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Home My WebLink About16470 --� ; , _1� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES " s 21660 E.Copley Drive Suite 190 .-- w (909)86a3195 Faz(909)861-3117 PRESS ��'� BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATION PERMITJ P/C o ADDRESS I�,7,_� C-��1�.� C_Y�-rST I�IZ DATE �� NUMBEFF•� # � APN LOT TRACT DA EE d � � ONST. GROUP p OWNER � f NI t��!Vt� p ADDRESS -� ZONING SETBACKS gCITY ��IA�"10�117 Al2 ZIP�STEL FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDEISIDE STREET RW ❑ � CONTRACTOR�b�-Uk"--y.� C'v h1S�T 12UCT1 u N� SIDE ❑ O ADDRESS PROPOSED USE L�-Mu�I - C--7�I 'Tt� I CITY 1�AL►J U'T ZIP�� TEL � . w ARCH/ENG/ � DESIGNER NO.DWEL. NO. �� , 1. ,u NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM �. p I HEREBV AFFlRM UNDER PENAL7Y OF PERJURV THAT I AM EXEMPT FROM THE CANTRAC70RS U� Gefege/Cefport I W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANVCINOR (n U COUNTVNMICHqEIX11HE5APENMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLI5H,0(iREPAIRANYSTRUF W patio/Deck TUHE.PRIOR TO ITS ISSUANCE,ALSO RE�UIFES THE APPLICANT FOR SUCH PEqM17 TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- W � CENSE LAW(CHAPTER Y(COMMENCINO WI7H SEC710N 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- � P�OVSpB FESSIONS CODE)OR THAT HE Oii SHE IS EXEMPT 7HEPEFROM AND THE BA515 FOR 7HE ALIEGED EXEMP- (� TpN.ANV VIOLATION OF SEC710N 7031.6 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof � A CML PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLURS(S5o0).): � ❑I,ASONMEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1RIefClel � WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70M,BU51- J � NE55 AND PROFESSIONS CODE:THE CANTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF ? PROPERTY WFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSELF OR � 7NROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVERTMEBUIIDINGOHIMPROVEMEMIS50lDWITHINONEYEANOFCOMP�E- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DIO NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,AS ONMER OF TME PROPEiiTY.AM EXCLUSIVELV CONTRACTINO WITH LICENSED COMRACTORS (� TO CONSTflUCT 7HE PR0.JECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI- VelU8ti0� ADJ.AREA W CENSE UW DOES NOTAPPLY TOAN ONMER OFA PROPEHTY WHO BUILDS OR IMPROVES THEREON,AND F Nh1000NTMCTSFORSUCMPR0.1ECT5WIhIACONTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE . Y roas uc�sE uw.). � ❑�AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON U 3 � � DATE OWNER U Z w � LICENSED CONTRACTORS DECLARATION w � I HEREOY AFFIRM UNDER PENALTY OF PERJURY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER � d G(COMMENCINO WIiH SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE.AND Z X AIV UCENSE IS IN FULL FORCE AND EFFECT. m lLl /� ,�' /� � UCENSE CLASS G�� LIQ NO.��/O�h,_I j WDATE �f"I u--(�1 CONTRACTOR �:M d � WOiiKERS'COMPENSATION DECLAFiATION -� � I HEREBV AFFIRM UNDER PENALTY OF PEiL1URV ONE OF THE FOLLOWING DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKEFS' _ Q COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PEFW RMANCE w Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION �, 1 ,e` Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��' , j , 9 ISSVED.MY WORKERS'COMVENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �� jCAfiRIER �TA — �PLAN REVIEW ZPOLICYNUMBER �L� OB�n�,� �i �� ELECTRIC - ' '—-' ' -- Q � (I}95SECf10NNE�NOTBE0.7M1.WlETIDOFhEPERNlTISFORONEMRDREDDOI.IARS(SiOa)OqLESS� PLUMBING Z 1 CER7IFV 7HAT IN THE PEHFORMANCE OF THE WOPN FOR WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL (3 SHALL NO7 EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE y WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THA7IF I SHOULD BECOME INSPECTION FEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR � CODE,1 SHALL FONTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE f � SMIP -..T_T=— - p DATE: lJ—I b—�1� APPLICANT: I J WMNINO:FAILURE TO SECURE WOFKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOYERTOCfiIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(i700,000),IN ADDITION TO THE COST Of COMPENSA710N,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEI^SFEES. FlETENTIONFEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � t HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CANSTRUC710N LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS FE{iM1T IS ISSUED(SEC.3097,CIV,C.), � Z W � LENDER'S NAME t- LENDER'SADORESS w TOTAL FEES '� � ,O� � � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT TME ABOVE INFORMATION IS CARRECT. I � I AGHEE TO CAMPLY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING � CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNT/TO ENTER UPoN THE � n , 6 Z ABOVE�MENTIONED PR PERTV FOR INSPECTION PURPOSES. COMMENTS JU ( � _l �v rc � � J � � m PEPMITTEE NAME(P INT) Q � � SiGNA7UREOFPERMITTEE TE - � � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Capy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—Applicant's Copy . . ._ _. � . , �0�� [� -- �G��'f�CG'VO(�I�I [�iC C��ff�� C�� CJ``� OG�� o ' ��[�� 'Q`u� �GJ�I� U o ,C�, SET B�ACK FLOOR JOIST FTGSIFORMS/STEEL � FHA REQMTS ELECTRIC GROUtVD UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CU�IDUIT SLAB GRADE FIREPLACE FOURIDATIOfV � TEMP POWER FIREPLACE BOfVD BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATMING �^I��°l `-- —"� 8 Fi'. BOND BEAM FRAMIfVGNENTILIATION FINAL BOND BEAM ROOF COVF_R v�—�S�1 PRE-GRADING ROUGH HEATIi�G BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING ' FIfVISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATIOiV POOL FINAL CEILING If�SULATiON OFF SITE IMPS. DRYWAL.L iVAIUNG DEDICATIONS � SEWER FIIVAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEE� P1TlL�. ON SITE IMPS. GAS AIR i E5T FINAL Z�NIiJG FI�1;�L CO�1ST. ��0( FIRE DEPT. FIfVAL F;fVAL NE�TING � — IIEALTH DEPT. FINAL ri;ti/��,ELECTRIC DEV. FEES FAID i._.._. — ' :_ '`ar'.L P�UMBII�IG ENERGY � ---- C •�C�G� o r.o c�,C�o �_. — � �O�MEIV�'S � . . . . � . �-�---- SEPTIC TAf�K SIZE � SEEP PIT/U S17E ` � -- ---- I � , � � , �