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Home My WebLink About17450� - � _ _ ,S ,',�6 , , , � "- ari � c , 1 f� CITY OF DIAMOND BAR ��' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� ( 21660 E.Copley Drive Suite 190 �i (909)86a3195 Fax(909)861-3117 PRESS ��A�'� BUILDING PERMIT APPLICATION � �IRMLY � o� JOBSITE �6g Q �/AZLo Td � APPLICATION Q PERMIT �P/C L�. ADDRESS ! (� /� �l DATE � � NUMBER I� # O — 1 I Z � APN L T � TRACT Sl�6 ISSUE ��_jl TYPE OCC DATE \J CONST. GROUP °C OWNER u C O � ADDRESS �.OZ ZONING . SEBACKS / Z CITY � �1'r0 ZIP L. � � REART � RW p Q APPUCANT G:I EL. SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ��S ❑ ADDRESS PROPOSED USE � CITY ZIP TEL. I w ARCH/ENG/ z DESIGNER r�� NO.DWEL. . NO. NO. a ADDRESS UNITS � � STORIES a"' BEDROOMS�, � CITY ZIP EL. ' � DESCRIPTION SQ.FT. FACTOR PSF ADJ. REANALUATI N p� OWNER-BUILDER DECLARATION SFR/ADD/REM � � O . � I HEREBV AFFlfAI UNDER PENALTV OF PEILri1RV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G818 6/Cfl ff ' W CENSEUWFORTHEFOILOWINOREA.AN(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCfTYOR �(n 9 � �� U COUMYWHICHREOUIRESAPERMRTOCONSTRUCT,/�LTER,IMPAOVE,DEMOLISH,ORREPAIRPNYSTRUC� P8Si0/DBCk Bv Z TURE.VRIOR TO ITS ISSUANCE,/�LSO RC-0UIRES hiE APPLICANT FOR SUCM PERMIT TO FILE A SIGNED W Z�O �� ' W STATEMENT hiAT HE OH SHE IS LICENSED PURSUMR TO TiE PROVISIONS OF THE COHTRACTORS LI• w y ,- � CENSE UW(CHAPTER Y(COAIMENCINO VATH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa•' FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND 7HE BASIS FOR THE ALLEGED EXEMP- TpH.ANY V10LAT10N OF SECTIOH 7071.5 BY ANYAPPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof � AGVIL PENALiY OF NOT MORE THAN FNE HUNDRED DOLLARS(SSoO)J: � � OI,ASOVMEROFTHEPROPERT/.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrt1R16fCi81 � � WILL DO THE WORK AND THE'STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70Il,BUSI- J NESS AND PROFESSIONS CODE:hIE CONTMCTORS LICENSE UW DOES NO7 APPLV 70 AN OWNER OF . � PROPEHTYNRIOBURDSORIMPROVESTHEREON,ANDVMODOESSUCHWORKHIMSELFORHERSELFOR � � CC iHROUGH HIS OR HER OWN EMPIOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � QOFFEREDFORSALEIF,FIOWEVER7HEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE- - ! Z TION,THE OMMERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR . � IMPROVE FORTHE PURPOSE OF SALE). - ❑I,AS ONMEROFTHE PROPEfRY,AM EJ(CLUSIVELV CONTMCTINO VrtTH UCENSED CONTRACTOFS Q TO CONSTPUCT THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8�10� ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOVMEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCOMMCTSFORSUCifPRQ1ECTSWIhlACONTRAC70R(S)LICENSEDPURSUANTTO7HECONTRAG QUANTITY DESCRIPTION � FEE '� .TORSLJCENSEUWJ. • . . ' . _ . 0 , O I AM IXEMPT UNOER SEC. � B.d P.C.FOR THIS REASON � , 3 � u" DATE OWNER � ~ � Z w � UCENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTY OF PEiUURY THAT I AM LICENSED UNDER PROVISIONS OF CHAVTER � . d Y(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS COOE,AND Z . � il� 4Y UCENSE IS IN FULL FORCE AND EFFECT. m � � LICENSE CLASS .g LIC.NO.��V / / � � J � V DATE CONTRACTOR �- . . . —- .�_I W � WOFiKERS'COMPENSATION DECLARATION � . . � ¢ U � I HEHEBY AFiIRM UNOER PENALTY Of PERIURV ONE OF THE FOILOWING DECURATIONS: Z '� , ' � '" � 0 _I HAVE AND WILI MAMTAIN A CERTIFICATE OF CANSEN770 SELF-INSURE FOR WORKERS' 2 , . � � COMPENSATION.AS PROVIDED BY SECTION 370o OF THE UBOR CADE,FOR THE PERFORMANCE �U � �OF THE WORK FOR WHICH THIS PERMIT IS ISSUEU. � � � 0 W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ' Q 97000F THE LABOR CODE,FOR THE PERPDRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKEHS'COMPENSATION IN/�u RANCE CARRIEH AND POUCY NUMBER ARE: CONSTRUCTION : � CARRIER D��//L_ PLAN REVIEW ✓ ' � POLICYNUMBER ELECTRIC VO � (fH6SECT10NNE�NOTBE00A�LETmOFhEPERAYfISFORONEHIMIRmDOLL/J15(5100)ORLE55} PLUMBING - w MECHANICAL Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH T UED,I C}' SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 5 OME SUBJECT 70 T � � O N WORKERS'CAMPENSATION LAWS OF CALIF , ND AGREE THAT IF I SHOULD BE E INSPECTION FEE ;, SUBJECT TO THE WORKERS'COAIPE N PROVISIONS OF SECTION 370o OF � UBOR CO I SHALL FORTH Ih1 COM ITH THOSE PROVISIONS. ISSUANCE p DATE: —�O O AP �ICANT: SMIP �.. w ' ENERGY P/C � WARNINd:FAIWRE TO SECURE VMDRKERS'COMPENSATION COVERAGE IS UNLAWFU�AND SH�LL BE � SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDFED 7HOUSPN� ENERGY PERMIT DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTpN37oeOFTHELABORCODE,INTERE57,ANDATTORNEI"SFEES. RETENTIONFEE: Q . ` \ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �� O � I HEREBVAFFIRM UNDER 7ENALTV OF PERIURV THAT THEFE IS A CANSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFiM1715 ISSUED(SEC.3oG7,CIV.C.�. Z W � LENDER'SNAME � , H IENDER'SADDRESS w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORREC7. TOTAL FE ES �/ O I � �'�U . i� � I AGREE TO COMPLV N7TH ALL CT'AND CWN1V ORDINANCES AND STATE LAWS RELA7ING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHOHIZE REPRESENTA7IVES OF THIS COUN7V TO ENTER UPON THE Z /�BOVE-MEMIONED PROPERTV FOR INSPECTION PUR70SES. COMMENTS � o � D G� L � m ERMITTEE NAME(PRINT) ^�� - � OF MITTEE DATE � ' RECPT.NO. PAID BY , VALIDATION WHITE—Depertment Copy,YELLOW--Finance Capy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � � � � �: 1. , . r C11'Y OF DIAMOOVD B/AR � ��,. ,, ' . _ �- . � B�BS�'ECTION F�EC�FiD ' � , . a.�.. .. , , m a , . � � . � e , e � e . , ,., _ _ , � �, � � , SET-B�GI(�� ', : � j�' FLOOR JOIST . , , - l . _ FTGS/F�RMS/STEEL � .w REQMTS: ELECTRIC GROUND UNDER FLOOR bUCT ,� � GROUND PLUMBING �2.; %G � '� =''`'��°��-•"-••••�-••• UNDER FLOOR CUTIDUIT . _ ' � SLABGRADE / ��'6" FIREPLACE.FOUNDATION-•�' `-. ' �" �' "� - � , i: - � . . TEMP POWER ' �FIREPLACE B�ND BEAM � - WATER SERVICE �;---, -- r .• MID HT. BOND BEAM ROOF SFiEATHING � GL l� 8 FT. BOND BEAM FRAMINGNENTILIATION �� -v � FINAL BOND BEAM ROOF COVER PRE-GRADING. ' ; .�. � � : � � j ROUGH HEATING BENCHING�� - - - '� ' � - � � � ROUGH E�. CT(�I,�. - ROUGH GRADING ROUGH �,L'Ut�IBIN� � FINISH GRADING � � SH01N�R/TUB�TEST - ' POOL ELECTRlC - EXT. LAtH)51DIN'G� � `D POOL FENCING WALL INSULATION - � POOL FINAI. CEILING INSULATION OFF SITE IfVIPS. � DRYWAL�NAILING DEDICATIONS SEWER p 2 FINAL ENG. SEPTIC TANK ;ti_`, -; ..• f . �•,-; �-; LANDSCAPE/IRRIG. SEEP PIT/L.L. ` ��' " `� ''�' � ON SITE IMPS. . GAS AIR TES� 1 FINAL ZONING FINAL CONST. y FIRE DEPT. FINAL � .� FINAL HEATING'� HEALTH DEPT. FINAL FINAL ELECTRIC'� DEV. F�ES PAID FIfVAL PLUMBING I ENERGY � ��7dd2 d � . �. �v�i� .SLR-'Y��(��4 ��.`_ 'L7'L _ ' �� .�� {�� `k�" ` --- - �' "u,' C�IViI!/ICItl 1 J �s�.r � �:•— a"� � - � - � - ��. ',.o�, .r+ .�� c�c;�s , t'f�-��. tv F2w.r� ��1.oz_�r's�;c'w � t�r� �,�, J c"::.`''�iC';�_' _ , . .,.; .`�;' ;,., ,; ;�: . . �..+�} �_`, ,.. - _._.._- . . . SEPTIC TANK SIZE SEEP PIT/U SIZE ��",_�� ' ki� �= . ��A�:;r ;, � � ,�,'�+,� � � ��n�� "�"y�'y, +�� ,�� a.=' \ � � � �r{t� 'r�ma,�. ' } I f� t-�,_ � '��'��'�*��^`°� �`- ' �!•.� 1 t., �, { � w�� i��` s �� •. s.� � ' ' S�-r�� :'�;�'�sv ��o':�,»� ' ' - � �,y�� t �,�, ti i'.'�*'� �.�aM+,� ,q . '. -,. �� , 4 5+ .,��A�� K�q �Sa � . . . � . . � � , R� �+ V ; .,, 1 a.f�`�� 6�}' . f�� '�A��+r' y± ,�, .. _ . — _ . __ :t �� t ' , �� CITY OF DIAMOND BAR � ��" - � -�---��`` --- DEPARTMENT OF COMMUNTI'1'&DEVELOPIvIENT SERVICES ' I 21825 E.Copley Drive , (909)860-3195 Fax(909)861-3117 PRESS � • ��"%�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION PERMIT �C u o ADDRESS 269$ �IazeTrail DATE � NUMBER-I�� O `� 1� °-° APN LOT 2 TRACT 51169 �SSUE TYPE ' OCC p OWNER Paul E LUC Shen DATE CONST. GROUP o ADDRESS '��110C1 ar ZONING SETBACKS Z C�Ty D�amon aY Z�p 9 �I6�E�. FRONT Ryy ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z Q CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSEDUSE Se�erate Garage w ARCH/ENG/ �z DESIGNER HOYIZOtI PBCIfIC NO.DWEL. NO. NO. a ADDRESS iamon aY UNITS STORIES BEDROOMS � CITY Diamon ar ZiP EL. � � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p p I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE CON7RACTORS LI� G8f0JB/C8ry0R �5 p 6 4 6 6 2 H.4O W CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSANO PROFESSIONS CADE:ANV CITV OR (n U CAUNTYWHICHREQUIRESAPEFiMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORHEPAIRANVSTRUC- 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 PUFSUAN7 TO 7HE PROVISIONS OF THE CONTRAC70RS LI- � CENSE LAW(CHAPTER D(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESSAND PRO- � PooVSpa . 0 FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (!5 U TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Rao( � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLlARS(t5o0)J: Z ❑I,ASOWNEROFTHEPROPERN,ORMYEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSATION, � COrt1f11BfCiel - WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BUSI� J N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILOS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOYEES,7ROVIDEDTHATSUCHIMPROVEMEN7SARENO7INTENDEDOR m w OFFEREDFORSPLEIF,HOWEVER71iEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- � TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT Bl11LD OR Z IMPROVE FOR THE PURPoSE OF SALEJ. _ ❑I,ASOWNEROF7HEPROPER7V,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCANTRAC70RS � TO CANSTRUCT THE PROJECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8I118t1Of1 �' ADJAfiEA W CENSE UW DOES NOTAPP�Y TOAN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND � WMOCAMRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTO7HECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIHM UNDER PENALTY OF PERJURV THAT I AM LICENSE�UNDER PFOVISIONS OF CHAPTER � d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z X AIV LICENSE IS IN FULL FORCE AND EFFECT. , � LICENSE CLASS B �,�.No. 7 3 9 3 4 4 j � J U DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z Z _IHAVEANDWILLMAINTAINACER7IFICA7EOFCONSEN7705ELF�INSUREFORWORKERS' _ Q COMPENSA710N,AS PROVIDED BV SEC710N 370o OF THE UBOR CODE,FOR THE PERFOFMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w I HAVE AND WILL MAINTAIN WORKEHS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 37oa OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS I- ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARflIER AtJD POLICY NUMBER ARE: CONSTRUCTION �(/�� CARRIER On-File PLANREVIEW � � ��uLICY NUMBER ELECTRIC Z Q 0 (1HLSSEC110NNE�NOTBEOOMPLEfEDOFTHEPERMITISFORONEMl1�DREDDOl1MS(f700)ORLESS� PLUMBING Z 1 CEHTIfY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (.'} SHALL NOT EMPIOY ANY PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE � WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE TMAT IF I SHOULD BECOME INSPECTION FEE = SU&1ECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHELABOR CODE,I SHALL FORTHWI7H COMPLY WITH THOSE PROVISIONS. ISSUANCE � � SMIP a �n p DATE: APPLICANT: J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERACaE IS UNUWFUL,AND SHALL BE ENERGY P/C � SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT � w� `� DOLLARS(5�00.000),IN ADDI710N 70 THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: Q a CONSTRUCTION LENDINC,AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PEFFORMANCE OF 7HE WOf1K FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ. Z W .