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Home My WebLink About11-1123 l _lF,�,`_ � CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �,_w , 21825 Copley Dnve,Diamond Bar,CA 91765 ' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 E$$ '�"'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE [�� /� I�� (�c APPLICATI N _ PERMIT /Y/l� �lC �� o ADDRESS_p ('i' � DATE NUMBER � � ISSUE � TYPE OCC APN LOT TRACT DATE �� / CONST.��yU�I✓ GROUP p OWNER i G o ADDRES�S � ZONING SETBACKS Z CITY i ZIP TEL. � S' FRONT RW ❑ o APPLICANT r e- TEL. �� 5' SIDE/SIDE STREET RW ❑ z � CONTRACTOR �G� !1 SIDE p � ADDRES � q PROPOSED USE G�I � - / 1� CITY . ZIP EL. " p � w ARCWENG/ �� ` � � z DESIGNER �-° G' �1 r' ' 10 a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THA7 I AM EXEMPT FROM 7HE CONTRACTORS LI- Gef89B/CBfpOR W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n � U CAUNttWH�CHREOUIRESAPERMIT70CANS7RUCT,ALTEH,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W P8SI0/DBCk W TURE,PRIOH TO ITS ISSUANCE,ALSO REQUINES THE APPLICANT FOR SUCH PERMIT TO PILE A SIGNED W I � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTFiACTORS LI� � � CENSE LAW(CHAPTER 8(COMMENCING WITM SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPB . 0 FESSIONS COOE)OR 7HAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGE�EXEMP- (� V TION.ANY VIOLATION OF SECTION 7037.5 BYANY APPLICAN7 FOR A PERMIT SU&IECTS 7HE APPLICANT T0 Z Re-Roof � A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(t5oo�.): Z ❑I,ASONMEROFTHEPROPERTY,ORMVEMPIOVEESWITHWAGESASTHEIRSOLECOMPENSAT10N, � COrt1ffIBfC121 WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7EN�ED OR OFFERED FOR SALE(SEC.70��,BUSI- J NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NO7 A7PLV TO AN OWNER OF �� ,\ C��p /� . � N PROPERTYWHOBUILOSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � �r CC THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m V Q OFFEREDFORSALE.IF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOlDWI7HINONEVEAROFCAMPLE- Z TION,THE OWNER�BUILDEq WILL HAVE THE BURDEN OF PROVING 7HA7 HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROF7HEPROPEHTY,AME%CLUSIVELVCONTRACTINGWI7MLICENSEDCONTRACTORS � TO CONS7RUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE COMRAC70R5 LI� V81U8fiOn � ADJ.AREA W CENSELAWDOESNO7APPLY70ANONTJEFiOFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCON7RACTSFORSUCHPRQIECTSWITHACONTRAC70H(5)LICENSEDPURSUANTTOTHECON7MC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J � W� l'�/ i � 0 ❑I AM EXEMPT UNDER SEC. B.a P.C.FOR THIS REASON Q LL Q �� ' 1./ DATE OWNER � Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERIURV 7HA7 I AM UCENSED UNDER VROVISIONS OF CHAPTER � d Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULI FORCE AND EFFEC� �1 n m � LICENSE SS LIC.NO. �/ ��/ � � � �IS� II J V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � 1 HEREBV AFFIRM UNDER PENALN OF PER1l1fiV ONE OF 7HE FOLLOWING DECURA710NS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LA80R CODE,FOR THE PERFORMANCE W Q �OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw 1 HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /}�) ISSUED.MY WORKERS'CAMPENS/A�/T�ION INSUHANCE CARRIER AND PO/L�ICY NUMBERARE: ONSTRUCTIO �/p„�J j CARRIER �� ',1 /1 C � VIEW s�/,� � Z POLICV NUMBER S'OD d t TRIC Q � (iHISSECTIONNEmNOTBEOJMPLETEDOF7HEPERMfT15FORONEHUI�DREDD011ARS(5100)ORLESS). PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE M/0RN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSA710N LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECAME INSP TION FEE � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE IABOR � CODE,I SHALL FOHTHWITH COMPLY WITH T SE PROVISIONS. C UANCE ✓ � � p DATE � APPIICANT: J WARNING:FAILURETOSECUFEWORKERS'COM SATI COVERAGEISUNLAWFUL.ANDSHALIBE ENERGYP/C � SU&IECTANEMPLOYEFTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(f100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN /�� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. ENTION F :l/lJ OCONSTRUCTION�ENDING AGENCY P ALT FEE: � I HEREBV AFFIRM UNDER PENALN OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCV ��. ! FOR THE PERFORMANCE OF THE WOfiK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). W �T LEN�ER'S NAME i F— LENDER'SADDRESS J w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES / /�' � � I AGREE TO COMPLY WI7H ALL CI7Y AND CAUN7Y ORDINANCES AND STA7E UWS RELATING TO BUILDINC � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PUFPOSES. COMMENTS � � OP� �� /`ee- m PERMITTEE A E(PRI T) � ' Q � I '� � SIGNATUR ERMI EE DATE = RECPT.N0. PAID BY ALIDATION ~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicanl's Copy CB�Y O� DGA4VVa�l�� Aff� E6�Sf�1��001� �I��OR� Oa�pC��400GY1 DQ4� ' Oa�pC�C�40Q Oa�pCC�400a QQ4@ Oa�pC�p SET BACK FLO�R JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT • GROUNO PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE B�ND BEAM WATER SERVICE MID H'T. ��ND 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 P�OL 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. f��_�� y_� FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY - ��.''� COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � — -- ----- ---- �