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Home My WebLink About11-575 �,� CITY OF DIAMOND BAR � r, � 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 '""'j BUILDING PERMIT APPLICATION FIRMLY } JOBSITE APPLICATION PERMIT p/C o ADDRESS.Z-3Z 13fj�¢/� ('/"��p� /2� DATE NUMBER /�# °D APN LOT TRACT �SSUE NPE OCC DATE CONST. �U�(rgROUP p OWNER /4f3 C»qiL o ADDRESS ' � � ��' U ZONING SETB CKS z CITY i ZIP TEL.�s-+9-�`(-�� FRONT qyy � o APPLICANT �E,..� t,.,r`�/�f TEL. REAR p z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR _FCon/L9 A./L SIDE p � ADDRESS SI S(x' ,�' J�✓n�r_/' ..�v G o CITY�,L/,FJ/�•�cir_ ZIP�� TEL,�nc�_Ts�-�l,� , PROPOSED USE o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRAI UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- G8f8(]B/CBfpOh W CENSE UW FOR THE FOLLOWING REASON(SEC.703t.5 BUSINESSAND PROFESSIONS CODE:ANV CI7V OR (n U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTEH,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W Pe�iO/DBCk W TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT 7HAT HE OR SHE IS LICENSED PUFSUAN7 TO THE PHOVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHAP7EH 6(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO• POOVSPB , � FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- (� V TION.ANV VIOUTION OF SECTION 7091.5 BY ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f5a0).): � ❑I,ASOWNEROFTHEPROPER7V,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfflrtlBfClel Z WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BUSI� J � � NESS AND PROFESSIONS CODE:THE CONTfiACTORS LICENSE LAW DOES NOT AFPLV TO AN OWNER OF � PROGERfV WHO BUILDS OR IMPROVES THEf7EON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR HER ONM EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOlDWI7HINONEVEAFiOFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPHOVE FOR THE PURPOSE OF SALE). - W ❑I,ASOWNEROFTHEPROPERN,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS � 70 CONSTRUCT THE PRQIECT(SEC.7014,BUSINESS ANO PROFESSIONS CODE:THE CON7RACTOFS LI- V81U8�1On ADJ.AREA W CENSELAWDOESNOTAPPLY70ANOWNEROFAPHOPER7VWHOBUILDSORIMPROVESTHEREON,AND � NTIOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOP(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS FEASON Q ?� U ti Q DATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � d Y(COMMENCING WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND �X MV LtCENSE IS IN FULL FORCE AND EFFEC7. m � r �/�� e J � LICENSE CL^ASS L�IO L�I�_ LIC.NO. ��Z Z C> � ^ - U DATE f `�/I � I� CONTRACTOR ��it/(} .iC I,�, d y, L " TG � W � WORKERS'COMPENSATION DECLAFATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCANSENT705ELF-INSUREFORWORKERS' a Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � w _1 HAVE AND WILL MAWTAIN WORKERS'COMPENSATION INSURANCE,AS RE4UIRED BY SECTION Q 370o OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMI7IS ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POL�CV NUMBER ARE: CONSTRUCTION j CARRIER�L��i L'/��j��!`'j/_�4✓l � ^��_ PLANREVIEW . Z POLICYNUMBER f.`/G T A�CG�G ��0 ELECTRIC Q � (iHISSECiIOfJNEmNOTBE�EfEDOFi}�PERIMISFORONEHIN�DRED00LLAFiS(5100)ORLESS} PLUMBING ��. 7 f w C Z �CERTIFY THAT IN THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL � SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&lEC7 TO THE (/j WORKERS'COMPENSATION�AWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE = SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37o00F THE LABOR CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE ��. � p DATE:�'�I��/� APPLICANT: �,/Y�s a..w � ,�I L�/� SMIP W J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTAN EMPLOYER TO CPIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PPOVI�ED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. 7 H� p� RETENTION FEE: ��_ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NMAE � LENDER'SADDRESS w I CERTIFY THAT I HAVE fiEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMA710N IS CORRECT. TOTAL F E ES !I�� I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED VROPERTY FOR INSPECTION FURPOSES. COMMENTS � J � — m 7ERMI7TEE NAME(PRINT) � Q � � SIGNA7UREOFPERMITTEE DA7E — G = RECPT.NO. PAID BY VALIDATION ~ WHITE—DepaAment Copy,YELLOW—Finence Copy,PINK—Assossor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ce�v �� o�,�a�� ,�� BI�S�[��'D�h� �[��ff�� a�pf�C�400a DG14C�. - Oa�pC C�40G3� Oa�pGC�400a DGJ4C . Oa�pGC� r o a 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 SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. . DRYWALL NAILING DEDICATI�NS SEWER � FINAL ENG. SEPTIC TANK LANDSCAPEIIRRIG. 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 ��b COMMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a U7 C - -- �3 --