`Z LENDER'S NAME i F— LENDER'SADDRESS /� � TOTAL FEES / (� (% � 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. L '1 �i��[ � I AGREE TO COMPLV WITH ALL CITV AND COUN7V ORDINANCES AND STATE IAWS RELA7ING 70 BUILDING J , o � CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � J � m PERMITTEE NAME(PfiINT) Q C!) � SIGNATUREOFPERMITTEE DATE � = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YEILOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co P PY, PY, PY. PY. PP PY �� f��Gil�l��[� ��af�i �� , ,` •� , '� ' ��1��'�C�u��r�l ��C�tC��iL� � - O�C°� U o . QLaS� O��C�� 0 � �C��t00� DQ� OG'�° � Q ' SET BACK I ;-'-T-- -----� FLOOR JOIST � � � i _.-- -._._----r------r-----....._.--- --- —------ - - FTGS/FQRMS/STE— EL � G � ! _FHA REQMTS � _�_Z ,�-------- . --._-- -----�---..._.._....- --- ELECTRIG GROUND ' ' UNDER FLOOF� DUCT , F� ---- -- ---- --i--- --- -___._ .__._.__�_� , __..._..-- GRC?UNQ PLUMBING _ _ _ ; UNDER FLOOR CUI�IDUIT i ' : �------ ----- - SLAB�RADE ZlJ,OZ��,.�� _ _ _FIREP!ACE FC1�JNqATlON '� ' _ _ _ _ _ _ .------- --_ ....---- TEMP POWER ! ' ; FIREPLACE BOND BEAM _ . WATER SERVICE __ ,.;. __ � ___._ . __.__ � _�ID HT. BOND BEAM-------- � ---�_.__ � _._...._..-- - ROOF SHEATHiNG y�Z�/.� 8 �. BOND BEAM _� _ FRAMINGNENTILIATION s�':�.�-o L �FINAI.BOND BEAM � - ----- --�-Y------ --._. ---._._...--------._.._._�,_ _...............__.. ROOF COVER ' PRE-GRADING ' ROUGH HEATING BENCHING _ ROUGH ELECTRIC _ F�OUGH GRADiNG ___ ____� ROUGH PLUNIBING i FINISH GRADING ___ _ ____ SHOWER�I'UB TEST POOL E!ECTRIC EXT. LATH/SIDING POOL FENCING �� I ' WALL INSULATION i POOL F1NAL � � --.- - --__...__- -,-----_ _._._._..---.____�_._. CEILING INSULATION '' OFF SITE IMPS. � DRYWALL NAILING DEDICATIUNS - ------- -- --.._- -- --.._...._.._._____—__---_ ._ . SEWER rINAL ENG. i SEPTIC TANK LANDSCAPE/1RRIG. SEEP PIT/L.L. � - � C?N SITE IMPS. --- -_- GAS A{R TEST FINAL ZONIfVG FINAL CONST. clRE DEPT. FINA! FINAL HEATING HEALTH DEPT. FtNA� FiN�L ELEG�RIC I DEV. FEES PAiD FIfvA�PLUMBING _� � � ENERGY ------- i -___ _- ��//_ _ _ - �zl z .��--- � � _.___- _z.Z ��_-l_�2 =— � � � � , - � - _— � �,��r��.��.o� .��= � _ , � � �c��-rs - - ._ SEPTIC TAP�K SIZE SEEP PIT/U SIZE -- — �" ---- � ------_ � � � — � . � , ' _!�� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��Y�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE p �( � APPLICATIOI� PERMIT �Q��,'7(� P/C o ADDRESS Z� r� ��2Q `rC`"� I DATE �� '� � NUMBER L�L� # DA EE 3 �Z TMPE OCC � APN LOT �L TRACT CONST. GROUP p OWNER S��'+� e �-r- p ADDRFnS�S 2- � 1' V�-� - � r.� 1 ' ZONING SETBACKS � CITY �I��..o P�I� 6�TEL. � FRONT RW ❑ APPLICANT ^ TEL. REAR ❑ � 3 SIDE/SIDE STREET RW ❑ � CONTRACTOR K ��-- 2C- v�..` '�. r SIDE ❑ Q AODRESS`L 3 � -t o CITY �'- 'r ZIP R��.TEL. �1/�I 2, PROPOSED USE wo ARCH/EN / � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STOFiIES BEDROOMS � CITY ZIP TEL. , � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION '� Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � p I HEREBY AFFIRM UNDER PENALTI OF PERNRY hIAT I AM EXEMPT FROM 7HE CON7RACTORS LI- G8f89B/CBfpOfl W CENSELAWFORTHEFOILOWINGREASON(SEC.7o37.58U5MESSANDPROFESSIONSCODE:ANYCITYOR (n C7 COUNTYWHICNREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck Z NRE,PRpR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CONTMCTORS LI� W � CENSE UW(CHAPTER o(COMMENCINO WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa - : FESSpNSCODE)ORiHATHEORSHEISEJ(EMPTTHEHEFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� TION.ANVVIOUTIONOfSECTION7031.58YANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Foof � ACIVIL PENALT/OF NOT AIORE THAN FIVE HUNDRE�DOLURS(f5oo).)� . � ❑I,ASONMEROFTHEPROPER7V,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial � . � � NALL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OH OFFERED FOR SALE(SEC.7oal,BUSI- J NESS AND PROFESSIONS CODE:THE CON7RACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERiVWHOOUILDSORIMPROVEShiEREON.ANOWHODOESSUCHWORKHIMSELFORHEHSELFOR m � THf10UGH HIS OH HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR QOFFEREDFORSALEIF,HOWEVER711EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- Z �'TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR TNE PURPOSE OF SALE). W ❑I,ASONMEROFTHEPROPEHTY,AME%ClU51VELYCONTRACTINOWITHLICENSEDCONTMCTORS Q TO CONSTRUCT THE PRQIECT(SEC.7oa1,BUSINESS AND�PROFESSIONS CODE:THE CANTRAC70R5 LI- VelU8f1011 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONMEROFAPROPERTVWHOBUIIDSORIMPROVESTMEREON,AND � WIqCONTRACT5FOR5UCHVF0.IECTSWIh1ACONTMCTOR(S�LICENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION � FEE � � TORS LICENSE UW J. Q ❑I AM E%EMPT UNDER SEC. B.d P.C.FOR THIS REASON Q 3 �� DATE OYMER V ll! � LICENSED CONTRACTORS DECLARATION W ,. , � I HEREBYAFFIRAI UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS Of CHAP7EH � Ur , d, Y(COMMENCINO WITH SECTION 7000)OF�IVISION 9 OF THE BUSINE55 AND PROFESSIONS CADE.AND Z iLi AIV UCENSE IS IN FULL FORCE AND EFFECL ' C Zo �'2� O� -�j � � � LICENSE C SS LIC.N0. � � V OATE d CONTRACTOR a W � WORKERS'COMPENSATION D ATI � A(� O�� ' � 1 HEREBV AFFIRM UNDER PEN�LTY OF PERIURV ONE OF THE WING DECUHATIONS: � Z 3 � � 6o vr.