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Home My WebLink About17006 . � CITY OF DIAMOND BAR 1 �, • __1�� --- � . -- -�- DEPARTMENT OF COIvIIvIUNTI'Y&DEVELOPMENT SERVICES � 21825 E.Copley Drive i . '� � (909)860-3195 Fax(909)861-3117 �� PRESS �`'-�� ; BUILDING PERMIT APPLICATION I FIRMLY � � JOBSITE APPLICATION � �1 � t � PERMIT P/C , 1.,, �� o ADDRESS_2R 1 9 CRYSTAf. R`I D , . ROAD DATE L-1 NUMBER # � � ISSUE TYPE OCC � APN LOT 2E� TRACT 47850 DATE CONST. GROUP p OWNER lli amnnc� RAr WeGt� T,T,C: o ADDRESS 3480 TorYan�a R1 vr�_ Sta_ �nf) ZONING SETBACKS Z ciTv Torrance ziP_QQ�Q3TE�.310-540-399 FRONT aw ❑ o APPLICANT Ri rharr� Goiil c� TEL. same S DEISIDESTREET RW ❑ z ¢ CONTRACTOR TCC CnnGtrii�Yi�n SIDE ❑ � ADDRESS �g�g gg o�sner � CITY ZIP TEL. PROPOSED USE itie�a �in�nl e fami 1� re�idence w ARCWENG/ �z DESIGNER R. Gould & ASSOC. NO.DWEL. NO. NO. a ADDRESS g�ma aa nwnar UNITS 1 STORIES L BEDROOMS � � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM Z O I HEREBY AFFIFM UNDER PENALTV OF PERIURY 7HA7 I AM EXEMPT FROM THE fANTRAC70R5 LI- G2fe JB/CelPOlt W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOF (n U CAUNTYNhiICHREOUIRESAPERMI770CANSTRUC7,ALTER,IMPROVE,DEMOLISH,ORFEPAIRANY57RUC- I n � , W TURE,PFIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck ` . STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- � CENSE UW(CHAPTER D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� LL' Pool/Spa � � FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEGEDE7(EMP- (� � TION.ANY VIOUTION OF SECTION 7031.5 BV ANY APPLICANT FOR A PEfiMIT SU&1EC75 7HE APPIICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): Z ❑I,ASONMEROFTHEPfiOPER7Y.ORMVEMPLOVEESWI7HWAGESASTHEIRSOLECAMPEN5AT10N, � Commercial - WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.70aa,BUSI- J � NESS AND PROFESSIONS COOE:7HE CON7RAC70fl5 LICENSE LAW DOES NOT APPLY TO AN OWNER OF � � PROPERN WHO BUILDS OR IM7ROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � Q THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPqOVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASONMEROFTHEPROPERTV,AMEXCLUSIVEL7CONTRACTINGWI7HLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU2SIOf1 J.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPpOVE57HEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEOPURSUAN7TO7HECONTRAC� �UANTITY DESCRIPTION FEE Y TOqS UCENSE LAW.). � � J � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U � � DATE OWNER U Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRM UNDER PENALTV OF PEiLIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d G(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z X MV LICENSE IS IN FULL FORCE AND EFFECT. W m � LICENSE CLASS B ��.No. 6 719 8 2 � J V DATE CONTRACTOR �C j d •-� W � WOFIKEFS'COMPENSATION DECLARATION Q � � I HEREBV AFFIRM UNDER PENALTY OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN7 70 SELF�INSURE FOR WORKERS' _ ¢ COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE w OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED. � � � �I HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SEC710N QQ 3700 0F 7HE IABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS Q� , � ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION I Vv J � CARRIER � ll 1 PLAN REVIEW Z POLICYNUMBER �I�CLLIR nn ELECTRIC Q � (fHISSECTIONNEmNOTBE00MREfEDOFTHEPERM(TISFORONEHUI�DREDDOLLARS(E100)ORLESS). PLUMBING /�/�� Z i CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL W �}' SHA�L NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE �(j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHELABOR (� (� ') � CODE.I SHALL FORTHWITH COMPLY WITH THOSE PflOVI510N5. ISSUANCE �+� V / � /��y� r p DATE:__�� APPLICANT: L-� P C�SI �O SMIP _ _ O �,l JENERGYP/C�- —-- ~'yY-�--� \.� WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE �, I ` LL SUBJECTAN EMPLOVERTO CRIMINAL PENAL7IES AND CIVIL FINES UP TOONE HUNDRED THOUSAND �ENERGY PERMIT � 1 r DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN I I D � J SECTION 3708 OF THE UBOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: Q I(�I�) � � CONSTRUCTION LENDING AGENCY PRE-ALT 6ffEU G � �(r J I Q I HEREBV AFFIqM UNDEF PENALTV OF PERJUHV THAT THERE IS A CONSTRUCTION LENDING AGENCV .�� ZFOR THE PEHFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.7097,CIV.C.�. �� ,r��,.,�=�� 'I W ._ +.��__'. � LENDER'S NAME i F- LENDER'SADDRESS ��`�� TOTAL FEES �I �� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. � I AGREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATIVES OF 7HI5 COUN7YT0 ENTER UPON 7HE hh �1 /�'1/(�� Z ABOVE- ENTIONED PROPERTY FOfi INSPECTION PURPOSES. COMMENTS �-` P � S S lfrl� —J<,c: � QPE ITTEE NAME(P ) � C� �� I � � SIGNATURE OF PER TTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy ( ��li'�Y �CDG� (�OG�I�fli C�I�� [�Q[f� .�_-- ' �u�l�L��C°�Otb�&�1 ffi�[�C��L�I� - . , o�� o�� o�c�� r� . _ ��a� .,. ato�-�� t SET BACK � FLOOR JOIST i _. � _.._._. � _. _---- i -- -- .------ ---..._. . _____ FTGS/FC�RMS/STEEL y�./7t7r; �� FHk REQMTS ' ELEGTRIC GROUND ' � UNDER FLOC�R DIiCT � i _ .... ___---.�--- ' ----- -- -._;...._ GR�UND PLUMBING ��._ .� �-'=!uDER FLOOR CU�IDUIT � __ � ------....._...._.._. SLAB GRADE �v ', � I .••� • �-� I FIREPLACE FOUNDATIrJN j ._..,�r---..._.. ..__ --- - TEMP POWER � _�__FI�RE tAGE E3QND_BEAM __ - --- ----___ ____ WATER SERVICE MID HT. BOND BEAM ---- _..__ ___-- ----- __...__. ROOF SHEATHING '�--�( 8 FT. BOND BEAM __i _____ FRAPJIINGNEN"fILIATiON I 3��0 Z �� I FINAL BOND BEAM ! _- ^_._ _._ ..�..__� _----._..-..------ ---_._-.. ROOF COVER PRE-GRADING ROUGH NEATING I/j�0 BENCHIRiG - - ROUGH ELECTRIC i�� OZ ROUGH GRADING -- - - ----------�- -.._.__._ ---.....__ _�__ ------._._�...---� ROUGH PIUfVIBING (_j� OLi FINISH GRADING -- - ------- -----.._..__... SHOWER/TUB TEST � I POO�ELECTRiC - - -- ----- EXT. LATHISIDIfVG ` �, � __ ,. . POOL FENCING , � --- ---- - -�-.r_.__� _-.........-- -.__.._.__ WALL If�SULATION � �� POOL FINAI '; __ CEIIING INSULATION _ OFF SITE IMPS. � --- - -- �-- DRYWALL NAILING �Z�� DEDICATIONS - -- --- ---- ___-__ ____..___._._�.__ SEWER FINAL ENG. SEPTIC TANK � lANDSCAPE/IRRIGD SEEP PITlL.L. ON SITE IMPS. uAS AIR TEST FINAL ZONING ` - v�_`J� FIfVAL COiVST. � �,�� lRE DEPT. FINAL _ FINAL HEATING "� �� HEALTH DEPT. FWAL � 1, � -- --- ------�-----�-�--_� FIN�1l_ELECTRIC � DEV. FEES PAiD 1-- /� ° � � --- . FIPVAL PLUMBING � � ENERGY i _ -��'�G , � -ol � I ---- -�----�--= -- - , _ _ �. � �'Uti O�C�� , - .�:. �:� ; - ---------- -�-------�- -- __ ' _-- CU6ViM�iVTS _ SEPTIC TANK SIZE SEEP PIT/U SIZE - -- ---- -_---___. . � . ------ =� � � � . - , CITY OF DIAMOND BAR �I �!1� � �� `�---��` -- DEPARTIvIENT OF COIvIIvfUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive �"� I r '� (909)860-3195 Fax(909)861-3117 �` PRESS ��"%�� BUILDING PERMIT APPLICATION � FIRMLY Q DDRIESS ��Q �� 'j 1Z(� APPLICATION PERMIT P/C p DATE O Zi NUMBER �� # � ��L ISSUE TYPE OCC APN LOT �� TRA T T 7 DATE CONST. GROUP p OWNER � C� L L..G � ADDRE�SS �1I'�� IZRIq1�G� Lt��_ ZONING SETBACKS Z CITY �[��?/�IN CC ZIP�TEL.31O S`f03�1 FRONT RW ❑ o APPLICANT TEL. S DE/SIDE STREET RW ❑ z Q CONTRACTOR LeL ( SIDE ❑ O ADDRESS ` PROPOSED USE '1 / ' .+�i I CITY ZIP TEL.