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Home My WebLink About18155 _��_ CITY OF DIAMOND BAR �-x�'� r�.� DEPARTMENT OF COIvAZUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��'-9�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ¢ ADDRESS �� APPLICATION r /�, � PERMIT � P/C p DATE ll/ K/ NUMBER # � APN LOT TRACT ISSUE TYPE OCC p OWNER 'r�� DATE CONST. GROUP p ADDRESS ZONING SETBACKS Z CITY TEL. FRONT qyy p � APPLICANT TEL. REAR ❑ �� SIDE/SIDE STREET RW ❑ CONTRACTOR SIDE ❑ � ADDRESS � � CITY / ZI �EL PROPOSED USE �OO� j)(� o ARCH/ENG/ iz DESIGNER NO.DWEL. O, p, a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I MI E%EMPT FROM TNE CONTMCTORS LI- G8f8QB/CBfPOf1 W CENSELAWFORTHEFOLLOWIN6REASON(SEC.7o31.5BUSINE55ANDPROFESSIONSCODE:ANVCITYOR (� U �JpJJ�'WF{ICMREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANYSTAUC- w w NRE,PRIOR TO ITS ISSUANCE,ALSO RE-0UIRES THE APPLICANT FOR SUCH PERAl1T TO FILE A SIONED w Patio/Deck � STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO TNE PROVISIONS OF THE CAMRACTORS LI� � CENSE UW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � POOUSPe � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� TION.ANVVqLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(S60o).): � OI,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1R10fC181 Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�s,BU51� J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT AGPLV TO AN OWNER OF � PqOPERTY WFq BUILDS OR IMPROVES THEREON,PND WNO OOES SUCH WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDE�THAT SUCH IMPROVEMENTS ARE NOT INTENOED OR m � OFFEREDFORSALEIF,FqWEVEf{THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINa THAT HE OR SHE DID NOT BVILD OF7 � IMPROVE FOR THE PURPOSE OF SALE). . w ❑I,AS ONRJER OF 7HE PROPERTY,AM EXCLUSIVELV CONTRACTIN�WRH LICENSED CANTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.7w1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81119SIOf1 ADJ.AREA = CENSEUWDOESNOTAPPLVTOANONTJEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�UCENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE IAW.). � ❑I AM EXEMPT UNDER SEC. B.8 V.C.FOR THIS REASON Q � U � DATE OWNER � ' Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRM UNDER PENALTY OF PE0.IURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS IN FULL FORCE�FFECT. m 0 LICENSE C/LASS LIC.NO. �� U DATE C/J � CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � U � I HEqEBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWINO DECLARATIONS: Z �Z _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNEFS' a Q COMPENSATION,AS PROVIDED BV SECTION 37oa OF THE LABOR CAOE,FOR THE PERFORMANCE U OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED. w � � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION � ^ 37a0 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN WR WHICH THIS PERMIT IS ��` � ,_T , J ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTFUCTION '7 1 lr7�l j CAARIER _ ��1Y97 �iC�� PLAN REVIEW ��----- Z POLICYNUMBER �� ELECTRIC Q � (iHI55ECi%JNNE�NOTBEOOMPLEfmOFhEPER1MlSFOqONEFR1nOREDD011ARSK100IORLE5S1 PLUMBING W Z 1 CERTIFV THAT IN THE PEFFORMANCE OF h1E WORI(FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE � (/� WORKEfiS'CAMPENSATION LAWS OF CALIFORNIh AND AGREE THAT IF I SHOUID BECAME INSPECTION FEE = SU&IECT TO THE MfORKERS'CAMPENSATION PROV B S OF SECTION 970o O LABOR CODE,I SHALL FORTHWITH COMPLY Wlhl THOS RO A ISSUANCE O t �p DATE: PLICANT. SMIP � W J WARNING FAILURE TO SECURE WOAKERS'CAMPENSATION RAGE IS UNUWFUL,ANO SHALL BE ENERGY P/C J � SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND pVIL ES 11P TOONE HUNDFED THOUSMlD ENERGY PERMIT DOLLAi75(5100,000).IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PqOVIDED FOR IN J SECTION J708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. e OC RETENTION FEE: � O CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: � 1 HEREBV AFFIqM UNDER PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AGENCV FOR THE PERFORMANCE OF THE WORK FqR WHICH THIS PERAIIT IS ISSUED(SEC.3oe7,CIV.C.�. Z W � LENDER'S NAME � LENDER'SADORESS ` \ w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORPECT. TOTAL FE ES � �� U � I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AN�STATE LAWS RELATINO TO BUILDINQ V � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF iH15 CWN7V TO ENTER UPON THE Z ABOVE-MEMIONED PROPERTV FOq INSPECTION PURPOSES. COMMENTS � ��'i/1�� / i S<</'.`!� � m PERMITTEE NAME(PRINn Q � N SIONATU PERMITTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDEN OD—File Co GREEN— py. ApplicanYs Copy ��"� �� IIDD�G�iQ�fi�9� �G�lff� af��G�� t� ��lf� �G'Q`U� a1��l.I��,� �� J o �GQ l� �G� � � ° SET BACK _ � _ , FLOOR JOIST � FTGS/FORMSlSTEEL j FHA REQMTS ELECTRIC GROUND UNQER FLOOR DUCT GROUND PLUMBING UN�ER FLOOR GUMQUIT SLAB GRADE FiREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE � e� � MID HT. BOND BEAM R�OF SHEATFiIPJG `��2 �� 8 FT. B�ND BEAM � FRAIVIIiVG/VENTILIATION � FINAL BOND �EAM ROOF COVER PRE-GRADING � ROUGH HEATING BENCHING ROUGN ELECTRIC ROUGH GRADING ROUGH PLUIVIBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. lATH/SIDING POOL FENCING � WALL INSULATIOfV POOL FINAL CEILIP�G INSULATIOP�! � OFF SITE lPV1PS. DRYWALL(VAILIMG DEDICATIONS SEWER FINAL ENG. SEPTIC TANK . LANDSCAPElIRRIG. SEEP PIT/L.L. ' ON SITE IMPS. GAS AIR TEST � FINAL ZONING FIh1AL COI�IST. ; FlRE DEPT. FINAi FiNAL HEATING HEALTH DEPT. FINAL FIPJAL ELEGTRIC DEV. FEES PAID FINAL PI�UNiBING � ENERGY � I �� CQ��l�s � SEPTIC TAfVK SIZE SEEP PIT/U SfZE -� r� � -- � [� _ _-- �