+�r��(,,_ . s -,., � IH�VEAHDWILLMAINTAINACERfIFICA7EOFCONSENTTOSELF-INSUREFORWOFKERS' 2 � c Q�c9�j'� , "�^O� � COAIPENSATION,AS PROVIDED BV SECTION�70o OF TI1E UBOR CODE,FOR THE PEFiFORMANCE W o Of TiE WORK FOR WHICH THIS PERMIT IS ISSUED. � W � I HAVE AND WILL MAIMAIN WOflKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION Q 37o00F THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK WR WHICH THIS PERMI715 ISSUED.MY WORKERS'CO PENSATION INSURANCE RRIER AND POLICY NUMB R�RE: CONSTRUCTION jCARRIER G�Q Y�-� �°�1 N��O N q p�qN REVIEW � POLICV NUMBER �< < a�2 ELECTAIC � (IFUSSK.'f10NNE�NOTdE00�.�lEfmOFhEPEFAtlTSFnRaNEHINiJHEDDOUAiLS(5100)OFiLESS) PLUMBING _ Z I CEHTIFV THAT IN 7HE PERFORMANCE OF THE WOHK FOR WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL � (} SHALL NOT EMPLOV ANY PERSON IN ANY MAN E�SO AS O BECAME SUBJECT TO THE � WORKERS'COMPENSATION UWS OF CALIf Nltd AND FEE TH�T IF 1 SHOULD BECOME INSPECTION FEE � � � SUBJECTTOTHEWORNERS'COMPENSAT PROVISI SOFSECTION37o00FTHE R � � CO 1 SMA ORTHWITH COMPLV WI HOSE�PR ISIO 5 ISSUANCE � ' 0 c� / � p DATE:� L 0 APPLICANT. � SMIP . w � ENERGY P/C J WARNING:FAILURE TO SECURE WORKERS' MP SATION C ERAGE IS UNLAWFUL,AND SHALL BE . � SUBJECT AN EMPLOYER TO CRIMINAL PEN IES 0 CIVIL ES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f10o.000),IN ADDITION TO7HE CO COMPEN ATION,DAMAGES AS PHOVIDED FOR IN J SECTION 970B OF iHE LABOR CODE,INTEREST.AND ATTORNEV'S FEES. ' RETENTION FEE: � ~ � CONSTFUCTION LENDING AGENCY PRE-ALT FEE: � I HEHEBV AFFIRM UNDER PENALTV OF PERJURY THAT THEHE IS ACONSTRUC710N LENDING AGENCY 1 FOR THE PEHFOFMANCE OF THE WORK FOR WHICH THIS PERMI7 IS ISSUED(SEC.3oe7,CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS � I CERTIFY THA7 I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORREC7. TOTAL FE ES �� w I AGflEE TO COMPLV WITH ALL CfTV AND COUNTV Oi1DINANCES AND S7A7E LAWS REUTING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V 70 ENTER UPON THE � � ZABOVE-MENTIONED PROPER7Y FOH INSPEC710N PURPOSES. COMMENTS � � ��/�� J�I�n� � m PERAIITTEE N E PfiINT � � � �� ' SIGNATU OF E, ITf DATE I � �/ RECPT.NO. PAID BY � VALIDATION � WHITE�epertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , - - — � • ' � � � : �� , �� 8��Q�� $��:�� , .. _ , � � � ' � ,.{�� * p .� A��: � p �l`�� -` � `� �� tn�tr"�s��. � �SET BACK j � FLOOR JOIST ' � ( . FTGSlFORMS/STEEL � � FHA REC�MTS � ELECTRIC GROUND ' UNDER FLOOR DUCT -�.; ' --------- GROUND PLUMBING UNDER FLOOR CUhIDUIT _1 I • , ----...._-------� SLAB GRADE _ FIREPLACE FOUNpATiON • - • � -- - -..._.__--- TEMP POWER I FIREP,LACE BdN� BEAM :. � � � WATER SERVICE _ __ MID HT. B�ND BEAM _`___ __^. � ROOF SHEATHiNG • 8 Ff. BONd,BEAM � FRAMINGNENTIUATI�N FINAL B—OND B�A,IVI " � ^ ROdF COVFR PRE-GRADING I v ROUGH HEATING �Z1��2 BENCHING ----__ _ ROUGH ELECTRIC � ROUGH GRADING � ROUGH PLUN161NG FINISH G�iADING SHOWERlTUB TEST PQOL ELECTRIC EXT. LATH/SIDING ' POOL FEhCING WALL INSULATIOPV ,�z� �i. �� POOL FINAL GEILff�G 1�6SULATION �y��_` �J% ( OFF SITE IMPS. �RYWALL fVAIUNG DEDICATIONS SEUVER FINAL ENG. � v SEPTIC TANEC LANDSCAPE/IRREG. � SEEP PIT/LL. ON SITE IMPS. I GAS AIR TE�T � FINAL ZONING ' -- ------ �.�.�._�� F'itiF;L C�JPJST. �—� FIRE.DEPT. FlNAi_ , _�__� � .-.v - -----_ ._ --- ---- Gl;uf',!_NEATING Z.�. � � HEALTH dEF'WI'. FiNAL , -------------------�-___ _ -__�._A ---------- ' -- - - -------_____ Fi;��+1_,ELECTRIC j ��j j �'J�V. �EES �AID �_'--'�;h,��PLUMBfPvG ` � ENERGY --.____._____ _.._.�_.---' , �• , _......_--..__ — — ___� --- ---------- ----------------�-- _ i � .,--_-,_.,_�,�� ^_�—� —.�__ �...—� � r''��C� �O �":�. � �'� �] �-- - -- . ---- � , ' t�✓�4��5 -- , _. __ �. .__—_ ��.___ _ � , --_._._...._._._.__.� � -- --- -- � w_._.�__ � � -- --------.._._.___.._. � ____------- -� �._._.__.__ � SEPTIC TAlVK SIZE � SEEP PIT/U 51ZE —� ------ -- ------— ; � — ---- ------ � _ � � � �� — -- , . —. ---__.__. � � . ; _ . ,�, . . � , � _____ -�----- ._-._.�_______.______--�--- --_-------j ' � —--��— CITY OF DIAMOND BAR I DEPAR'I7v1ENT OF COMMUNITY 8c DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��'""� BUILDIIVG PERMIT APPLICATION FIRMLV o DDRESS Z�9� ��C4�e Tra � I�(� APPLICATION PERMIT ` �t+�i P/C � I � DATE 10' �.S" O 3 NUMBER � 1� �1 T° APN LOT � TRACT 5 1 )b 9 ISSUE TYPE OCC DATE CONST. GROUP p OWNER P�►�i � 'L�,��. sh��, � ADDRESS�-I o1 D i Glrnor�r� QGt1r 1, 4$�O 1 ZONING SETBACKS � Z CfTY D-�✓ ZIP�T TEL. FRONT RW p � APPLICANT �HOr'�ya�1 TEL.4�$bnl-�O/ql �� REAR ❑ � SIDE/SIDE STREEi RW O ¢ � CONTRACTOR R� �L.th11`J�f� SIDE p Q ADDRESS ZO�-) �I Q E � CITY �1�e �YCI ZIP�17 TE�.9/592•5 PROPOSEDUSE_ _ �'� {�- Plu�b;. ra w ARCWENG/ T- � DESIGNER � NO.DWEL. NO. NO. a ADDRESS UNITS I STORIES _BEDROOMS � CITY ZIP TEL � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENPLTY OF PERNRY THAT I AM IXFAIPT FROM THE COHiRA[.'fOfS L4 Garape/Carport W CENSEUWFORTHEFOLLOWINGREASON(SEC.70.7t.58U51NE55ANDFROFE5510NSCADE:ANYCITYOR (n U COU1(h'WHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPNRPNYSTRUG w w TURE.PRIOR TO RS ISSUANCE,ALSO REOUIRES THE AP7LIc'.ANT FOP SUGIi PERMIT TO FILE A SIGNED w Patio/Deck S7A7EMENi 711AT HE OR SHE�S LICENSED PURSUANT TO THE PROVISIONS OF TiE COHTMCTOR9 LF � CENSE UW(CHAPTER B(COMMENCWG WITM SECrION 7000)OF DIVISION 90F THE BUSMESS AND PRP �- PooUSpa FESSqNSCODE)OR7HATHEORSHEISIXEMPTiHEREFROMANDTHEBASISFORTHEALIEGEDE%EMP- (� � TpN.ANVVIOLATpNOFSECTION7o31.5BYANYAPPLICJWTFORAPERMITSU&IEC75iHEAPPUCANT70 Z Re-Roof A CML VENALTY OF NOT MORE 1}IAN FIVE MUNDRED DOLLARS(f500).): Z ❑�ASONMEROFTHEPROPERTY,ORAIVEMROVEESWITHIVAGESASTHEIRSOLECOM7ENSATION, � COfilrtlBfC18I � NALL DD THE WORK,AND THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SAIE(SEC.701t,BUSL J � NESS AND PROFESSIONS COOE:7HE CONiRACTORSIICENSE UW DOES NOT AVVLY TO AN OWNER OF � VROPEHiY NTIO BUtt.DS OR IMPROVES THEREON.AND NRfO DOES SUG1 NVRK HIMSELF OR HERSELF Oq � THROUGHHISORHEflONMENPLOYEES,PROVIDEDTMAT5Up1WPROVEMENTSARENOTPITENDEDOR m w OFFER�FORSALEIF,FqWEVER7MEBURDINGORWM30VEMINTIS50LDWRHINONEYEAAOFCOAIPLE � TpN,THE OWNEf4&11LDER WILL HAVE THE BURDEN OF PROVINO 7HA7 HE OR SHE DID NOT BUIID OR Z WPROVEFORTHEPURPQSEOFSALE} ' Q_ ❑I,ASONMEROF7HEPROPERfV.A1AEJ(CLUSIVELVCONTRACTINGWfTHUCENSEDCOMfNACTORS TO CONSTAUCT 7NE PR0.IECT(SEC.7a1,BUSINE55 AND VROFESSIONS CO�E:THE COHTRAC700.5 LI- V01u3flon ApJ.AqEA W CENSE UW DOES NOTAPPLV TOAN ON7JER OFAPROPERTY WHO BUILDS OR IMVROVES THEREON,AHD � WHOCONiRACT5FOR5UCMPR0.1ECT5WITMACONTMCTOR�S)LICENSEDPURSUANTTOTHECONTRAC pUANTITY DESCRIPTION FEE � -� Y TORS LICENSE LAw.). .