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Home My WebLink About10-1042� _�`_ CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 9176 (909)839-7020 Fax(909)861-3117 Buildi��,a��19)839-7027 PRESS "�^' � BUILDING PERMIT APPLICATION FI�iMLY ¢ DDRIESs�yI �/ /.�"/�y [ ,�Y�,,��/� ( li� i f � �d-�p�v7. O �O I r DATEICATION PERMIT p/C . � o ---c� /'-�� G��G�^-- D'�� NUMBE # � °r° APN LOT RA ; DA EE I�'tlI'�O ONST. �C�GROUP p OWNER o ADD SS - i ZONING SETBACKS Z CITY ZIP TEL. FRONT Ryy p o APP ICANT � TEI. � SIDE/SIDE STREET RW ❑ z Q CONTRACTO !l , � � IDE p � ADDRES ROPOSED USE ,I o� CITY ZIP_�✓9�EL. � � ARCH/ NG/ , z DESIGNER 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 O p I HEREBV AFFIRM UNDER PENAL7Y OF PERJURV THAT I AM EXEMPT FROM THE CONTRAC70R5 LI- GefegO/CefPOff W CENSEUWFOR7HEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n U CAUNTVWHICHRE�UIRESAPEPMITTOCANSTfiUCT,ALTER,IMPROVE,DEMOIISH,ORREPAIRANYS7RUC- � w TUFE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS ll� � � CENSE UW(CHAPTER 8(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PFO� POOUSPB , 0 FESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� V TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT TO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(SSaO).): _ Z ❑I,ASONMEROF7HEPROPERTV,ORMYEMPIOVEESWITHWAGESASTHE1R50LECOMPENSAT10N, � COrt1rtIBfCi81 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I�,BU51- J N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPERTV WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OH HERSELF OR Q iHROUGH HIS OR HER ONRJ EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m w OFFEREDFOHSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEN71550LDWITHINONEVEAROFCOMPLE� � TION,THE OWNER-BUILDEH WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE). = OI,ASOWNEROF7HEPROPEHT�',AMEXCLUSIVELVCON7RACTINGWITHLICENSEDCONTRACTORS W � TO CANSTRUCT THE PRQIECT(SEC.)011,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VBIUflI10 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPHOPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACqNTRACTOR�S)LICENSEDPURSUANTTOTHECANT{UG QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). � ❑I AM EXEMPT UNDEii SEC. B.8 P.4 FOR THIS REASON Q � � � - U ZDATE OWNER � �_�_ � LICENSED CONTRACTORS DECLARATION w � I HEHEBY AFFIRM UNDER PENALN OF PERJURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � a B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z MY UCENSE IS IN FULL FORCE AND EFFECT. m 0 LICENSE CLAS LIC.NO, f O� �^� j . V DATE � CONTRACTOR V7l/ d W � WORKERS'COMPENSATION DECLARATION a NI HEREBY AFFIRM UNDER PENAL7Y OF PERIURY ONE OF THE FOLLOWING DECIAflATIONS: Z ZAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ . Q � COMPENSATION,AS PROVI�ED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED. � W _I HAVE AND WILL MAINTAIN WOfiKERS'COMPENSATION INSURANCE.AS FEOUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMI715 /�c � ISSUED.MY 'CO ENSA710N INSURANCE CARRIFR AND POLICY yWMBER E' CONSTRUCT /w//j'�' ¢ �� fA_��I� ��4��.5`�/ ] CARRIER � PLAN REVIEW Z POLICY NUMBER � C � �Q �_�� Q � (iHISSEC�qNNE�NOTBE00t.1R.ETEDOFhIEPEP/M15FORONEHUPDREDD0UA0.S(f700)ORLESS} PLUMBING Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WMCH THIS PERMIT IS ISSUED,I MECHANICAL �� SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE , � WORKERS'COMPENSATION LAWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � � SUBJEC7 TO THE WOHKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR _�y�,\ COD ,I SHA�Yf�RTHWITH COMPLY WITH THOSE PROVISIONS. � ) U NC � V UL p OATE:.�yyl j�_S�LJ__Ll APPLICANT: �lFJN� MIP `� �J TT � J WARNINGrFAIIURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNtAWFUL.ANDSHALLBE ENERGYP/C � SUBJECTAN EMPLOVER TO CRIMINAL PENALTIESAND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ETEN ON . G""� a CONSTRUCTION LENDING AGENCY P E•A T FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THEFE IS A CONSTRUCTION LENDING AGENCY � � FOR THE PERFOFMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.7097,CIV.C.). Jr � '� �D� Z W � LENDER'S NAME � LENDER'SADDRE55 � TOTAL FEES '7�•� � 7 � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. W I AGREE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING � � CANSTRUCTION,ANDHEREBVAUTHORIZEREPflESENTATIVESOFTHISCOUNTVTOENTERUPONTHE �SLy�� OV MENTIONED PROPER7V FOR INSPECTION PURPOSES. � �y �,� � COMMENTS J ��5/ ' � m PEFiMI7TEE NAM IyT) � � � 0 s �✓ � SIGNATURE PE ITTEE D E � = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROa–File Copy,GREEN—Applicant's Copy � CB�V O� DVA6ViS7ND ��48�. � BB�SI�aI�:C�B�N O�I�COE�� i-�,.:1�.�'�'' '' .`�' '�, �' 4:� oa�p�c�400a oa� `� oa�p��4oa - oa�ac�c�ooa �a4r� `oa�p�c�oa �: 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-GRAQING 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 I LANDSCAPE/IRRIG ____ SEEP PIT/�.L. � ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC _ _ __ (Q �,� DEV. FEES PAID FINAL PLUMBING ENERGY ��o � COMMEIVTS �,�.�,�� d` ►� SEPTIC TANK SIZE SEEP PIT/U SIZE a ------- � � ---- �