�� w ARCH/ENG/ �� o�I�qs�� iz DESIGNER � 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 �Q �L O p I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM 7HE CANTRACTORS LI- Geffl90/CefpOff �q � W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n U COUNTYWHICHFEQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORFEPAIRANVSTRUG w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll� � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB 0 FESSIONSCODE)OFTHATHEORSHEISExEMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICAN7 TO Z Re-Roat � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f50o).): � ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTNEIRSOLECOMPENSATION, � Commercial - Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.7041,BU51- J � NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF� � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWI7HINONEYEAROFCOMPLE� Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SI1E DID NOT BUILD OR . � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWI7HLICENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll- V8IU8�10l1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTO{1(5)LICENSE�FURSUAN7707HECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � � O I AM EXEMP7 UNDER SEC. B.8 P.C.FOR THIS REASON Q �� ` \ �y � _ � �0 V w`"� ' �V Z DATE OWNER � �/ ,� � ' O 0 w �' �Q LICENSED CONTRACTORS DECLARATION W + � � t�� \( � �C V- I HEREBY AFFIRM UNDEF PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � 'I � �(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z V, ( _ .� r `X MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASS ✓ LIC.NO.� Z Z � v D � � � V DATE S CONTFACTOR�� a � -p� W _ �y � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF 7HE FOLLOWING DEClARA710N5: Z Z _I HAVE AND WILL MAINTAIN A CER7IFICA7E OF CONSEN7 70 SELF-INSURE FOR WORKERS' _ Q COMPENSATION,AS PROVIDED BV SECTION 37000f THE 1A80R CODE,FOR THE PERFORMANCE w O HE WOflK FOR WHICH THIS PERMIT IS ISSUED. � � w I HAVE AND WILL MAINTAIN WORKEHS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION Q 37o00F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK f-0R WHICH 7HI5 PERMIT IS ISSUED.MV WORKER'COMP NSATION INSU9ANCE CARRI R AND POLICY NUMBER ARE: CONSTRUCTION � CARRIER �� U�,C/� �.7 PLAN REVIEW Z POLICV NUMBER��`D L �L�_I�_ ELECTRIC Q (iHISSEC1qNNEmNDTBEODMPLEfEDOFiHEPERMfTISFORONEHUPDREDDOLUAS(5100)ORLESS� PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL � � �--�� ^� � '� (.r} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE yL ' � N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE I = SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700OF THE LABOR I ^p�n (� L` �� "'� /u!\(� CODE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE �VI rc li I. `� '� � SMIP I �A p DATE: APPLICANT: � � ENERGY P/C I _ /- J WARNING:FAILUFE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUI,AND SHALL BE � SU&IEC7ANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDHED7HOUSAND ENERGYPERMIT ��•�•"-"� � r DOLIARS(Sloo.o00),IN ADOITION TO THE CO57 OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ' � SECTION 3708 OF THE LABOR CODE.INTEflEST,AND ATTORNEV'S FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � I HEHEBV AFFIflM UNDEF PENALTV OF PERJURV THAT THERE IS ACANSTRUCTION LENDING AGENCV � FOR THE PERF-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,pV.CJ. Z W � LENDER'S NAME H LENDER'SADDRESS � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES ,J�� •yU w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO�UILDING � CANS7RUCTION,AND HEREBY AUTHOR2E FEGRESENTA71VE5 OF THIS COUN7V TO ENTEFi UPON THE � ABOVE�MENTIO D PR07ERTV FOR INSPEC710N PURPOSES. COMMENTS Z � Uv�-S L. . 8v' 1Q _ m PERMITTEE NA (PRINT) � � Q N = SIGNAT EO PEHMITTEE DATE n, RECPT.NO. � PAiD BY C%/� VALIDATION `� ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENFiO�File Co GREEN—A IicanYs Co P PY� PY. PY, PY, PP PY � t��'i'� cC�� f�ilt�ir�C� t�t�a� � �Ir��G�[��0�(r� �G��;3[i� � . � ti o ° ��a : o i�P o � �� _ - � o�c��:� M ,� o� � ��c�a � --- 9 SET BACK ��— .__ _.` ( FI_OOR JOIST ! � -- --_ _.. ._.__�_...._..__._� . _ _._ _ ._..._� ------ ._.__._ FTGS/FORMS/STEEL ; FNA REQMTS � _ _ E�ECTRIC GFiOUND � � UNDER FL�OR DUCT � � • --- -------- � -_— -- i- ..__ __.____ -- --- , _---- _ � ___ GROUND PLUMBING ' UNDER FLOOR CU(�iDUIT i __ SLAB GRADE _ ., _FIREPLAGE_FOUNDATIC?N_ ' � --_ --- t_______ ------------ TEMP POWER i ;_ FIREPLACE BOND BEAM � WATER SERVICE I i MID H7. BOf�lD BEAM ___.._.�___.__ _._.___ .._. __.....______ ____ __.____. _._ _..__ ROOF SHEATHING 8 Ff. BOND BEAM __ __ FRAMING/VEPJTILIATION , FINAL BOP�D BEAM - ----- --.._ _____ _..._.. .....---•-----^ -------.....------. ROOF COVER PRE-GRADING ; __ ROUGH HEATING �,�(J� BENCH!NG � ROUGH ELECTRIC �3��, Y,t1� RQUGH GRADING _ � _ RQUGH PLUIVIBIIVG I �Y�, ! FIt�JISH GRADING --* -- -------- ------..___.--._.. SHOWER/TUB TEST ' POOL ELECTRIC EXT. LATH/SlDING � I PC�OL FENCING � WALL ItVSULATIOIV POOL FINAL CEILING IN�ULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS _.. ---- — _..__ SEWER FINALENG. ---�----_.._----_ �__� SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/LL. — �-�--- - -0N SITE IMPS. __ �_____....--- GAS AIR TEST FINAL Z�NING FINAL CONST. i j , G!RE DEPT. FINAL ~ � FINAL HEATING � HEALTH DEPT. FINAL ;— - � - - ------ __ - --------_.. FINAL ELECTRIC �=�.1�,��=� DEV. FEES PAID _� _ �_ _ FItJAL PLI,�MBING ' � E�IERGY � ��o � � .. ��.��t��_�.T�'i _ _ .V-- — - -- -- � � , i �� -- 1 �� ---- SEPTIC TANK SIZE ------ � SEEP PIT/U SIZE -- — � �-�-��— . � � � __ _ _......----------- ,. � -- CITY OF DIAMOND BAB J ' W�!�� ' �---�'�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,� I 21660 E.Copley Drive Suite 190 ' (909)86a3195 Faz(909)861-3117 PRESS ��'��' BUILDING PERMTT APPLICATION FIRMLY o DDRESS � �� 1�� DATEICATION G� � � NUMBER S � #/C $ ' ,_ ISSUE � TYPE OCC APN LOT�� TRACT DATE CONST. GROUP � OWNER � � o ADDRF�$S 3� b r/Q-YP?J7K{ I�I ZONING SETBACKS S cmr J�,r�rrs ZIP TEL. FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR -J _ SIDE O ¢ ADDRESS � r PROPOSED USE � CITY / . ZIP TEL. oARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. nW. ADDRESS UNITS I � STORIES � BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. � ��fACTOR��PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFlRM UHDER PENALTY OF PE0.NRY THAT I AM E%EMPT FROM THE CANTMCTORS LI- Gflf89B/COfpOR � W CENSEUWPDRTHEFOLLOWINaREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n U COUHryWHICHREWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC• � W Patio/Deck Z 7URE.PRIOR TO ITS ISSUANCE.ALSO RE�UIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED- w STATEMENT THAT HE OR SHE IS IJCENSED PURSUANT TO hIE PROVISIONS OF THE CONTMCTORS LI- W � CENSE UW(CHAVTER Y(COMMENCINQ NA7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO• � POOVSpB � I FESSqNS COOE)OR hiAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR 7HE ALIEGED EXEMP- TION.ANVVIOLATIONOFSECTIOH70.71.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAN7T0 Z Re-Roof A CML VENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(l500).): Z ❑I,ASONMEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOIECOMPENSATION, � Commercial – WILL 00 THE WOHI(,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70H.BU51- J NESS AND VROFESSIONS CODE:THE CONTMCTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF � PROPENTYNRIOBUILDSORIMPROVESTHERC-0N,ANDNMODOESSUCHWORKHIMSELFORHERSELFOR � Q hiROUGHHISORHERONMEAIPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m Q ,OFFERWFORSALEIF,HOWEVER7MEBURDINGORIMPROVEMENTISSOLOWfTHINONEYEAROFCOMPLE- Z 'TION,THE OWNERAUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE f-0R THE PURPOSE OF SALE). ❑I,AS ONT/ER OF THE PROPEHTI;AM E%CLUSIVELY CONTMCTINO WRH