� � �I AM EJCEMPT UNDEN SEC. B.8 P.C.FOR THIS REASON I 101 L S � � lL O DATE ONMER � �.)Q � d ,S ' L1 � LICENSED CON7AACTORS DECLARATION •S �� , � 1 HEREBYAFFIRN UNDER PENALTV OF 7ERJURV THAT IMI LICENSED UNDER PROVISqNS OF CHAVTER � , -1_3 �r � G(COAIMENGNG WITH SECfION 1000)OF DNISqN 30F 7HE BUSINESS IWD PROFESSqNS COOE,AND Z VVG� � W LK:Q15E IS P!FULI FORCEAND EFFECL /1 ��A m , ' ��e� � � T �I � LICENSE CLASS C' �� LiC.NO. j / � � C� w DATE CONTRACTOR RD Pl�.ernb.'n�� r ��i ✓ � WORKERS'COMPENSATION DECLARATION prf N1 HERFBV AFFlRM VNDER VENALTV OF 7ERIURY ONE OF THE FOLLOINNG DECIARATqNS: u� 0 _IHAVEANDWILLMAWTAINACEfifIFICATEOFCONSEMTOSELF�INSUREFORWORRERS' ¢ COMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CODE,FOR7HE PERFORIAANCE OF iHE WORI(FOR NM111G/7H15 PERMIT IS ISSUED. 0 w _1 HAVE AND WILL MAIMAIN WOPo(ERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 9700OF 7HE LABOR CODE,FOfi THE PERFORMANCE OF THE WOfa(iOR WHI(]i 7HI5 7ERAIR i5 LSSUEO.YY WORI(ERS'CONPENSATION INSUHIINCE GqR1ER AND POLICI'NUM9ER ME CONSTRUCTION J j CARRIER PLAN REVIEW ZaoucrNuueEa ELECTRIC ¢ � (nass[cr1oNHE�Mo7sEooh6tErmoFnff4TMrBwaaEHlN�UfiEooalAfs�SloqanLESS} LUMBING 1 Z I CERTIFY TMAT IN THE PEHFORMANCE OF THE WORN FOR VR11C11 THIS PERY17 IS ISSUED,I MECHANICAL (.'J SHALL NOT EMPLOV ANY VEFSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE Uj W'ORKERS'COMPENSATION UWS OF CALIFORNIA AND AGREE T11AT IF I SFiOULD BECOME INSPECTION FEE ? SUBIECT TO THE WOf1KER5'CqAPENSATqN PROVISIONS OF SECTION 37o00F THE IABOR CODE,1 SHALL FOfi�M177H COAIPLV N7iH TlIOSE PRONSIONS. �SSUANCE 1� � SMIP p DATE: APPLICANT: . . wWARNINO:FAIWRE TO SECURE VXNiKERS'COMPFNSATION COVEfUGE IS UNLAWFUL,AND SFMLL BE ENERGY P/C ,�� LL SU&IECTAN EAIPLOYER TO CRIMINAL GENALTIESAND CML FINES UP TOONE HUNDRED TF10U5AHD ENERGY PERMR DOLLMS(5100,000),INADDfT10N TO THE C0.STOF COMPENSATION,DAAUGE5/5 PROVIDED FOH M ¢ SECTION 37oB OF THE UBOR CODE,INTEREST,ANDA7TORNEYS FEES. � RETENTION FEE: . a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: 0 � 1 HEREBY AFFIRM UNDER 7ENALTY OF PERIURY THATTHEHE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF TME WORK FOR NTi1CH 7HI5 PERMIT IS ISSUED(SEC.JOB7,CIV.C.). Z W � LENDERSNAME F- LENDERSADDRE55 I � TOTAL FEES y � I CERTIFY iTiAT I HAVE READ THIS APPLICATqN AND STATE iHAT 7HE ABOVE WFORMATqN IS CORRECL � w 1 AGREE TO COMPLV WfTH N.L CRY NJD COUNTY ORDINANCES AIJD STATE UV/5 PEUTING i0 BULLDING � CONSTRUCTION,ANDHEREBVAUT/iOWZEREPRESENTATNE50FTHISCOUNfVTOENiERUPONTHE � Z ABOVE-MEMqNED PROPERTY FOR INSPECTION 7UR705ES. COMMENTS 0 � �Sv�n�eret�dc� rYlc�.sz41 1 c r�o s m � v�� Z$� � 0 �/j SI PEAFifTTEE DATE = RECPT.NO. 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F:i�!A_ � ---------�---- --------- �ItiAL ELECTRIC --- -- -------------; D�l'.FEES PAID �i'�!AL P�UPABING � G : i ENERGY s � CQMI�iENTS - - -- --- - st�rfc T�r�K sizE S�EP PIT;U SIZE ; � _ �-:� � _,�-r ----.. _....._._.._....... __ __.. _............._...._....... ......_. .. ._ ....... ._.._ _... _.. _................_..__.... ...._. K�:-- � �., ------ ------- _ ____-----._....._._..._..-------..__..._. ._._. _. ------ ---------...-----....--— -------...........---..._..___-- ,.� 2 , , -,----�'�```--- CIT'Y OF DIAMOND BAR ��e . , � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive - (909)860-3195 Fa�c(909)861-3117 PRE$$ �"'-�� BUILDING PERMIT APPLICATION FIRMLY � oN JOBSITE / d DATE CATION � � � � NUMBER .� I � #/C ADDRESS D O � �o ISSUE p TYPE ' OCC APN LOT �� TRACT S�� DATE I:� � CONST. GROUP °C OWNER � O " ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑ o APPLICANT TEL. S DE/SIDE STREET RW O z ¢ CONTRACTOR SIDE ❑ o CIT`( �Q<d ZIP��jQ TE�x"]�_ PROPOSED USE � wo ARCH/ENG/ , iz DESIGNER NO.DWEL. • NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF AD AREANALUATION p� OWNER-BUILDER DECLARATION 3FR/ADD/REM Q, �� y� � � O p I HEREBV AFFIRM UNDER PENALN OF PERIURV 7HA71 AM ExEMP7 FROM 7HE CONTRACTORS LI- Gef896/C8fP0A W CENSELAWFORTHEFOLLOWINGHEASON(SECJo31.5BU51NES5ANDPROFESSIONSCO�E:ANVCI7VOR (n � U COUNNWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W TURE,PRIOR TO ITS ISSUANCE,ALSO REDUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooVSp3 � fES510N5CADE)ORTHATHEOPSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- C7 � � TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSUBJECTSTFIEAPPLICAN7T0 Z"'Re-Rool A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDfiED DOLLARS(S5oo).