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Home My WebLink About10-1254 (5) ��_ 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 "��'� BUILDING PERMIT APPLICATION FI�iMLY y�, JOBSITE APPLICATION PERMIT !�� p/C o ADDRESS L_3S �,2G�f'U IGI,, Gr�sfi DATE NUMBER��I2C�L� # o ISSUE /7 TlPE T° APN LOT TRACT DATE ��l /�/Q CONST.� GROUP p OWNER �o�otx-� �C-�cf,Z a ADDRESS �3 L�ec` � �Y- "t— ZONING SETBACKS z CITY p�c-�vh�nd Qa.l ZIP q��/v� TEL. i.ct FRONT RW ❑ p APPLICANT` - TEL.�I`I � S DE/SIDE STREET RW ❑ z � CONTRACTOR 'S1nP,rJ��r F-�fe��n c � 1�/G SIDE ❑ ADDRESS �.3� � � � v PROPOSED USE o CITY l�rra. ZIP ga��1 TEL. � �1 o ARCWENG/ � �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENAL7Y OF PERJURY THAT I AM EXEMPT FROM THE CANTRACTORS LI- Gefe90/CBfPOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o37.5BU51NES5ANDPROFESSION5CO0E:ANYCITVOR (n U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT.ALTEF,IMPROVE.�EMOLISH,ORREPAIRANYS7RUC- w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STA7EMENT 7HA7 HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF 7HE CANTRACTORS LI- � � CENSE LAW(CHA7TER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPB � FESSIONS CADE)OR THAT HE OF SHE IS EXEMPT7HEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof ' A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(S5o0).): ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, 0 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7ou,BUSI- J COrt1rtIBfClel � NESS AND VROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND NhiO DOES SUCH WORK HIMSELF OR HERSELF OR CL THROUGHHISORHEROWNEMPLOVEES,PHOVIDEDTHA75UCHIMPROVEMENTSARENO71N7ENDEDOR m � OfFEREDFOR5�IE.IF,HOWEVER7NE8UILDINGORIMPROVEMENTIS50lDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BU{iDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,AS ON?!ER OF THE PROPERTV,AM EXCLUSIVELY CON7RAC71NG WITH LICENSED CANTRACTORS � TO CONSTRUCT THE PR0.1EC7(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CON7RACTORS LI- V81Udfi0fl ADJ.AREA W CENSE UW DOES NOT APPLY TO AN OVMER OF A PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND � NM1IOCONTRACTSFORSUCHPROJECTSWITHACANTMCTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y 70RS IICENSE LAW.). , �� ❑I AM EXEM7T UNDER SEC. B.8 P.C.FOR THIS REASON Q U � � DATE OWNER � Z w � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X AIV UCENSE IS IN FULL FORCE AND EFFECL m � L�J ' -�A � LICENSE CLASS �—+XL� LIC.NO. �� C O j , V DATE��} �C3�C�� CONTHACTOR d W � WORKERS'COMPENSATION DECLARATION Q , -ez G.L �.Vri.� t NI HERE/BY AFFIRM UNDER PENAL7Y OF PERIURY ONE OF THE FOLLOW WG DECLARATIONS: Z ' � J I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF�INSURE FOR WORKERS' _ � CQMPENSATION,AS PfiOVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q /OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w — I HAVE AND WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS1'CAMPENSATION IN�URANCE CARRIEfi AND POLICY NUMBER ARE: CONSTRUCTION , j CARRIER �S'�C.�'t`C��v�� 1 PLAN REVIEW Z POLICVNUMBER C�i��E]�6CT r`J/�JI U ELECTRIC Q Q (IHISSECTqNNE�NO7BEUJMR.EfEDOFTFIEPERMfTISFORONEHUI�DREDDOL1AfLS(f100)ORLESS} PLUMBING I Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I ECH IC r � U' SHALL NO7 EMPLOV ANY PEq50N IN ANv MANNER 50 AS TO BECAME SUBJECT TO 7HE '. N WORKERS'COMPENSATIONLAWSOFCALIFORNIAANDAGREETHATIFISHOULDBECAME INSPECTIONFEE i � SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR �� i � CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. p DATE:�ec_ I`�ZoIQPPLICANT. .� ✓ SMIP � J WARNING:FAILUHE TO SECURE WORKEAS'CO � NSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOVERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC710N 37oe OF THE LABOR CODE.IN7ERE57,AND ATTORNEY'S PEES. NT �� , d CONSTRUCTION LENDING AGENCY PRE-ALT F O � 1 HEREBV AFFIRM UNDEF PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. Z W I �Z LENDER'S NAME , � H LENDER'SAD�RE55 � TOTAL FEES ��J'�'�-� � I CEqTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. w I AGREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS COUNTV 70 EN7ER UPON THE ZABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � J �` � � m PERMI E AME(PqWT - � Q N � SIG 7U FPERMI7TEE DATE � � = RECPT.NO.' PAID BY VALIDATION � ~ WHITE—De artment Co YELLOW�inance Co PINK—Assessor Co GOLDENROD--File Co GREEN— I p py, py, py, py, ApplicanPs Copy �B�V OI� D�A61f��V�D �A� , . �. Id�SI�I�C�O�� IRf�C�RD oa�p�c�400a oa� ; : oa��4oa aa�pr��oa ��a�� 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. BQND 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 DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE OEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAIQ FINAL PLUMBING ENERGY C�ft�� — — COMMEfVTS ��-��, � � ' AT� �� SEPTIC TANK SIZE SEEP PIT/U SIZE a c� Q — ------ ----- � .