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HomeMy WebLinkAbout17850 CITY OF DIAMOND BAR ��, + �-- ��`` --- DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES I 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3117 - PRESS ��"���� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE ''��'Z� � �--r�� 2`���T APPLICATION PERMIT P/C ADDRESS � 4� DATE d VL NUMBER� # �.1. '" � - /��., ISSUE ,Q� TYPE OCC `r APN..- LOT � TRACT T 1 ��� DATE ��tl v��NST. GROUP p OWNER �%�6 `�' S� 1� 4� • 'I o ADDRESS �'�3 ? ---Id ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑❑ o APPLICANT TEL. S DE/SIDE STREET RW ❑ ¢ CONTRACTOR CL-I�0 �� �C� SIDE ❑ ADDRESS C� i � N � " ?� � CITY Ak`��� QZIP ���5 TEL�I �C�y �d� � PROPOSED USE w ARCWENG/ iz DESIGNER_ ����N �`��� �� NO.DWEL. NO. NO. � ADDRESS —�5 ��ll�'�� UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM �y['�J O .�.p I HEREBY AFFIRM UNDER PENALTY OF PERJURV 7HAT I AM EXEMP7 FROM THE CON7RAC70RS LI- G8f89B/CBfpOfl 9 .S ' W CENSE UW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANY CI7V OR (n ' U COUNTYWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OFqEPAIRANYSTRUC- W patio/Deck Z TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIfiES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED U � w STATEMEN7 7HA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTOFS LI- w � CENSE LAW(CHAPTEH B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOVSP2 O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEGEDE%EMP- (� � V TION.ANV VIOUTION OF SEC710N 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS 7HE APPLICANT TO Z RB-R00( - � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWI7HWAGESASTHEIRSOLECAMPENSATION, � COmmBfCi81 � WILL DO THE WORK,AND THE STRUCTUqE IS NO7INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELf OR Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPpOVEMENTISSOLDWITHINONEVEAROFCAMPLE- ��1• Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OH � � IMPROVE FOR THE PURPOSE OF SALE). ; w OI,ASONRJEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTINGWI7HLICENSEDCANTRACTORS � TO CANSTRUCT THE PR0.IECT(SEC.70M,BUSINESS AND PROFESSIONS CADE:THE CONTHACTORS U- VdIU0Il0� OO ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEfiEON,AND � � WHOCANTRACTSFORSUCHPRQIECTSWITHACON7RAC70H�5)LICENSEDPURSUAN7TOTHECONTFAC- QUANTITY ESCRIPTION FEE Y TOHS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U � � DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTY OF PEPJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � (�' d 4(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z X IAY LICENSE IS IN FULL FORCE AND EFFECT. �J ,1 • � LICENSE CLASS � . LIC.NO. 1����'y j � J V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBVAFFIRM UNDER FENALTY OF PERJURV ONE OFTHE FOLLOWING DECURATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ ¢ CAMPENSATION,AS PROVi�ED BV SEC7iON 370o OF 7HE LABOR CODE,FOR 7HE PERFORMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w �I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION `��yy Q 370o OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��1�( `�/ . � ISSUED.MY WORKERS'COM1PE`NSATION SUFANCE CARRIEH AND POLICV NUMBERAFE: CONSTRUCTION 1 _ ��tJ J ' j CARRIEFi �N �i� " PLAN REVIEW 2� 7 S�. ' Z POLICV NUMBER ELECTRIC ���• a• ¢ O� . � (IFiISSECTIONNE�NOTBEOQMPIEfEDOFhiEPEFUATISfORONEFNI�DREDDOILARS(5100)ORLESS). PLUMBING -S�d' �C � W c �• � Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1ED,I MECHANICAL J d�' ` (,'} SHAIL NOT EMPIOY ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE �;� � WORKERS'COMPENSATION UWS OF CAUFORNIA,ANDAGREE THAT IF I SHOULD BECOME INSPECTION FEE . �/ � SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHElABOR JU �T � CO�E,ISHALLFOHTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE � T•� � SMIP � ��� � p DATE: APPLICANT: y , —� WARNING:FAILURE TO SECURE wOfiKERS'CAMPENSA710N COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �.- `� J (� ' \ ' � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT L �J�- � DOLLARS(f700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR M „ J J SECTION 3708 OF THE LABOH CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: %� 2 a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION IENDING AGENCV � FOR 7HE PEHFORMANCE OF 7HE WORK FOR WHICH THIS PERMI7151SSUED(SEC.3097,CIV.C.). , Z W � LENDER'S NAME H LENDER'SADDRESS � TOTAL FEES� 3 L -3 (�J r � � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. -� w I AGREE TO COMPLV WITH ALL qTV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESEN7A71VE5 OF 7HI5 COUNTV TO ENTER UPON THE 3�3. � � ABOVE�MENTIONED PROPERTY FOq INSPEC710N 7URPOSES. J Z COMMENTS � ��-l� 1-��b - w,r�� ��Fos�- .p . m PERI�IITy'E N�E(PR � a� V'� �'i �G" Q� � � SIGNATURE F PERMITTEE DATE � ^ ✓ = RECPT.NO. � PAID BY VALIDATION ~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , ... • , ,. ,. . ., . . „. � . . , ., ,. .. .. .. . . ,.. . ... , w.. . . �u�'�" '�� �����.�i�t�1� ��� :.� �: . ���1���'���'9��'i I�f���C�I� � 0� 1100GJ . DG'Q�� ' OG�°�C��1� . ;[��fs��Y1 .bn. �d�. � ,S�k' �'"��[�� ��l o� ,��. SET BACK ---T- , i FL�QR JOIST ; -- -- _._...._ _.... � _.__ ___ __.__--- , ._......_.__._.._ �_ FTGS!FORMS/STEE� ; FHA REC�MTS i - ------ ------- --- ---- — ELECTRIC GROUND �.Z?�'�-� _�'� � UN�ER FLC?OR DUCT 1 — -- --!