�: �I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q Z Commercial WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�t,BU51- J � NESS AND PROFESSIONS CODE:THE CON7RAC70RS UCENSE LAW DOES NO7 APPLV 70 AN OWNER OF � I PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m QOFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMEN7ISSOLDWI7HINONEVEAROFCOMPLE- Z TION,THE OWNER�BUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILO OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS OWNER OF 7HE PROPEHTV,AM EXCLUSIVELY CON7RACTING WI7H LICENSED CONTRACTORS Q TO CANSTRUCT THE PR0.IECT(SEC.70l1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8SIOf1 ADJ.AAEA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPER7VWHOBUILDSORIMPROVES7HEREON,AND = WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE YTORS LICENSE IAW.). � �� ❑I AM EXEMP7 UNDER SEC. B.6 P.C.FOR THIS REASON ' � �•.{,�i i �I• U � ,� � � l DATE OWNER � /� Z W ` �Y�V � LICENSED CONTRACTORS DECLARATION w �/ ob � I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ]/l U V, � o(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND � �./ • 'X MY UCENSE IS IN FULL FOFCE AND EFFECT. m 1 G � IICENSE,�LA S � UC.NO. y j � � V DATE � I CONTR �- / � W � WORKERS'COMPENSATION DECLARATION � a h. = U � I HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLIOWING DECLARATIONS: Z Q � I HAVE AND WILL MAINTAIN A CERTIFICATE Of CONSENT TO SELF-INSURE FOR WOFKEHS' _ COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR TME PERFORMANCE U ¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �. � w I HAVE AND WILL MAINTAIN WORKEHS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH7HI5 PERMI715 ISSUED.MY WOFiKERS'CAMPENSATION INSURANCE CARRIER M1D POLICY NUMBER ARE: CONSTRUCTION � CARRIER��i�}7E Fv�l/��y PLAN REVIEW ZPOLICV NUMBER ZZ� �Q s �� ELECTRIC D 4� Q 0 (IFiIS5ECT10NNE�NOTBEOJNIPLE�EDOFTHEPERMITISFORONEFNPDREDDOlLA0.5(f100)ORLESS). PLUMBING Z I CERTIFVTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (,�} SHALL NOT EMFLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE � WORKERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGFEE THAT IF I S OULD BECOME INSPECTION FEE SU&IECTTO THE WORKEFS'COMPENSATION PFOVI S OF SECTION O E LABOR '�� Cj�DE SHALL RTHWITH COMP S VISIO ISSUANCE � � 6 " SMIP p DATE: I 'IL APPLIC ' J WARNING:FAILURE TO SECURE WOFiKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(S7oo,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PFOVIDED FOR IN J SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: � ' � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS A CONSTRUCTION LENDING FGENCY � FOR THE PEFiFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W 2 LENDER'S NAME � F_- LENDER'SADDHESS w I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES �� I AGREE 70 COMPIV WITH ALL CITV AND COUNTV ORDINANCES AND S7ATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. , COMMENTS 0 �� m P AM INT) / Cn /' SI OF PERMITTEE D E = RECPT.�'O. PAID BY VALIDATION � ~ W E—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . —J ... . � . . . �:;. _ ,. . . ..0 ..,r.::r,.,. . . . .,�.,. .. . .. .t ' � .. . .H ,.�: .. -i. , • , i.P: �0 U U �� li.1��/W��Utl� �4W� � � ' � ��Io:J�`��U U�Utl ��l�o��lLd' � � - �lf�.Ic��II'L5 l� DCi�1 T�- L�S Gi U � UWCJLr�` '-f ULJW •. �LiIU� •[ Ull�1 0 , Q � SET BAGK � FLOOR J�IST ��' _�._ ._ __..-- ,____ _---.. _�., ----._ _._._ ----- � - � _.._...._ ...____.__ FTGS/FORMS/STEEL :� FHA RE�MTS ELECTRIC,GROUND � � UNQER FLQ�JR DUCT -� -- --- ------- -------- ------._._.. ---...._.. _. _._._...____ ____----- GROUND P�UMBING � UNDER FLOOR CU�IDUIT ; --- - --. _.._._ ----.._..------ SLAB GRADE _ __ _ � FIREPLACE_FOUNQATION �. -- — _._.. TEMP POWER I ; FIREPLACE �OND BEAM --- ------ ----- WATER SERVICE �_ ; MID HT. BQND BEAM _ - _ ROOF SHEATHING � i 8 FL BOND BEAM , � � �_ r..___ ..____..._ — .—..__._..__......_.__.�-�— __.__._.................... FRAMINGNENTILIATION • : FINAL BOND SEAM ROOF COVER { PRE-GRADING ROUGH HEATING ^ ' --- -BENCHING --------- --- ROUGH ELECTRIC ROUGH GRAJING ROUGH PLUMBING ! ' FINISH �RADING --- ----- ---- -- -- SHOWERlTUB TEST I i � POOL ELECTRIC ____._._._-.. -.--- EXT. LATH/SIDING i ; POOL FENClNG -• - --- - ---_._� _.________ �__�-__..._..__—_____ WALL INSULATION ; POOL FINAL ' ---- CEILING IN�ULATION ; OFF SITE IMPS. ' --- ----�-- —___� _-----------..-.._...�---- DRYV�IALL NAILING DEDICATIONS SEWER FINAL ENG. - ------- SEPTIC TANK LAND�CAPEtIRRIG. -- �-----__ -- SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST � FINAL ZONING ---- -----__�_. FINAL CONST. � � F!RE DEPT. FINAL. FINAL HE,4TING i HEALTH DEPT. FINA� —- FINAL ELECTRIC 8�� ' � DEV. �EES PAID� FINAL PLUMBING ; ENERGY - ; --- -- -------- C��OO G�OO C�o � � i ---- CUMM�iVI"S --- ------__ SEPTIC TA�K SIZE SEE� PIT/U SIZE — � ---- � [� I ' c� , _. , - . � I si- � �� , ^. _��_ CITY OF DIAMOND BAR - � '�� . DEPARTNIENT OF COMMUNTTY 8c DEVELOPMENT SERVICES � 21825 E.Copley Drive PRESS � (909)860.3195 Fax(909)861-3117 '�'""' BUILDIIVG PERMIT APPLICATION . FIRMLY a DDRESS�d��r 13l�+rx Trn�I APPUCATION 2j '�d_ � NUMBER��#/C I �� I � DATE �/ f�C7 o� ! ISSUE TYPE OCC APN LOT iZ TRACT � _ DATE CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑ � APPLICANT E� TE�9�/�2-�GZ^. REAR ❑ � . SIDE/SIDE STREEf RW ❑ � CONTRACTOR�"�L LlZu�dSG�s.... v�.i_ SIDE ❑ � ADDRESS PROPOSED USE 28�i Q�.O� �� CIN ZIP TEI�, y -d �-� w ARCH/ENG/ z DESIGNER ��" NO.DWEL. NO. NO. a ADDRESS 1 �LY UNITS STORIES BEDROOMS � CITY ��/.Jc�.