LICENSED CON7RAC70RS Q TO CON5TRUCf THE PRQIEC7(SEC.7oal,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V91U8I1Of1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPER7VWHOBUIlD50RIMPROVESTHEREON,AND � 1NpCOHTRACTSFORSUCHPRO.IECTSWITIACONTRACTOR(S)LICENSEDPURSUAHfTOTHECONTRAG pUANTITY DESCRIPTION FEE � TOqS LICENSE LAW.). J O ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q 3 � � ¢ , DATE OWNER �' . W F LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALN OF PEFUURY TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Vi � Y(COMMENCINO WITM SECTION 7000)OF DIVISION�OF THE BUSINESS AND PROFESSIONS CADE,AND Z AIY LICENSE IS IN FULL FO CE AND EFFECT. m LLJ ` � LICENSE CU1SS LIC.NO. G j V DATE CONTRACT d W � WOAKERS'COMPENSATION DECLARATION Q Q b�d /3 KI` d�t� N 1 R AFFIRM UNDER PENPLTY OF PERNfiV ONE OF THE FOLIAWING DECLARATIONS: � � � Mi.. CA Q [/Nr � I HAVE AND WILL MAINTAIN A CEFTIFICATE OF CONSENT TO SELF-INSURE FOP WORKERS' 2 COMPENSATION,AS PROVIDED BY SECTION 97000F THE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOH NMIq1 THIS PERMIT IS ISSUED. � �/ .l � (� � /� 'w J W _1 MAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION Q370o OF THE LABOR COOE,FOR THE PERFOHMANCE OF THE WORK FOH WHICH THIS PERMIT IS � ISSUED.MV WORKERS' EN$�TJON INSU E CARRIEp M1D POLICV NUMBER ARE: CONSTRUCTION � CARRIER �"p�� PLAN REVIEW � POLICV NUMBER ELECTRIC � (iV45SE(,'fqNNE�NOTBE00AFLETmOFiHEPEFa.9TEinROF1EMJrDREDWLLARSIttm)ORLESS) PIUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE MIORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL . ( (3 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE � WORKERS'COMPENSATION UWS OF CALIFOFNIA,AND AGREE 7MAT IF I SHOULD BECOME INSPECTION FEE � SUBJECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION J7oo OF THE LABOR � _�\ � cooE,� omrNnn�coMv�r wm/+�yo�sE aaovisioNs. � ISSUANCE � :l /O L/j,A�.I�V dYiG�-.+ SMIP p DATE:_�� APPLICANT: �.--- s . . w ENERGY P/C J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE � SUBJECT AN EMPIOVER TO CRIMINAL PEN/�LTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(i10o.o00).IN ADDITION TO 1HE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN � {�-- J SECTION 37oe OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � Q d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY n- FOR THE PERFORMANCE OF THE WOfiN WR WHICH THIS PERMIT IS ISSUED(SEC.3oD7,CIV.C.). � 2 W � LENDER'S NAME F_ LENDER'SADDRESS � 1 CERTIFY THAT I HAVE READ THIS APPUC�TION AND STATE T1iATTHE ABOVE INFORMATION IS CORRECT. TOTAL FEES � � W 1 AGREE TO COMPLV N77H PLL CfTY AND COUHTI'ORDINANCES AND STATE LAWS REUTING TO BUILDING � CONSTPUCTION,AND HEREBY AUTFIORIZE REPRESENTATIVES OF 7HI5 CAUNTV 70 ENTER UPON THE . ZABOVE-MENT ED PROPERTY f-0R INSPECTION PURPOSES. COMMENTS �� 0 �— :1_ _ � ' . � Y/'�I m �ERMITTEE NAM RINn ' Q � � SIONA PERMI E 0 � = RECPT.NO. PAID BY VALIDATION ~ WHITE�e rtment Co YELLOW--Finance Co PINK—Assessor Co GOLDENRO ile Co GREEN— plicanYs Co Pe PY� PY� PY. PY. AP PY ` . .. . _ . . . . .. . . . . . . t . C�TY O� DIAIVIOND BAR �f�SP�ECT90N RECO�� --- , �� 0 � >�, ' .��`� a �� • � e � e � v � ., .. �.ria, ,. ,� . t.�. . ._._� ., SET BACK , FLOOR JOIST' . , ' '� - FTGS/FORMS/STEEL � ' ' FHA REQMTS � ELECTRIC GROUND ' UNDER F�OOR DUCT J ' GROUND PLUMBING UNDER FLOOR CO�ID�11T � . . � '� _ SLAB GRADE � FIREPLACE FOUNDATION ' ' ' •- TEMP POWER FIREPLACE BOND BEAM- — WATER SERVICE MID HT. BOND BEAM - - •- "' � �� ROOF SHEATHING • � 8 Ff. BOND BEAM � ��1 ' ' � ' ' � � FRAMINGNENTILIATION � � FINAL BOND BEAM � � ROOF COVER PRE-GRADING } ROUGH HEATING p BENCHING ; ROUGH ELECTRIC ROUGH GRADING � ROUGH PLUMBING FINISH GRADING � � SHOWERlTUB TEST POOL ELECTRlC � 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 DEPT. FiNAL FINAL HEATING �. ;�--� _ � HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY � m � o',� �,.r`��` ' - COiVIiViENTS- ' . . . . , ��. _ . . o A., . • ,. � • . ! . . ,. � 4�� _ SEPTIC TANK-SIZE SEEP PIT/U SIZE � � � M ��' .