-- -- -- _ _ ---_ GROUND PLUMBING � __ _____ ;_URlQFR�LOOR CUI��DUIT j ; ---- �..----------- ; --------- -__ ._._ � -r- __.. ...._ _ SLAB aRADE � FINEPLACE �OIJN[3AT101� ___ _ --- - - TEMP POWER _ i � FIREPLACE BO�iD BEAM __.___`---.�__�_u_"�—_._._...�_ �� - ---- . __ W,4TER SERVICE _ ` �_ MID HT. B�NQ BEAM _ AAA,,,��� -- , ROOF SHEATHING �//���� :j_i_8 FT. BaND BEAM _____. _..----' ! - ---• . -- ---- --_ _....__._ �r... FRAMIf�G/VENTILIATION��, ; :. _i �___: -.- . = FINA�BOND BEAM �.------ -�-- ---- ----;----- ROOF COVER �—_�--- -� PRE-GRF,DING ,_ _ _-- ROUGH HEATING �—` � i BENCHIPdG i _i ____ _ __. ___, ---.____ ._ � � ROUGH ELECTRIC �� I i ROUGN GRACINCa __i ______ __ - -- -4- _ �iOUGH PLUMBlNG � ; _ ' FINISH URADING -�------_!.__._.__--- ------ . ________ __�,, SHOWERlTUB TEST ; �POOL ELEC-�RIC � ` . _ - - - ---- = - - - - EXT. i.ATH/51DING ���.(j � . . i ! PO�L�FFiVC(lNG WALL IiVSULATIOiV --�- —- �- �--_— �----.__ ---.___- - �- ,------_.----.. _._.__. ' � � POOL FINAL I � -- ------- ----- = -- -.-..---- - CEILING INSULA�'ION—j- j OFF SiT� IMPS._ __.___.--._- - - _��l �.22�i1 ---- DRYWALL NAIUNG /D / UZ �- � DEDICATIOPlS --- ___— -----— _..__---- ___— ,------._._...___.___ . SEWER FINAL ENG. � _ — + -- —j,. ----- _______ � i . — - -- --------------__.__�—^ SEPTIC TANK Lf�NDSGAPE/IARI -� GAS AIR TEST � � � FUII�AL Z�?NIN� ` _�_�f,� ; � __ � __.. � - , ' T/��'��� - - _____. FIN,4L COfVST. I. , F�PT. FfNA! � FINAL HEATING _ y � ; HEALTF-i UEPT. Fli`!P��� ------ FINAL ELEGTRIC 1 � � UEV FELS PAlD __, _l �___.._ _-___ -- -- -- .....-- FItJ�L PLUMBING �_� _ _ � � ENc�RGY -- --- ------- �S� N�_I I ��— _------ ' --------_ __.__. q u.�b �s-c�(��� , 6�Z ---------� � — - - - --.- � z N� s�r�u y � �-� o �- . .,�w--�����-- . �- � - �-,��- .� 4. Z - -- - - -- - -; , ��,;�„� `.v..��,,6 ., . _�{,, " �' 1 i___. . �._.___ -- ----- ------- ----- ----- i CO�li�/i�i��TS .pL�'Fo f�._C�zc�,S�c�i_7�`�—_ - -—�'h;S� S_Y�x,�k—�-S� �� � �� --- 5_►5=_o_2�N��' S�i_o_(�=--�-�-� --- — -___------ 5�-l� _aZ ����l��� � — -_ __ _._____ ___-- b-to-o z _5otx'. p�,�st� W��(�i 2�F-oO2 __-l� ----- ----_.— --__._._._-- ���/L ,:-C�'�C�fi'�(-�Lr/���s _.E�s�—L -— - ------ �o..y'io�-p,� , -a,�°���e— _ ,� - - � . �a`�d'��--�f--�- - -- -�- -" /1������ SEPTIC TAf�K S1ZE � SEEP PIT/U SIZF — - --- ---..._._---- � -- �� , [�� .�___- ____ ----------..___----- � I ._ -_ _ � � _ __ . . . ..- .. �„�. .�-� ,�. � : tx ,. � , , ;;: . : ': .. � � CITY OF DIAMOND BAR `^ � . . . ..., .. , - -�� -- DEPARTMENT OF COh�YfUNITY&DEVELOPMENT SERVICES - � � . � . ; ^, � 21825 E.Copley Drive � � j : ..(909)860-3195 Fax(909)861-3117 - ; , ' . PRE$$ � .���M• . ., BUILDING PERMIT APPLICATION �: ;. , . _ . . `,..