�Y/rvP- ZIP Qy�tin TEL / -Z'�- � u� � ,�� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDEH PENAL7V OF PERtt1RY THAT I AM E%EMPT FROM THE CONTRACTORS LI• G9f8gB/C8(POh W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANVCITVOH (n U COUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC• W Patio/Deck TURE,PRIOR TO ITS ISSUANCE,AlSO REDUIRES THE APPLICAN7 FOH SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- w � � CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa FESSIONSCODE)ORTIIATHEORSHEISEXEMPTTHEREFROMANO7HEBASISFORTHEALIEGEDEXEMP� C7 � TION.ANY VIOUTION OF SECTION 7031.5 BY AHV APPLICANT FOR A PERMIT SU8JEC757HE APPLIC/J1T T0 Z Re-Root � ACiVIL PENAL7Y OF NOT MORE THAN FIVE HUNDRED DOLURS(i5a0).): ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, Q � Z Commercial - WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOP SALE(SEC.70a�,BUSI- J � NESS AND VROFESSIONS CODE:THE CONTRAC70R5 LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERTI'MAIOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCNWORKHIMSELFORHERSELFOR m Q iHROUGH HIS OR HER ONM EMPLOYEES,7ROVIDEO THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR 0 OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEHTISSOLDN7THINONEYEAROFCOMPLE• Z TION,7HE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT NE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS OWNER OF 7HE PROPEHTV,AM EXCLUSIVELV CON7RAC71N4 WITH LICENSED COMRACTORS Y� WTO CANSTRUCT THE PR0.IECT(SEC.70//,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- VBIUflIIOfI �-�:E ll ` ADJ.AREA CENSE UW DOES NOTAPPLY 70 AN ONMER OFA PROPERTY WHO BUILDS OR IMPROVES TIEREON,AND � WHOCONTMCTSFORSUCHPR0.IECTSWITHACONTMCTOR(S)LICENSEDPURSUMlT707HECON7RAG DUANTITY DESCRIPTION FEE � Y TORS LICENSE UW.). ¢ ❑I AM EXEMPT UNDER SEC. B.6 P.Q FOR THIS REASON Q � � U � � DATE OWNER V Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTY OF PERIURY 7HAT I AM LICENSED UNDEH PROVISIONS OF CHAP7ER V. P�� 9(COMMENCINO WITN SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z '� XL' MV LICEHSE IS IN FULL FORCE AND EFFECT. m n.� � UCENSE CU'SS ` ��/'�2��J'�LIC.NO. ��3�� j r v1 , V DATE •,��'-O� CONTRACTOR�� y�� 0- � _ W � WORKERS'COMPENSATION DECLARATION U ' � � 1 HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWING DECUMTIONS: ' � � Cn Q � I HAVE AND WILL MAINTAIN A CEfiTIFICA7E OF CONSENT TO SELF•INSURE FOR N9HKERS' _ � COMPENSATION,AS 7ROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR NAIICH THIS PERMI7 IS ISSUED. � `� � w �HAVE AND WILI MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION /� Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS �..` /, ISSUED.MY WORKERS'COMPENSATI N INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION "� [/ Q � CARRIER S�'�-� N� PLAN REVIEW - � Z POLICY NUMBER • �--�TA ^�D� ELECTRIC � Q 0 (fHISSECf10NNE�NOT8E00MPLEfEDOF1ViEPEFi�ATISFORONEMIFDREDDOLLARS(f100)ORLES51 PLUMBING Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO.I MECHANICAL U' SHALL NOT EMPLOV ANY PERSON IN M!Y MANNER SOAS TO BECOME SU&IECT TO THE �/j WORKERS'CAMPENSATION UWS OF CALIFORNIq AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SUBJECTTOTHEWORKERS'COMPENSATIONPHOVISIONSOFSEC710Na7ooOFTHEUBOR ISSUANCE ��L • CADE,I SH/U.L FOHTHWI7H COMPLV WITH TH�O/�SE_PROVISIONS. �I � y �� C�U�j"j'/Q k�/✓� �SMIP �.��_ . p DATE:�:_„d�ILj— APPLICANT: TT� � � � �� ENERGY P/C J WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE LL SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDRED7HOUSAND ENERGYPERMIT OOLLARS(f100,000),IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE.IN7EFEST,AND ATTORNEV'S FEES. � RETENTION FEE: / - 1 Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ! O � I HEREBV AFFIHM UNDER PENALTY OF PERIURV THAT THERE IS ACONSTRUCTION LENDING AGENCY � FOR THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMI715ISSUED(SEC.30Y7,CIV.C.). � Z W � LENDER'S NAME F= LEN�ER'SADDRESS ./� �` w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �/�� O� V�/']� ' � � I AGREE TO COMPLV WITH ALL CITV AND COUN7V ORDINANCES AND STATE UWS RELA7ING 70 BUILDING ✓ V `! � CANSTRUCTION,M1D HEREBY AUhiORIZE REPRESENTATIVES OF 7HI5 COUNTY TO ENTER UPON 7HE Z ABOVE•MENTIONED PHOPERTY FOR INSPECTION PURPOSES. COMMENTS ' � ,g�L J = G � � ¢ PERMIT7EE NAME(PRINT) � �� N � � SIGNATURE OF PERMITTEE DATE � = RECPT.NO. PAID BY VALIDATION ~ WHITE—Depertment Co YELLOW�inence Co PINK—Assessor Co GOLDENRO�File Co GREEN— py, py, py, py, ApplicanYs Copy L - - - - ��-t.�� .. �.�...� �o.,. r;j1.:+3:�. •`: �..t�+:` :' K�Y6 �:, J�� =�I'. °,�,+L , � �11�'^'S ` " .➢;. 1$��.:'�', s,.t,.� r .. ,:... . .. . ,.. . . �. .. .. . . � • . .. . . • .;5: -+- , �-�" .fd..�./. '��9.� . . . • --.. . _ _.. . - �o��ll �If- ��/rU��0C1� �� ' - � �II�1��W✓��II�1 ��Ld��IID . .��ooa o � o � , o � oa�° o a ��:= b o .� �� - o a e�� SET BACK � ' FLOOR JOIST FTGS/FORMS/STEEL � FHA REQMTS � ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING _�Lf; � UNDER FLOOR CU�IDUIT � SLAB GRADE � � FIREP�ACE FUUNDATlON � TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ' , ROUGH ELECTRIC ROUGH GRADING ROUQH PLUMBING FINISH GRADING SHOWERrT'UB TEST POOL ELECTRIC EXT.LATH/SIDING POOL FENCING ��,rf{� � _�� 0. G WALL II�SULATION POOL FINAL - CEILING INSULATION «' ' vi . _ _Gg- �� DRYWALL NAIUNG DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/1..�. ON SITE IMPS. GAS AIR TEST p� FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBI G ENERGY T �'�',t� - ` �G�i .O�O�o COfViNiEfVTS SEP71C TANK SIZE SEEP PIT/U SIZE r � � � �� ' . � _.. �o�� 5 � � ' , � � , �� C1TY OF DIAMOND BAR - � , DEPARTIvIENT OF COMMUNTTY 8c DEVELOPMENT SERVICES � �� Zis2s E.coPi�y n��e PRESS � (909)860-3195 Fax(909)861-3117 ,�`""' BUILDING PERMIT APPLICATION . FI R M LY � JOBSITE �J/�G� �,/ -" APPLICATION PERMIT P/C o ADDRESSGI(J f� P��-��.. I2�L DATE D�II�`�'3 NUMBER # O� � � ISSUE�- TYPE OCC APN LOT�_ TRACT DATE CONST. GROUP p OWNER , p ADDRESS � (IZAI ZONING SETBACKS Z CITY S� �'�Q ZIP ' TEL. - FRONT RW ❑ � APPUCANT �S�f C�rE. TEL. - REAR p ' � SIDE/SIDE STREET RW � � CONTRACTOR 06LS l G SIDE ❑ � ADDRESS �.