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1 I CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117 FRE
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS 23.ryr >/X2?AC- 27G. F.
APN LOT TRACT -
OWNER A7M7WP ,6ACLLCI' %14� - � "'
ADDRESS
CITY CX -Wi.4G • ZIP TEL
APPLICANT S/ N tip'" TE i 0
CONTRACTO s/6A—C- cef
ADDRESS r
CITY &n:_1(a-Av0Yrjt5M ZIP-t'-t-F-LJ TEL
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U.
CENSE UAW FOR THE FOLLOWING REASON (SEC. 7071.E BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTYWHICH REOUIRESA PERMIT TOOONSTRUCLILLTER. IMPROVE, DEMOLISH. OR REPARANYSTRLIC•
LURE, PRIOR TO ITS ISSUANCE, ALSO RECUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U-
CENSE LAW (CHAPTER S (COMME—NO WITH SECTION "W) OF DIVISION S OF THE BUSINESS AND PRO-
FE55CM CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7001.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
ACIVL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 05000:
❑ L AS OWNER OFTHE PROPERTY. ORMY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WIL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 70". BUST -
MESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE UAW DOES NOT APPLY TO AN OWNER OF
PROPERTY W11O SURDS OR IMPROVES THEREON. AND VAHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE F. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITIMN ONE YEAR OF COMPLE-
TION. THE OWNER GUIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD on
IMPROVE FOR THE PURPOSE OF SALE}
O L AS DINNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70M, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY VA40 BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S)UCENSED PURSUANT TO THE OONTRAG
TORSUCENSELAW.).
O 1 AM EXEMPT UNDER SEC, B. 6 P.C. FOR THIS REASON
DATE �.�—H✓}�Grb OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
B NWI COMMENCGTH SECTION70DOJOFOMSION70F THE BUSINESSAND OPOFE55IONS CODE- AND
LICETHSE IS INFULL FORCE AND EFFECT.
LICENSE CLASS ! LIC. NO. A
DATE -• coNrRAcron�{
WORKERS' COMPENSATION DECLARATION I HEREBYAFFBW UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECURATINS./^jam
_I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT Tn ;-!".51 ME FOLWORKERS'
COMPENSATION. AS PROVIDED BY SECTION 77000E THE LA.i7tC :')P THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMITISISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS RED;; 4_..: SECTION
77DD OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(nISSEcrnNNEED NOT BEcaICE
PERMITISFORONE s+ 1OnLESSi
I CERTIFY THAT N THE PERFOE WORK FOR HICH I ERMIT ISI.,UED,I
SHALLNOT EMPLOY ANY PERSNJNER SOAS BE SUBJECT NEWDPo(ERS'COAIPENSATION LARNIA,ANO RE IFI BECOMESUBJECT TO THE WORKERT Co0OFTHE LABOR
WOE.151UIL fORTIWIITH COOSE PRDATE: 0'"V5—CoAPPLI-WARNING: FAIURL TO SECURE WORTCOVERAGEISUNLAWFUL. AND SNAIL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CV4 FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (SI00.0W). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
i SECTION 7708 CC THE LABOR CODE, INTEREST AND ATTORNEYS FEES,
L CONSTRUCTION LENDING AGENCY
IHEREBYHINDER PENALTY OFPERJURY THAT THERE ISACONSTRICTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.7OW, CIV. C,).
j LENDERS NAME
LENDERSADDRESS
I CERTIFYTHAT I HAVE READ THIS APPLICATION AND STATE THAT THE V f0 ATION IS CORRECT.
I AGREETO COMPLY WRTH ALL Crry AND COIXNTY ORDINANCES T LAWSR T%TO BUILDING
3 CONSTRUCTION, AND HEREBY"
EREBY AUTHORIZE REPRESENTATIVES TO NTERUPONTHE
ABOVE.MENTIONED PROPERTY FOR NSPECTION PURPOSES.
J iiZJiG�{ f'
PERMITTEE NAME ._ ����
D J
"NATURE OF PERMITTEE. DATE
CATION �� 2 —�� PERMITNUMBER � P 6 O
DATE `J t'•
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE -7 C,-'' •3 A" 4( cS1610S
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
-DESCRIPTION
SO, FT.
FACTOR PSF
ADJ. AREANALUATION
SFR/ADD/REM
Garage/Carport
WPatio/Deck
L-
PooVSpa
ZRe
-Roof
Commercial
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m
Valuallon ADJ.AREA
QUANTITY
DESCRIPTION ' (
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CC'I'IIAUCTION !III InAI
PLAN REVIEW k- F 1
ELECTRIC or
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
-
SMIP .
ENERGY P/C FEB 1 2000
.I
ENERGY PERMIT
1
RETENTION FEE:
PRE-ALT FEE T
TOTAL FEES
1
JUTS
RECPT� PAID BY U VALIDATION
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WHITE—DBpaRment G017y, YELLOW—FNanOO LAP✓. YINR—ASSIHISM VM, a-wy, U—Mr—pp— 5 %-WY -
CITY OF DIAMOND BAR., -
_.�
'INSPECTION'RECORD _ ��.�. ','.• ; • : '
SETBACK ti .. (: i ;�
-,
_ ; . „,
FLOOR 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 HT. -BOND BEAM
-
ROOF SHEATHING
-
8 FT. BOND -BEAM
-
• • - I
FRAMINGNENTILIATION
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
f
SEWER
_
_.
FINAL ENG.
.SEPTIC TANK_ .._. _.... . __.
_ _ ...
'.. :L'
LANDSCAPE/IRRIG.
SEEP_PIT/L:L.=. --= .- =
ON SITE IMPS.
f :.
GAS AIR TEST; -
FINAL ZONING
-FINAL CONST.
p
': __
FIRE DEPT. FINAL
FINAL HEATING
-
HEALTH DEPT. FINALr.
FINAL"ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE -
-
SEEP PIT/U SIZE
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