-. . . . , . : , ` , , � fIRMLY;. ' ,, y�, JbBSITE '��"ir�' '"^���,-'�"�..'.��,,��1,�C,� �.� �APPLICATION � PERMIT ' J �^'^'••�,P/C � , ,.,� '.o ADDRESS_ � �.� DATE E j� ,�,�,r*..R.� `NUMBER 4':-��7q ��.� TM`�� ' � ` ;�. ISSUE ,� NS OUP r, � . ; �.'� � ,` F �` �� n' APN r L�V � � T�RACT '�'�� ;,:��'' ' .DATE :. , �+i� , _ `;,. � . � . T :.: ::" GR j,. . - . p .OWNER �11i� . �.'. }k° "� _ x .�� p ADDRESS �_�'~��,+�� n ''iu .;:r"'�" �� z . "M=���'`` '"^ `-'ZONWG -.' SETBACKS > ,: - � ;.��.� » ,. ,.,.. , FRONT ,,', . , '. Z CITY� . " ZIP -. ' ;TEL .`:: RW �,• ❑ � APPUCANT. - 7'EL , �REAR :, .. .. . ❑ -`Z = � - ,;"SIDE/SIDE STREET . RW. ' ❑ I ,¢ .CONTRACTOR �`+ 'I�.r�' l�``E�� ��,w,`, ` t SIDE � - ❑ ., ��` .F. 3?'" ' ,.�.. �= ... _. � � � - - .. � .. .. `ADDRE C� �.l t� .. �f SS "ii.,• . .:;��� ,, � , O i' , , ,.� „.;, , µ. . .�a C;• '<,.4 - PROPOSED USE. . , , . � . � !. .,. .. .,: ; ` ir; CIT,Y; �. �'�' ad-��•ZIP t '�.;r:.TEL.��1:'�'3��.�`,+p - , , w-''ARCH/ENG/ r� ' ` � -.o �;��C��'��.�: @ v��l�.�� 1 - _ •: , , z . DESIGNER � �.<" . :,w , ,�.;Fn � � NO DWEL NO. N0. . �a, ADDRESS � ��,���:�3�C.,.,� . , � i �v�. .; .. ` • -.. ' : - UMITS � STORIES BEDROOMS ' " .. , , P.. :.,�. .CITY . .., . ZIP . ,` ;.TEL. ; . . ., ,.. .:.. _ _ _ . ., .. : �,_._.w... ,...�,.-_-...d..,�...a. ,.>,..e.�.�.,...��. .;�,�.. ____..� -..- ..,�-.-....��,,w-.� •--.�,w.-�-._.�.,.- �»,� :z � •.cn �`" � ,` • .-. ,� DESCRIPTION'�SQ.FT. ,` FACTOR PSF * �"'ADJ.AREANACUATtON ;.` p� . ' ` " `"`OWNER-BUILpER DECLARATION .�.��� , � - ".' ; .� , . � ' ° .� '.. , -SFR/ADD/REM� ��p " ' �I HEREBV AFFIRM UNDER 7ENALTV OF PEPJURY:THAT I AM EXEMPT FROM THE CONTRACTORS LI ��Gdl8g0/CBfpOfl-�e�.: ��'�+f• �� .��-��� � 'ry � �-:'-a ���, .:'W' �"CENSELAWFORTHEFOLLOWINGREASONjSEC 70315BUSINE55ANDPFOFES5ION5CODE ANYCITYOq '^ . ' ]' ' .�,V, ..� ., .'� i . .... . t -,�:. y-:. . - '+ � ..� U' COUNTVWHICHREOUIRESAPERMITTOCONSTRUCTALTEF�IMPROVE DEMOLISH,ORREPAIRANVSTRUC ,� ..,. �.•�w �. TURE,PRIOR TO ITS�ISSUANCE,AL50 REOUIRES�THE APPIICANT FOR SUCMPERMIT TO FI�E A SIGNED ' - .�-�PailO/DBCk " . . ♦�j� :. s .,, ,, � ..:-. • ��� ��,`,. `}. � STATEMENT 7HAT'HE OR SHE IS IICENSED.PURSUANT;TO.THE PROVISIONS OF THE CANTRACTORS LI- '� '"�:� CENSE lAW(LHAPTER 9(COMMENCING WITH SECTION 7000)�OF DIVISION 3 OFTHE BUSINESS AN��.PRP �' �� POOUSpB ,� . >; ' . .��'. O FESSIONSCADE)ORTHATHEORSHEIS,EXEMPTTHEREFFOMANDTHEBASISFORTHEALLEGEDEXEMG� �- ,(� ; . . � � . � � ��' ..- U TION.ANY.VIOL4TIONOFSECTION�7037.SBYANYAPPLICANTFORAPEFMITSUBJECTSTHEAPPLICANTTO � R2-ROO} � � �� � '�-�� "� "'� ��'t""'^� '� .�.�-»•w+w�++. AClW6�EMA4iV:OFNCTFM9R6.FM/�MFN�6WINBRE�BBOl�WHS{ . �.. �� . . � .. . �� � ' � '`Z � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWI7HWAGESASiF{EIRSOLECAMPENSATION, 0 -COrtIR1BfCl31 � �� . - a�a ' �� WI�L�O 7HE WORK,ANO,THE STRUCNRE IS NOT INTENOED OR OFFERED FOR�SALE(SECJo4t,-BUSb - J �. NE55 AND PROFESSIONS COOE:THE CON7RACTORS LICENSE LAW DOES NOT APPLV TO AN.OWNER OF � � - . - _ � �PROPERTYWHOBUILDSORIMPROVESTHEREON,AND.WHODOESSUCHWORKHIMSELFOR.HERSELF�R. - � ��� Q�� THROUGHHISORHEROVM�EMPLOVEES,PROVIDED7HA75UCHIMPROVEMENTSARENO71N7ENOEDOq m � � - �. . � �0. �.T�ON,hiEOWNER-BUILDER�WILL-HAVEdHEBUROENOFPROVINO�7HATNEOfl�SHEDIDNOTFCOMPLE ��` �- ' ` <�" � � � W � � .OFFEREDWRSALEIF.HOWEVE0.711EBUILDINGORIMPFiOVEMEN71550LDWITHINONEVFARO,BUILDOR - � � �� � 'Z ,IMPROVEFORTHE�PURPOSEOFSALE). �� � " '� - '� ` _ . ❑I.ASOWNEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINGWITHLICENSEDCON7RACTORS � � et � � ;.: ' ' : �-. TO.CONSTRUCT THE PR0.IECT(SECJo1a,BUSINESS AND PROFESSIONS CODE:THE�CONTRACTORS ll ' � � ;l/alU2tlOf1 f✓��� s' �:�'^���. � -��� ADJ AREA` �� - � � � ' � -W CENSE LAW DOES NOTAPPLY TOAN ONTJER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND ^ � r �. '� �WHOCONTRAGTSFORSUCHPROJECTSWITHACANTRACTOR(5)LICENSEOPURSUANTTOTHECONTRAC _ ION '• °� ", -- _;FEE t � Y� >�' roas ucENSE uw� , . '� QUANTITY DESCRIPT , , k � , � ' � �� . .r. .� , r ;, '� �, _. . .. _ ��J ::_.-,, . .. - ., , ' ❑1 AM�EXEMPT.UNOEP SEC � ' � � 8.8 P.4 FOR THIS HEASON � � � .;:'� . ;: ' . ,., , ._ _ . . .. �. .. .�� . � ... _ : � ... �- - .. :. , U. .:'_ . - .. ' �: . � � � — � . � � ,., �..LL. �. . . .� . �,� �. .F Q �'� � � �� DATE . .... :' OWNEq .' �. . :� ... F. i `� W {'_Z � . ... -- . .. . U' - � �� UCENSED CONTRACTORS DECLARATION w � ,.,�, .'-; . .�.,�i , •<: �:. i.�:.,. . .�. .- ..._..; , . .:!: ,.. s .: ` I HEREBV AFFIRM UN�ER PENALTV OF�RERJURV THAT IAM LICENSED UNOER PROVISIONS OFCHAPTER � �` �, � - �:"re.,/s � '� ,�I�' � 1 a.'� z �4r� "�.-,d .,,8(COMMENCWGWITH�SECTION7oqo)OFDIVISION�3�9FTHEBUSINESSANDPROFESSIONSCODE,AN� � ;Z� � � � � �� �.dY"' k.-���� � '�.v�� "� �;� � �:`a �..;X -MYLICENSEJS M�FULIFOHCEAND EFFECL ' "."� ' ��.:�. �' ;„- �. . "'� �'.,��W �., .... , ... � ' ,r� _ ��07 � . � :( y y �.: ,.� ;� UCENSECLASS' �. '�� ' LIC.NO.�� �5�r'� .�e�� ��1 ",�,.� � � .� . . ' ��,��, �. {�.�; �, _ . .. ,.. , . � , , . . .... ' .. .� ,'...: ' � '.J' . . , . ' x:'. : ..V � DATE �.:... . ..: '_ �:CONTRACTOR „ ,. ;., . .., ..,. ..,.. Q: ::.- . :�� . . .w . .,. �,- . .. :� . �� .. �_ � . . . .. -.. ,� ... . . ..,. � . �:. � .. �,.. , ,.'�: , i � � ' WORKERS COMPENSATION DECL4RATION =� �: . , a - _ .. �acn.n ... -•ar., � L-:� � , ., .._ �_,- >._. :._.v. �. - - . _ �. � ,. ;-o- .� ,.;; _:- ,,„ � I HEREBV AFFIRM.UNDER PENALTY OF PEfLIURY ONE OFTHE FOLLOWING DECIARATIONS , Z . ,! , � �""� �_HAVEA.VD'YALLMAINTA!t�ACcRTFlCAic..FCONS'cN7TJaclr"INSUFEFOR�WORK_HS-��� ¢ ����� � '��� . '�.Z ' ' �'_ .' ' Q " COMPENSATION,AS PROVIDED BV SECTION 370o OF THE UBOR COOE,FOR THE PEAFORMANCE ` �U� �. Q . OfTHEWORKFORWHICH�TH15PERMIT15155UE0..� „ ' , .� . , �'c � �.�'. � ���I HAVE AND WILI MAINTAIN�NORKERS'COMPENSATION INSURANCE AS HEOUIRED BY SECTION � . 3 i? '..� � - J � R COOE,FOR THE PEFfORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS -,�� ��� � � s'�.'��'�yb^ � yr�[y - ¢ EHS'COMPENSATION�NSURANCECAFRIERANDPOLICY�NU/ABEFl.4FiE ,:� CONSTRUCTION� � ��� �'yye�V� yW} "� � ? 370o OF 7HE LABO ' .. ISSUED..MY WORK £ �' , CARRIER ��-.' .� �Y.�. . . . �FLAN�FEVIEV�I'-� ^�4Y -�7 f♦ 3�� � - ,i+. ;�.. '' ''.: ......., a .� .. .. „ . �* 0 POUCYNUMOEfl ,, , .;. .. .- . . ELECTRIC —�'1 E^i�. > • - �'. Q . .."' . " . �;." ... � ' ,.'. � � ,- . ..�: .. . .:.�� +li�- . }:. . � �rri�sse�r��rarseo:x,�a�'rmoFn+eaew.vr�sroaor�eraxoae000�ipas�siao)oa�essF PLUMBING � � � �� , � ..w , .- . .�... .-� . ......, ,. . ... ., .....�., . . - {a� s ... . . ... . � � ; � Z , �I CERTIFVTHAT INTHE PERFORMANCE OF THE WORN FO(i WHICH THIS PERMIT IS ISSUED I�`��, , MECHANICAL • J�'��i ' ' � -U' � .SHAIC NO7 EMPCOV ANY PERSON IN ANV MANNER 50 AS TO�BECOME SUBJECT TO THE " � - • -� }�'" � �'� ,. ,(/� 'WORNERS'COMPENSATION LAWS OF CAUFORNIA,AND�AGREE THAT IF 1 SHOULD BECOME�� �. INSPECTION FEE ' ' ' --� �� ', � �� � �� CADE.I�_SHALLFOPTHWITHCOMPLV WIhITHOSEPROVISIONS. R -� � �SSUANCE ; '�� �� �i�E � '� �i '�.�• . . ' .. . ,,.��. ..�.." ..,:' ',_. , �.. ,.:�. . �:. . . SUBJECT TO THE WORKERS CAMPENSATION PROVISIONS OF SEC710N 370o OF 7HE LABO � � p DATE: � �•APPUCANT.�� . . SMIP�`� . � �*i� �.fa'��+ .�a'� ;� ��_: '. JENERGY P/C ` "s.��'J � _ - =: ��WARNING FALURE TO SECURE WORKERS'�COMPENSATION CAVERAGE IS UNUWFU�,ANDSHALL9E� . ' [' � � �- � � ,� . SUBJECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDPEDTHOUSAND ENERGYPERMIT"- - ''.t.Y�.�fY�,1��",''s' , DOLLARS�S1oo,000),IN AD�ITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN.' � �'s�+� � J � SEC710N 37oB OF THE LA90R COOE,INTERESL AND ATTORNEYIS FEES. �� .+ � � � � � � p���� � -��{�„ p�. REfENTION FEE:,: +%'�,,. a� `-�: :`, `` - CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � ._,,,.r O. _ .. - �� � I HEREBV AFFIRM UNOER PENALTV�OF PERJURY THAT THERE IS ACANSTRUCTION LENDING AGENC7 � ' � '4 � � . FOq THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMI7IS ISSUED(SEC,3oY7,CIV.C.�. �� '- , � . � . -. . .. � - Z .. : � . . � . .... . . .. ... . � . . . ,. , .� W � ..