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Home My WebLink About10-1180 1�L_ CITY OF DIAMOND BAR Q � 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 � oN JOBSITE �'?r� D. _/�h �, , . ,1 APPLICATION PERMIT p/C ADDRESS �'� 'D�'r�� _��-- DATE NUMBE�v-//$Oq r° APN LOT TRACT �SSUE //r�� TYpE OCC DATE CONST.��GROUP p OWNER �I'�AN �a}�1-E� � ADDRESS ZONING SETBACKS 0 z CITY ZIP TEL. a " FRONT Ryy p o APPLICANT TEL. S DE/SIDE STREET RW ❑ z ¢ CONTRACTOR H � SIDE ❑ � ADDRESS • PROPOSED USE� � � -� � CITY �� L7✓i,� ZIP Q,,,/_�. TEL. _ w ARCH/EN� ��TPjs z DESIGNER '� a ADDRESS NO.DWEL. O. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS N cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/AOD/REM O I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f89B/CBfpOfl W CENSEUWFOR7HEFOLLOWINGREASON(SEC.7o31.5BU51NE5SANDPROFESSIONSCODE:ANYCITVOR (f� U COUNTVWHICHREOUIFESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC� w TURE,PRIOfi TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED w Patio/Deck � STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER B(COMMENCING WI7H SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO� POOVSP2 Q FESSIONS CADE)OR THAT HE Ofi SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THEALLEGED ExEMP- (� V TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICAN7 FOR A PERMIT SU&1EC75 7HE APPLICANT TO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(i500).�: Z ❑�,ASOWNEROFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfI1rtIBfClel WILL DO THE WORK,AND THE ST{lUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7011,BUSI- J N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � VROPER7Y WHO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDEO THAT SUCM IMPiiOVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIFHOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOM7LE� Z TION,THE OWNEN-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OH SHE DID NOT BUILD OR � IMPROVE FOR TNE PURPOSE OF SALE). ❑I,AS OVMER OF THE PROPER7V.AM E%CLUSIVELV CON7RACTING WITH LICENSED CANTRACTORS � TO CANSTRUCT THE PRQIECT(SEC.70M,BUSINESS ANO PROFESSIONS CODE:THE CONTRACTORS LI- V01U0�i0f1 Z I +� ADJ.AREA � CENSE LAW DOES NOTAPPLY TO AN ONRJER OF A PROPERTV WHO BUILDS OH IMPROVES THEREON,ANO WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC� QUANTITY DESCRIPTION FEE Y 70RS LICENSE UW.). � J � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � - d B(COMMENCINGWITHSECTION7o00�OFDIVI510N30FTHEBUSWESSANDPROFES510N5CODE,AND Z X MV UCENSE IS IN PULL FORCE AND EFFECL � � LICENSE CLASS �� LIC.NO. /��Z� � V DATE 1I�2/I 11 CONTRACTOR �' � 1 l � d W �� WORKERS'COMPENSATION DECLARATION Q NI HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECURATIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCqNSENTTOSELF�INSUREFORWORKERS' = I COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U O OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � ', � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED 8V SECTION _ Q 370o OF THE LABOR CODE,FOR THE PEHFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �/��. ISSUED.MY WORKERS' MPE ATION INS��CE CAFRI AND POIICV NUMBER ARE: CONST CRO TION Q "'� L'. ] CARRIER f��G PLA VIEW Z POLICY NUMBER_/ (r/�� r ELECTRIC Q � (iHISSEC�qNNE�NOTBECOA1FtEfEDOFhFPEPMfTISFORONEFM1Jt�DREDDOLLPAS(5100)ORLESS} PLUMBING Z �CERTIFY THAT IN 7HE PERFORMANCE OF 7HE WORN FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL C} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE � WOHKERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME EC = SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR I� � CODE,I SHALL FOFTHWITH COMPLV WITH THOSE PROVIS��IOIIINqS. SSUANC ./L � p DATE:�[,� APPLICANT: ''`^X/I/ �P � // J WARNING:FAIWRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � � SUBJECTANEMPLOYEFTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT DOLURS(S10o.o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE.INTEREST,AND A7TORNEv'S FEES. NT N FE : (�.�.� OCONSTRUCTION LENDING AGENCY EE� � I HEHEBVAFFIRM UNDER PENALTV OF PERJURY THATTHENE IS ACONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOq WNICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME � � LENDER'SADDRESS � I CERTIFV THAT I HAVE FiEAD THIS APPUCATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES '/ w 1 AGREE TO COMPLV WITH ALL CIiY AND CAUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UFON THE � Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PUFPOSES. COMMENTS � � � � �a�9�t° ¢ PERMITTEE NAME(PRINT) �n�^1� ��I ` !./�� :� � � N ` L`�I �� A / // � SIGNATUREOFPERMITTEE DATE = RECPT.NO. PAID 8Y _ _ VAI InATIQN -- ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GAEEN—ApplicanPs Copy I c��v �� u�n�� . _ i�s��u�� oa�p��4o0a o i�� aa�P�C��e,3 .- Qa�pC��:��0�1 .; :o[��G. � �I��Gl .,u. SET BACK ' FLOOR JOIST FTGS/FORMS/STEEL F,HA 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 `_�, �_i 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRAOING 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 LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINALCONST. � �Q _ _ FIRE DEPT. FINAL __ FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY C.��U�o � COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � a