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Home My WebLink About12-1630 �,,�_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �"°�' BUILDING PERMIT APPLICATION FIRMLY } JOBSITE f� /f /�//p / APPUCATIO�I, PERMIT i �Q p/C o ADDRESS �� lJO,� ( iC/l/L �! j DATE �(/ �� Z NUMBER � �`� p `r APN T TRACT ATE D � (/ TMPE OCC � e {� u� G�,� CONST. GROUP I p OWNER ADDRE S ZONING SETBACKS � G FRONT q�/y p Z CITY ZIP TEL. ' � o APPLICANT /7 /i� REAR p ¢ � /�lC ?�� SIDE/SIDE STREET RW ❑p a� CONTRACTOR Gr � SIDE 2G' �' /� o CDDRE S� - ' ZIP TEL. � ' q � PROPOSED USE GI� �O Cl . R'� w ARCWENG/ GY�� z DESIGNER � w NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALiY OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI- G8f0QBIC0l�OfI W CENSEUWFOR7HEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFESSIONSCADE:ANYCITYOR (n U CAUNTYWHICHREQUIRESAPEFiMITTOCANSTfiUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANVS7RUC- W patio/Deck w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� CENSE LAW(CHAPTER B(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- �'1' POOVSPe . 0 FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEJ(EMP- (� V TION.ANVVIOUTIONOFSECTION7031.58VANYAPPLICANTFORAPERMITSUBJECTS7HEAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f50o).): I � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1rtlBfCl21 � Z WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701l,BUSI- J � � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPER7V WHO BUILOS OR IMPROVES THEREON,AND NhiO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m w OFFEREDFORSALEIF,HOWEVER,7HEBUILDINGORIMPROVEMEMISSOIDWITHINONEVEAROFCAMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OH Z IMPROVE FOR THE PURPOSE OF SALE). _ ❑I,AS OWNER OF 7HE PROPERTV,AM EXCLUSIVELV CON7RAC71NG WITH LICENSED COMRACTORS W [[ TO CANS7RUCT THE PRQIECT(SEC.70�1,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V8111aI1Of1 ADJ.AREA W CENSE UW DOES NO7APPLV 70 AN OWNER OF A PROPER7V WHO BUILDS OR IMPROVES 7HEREON,AND � NTIOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOP(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � Y TORS LICENSE UW.). QO I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS HEASON Q � U � � DATE OWNEH H Q W � LICENSED CONTRACTORS DECLARATION w � I HEHEBY AFFIRAI UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WI7H SECTION 7000)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CODE,AND Z X MV LICENSE IS IN FULI FORCE AND EFFECT. � LLJ (� � UCENSE CLASS � LIC.NO.�//// C/ j U DATE /� � � CONTRACTOR d W � ' � WORKERS'COMPENSATION DECLA ATtON � � I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOl.LOWING DECURATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CANSENT TO SELF•INSURE FOR WORKERS' _ Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 37oa OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORN FOR WHICH TMIS PERMI7IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION J j c�aqiER PLAN REVIEW � POLICVNUMBER Z ELECTRIC Q �� (fHLSSECiIONNEmNOTBEO�MPLETEDOFTHEPEWMISWRONEFNI�DREDDOLLAiLS�S100)ORIESS} PLUMBING Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL i C7 SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE I � WORNERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE I � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOfl �� CAD�,I ALL F RTHWITH COMPLY WITH T SE PR visioNs'./ /�''�� ISSUANCE e p DATE: /�/U � APPLICANE �. �GZ (�! �' (/ � SMIP J WARNING:FAILUqE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C � SU&IECT AN EMPLOVER TO CRIMINAL PENAlTIES AND qVIL FINES UP TO ONE HUNDREO THOUSAND ENERGY PERMIT DOLURS(f100,000).IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC710N37o8OFTHELABORCODE.IN7ERE5T.ANDATTORNEYSFEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT 7HERE IS A CANS7RUC710N LENDING AGENCY FOH THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS - � TOTAL FEES ,j Z- � � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. � I AGREE TO COMPLV WITH ALl CITY AND COUNTY ORDINANCES AND STATE UWS REIATING TO BUILDING � � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED GROPERTV FOR INSPECTION PURPOSES. COMMENTS � //G�li//�GL ��l��4-T/O� m PERMITTEE NAME RINT � � � /O�o% � ^ , � SIC.NATU HMITTEE DATE = RECPT.NO. PAID BY ALIDATIO . ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GAEEN— P PY� PY, PY. PY. ApPlicant's CoPY �0�1( �IF �DA61�� l��ff� I�SI�(��90� ��C�� Oa�pC�C�400a o ,S�C��.:. Oa�pC�a O�1�pC�(�400a � � QG�4C� CI�)�3pGC�40a . . SET BACK FLOQR 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 FRAMINGNENTILATION 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 SEWER FINAL ENG. SEPTIC TANK LANDSCAPElIRRIG. 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 _____ _______ t1��'� �Z C�'�rl C�o � COiVIMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � �