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Home My WebLink About12-789 ��`_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � -�..W 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Bmldmg Inspect�on Hothne(909)839-7027 PRESS �"°"'. BUILDING PERMIT APPLICATION FIRMLY � JOBSITE n,.,//�,� CKL7��N�UR • DATE'CATIO PERMIT t2 �/ p/C ,�� o ADDRESS LU✓rJ �' �q I� � NUMBER ' n_1 a �'I�q � issuE � � t� TYpE occ APN LOT TRACT DATE CONST. GROUP p OWNER C1� D6.� 0 ADDRESS ZONING SETBACKS �I M� Q�,/ FRONT RW O k�y�� ,«,*L ZIP TEL. o APPLICANT n TEL. REAFi ❑ Z SIDE/SIDE STREET RW ❑ � CONTRACT SIDE ❑ ADDRESS � CITY P�� ZIP �J TEL PROPOSED US S� w ARCH/ENG/ � 9 �aj'� iz DESIGNER X �ILNNI�L�IC.- �M� NO.DWEL NO. NO. a ADDRESS � CITY . ZIP TEL. UNITS STORIES BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFRlADD/REM O p I HEHEBV AiFIRM UNDER PENAL7Y OF 7ERNRY THAT 1 AM EXEMPi FROM THE CONTMCTORS LI- Gele9B/CefPOR W CENSEUWFORTHEFOILOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCIT/OR (n 'U COUIlryWHICHREWIRESAPERMIT7000NSTRUCT,AITEfl,IMPROVE,DEMOUSFI,ORREFAIRANYSTRUG W � - W NRE,PR�OR TO RS ISSUANCE,AL50 REWIRES THE A7PliCANi FOR SUCH PERMIT TO FILE A SIGNED W PatidDeck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIDNS OF THE CONTMCTORS L6 � � � CENSE LAW(GiAPTEH e(CAMMENCINO WITH SECTION 7000)OF OIVISION 3 OF 7HE BUSINESSAND PRa PooUSpa , 0 FESSIONSCOO�ORTHATHEORSHEISE%EMPTTHEREFROMANOTHEBASISFORTHEALLEOEDEXEMP• (' V TION.ANYVIOLATIONOFSECTION7031.SBYANYAPGLICANTfORAPERMITSU&IECTS7HEADP�ICANTTO Z� RaRoof ACML PENALTY OF NOT MORE THAN FNE HUNDRED DOLLAHS(1500).): 0 ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � � Commercial - Z WILL 00 THE WORK�D TNE STRUCTURE IS NOT IHTENDED OR OFFERED FOR 3ALE(SEC.7ou,BU51� J � NESS ANO PROFESSIONS CODE:THE CAN7MC70R5 LICENSEUW DOES NO7 APPLY TO ANAVMER OF � �� PqOPERTY NM1iO BUILD3 OR IMPROVES THEREON.M1D WHO OOES SUCH WOHK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER ONRI EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMEMSARE NO7INTENDED OR m � . Q OFFEREDFORSALEIF,HOWEVER7HEBUILDINGOHIMPROVEMENTISSOLDWfTHINONEVEAROFCOMPLE- Z TION,7ME OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUIID OR . . � IMPROVE FOR THE PURPOSE OF SAL�. � ❑I,AS ONMER OF THE PROPERTV,AA1 E%CLUSIVELY CAMRACTINO WfTH LICENSED CONTRACTORS Q TO CONS7RUCT THE PR0.IECT(SEGJOl1,BUSINESS AND PROFESSIOHS CODE:THE CONTMCTOpS LI- V2IUHIIDR OOO � ADJ.AREA� � W CENSE LAW DOES NOTAP7LY TOAN OWNER OGA PROPERTY WHO BUILDS OR IIAPROVES 7HERC-0N,ANO � � � WNOCANTRACTSFORSUCHGROJECfSWITHA00NTRACTOR�S)LICENSEDPURSUANfTOTHECONTMG pUANTITV DESCRIPTION FEE � � TORS LICENSE LAW.). � O I AM E7(EM7T UNDER SEC. �B.8 P.C.FOR TMIS REASON � I � ¢ � DATE OWNER �F- � . .. '. � � W . . . �, LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIpM UNDER PENALTY OF PERJURY THAT I AM�LICENSED UNDER PROVI ION F CHAPTER � � � � 9(COMMENC4JCi WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFE I CODE,AND Z, X`� 1AY UCENSE IS IN FUIL FORCE AND EFFECT. m LL! � UCENSE C S LIC.NO. j _ V DATE v COMRACTOR a - - . W � WORKERS'COMPENSATION DECLARATI Q � I HEREBY AFFIRM UNDER PENALiV OF PERIURY ONE OF 7HE FOIIOWINGDECCARATION Z ' � � _I HAVE�AND WILL MAINTAIN A CERTIFICA7E OF CONSEMTD SELF-INSURE FOR WORKERS' _ COMPENSATION,AS PROVIDED BY SECTION 3700Of THE UBOR CODE,FOR THE PERWRMANCE W Q � /�OFTHE WORN FOR WHICH THIS PERMI7IS ISSUED. � � � - QW y��[� I HAVE AND WILL MAIN7AIN WORKERS'�COMPENSATION INSURANCE,AS REWIRED BV SECTION / 3700 OF THE LABOR CODE,FOR THEPERFORMANCE OF THE WORK FOR WHI01 THIS PERMR IS ,Q • ¢ ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION�� dl�� `� CARHIER /�� PLAN,FIEVIEW �'3Q ; 4-s Z0 Y POLICYNUMBER ��y,t�� ELECTRIC �•� ¢ 0 (nLLSSEcfqNNEIDwiBEaoARErmoF7l�aEw�frs oNEHJN7RE)npoul�g�m�oqtEss) �PLUMBING � . Z I CERTIFY THAT IN THE PERFORMANCE OF 7HE RK wrncH niis PEw�rt is issueo,i �MECHANICAL C} SHALL NOT EMPLOV ANY PERSON IN Ap1Y NE SO O BECAME�SUBJECT TO THE � � WORKERS'COMPENSATION UWS OF CK� IA REE THAT IF I SHOULD BECAME �NSPECTION FEE � SU&IECT TO THE WORKERS'COMFENSl1T N V IS� OF SECTION 37o00F THE LABOR - � Q , � cooe,i sruu Foar�nni coua�v win� os o i Ns. ISSUANCE Z- O p DATE:�ti APPUCANi: �SMIP J WARNINO:FAIWRE TO SECURE WORKERS'CAMPE ATION RAGE IS UNLAWFUL,AND SHALL BE ENEFiGY P/C . � SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AN CIVI IN 5 UP TO ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(5100,OOo),IN ADD�710N TO THE COST OF CA SATION,DAMAGES AS PROVIDED FOR IN � SECTbN770eOF7HELABORCODE,WTEREST.ANDATfORNEY'SFEES. � RETENTION FEE: OCONSTFiUCT10N LENDING AGENCY PR(E�-ALT FE� ,/,� �� I HEREBYAFFIRM UNDER PEN/1�TY OF PERIURY THAT THERE IS ACONSTRUCTION LENDINO AGENCY 1'S� �� V O n-� �FOR h1E PERFORMANCE OF THE WORK FOR VRi1CH THIS PERMIT IS ISSUEU(SEC.30i7,CIV.C.). -�"° � Z W �. LENDER'S NMIE F- LENDEfYSADDRE55 /, �� ICERTIfY7HATIHAVEREADTHIS PLI IONANOS7ATETMATh1EABOVEINFOHMATIONISCORRECT. TOTAL FEES ��' `� 1 Z w I AGREE TO CAMPLY N7TH ALL C AND MY ORDINANCES