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Home My WebLink About10-1165 (5) �„� _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&IDEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 E$$ �'"�'� BUILDING PERMIT APPLICATION FIRMLY I o DDRESS I3 1/� C�1LI B��IZIJ�i D�y+W��/�'—� DATE CATION/I�/S�/O NUMBEFjC O� �(/��►/C �� Q7� � ISSUE D/� O/_ // TYpE �, M OCC APN LOT TRACT DATE �� CONST. �A�� GROUP p OWNER TI7�MAS 'SMITN p ADDRESS �2 I E ZONING SETBACKS Z CITY l�.l�l� ZIP %1�9 TEL. _ b FRONT pyy p o APPLICANT �YF1�N� L�B�tLTO-�CL�L: REAR p Z SIDE/SIDE STREET RW ❑ � CONTRACTOR �/� 113 SIDE ❑ ADDRESS 3 .�y��, � CITY �05T�IL P.V►y LA ZIP�.Q� TE PROPOSED USE I^►S � O ��/UN w ARCH/ENG/ "� . A� z DESIGNER �� n w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � SFR/ADD/REM I HEREBV AFFIRM UNDER PENALTV OF PERIURV THA71 AM EXEMP7 FROM THE CONTRAC70RS LI� GefeJO/CefPOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCI7VOR (n U CAUNTVWHICHREOUIRESAPEiiMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- I w TUiiE.PRIOH TO ITS ISSUANCE.Q50 REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED W Patio/Deck � STATEMENT 7HAT HE OR SHE IS LICENSED PUHSUANT TO THE PROVISIONS OF THE CON7RACTORS LI� � � CENSE UW(CHAFTER G(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP� � V TION.ANVVIOUTIONOFSECTION703/.5BYANVAPPUCANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof �. A CIVIL PENALTI OF NOT MORE RiAN FIVE HUNDREO DOLLARS(f5oo).): Z ❑I,ASOWNEROF7HEPROPERTV,ORMYEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � COrt1rtIBfCiel WILL DO THE WOHK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,8U51- J N NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF � PROPER7V NTiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCM WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPIOVEES,PqOVIDED THAT SUCH IMPROVEMENTS AqE NOT INTENDED OR m w OFFEFEDWRSPLEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- 0 TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILA OF Z IMPROVE FOR THE PURPOSE OF SALE). _ ❑I,ASOVMEROFTHEPROPERTV.AMEXCIUSIVELYCON7MCTINGWITHLICENSEDCONTRACTORS W ([ TO CANS7HUC7 7HE PRQIECT(SEC.704�,BUSINESS AND PROFESSIONS CADE:THE CANTMC70RS LI- V81U8�IOf1 ADJ.AREA W CENSE LAW DOES NOTAPPLY 70AN OWNER OFA PROPERTV WHO BUILDS OR IMPFiOVES THEREON,AND � WHOCON7RACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � `-' yS r� � � OATE OWNER � I �u1lE2 2 w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDEH PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F 7HE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULL FORCE AND EFFECT. m LLI Q��j � LICENSE CLASS �� LIC.NO. V 7��I O� � WDATE I�f�ZQI'U CONTRACTOR��Y INC] d � WORKERS'COMPENSATION DECLARATION Q NI HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLAPATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' ¢ _ COMPENSATION,AS PROVI�ED BV SECTION 3700 OF TME LABOR CODE,FOR TME PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Iw �I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSUFANCE,AS REOUIRED BV SECTION Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOHK FOR WHICH 7HIS PERMI715 //�n ISSUED.MV WORKERS'COMPENSATION INSURlNCE CARRIER AND POLICV NUMBER ARE: CONSTRUCT ��/ � CARRIER RIG A►7'I�R,� N R IE � � �POLICY NUMBER � �Q�� E � Z Q Q (iHISSECTIONNEmNOTBECOAAPLEfEDOFTiEPERMfTISFORONEHUMFiEDDOLIARS�f100)ORlESS? PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL CJ SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE ' (�j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR � � COOE,I SHALL FOPTHWITM COMPLY WITH'HOSE PROVISI 5. �SSUANCE 6 l 0 ��p DATE: APPLICANT: J WARNING:FAILURE TO SECURE WORNERS'COMPENSATION COVEHAGE IS UNLAWFUL, ND SHALLBE ENERGY P/C � SU&lEC7ANEMPLOYERTOCRIMINALPENAL7IESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPEAMIT DOIURS(S70o.o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PPOVIDED FOH IN � SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. HETENTI FEE' � � OCONSTRUCTION LENDING AGENCY -ALT FEE:,, � I HEREBV AFFlFM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY /C/ � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7097,CIV.C.). Z W � LENDER'S NAME � LENDEH'SADDRESS r w I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES �� a/ �/�1�� I AGREE TO COMPLV WITH ALL CITY AND CAUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING ///��///�� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ^w ^�O�A� Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS� �� ,�C�ANA� Z..�4M`�E2T-�,4n1 m FEFA/l NAME(PRINT) � � ��Q � �i �,e 10�"l �t7 . . .. � n � 51 OF P MI DA E � �/ = RECPT.NO. PAID BY I � �O Y VALIDATION ~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy C��'V CDI� �8�►611VCD�1� �AaB� I�Sf�l��f�� BI��OR� � - oa�p��ooa oa4c� oa�p�c�4oa oa�pr�c�400a `�a�� oa�p��4oc�` 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 R�UGH 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 FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL � _____ FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY --- ------- C�'1 �000C� — -- -- COMMEfVTS �ti,G„��_ � �� SEPTIC TANK SIZE SEEP PIT/U SIZE a � � ------------------- .,�,��, � .