�d � �a4`��"��`�� w�� : � � �' � � ��q { 3 , t r� �,� � � R "�'� �! A�.YY^ S�`#'C ,N } �� t . �� z� � ' �� #�, ,�� c i� � �;'�; � � � , �_�'��`r� ; ,'` s��,��a��ry, �� t] �g �'�,uM "'��'0�n � `, � . � . . � ! � '�1 • .1 I �u,��,'`�?�I }� -. . � � r r � 2 }� ,� � ar, '�t��sti. . _ , + • � . �t 't � �--� CITY OF DIAMOND BAR � ; `" -- --��` --- DEPARTIvIENT OF CONIIvIUNITY&DEVELOPMENT SERVICES � �, 21825 E.Copley Drive , (909)860-3195 Fax(909)861-3117 � PRESS '`%�� BUILDING PERMIT APPLICATION FIRMLY ¢ DDRIESS Z�I � � APPLICATION O �� PERMIT � P/CO� �� o ` DATE � NUMBER # � ISSUE ��_.�TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER O o ADDRESS � ` ZONING SETBACKS Z CITY ��n-p..,l �„t'✓ ZIP TEL. O.)- 1 � FRONT RW ❑ o APPLICANT TEL. 1T�� S DE/SIDE STREET RW O z ¢ CONTRACTOR SIDE ❑ o ADDRESS PROPOSED USE �V'C.iw� rrp �us�d.L.� 7��,¢ /, CITY ► ZIP qi� TEL. .- = u �-�b w ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/FEM O I HEREBV AFFIRM UNDER PENAL7V OF PERJURY THAT I AM EXEMPT FROM THE CON7RACTORS LI- G218JBIC2fPOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o37.58USINESSANDPROFESSIONSCODE:ANVCI7VOR (n U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w TUHE.PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMI770 FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70R5 LI� � CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � POOVSP2 � FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE AILEGED E%EMP- C7 V TION.ANV VIOLA710N OF SEC710N 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z R0-R00( � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500)J: Z ❑I,ASOWNEROFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercia� - �WILL DO THE WORK,AND THE STRUC?URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7o�d,BU51- J �� NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF � O�� L '-, PROPERTY NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR �W� Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN7S ARE NOT IN7ENDED OR m 0 OFFEREDFORSALE.IF,HOWEVER,hiEBUILDINGORIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BUHDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � 70 CONSTHUC77HE PROJECT(SEC.70�1,BUSINESS AND PROFESSIONS CADE:THE CON7RACTORS LI- VelUetlOfl ADJ.AREA W CENSEUWDOESNOTAPPLYTOA7JOWNEFiOFAPROPERTVWHOBU1LD50RIMPROVESTHEREON,AND � WHOCANTRAC75FORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J � ❑I AM EXEMPT UNDER SEC. B.6 P.G FOR 7HI5 REASON � y . �i ¢ LL' DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UN�ER PENA�TY O;PERJURY THAT I AM IICENSEO UNDER PROVISIONS OF CHAPTER � j "Py��'�} S f n � Y(COMMENCINGWITHSECTION70000FDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z �v � �X MY LICENSE IS IN FULL FORCE AND EFFECT. m ' � LICENSE CLASS LIC.N0. j � J V DATE CONTRACTOR d W i � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PEFLIURV ONE OF THE FOLLOWING DECIARATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ Q CqMPENSA710N,AS PROVIDED BV SECTION 370o OF 7HE UBOR CODE,FOR 7HE PERFORMANCE w OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w � I HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SEC710N Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �J� ISSUED.MV WORKERS'CAM�PEN,�SA�TI.O�N INSURA CE CAR+RIER AND POLICV NUMBER ARE: CONSTRUCTION � Y/� J CARRIER � 1 N��NC/ PLAN REVIEW 7 � 1 Z POUCYNUMBER ,29�—Q,� ELECTRIC Q L� � (iHISSECf10NNE�NOTBEL�OMPIEfEDOFTHEPERMRISFORONEHUI�DREDDOLIARS�f700)ORLESS). PLUMBING ,.,�C Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ' C� SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD�ECOME INSPECTION FEE ? SU&IECT TO THE WOfiKERS'COMPENSATION PFOVISIONS OF SECTION 37000F THE LABOR CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �� 1��^ p DATE:�+—/�—u2 APPLICANT: UG7 � SMIP j . )D J WAHNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � SUBJECTAN EMPLOVER TO CRIMINAL PENAL71E5 ANO CIVIL FINES UP 700NE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(S1o0,o00),IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �( � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: e��V� a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIpM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFOfiMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ. . Z W � LENDEF'S NAME F- LENDER'S ADDRESS /'� � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E� �� `� '\ w I AGREE TO COMPLV WITH ALL pTY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING �[ � V 7 � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � ABOVE-MENTIONED PROPEflTV FOR INSPECTION PUFPOSES. Z COMMENTS " � (��-r� Y�l m PERMITTEE NAME(PRINT) � N ^••/f�G—0�— � SIGNATURE OF PERMITTEE DATE � = RECPT.NO. PAID B VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , • . . ..r. .: , . ��``� �� [�GG�.�(��@ ��(f� � ' �[r��'�C��i'0�(� G�(�C�00 V�� .... . 0 ° �� O/�� G�� 0�� - DQ t� OG� � � :� �, a.. �,. � .� �_ SET BACK I _��u _ FLOOR JOISI" -- ------- - FT'GS/FORMS/STEEL - � FHA REQMTS I ___ _- --. 3!3°a=�----- - -..___� � ---- .__..____ __. _. . ._— -- --- ELECTRIC GROUND i UNDER FLOOR DUCT ' � -- GROUNQ PLUMBING � �_�3'D�- _._______ _; UNQER FLOOR CUt�I�UIT__ � • ;------- -__._. SLAB GRADE � `� -j,3_�� __ _; FIREPLACE FOIfNDATION __ TEMP P4WER ___ � _,___ ' FiREPLACE BOND BEAM __ !______ -._.;...._ _...._.__ WATER SERVICE i MIC}HT. 8(3Nd BEAM i p - - ---� ----------- -- ROOF SHEATHING � O �dZ ___ I t 8 FT. BaND BEAM � - -- -- --- ---..----__, _----.._._ FRAMINGNENTILIATION' �U 2 �_'_�INAL BOi�D BEAM ' - - _....-----....._- � -..__.__-.. ROOF COVER • PRE-GRADING I I ROUGH HEATING BE�JCHING j � - --- -- ROUGH ELECTRIC a f I RQUGH GRADING -- --- ---- ----- ROUGH PLUMBING L ' FINISH i RADIN� -- -�- ---. _. ...�---- _.._..__........_ SHOWER�UB TEST ; POOL ELECTRIC - -- - --- --------- EXT. LATH/SIDING � S�J 2 ; ' PO�L FEP�CING `,�OZ,. -— ----- —.._-- --..____ _ ---------- WALL If�SULATIOPI --�j POOL FINAL ' - - -- --- ' ----- CEILING IN�ULATION /� v� � �j OFF SITE lMPS. � ::� DRYUVALL NAIUtVG �I 57lJ Z - - ---- � DEDICATIONS �--�__ -__ --� -- � SEWER c��DL FINAL ENG. i- ------_ SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. � ON SITE IMPS. i - - --- --�- ---�� ----.._�_ GAS AIR TEST j /� FINA�Z�NING -- - �- — FINAL C�NST. �/' �� j F�RE DEPT. FINA�_ ' --J�y� --+--------_.. FINAL HEATING ,�,�� '/ � HEAI_7H DEPT. FINAL FINAL ELECTRIC ;�+ , �� _ ; DEV. FEES PAID -- - ..._.-- -__._---___ ___........---- FIPVAL PLUhhBING _� � � ENERGY _ i _ I ; � _. _ __..___ � � �� o� � � ; CU�JiMEi�TS SEPTIC TANK SIZE SEEP PIT/U SIZE R� --- ----- ---__..------ ,� � -----. ___...__ ___----- � — �, CITY OF DIAMOND BAR I -�� -----��` --- DEPARTMENT OF CONA�IUNTfY&DEVELOPMENT SERVICES ' . 21825 E.Copley Drive , '�- (909)860-3195 Fax(909)861-3117 PRESS '"'�.