AND STATE UWS REUTING TO BUILDIN(3 d � CANSTRUCTION,MIDHEREBYA R REPRESENTATNESOFTHISCWNTYTOEMERU70NTHE ' Z ABOVE-MEMIONEDPROPERTVF RIN P CfIONPURVO5E5. COMMENTS ` o x �� M� _ m PERMfTTEE NAME(VRINT) " � � Y I°I v � \ `a� J 1� Uj IONATUREOFPERMITT DAT � �/� � RECPT.NO. S� PAID$Y ,�l1� ' VALIDATION WHITE—Department Copy,YELLONI—Finence Copy,PINK—Assessor Copy,GOLDENROD—Fle Copy,GREE�ApplicanYs Copy c�rv oF �iA�no�v� B�R INSPEC�'ION REC4Ft� ... �� .- . : , _� __ - - - f - - �, � - �� . _ �,.. . , ,� � : . � _ _ . _.. . �, �� '�a r '� i .. a�,�� ' � �� _ 9 ° 0 � € �� ° � 6 � ° �� „� .:a.�.. .....- �"�.. : ��.�, .. . r�::r,+�* .�:-- - .�.. � �. �, :'o- . �.ar� ;r � �-�� ' -r�-. � - r� SET BACK . � I FLOOR J015T V . ---. _._..___._ --- ------ I __----__----- —_ _ __. __._._. -- - --- ____ _----.. ... _._.—.........--- FTGS/FORMS/STEEL �FHA REQMTS -- -- ---_.---- _— ELECTRIC GROUND � �UNDER FLOOR DUCT GROUND PLUMBING �_ i UNDER FLOOR CONDUIT SLAB GRADE � j FIREPLACE FOUNDATION TEMP PO�VER �FIREPLACE BOND BEAM WATER SERVICE I MID HT.BOND BEAM ROOF SHEF�THIfJG ;8 F�(.BOND BEAM FRAMING/VENTILATION j FINAL BOND BEAM - — ---- ;— ------ -— -- -------- ROOF COVER 'PRE-GRADING — -- ----- -- — I----- ----- --- -- ROUGH HEATING 'BENCHING ----------- --------------------- --------- --------------_ _.._ _.__...-----._._ _____..._._ ----- .._._.._____._---_____.-----..______. ROUGH ELECTRIC ,ROUGH GRADING ROUGH PLUMBING I fINISH GRADING SHOWER/TUB TEST I POOL ELECTRIC EXT.LATH/SIDING j POOL FENCING WALL INSULATION �POOL FINAL CEILING INSULATIQN OFF SITE IMPS. QRYWALL NAILING DEDICATIONS ---- ----- - -.__ . --- ---- --- -------- -- - --__ _ - -- --_ ___. ___ __ SEWER ' _ FINAL ENG. ----- ---- ------- - -- - - ----- - - - -..._._ _.--- -- ---- ------- _ - -----_ _..- ---..-- ---- SEPTICTANK LANDSCAPE/IRRIG. __ __ SEEP PIT!L.L. I ON SITE IMPS. GAS AIRTEST FINAL ZONING FINAL CQNST. I FIRE DEPT.FINAL FINAL HEATING �HEALTH DEPT.FINAL FINAL ELECTRIC l'Z �DEV.FEES PAIO FINAL PLUMBING i ENERGY FINAL PLANING I FINAL ENGINEERING • � a �" ��-,��--. CaMMENTS ___—__ ____ ___ SEPTIC TANK SIZE SEEP PIT/U SIZE — ; -- ----- --------------- ----- - ------- ------- ------�------------ �;_ �'r� — ----------- ----___------ €�' ��%� _ � ��= .,�� .. � . ��. � �.: � ,�.�� ,��: ��;�� , ��,� ------- ---------...-------------- ---------__.—------ --....------ —-------.....-- Y �� _ �+�� ' �£,� . - - ----- — — -------�- �--------- a �� ,� � f�i��* "� -� _ - — — -- — �,-"r;,� ��"- � _ . � ��.�. '•: _ �-�':-�, 's