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Home My WebLink About11-358 �, . , ��_ CITY OF DIAMOND BAR � 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 FIRMLY JOBSITE (� n APPLICATION PERMIT /C �CZ \ o ADDRESSx ��SD I �I/��"�rY,c.Y�CJ� n�'^ DATE__i�/� NUMBER I '� 1��'3Sq• � ISSUE TYPE OCC � • APN � `_OT TRACT DATE �- � CONST. ✓�GROUP p OWNER e � ADDRESS � ZONING SE ACKS o � Z cirv D�a d ZIP T L. � - 5/ FRONT qyy p , p APPLICANT ��• � � � SIDE/SIDE STREET RW ❑ z � CONTRACTOR �J � SIDE p o ADDRESS PROPOSED USE (' w ARCFi/ENG/ ZIP ��( eT�L. t(/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZI TEL. UNITS STORIES BEDROOMS u� v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENAL7V OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f89B/C01pOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.70.�1.5BUSINESSANDPROFESSIONSCADE:ANYCITVOR (n U COUHTYWHICHREDUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVS7qUG w TURE,PFIOR TO ITS ISSUANCE.AL50 qEQUIRES TIiE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w Patio/Deck � S7A7EMENT 7HAT.HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CQN7RACTORS LI� � � CENSE LAW(CHAPTER Y(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOP7HEALLEGEDEXEMP- (� V TION.ANVVIOLATIONOFSECTION7037.58VANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z He-Root � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSA710N, 0 CORIfI10fClal WILL DO THE WOHK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a1,BU51- J . � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � VROPERTY N?i0 BUILDS OR IMPROVES 7HEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR CC 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m Q OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIA/PROVEMEMISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HA7 HE OR SHE DID NO7 BUItD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTY,AMExCLUSIVELVCON7RAC71NGWITHLICENSEDCAN7RAC70RS Q TO CANSTRUCT THE PR0.1EC7(SEC.70�1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U8t1Of1 ADJ.AREA W CENSEIAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILD50RIMPROVESTHEREON,AND � . � VMOCONTMCTSFORSUCHPROJECTSWI7HACON7RACTOR(S)LICENSEDPURSUAN770THECONTRAC- (]UANTITY DESCRIPTION FEE � Y TORS LICENSE LAW.�. � ❑I AM ExEMPT UNDER SEC. 8.8 P.C.FOR THIS REASON Q � U � � OATE OWNER H Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIFiM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � � d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULL FORCE AND EFFECT. m llJ � � LICENSE CLASS LIC.NO. � _ V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z � _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUFE FOR WORNERS' ¢ S CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE U OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 370o OF THE UBOR CODE,FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� ISSUED.MV WORNERS'fAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �� • � J j CARRIER PLAN REVIEW Jcf7 • Csa � POLICY NUMBEfi Z ELECTRIC ¢ � (iHISSECfIONNEmNOTBEO0A4PLEfEDOFhIEPERMfTISFORONEHUt�DREDDClLA0.S(f100)ORLESS} PLUMBING Z �CEFiTIFY THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL (,'} SHAILNOT EMPLOYANV PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TOTHE ' � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREE7HA71FISHOULDBECOME INSPECTIONFEE = SU&lEC7 TO THE WORNERS'CONPENSA710N PROVISIONS OF SECTION 370o THE LABOR n CAD ,I SHA FORTHWITH CO LY WIT 5 ROVISIONS. ISSUANCE (�"'�r � S � p OATE:� I APPLICANT: SMIP f J �WARNING:FAILURE TO SECURE WORKERS'COMPENSATI OVEFiAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � ' � SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CI INES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(i10o.o00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ^� j�/� � SECTION37080FTHELABORCODE,MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: __ /�y�+�/1J OCONSTRUCTION LENDING AGENCY P ALT FE � I HEREBV AFFIRM UNDEF PENALTY OF PERJURV THA7 THERE IS A CONSTRUCTION LENDING AGENCY ��j� � �i. D O FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMI7IS ISSUED(SEC.3097,CIV.C.�. Z W � LENDER'S NAME � LENDER'SADDRESS � TOTAL FEES � ��" �l�' 9 � I CERTIFY TFIAT I HAVE READ 7HI5 APFLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. w I AGFEE TO COMPIV WITH ALL CITY AND COUN7V ORDINANCES AND STA7E LAWS RELA7ING 70 BUILDING � CANS7RUCTION,AND HEREBV AU7HORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPoN THE � ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. Z COMMENTS � J � m FERMITTEE NAME(PRINT) � ' � G �O��7 ✓ �o��' � SIGNATURE OF PERMITTEE DATE = RECPT.NO. PAID BY � .-��L VALIDATION ~ WHITE—DepaRment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy CV�Y O� DOA6Vi0�l� ��,�d � ----_ 9�S�lEC��C�� 9�I��OFBD .. , , . .. - � . ;�. - ,'_��]�pGC�`�'�0[n�- `Do Q�' 0��?C�C� r�G� "�GJ�3p�t�S�00f� �' o '�r'��' '��},�I�° a 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 HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM � ROOF CA�V�' r�/� � 1�/� , PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRAQING � ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC � EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEI�ING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPT�C TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING j FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY i ��o c •L �,� COMMENTS _1a��,��, _!� �� `� z � SEPTIC TANK SIZE SEEP PIT/U SIZE a � � � :