH ELECTRIC - • ROUGH GRADING ROUGH PLUMBING 1 FINISH GRADING SHOWER/TUB TEST ' POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL 'FINAL - CEILING INSULATION OFF SITE IMPS. DEDICATIONS DRYWALL NAILING FINAL ENG SEWER : - : LANDSCAPEIIRR la SEPTIC TANK SEEP Pri/L.L. ::ON SITE IMPS. GAS AIR TEST , FINAL ZONING FINAL CONST An'. ----W Arr : I FIRE DEPT FINAL RNAL HEATING :HEALTH DEPT. F:NAL I AL ELECTRIC :(..,4,/ DEV, FEES PAID COMMENTS ":'4..#.4............ ; /.." ENERGY t... :i: SEPTIC TANK SIZE SEEP PIT/U SIZE r