��+' BUILDING PERMIT APPLICATION FIRMLY o DDRIESS�v� �' � DATECATION �l� �Z NUMBER 1i/��'�� ISSUE /j1 i O� TYPE OCC APN LOT TRACT DATE G�I CONST. GROUP p OWNER � " ADDR�S :�- � ZONING SETBACKS Z CITY 1� IP q� TEL. 6 m 3 t S� FRONT Ry�/ ❑ o APPLICANT n TEI. S DE/SIDE STREET RW ❑ z ¢ CONTRACTOR L Ci�a ) YtL. SIDE ❑ � CIT`/ EIN�i1 in��_ ZIP�1_7�9fEL. � � i • PROPOSEDUSE /V(��j�j _ L � `iDal � ��k Di)la� �'�'6 w ARCH/ENG/ e �� iz DESIGNER �� C. C'+l�/IMS NO.DWEL. NO. NO. a ADDRESS I�.F}YL AM's�L.n� Pf��.a/ UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY THAT I AM EXEMPT FROM THE CONTRAC70R5 LI� G8f89B/CBfpOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROfESSIONSCODE:ANVCITVOR (n U COUNTYNM1iICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANV57RUC� � W TURE.PRIOR TO ITS ISSUANCE.ALSO REOUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO fILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � PoOVSpB � ��v FESSIONSCODE)OHTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (3 � TION.ANVVIOUTIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO� Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLIARS(5500�.): Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSATION, � COrt1rtI0fC181 �- WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BU51� J � NESS AND PROFESSIONS CADE:7HE CONTRACTOFiS LICENSE LAW DOES NOT APPLV TO AN OWNER OF L �N� ��O PROPERT/VhiOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSEIFORHERSELFOR � 1� •� � THROUGHHISORHEROWNEMPLOYEES,PROVIDED7HA75UCHIMPROVEMEN7SARENOTINTENDEDOR m QOFFEREDFORSPLE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL MAVE THE BUHDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � 70 CONS7RUCT THE PRQIEC7(SEC.7oI4,BUSINE55 AN�PROFESSIONS CODE:THE CONTRACTORS LI- VelU8�i0f1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON;AND � WHOCANTRACTSFORSUCHPRQIECTSWITMACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG (]UANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � I ' � � ,� a D 1 DATE OWNER U Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER � � d B(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z `X MY LICENSE IS IN FULL FORCE AND EFFECT. m � � , .. � LICENSE CLASS LIC.NO. j •� � J - CG _ U DATE CONTRACTOR a �/� ( W GI � WORKERS'COMPENSATION DECLAFiATION Q `' � I HEfiEBY AFFIRM UNDER PENALTV OF PERIURV ONE OF 7HE FOLLOWING DECIARATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' _ Q CAMPENSATION,AS PROVIDED BY SECTION 3700 0F THE LABOR CODE,FOR THE PERFORMANCE w Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � e n w C1N �I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE.AS FEOUIRED BV SECTION /'1 Q 3700 OF 7HE LABOR CODE.FOfi 7HE PERfORMANCE OF THE WORK FOR WHICH THIS PERMIT IS t ) ISSUED.MY WORKERS'COM�LPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION b � � CARRIER '�7�fi-e� �� PLAN REVIEW Z POLICV NUMBER �� --Q Z ELECTRIC Q � (i}11SSECf10NNE�NOTBEODMPLEfEDOFiHEPERMfTISFORONEHUWREDDOLLARS(5100)ORLESS). PLUMBING S � W � Z I CEfiTIFV THAT M THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL �} SHALL NOT EMPLOV ANV 7ERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE , � WORNERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECAME INSPECTIONFEE ? SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 37000F THE LA80R , O.1' CO�E,I SHALL FORTHWITH COMPLY WITH THOS,E/�PR�OVISIONS. � ,,�/ ISSUANCE � ��.— 1 IN/��'`� 7/T1V h SMIP �. �� p DATE: � APPLICANT: , J WARNING:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT DOLURS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ¢ SECTION37080FTHELABORCODE,INTEFEST.ANDATTORNEV'SFEES. RETENTIONFE� t I'• I d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCV � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME F= LENDER'SADDHESS w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES o�O � � I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS o �o h.�� m PERMITTEENAME(PRINT) � --/ -D Z - � � SIGNATUHEOFPERMITTEE DA7E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR 6—File Copy,GREEN—Applicant's Copy • . . , . , , _ .. . , . . C��I��' �I� ��L�6�ilG�f�l� i�3Q� ,�, . u6��°��3� f�[[��I�� ,. �G �C�JOa o 'S� OG�C�CrU�4(� 0[��G�J DQ4C � r o ' — , -__ . . . 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