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Home My WebLink About11-1354� ��_ CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� ;,,_W . 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7 �n PRESS '°�'` BUILDING PERMIT APPLICATION /�-- FVRMLY o� JOBSITE r� �7 APPLICATION PERMIT P/C I ADDRESS O�� JC'n��G►. � • DATE NUMBER " # � ISSUE Q � TypE p�� APN LOT TRACT DATE OCC p OWNER ��G�V�.C. ��1"1 I I i�'n�G� � CONST. W�'1� GROUP p ADDRESS '�I�l ��1�v�� G(� � ZONING SET ACKS Z CITY(�•"3 0,� ZIP 'ILi . TEL.�1��j Clb-3�j'SG FRONT RW ❑ p APPUCANT ' TEL.(1� 45�-�2ky � REAR � SIDE/SIDE STREET RW ❑ Q CONTRACTOR �,S�i�/`C- �oC7�C(' ��(5 . SIDE p ADDRESS<1'�� 5• �^ro w � CIN /k2v S G� ZIP�11�UZ TEL.� tSS -c12$ PROPOSED USE w ARCH/ENG/ � z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � <n DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O . p I HEREBV AFFIRM UNDER PENPL7Y OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f89B/CBfpOh W CENSE LAW FOR THE FOLLOWING REASON(SEC.7o31.5 BUSINESS AND PROFESSIONS CODE:ANV CI7V OR (n U CAUNTVWHICHRE�UIRESAPEFMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG � w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAP7ER 9(COMMENCING WITH SECTION 7o00)OF DIVISION 3 OF THE BUSINESS AND PRO- V' PooVSpa O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP� (� V TION.ANYVIOLATIONOFSECTION7a31.5BYANYAPP�ICANTFORAPEFMITSUBJECTSTHEAPPLICANTTO Z Re-Roo( . � A CIVIL 7ENALTY OF NO7 MOpE THAN FIVE HUNDRED DOLLARS(3500).): � � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfnfnBfCl21 Z WILL DO THE WORK,AND THE STRUCTUFE IS NOT IN7ENDED OR OFFEFiED FOR SALE(SEC.704�,8U51- J � � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF � ' PROPERTY WHO BUILDS OR IMPROVES THEREON,AND HMO DOES SUCH WORK HIMSELF OR HEHSELF OR � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THA7 SUCH IMPqOVEMENTS ARE NO7 INTENDED OH m Q OfFEREDFORSALEIF,HOWEVER,7HEBUILDINGORIMPqOVEMENTISSOIDWITHINONEYEA{iOFCOMPLE- Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HA7 HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPER7V,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS Q TO CANSTRUCT THE PR0.IECT(SEC.7014,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V81UetlOfl ADJ.AREA W CENSELAWDOESNOTAPPLY70ANONMEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITV DESCRIPTION FEE Y TORS LICENSE UW.). QO I AM EXEMPT UNDER SEC. B.8 P.C.FOR 7HIS REASON Q � U ti � DATE OWNER F- 0 W � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDEFi PENPL7V OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F 7HE BUSINESS AND PROFESSIONS CODE,AND Z � , � � XL� MY LICENSE IS IN FULL FOfiCE AND EFFECT. m C\�� n LLI � UCENSECLASSC3�G �Z. LIC.NO. JIIC'S�I�� '7 j , U DATE`�S^ �� . CONTRACTOR Y.I�SLf.�� FOO"'�C�! .. a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER OENALTV OF PERJURV ONE OF THE FOLLOWING DECtARATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a ¢ COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION J - j CARRIER �-D GIC.�pn C 0��(rY�^\��S • PLAN REVIEW � POLICYNUMBER WG-I� C�3�^S_C�IQ )�-DI I ELECTRIC Z • Q �j � (IHISSECi%XJNEmNOTBECI7MF�EfEDOFTHEPERMfTISFORONEHUt�DfiED00lLARS(5100)ORLESS). PLUMBING �/ �) J Z �CERTIFV THAT IN TNE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO 7HE (/� WORKERS'COMPENSATION LAWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SUBJECT TO THE WORNERS'COMPENSA710N PROVISIONS OF SECTI N 370a OF THE LABOP CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISI 5. ISSUANCE �/�� p OATE:��y� �� APPLICANT: SMIP , J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION C V RAGE IS 11N FUL,AND SHALL BE ENERGY P/C � SUBJECTAN EMPLOYEF 70 CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC710N 3708 OF THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ,a OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �-V � I HEREBYAFFIRM UNDEfi PENALTV OF PEFiJURY THAT7HERE IS ACONSTRUCTION LENDING AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDEfl'S NAME � LENDER'SADDRESS � TOTAL FEES , 7� � I CER7IFV THAT I HAVE fiEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. w 1 AGREE TO COMPLV WITH ALL CIiY AND CAUNTV OFDINANCES AND STATE LAWS REU7ING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON 7HE � ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. Z -�-. COMMENTS � �"�n cnn 1 dG�In v�-�"��' m PERMI EE NAME T) ' � c¢_n „(��, L�"► ( � SIGNA E FPER E DATE Z RECPT.NO. PAID BY VALIDATION ~ WHITE—DepaRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy C9�V �f� �9A�ii�V�� AB� . I�Is(�1��'�Of�9 ff�[c�O�dD , ,Da�pC�G400a QQ4C� 01►.�1�pCC�40a Oa�pC�C�400a ° DLa4C '� Of:I��PC��I�-�, �� SET BACK 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 H'T. BOND 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 SHOWERlTUB TEST POOL 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. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL ---- -- ---- - ---- --- - -- --------�---------...._._.._...--------- FINAL ELECTRIC DEV. FEES PAIQ _ _________ FINAL PLUMBING Bp �_(� � � ENERGY � � ��o � COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � c� �