(• �,jy�,Q l r�al • � ,�.,�,.1 _ C� � CITY dtr'�L��W ZIP �i7(,�t.TEL. PROPOSED USE�'Ul`�1 ��- �T� w ARCH/E� iz DESIGNER �z-�`� � �`�s-�rc.2- NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY L�rrv.=.-;�--tM ZIP�Q�Q� TEL. N DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PE0.NRY THAT I AM EXEMPT FROM THE CANTRACTORS LI- G9fH B/Cfi 01I W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPFOFESSIONSCODE:ANVCI7VOR (n 9 � I U COUNTYNRIICHREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W patio/Deck w NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W , STATEMENT THAT HE OR SME IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CANTRAC70RS LI� � � CENSE UW(p1APTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PRO- � POOVSPB ' FESSIONS CODEj OR 7TUT HE OR SHE IS E%EMPT TiEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- � TION.ANYVIOUTIONOFSECTION7031.SBVANVAPPLICANTfORAPERMRSU&lECTSTHEAPPLICANTTO Z Re-Aoof � ACIVIL PENAIT/OF NOT MORE hIAN FIVE HUNDRED OOLURS(f5o0).): Z~ ❑I,ASONMEROFTHEPROPER7V,ORMVEMPLOVEESWITHWAGESASTHEIHSOLECOMPENSATION, Q � WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.70at,BU51• � COrtlfil0lCI01 � � � NESS AND PROFESSIONS CODE:THE CON7RAC70fiS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTY VhiO BUILDS OR IMPROVES THEREON,AND Vh10 DOES SUCH WORK HIMSELF OR HERSELF OR Q 7HROUGH HIS OR HER OMM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT IN7ENDED OR m QOFFEREDFORSALEIF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDN7THINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE OID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS OWNER OF THE PROPEHTV,AM EXCLUSIVELY CONTRACTING WITH LICENSED COHTMCTORS � TO CANSTRUCT THE PR0.IECT(SEC.7oa�,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- VelUBflOf1 ADJ.AREA W CENSE UW DOES NOTAPPLY TOAN OWNER OFA PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRAC70R(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � Y TORS UCENSE UW.�. � O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U � LL � DATE OWNER V Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBYAFFIRM UNDER PENALTV OF 7ERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � � Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TNE BUSINESS AND 7ROFESSIONS CADE,AND Z �� MY LtCENSE IS IN FULL FORCE AND EFFECT. m 0 LICENS�E qCLASS/�� LIC.NO. �/' ,�/� � V DATE C.�L�IK N� d CONTRACTOR MGV !1 J W � WORKERS'COMPENSATION DECLARATION Q = U � I HEHEBY AFFIRM UNDER PENALTY OF PERIURV ONE OFTHE FOLLOWING DECLARATIONS: C� Q 0 I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF-INSURE fOR WOHKEPS' 2 � COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE L/�BOfi CODE,FOR THE PERFOHMANCE W OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSUHANCE,AS REOUIRED BV SECTION �� ' � Q 97000F THE IABOH CADE.FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY M/ORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � Q � CARRIER PLAN REVIEW � ZPOLICYNUMBER ELECTRIC Q � (fHLSSECTIONNE�NOTBEWMR.EfIDOF71�PER1MlSFDR�ONEMMKiEDDOUAfiS�t10U)ORLESS� PLUMBING W Z I CERTIFV THA7 IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (,'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE � WORNERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECT TO THE WOHKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � SMIP, p DATE: APPUCANT. . w ENEfiGY P/C J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE � SUBJEGTANEMP�OYERTOCRIMINALPENPLTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(i100.o00).IN ADDITION TO THE COST OF COMPENSATpN,DAMAGES AS PROVIDED FOR IN � J SECTION37080F7HELABORCODE,IN7EREST,/WDATfORNEV'SFEES. � FlETENTIONFEE: Q d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CANSTRUCTION LEN�ING AGENCY n- FOR 7HE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMI715 ISSUED(SEC.3077,CIV.C.). � Z W � LENDER'S NAME F- LENDER'S ADDRESS � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES��' � ,� W 1 AGREE TO CAM7LV WITH ALL CITY AND COUN7Y ORDINANCES AND STATE UWS REU7ING TO BUILDINC. � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF TNIS fAUNTV TO EMER UPON THE � ZABOVE-MENTKKJED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � � L C.E� � - ' �— � . ¢ PERMITTEE NAM � � �n �� b N SIONATURE OF PE MIT7E � DA7 _ . RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � "/ � I . 1 V. . .. ..: , ,. . . . .., , .. . . ,.. . ; . . . �.. ,.. �U1�'�f �I� ��G�I�1�(�I� I��I� , .,, � ' , . , , , , O�IS�L�(C3'��'Df� �(��6�� ,. 'Q�r�� Q ' J�, ° a Q o t,� ��r`�=�� `; �� '��. �r�'. � � ��' SET BACK ; FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CO�IDUIT ' SLAB GRADE FIREPLACE FOUNDATION ' 1'EMP POWER FIREPLACE BOND BEAM WATER SERVICE -. MID HT. BOND BEAM � ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATWG BENCHING - , ROUGH ELECTRIC ROUGH GRADING FIOUGH PLUMBING FINISH uRADING SHOWER/TUB TEST POOL ELECTRIC EXT. 1�4TH/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 PAID FINAL PLUMBING ENERGY ,� Of� o �o C4NiiViEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE � � `� � _ __ _ , , , �r—•-- -� - � �� ' ! li � 1 I � + i ( I I - I � I ; i � �' �, a ' U � � j ; � o a� � `�° " I U � �j • O � � N i � � a �, I � p.� �'a �� U � � , � -� � o ~ ` � � ; '� '> > � a� m m o i � � oo � ca � � � � z E c c U � 'y o � o aoE E , � N > �`_ .� Z r � � cu i Ojp � � . � � N � � � � N � ' I , � � � � � ' L � � i i-� C �. 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