�...LENDER'S.NAME.. ' � . . . . , . .. . . � _ /r � � - �.F- tENDER'SADDRE55 � � ' � � �� F• � /+' '����� I AGREIE TO CqMPLYVWRHAALL CITV ANO CO NTY ORDINANCES AND STATOE LAWS RELATING TO a�Ro NG �T'OTAL FE ES�.,�= + �e��, _ '�� '' �; t"$ _ �'�� � -,�,�_ - ;: 3 � CONSiFUCTION,ANO HEREBV AUTFIORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER-UPON THE " � �' a'-��s ; "` , .'-� Z � ABOVE-MENTIONED PROPERTV FOR INSPECTION.PURPOSES ;����' . .." .��-� � '._. �� . �'.� �' . .. ;:. - ... _.; ' . . .. � . ; .,... �_t ' .,p `.'i�.�,f. :*i��'�'t�` '����1) �..;i � i i.'. ��.�.gi'' � .., . _ � . .. COMMENTS ` � . � � � , .- . . .. � 4. � :s..- b� � '.m . PER�1IT"�E NAME(PH T) . . : �'' �e+''R ' : . ..Q �i.f -y�. .�i-. �+'c7;. A'g',�„" '."!- .� .. ,.(!! �� F„.w.�.. � _ ' s, a. �'. , ._t I� _ �,,��r �� . .. ��., - N�.. . . .,,,,�, . , �.� .. � SIGNATURE F PERMIITEE � , � � � , �ATE, . ,- � � "� . ' _ �. . ...RECPL NO( `. .�.. �� ••� • PAID BY �-� � " ' .. ".VALIDATION �+,�'��"r , . :2 . . .x . . . . . �f`~ ' � - �` � � `.. 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' .. �. _ . ..:,..; :- . . . . . m � .. - . . . ... . . . .�- . .. . � _ � :. �� . . _ � . _ - . . . - . . .. . . ._ . ._ .. . . . � . . . _ .. _ � �_!� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I 21660 E.Copley Drive Suitc 190 I (909)860-3195 Fax(909)861-3117 PRESS ��'��'� BUILDING PERMIT APPLICATION FIRMLY o D RIESS ��ZS G Y�'I S ��`1 �i"'�! �' 1�`"`' DATEICATION �� �j NUMB R I #/C I c� ISSUE /{'1 , NPE ' OCC APN LOT TRACT DATE ���� CONST. GROUP p OWNER �10�- `L ADDREnSS 27 0� f7 i o. rKo /� , 2B ZONING SETBACKS �w CITY a%%A IM g�'ZIP9f�� TEL.9�Q��.��� I REART RW p APPLICANT TEL.� SIDE/SIDE STREET RW O � CONTRACTOR C Mt r+��G►.'I �h� SIDE ❑ Q ADDRESS � � t_ A�/�- � CITY ,F, I MPr�� ZIP�Z TEL.(,,.1��J PROPOSED USE o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS �STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FROM 7HE CONTFUCTORS LI- � Garage/Carport I W CENSE UW FORTHE FOLLOWINO RELSON(SEC.7o31.5 BUSMESSAND PROFESSIONS CODE:MlVCITYOR �� U COUMYWHICNREWIRESAPERMRTOCONSTRUCT,QTER,IMPROVE,DEMOUSH,ORREPAIRANYS7AUG W Patio/Deck I Z NRE VRpR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO � STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE COHTMCTORS LI- � � C CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSMESS AND PHO- POOUSPe I '�C FESSIONSCODE)OR711ATHEORSHEISE%EMPT7HEREFROMANOTHEBASISFORTHEALLEGEDEXEMP- V TION.ANV VIOUTION OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SU&lEC7S 7HE APPIICAN7 T0 Z Re-Roof � ACIVILPENKT'OFNOTMORETHANFIVEHUNDREDDOLURS(fSooJ.): � ❑I,ASOWNEROFTHEPROPERTV,OFMVEMPLOVEESWITHWAGESASTHEIFi50LECOMPEN5A710N, � COfflrtlBfCl81 ' WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BU51� J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPEHTI'N?iOBURDSORIMPROVESTIEREON,MIDMMODOESSUCHWORKHIMSELFORHERSELFOR m � THfqUOM HIS OR HER OWN EMPLOYEES,7ROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR Q ,OFFEREDPDRSALEIF,MOWEVER7NEBUILDINGORIMPROVEMENTISSOLDWRMINONEYEAROFCOMRE- Z TION,THE OWNER�UIIDER WILL HAVE THE BURDEN OF PFOVINO THAT HE OR SHE DID NOT BUILD OR I � IMPROVE FOR THE PURPOSE OF SALE). ❑1,AS ONMER OF THE PROPEHfV,AM E%ClU51VELY COMMCTING WITH LICENSED CONTRACTORS � � TO CONSTRUCT THE PRQIECT(SEC.7oat,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- V81U8110f1 ADJ.AREA � W CENSE UW DOES NOTMPLY TO AN OWNER OF A PROPERTY NMO BUILDS OR IMPROVES T1IEREON,AND � WFIOCOHTMCTSFORSUCMPP0.IECTSWIh1ACONTMCTOR(5)LICENSEDPURSUAHTTOTHECONTRAG pUANTiTY DESCRIPTION FEE � � TORS LICENSE UW.). O ❑I AM El(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q , 3 c� � ¢ . �ATE ONMER U . Z W �Q LICENSED CONTRACTORS DECLARATION W � CC 1 HEREBV AFFIRM UNDER PFNALTY OP PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �r � Y(COMMENCINO WIT1 SECTION 70oD)OF OIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS IN FULL FORCE M1D EFFECT. m ^ . � � LICENSE C SS G `� LIC.NO. � �O� J V DATE_ �I�GT CONTRACTOR a W � WORKERS'COMPENSATION C T Q .L �� �r A0O� �� , N 1 HEREBV AFFIRM UNDER PENAL7V OF PERIURV ONE OF THE FOLIOWIN DECLARATIONS: U G�__ J Q� `�, � �� Q 2 ryR � � I NAVE AND YVILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORNERS' _ � COMPENSATION,AS PROVIDED BY SECTION 370o OF TME LABOR CADE,FOH THE PERFORMANCE W OF THE WORK FOR NM�CH THIu PEHMIT IS ISSUED. � 0 w �1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION Q ��3700 OF THE LABOR CODE.FOR THE PERf-0RMAtJCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKE S'WMPENSATION I URANCE CARR�IEq/,u��D1yOLICV NUMBEF aE: CONSTRUCTION � CARRIER G�YQ �v� 1`"^V�^��'V� � PLAN REVIEW � POLICY NUMBER �� K AD 2(z45�' ELECTRIC � (i1LLSSE(,'fqNNE�NOTBEWMREfIDOFhEPERMTiSfOHONEFiIN�DREDDOUTAS(f10D)ORLESS} PLUMBING Z I CERTIFY THAT IN 7HE PERFOHMANCE OF 7HE M/0RK FOR W ICH THIS PERMIT IS ISSUED,I MECHANICAL (,'} SHALL NOT EMPLOY ANV PERSON IN ANV MANNE O AS T ECAME UBJECT TO THE Uj WORKERS'CAMPENSATION UWS OF CALIFOR , ND A EE THAT I SHOULD BE INSPECTION FEE ? SUBJECTTOTHEWORKERS'COMPEI7SATION O SION OF C N37000 LABOR ` CAD I SH ORTHWITH COMPLY WI7H T SE ROV 10 . ISSUANCE � p DATE: � 0 APPUCANT: SMIP � ENERGY P/C J WARNINO:fAILURE TO SECURE WORKERS'CO PEN N CO RAGE IS UNUWFUL.AND SHALL BE � SU&IECTANEMPLOVER70CRIMINALPENALT 5 IVILFI SUPTOONEHUNDRED7HOUSAND ENERGYPERMIT DOLLARS(f1oo.000),IN ADDITION TO THE COS OF MPEN ION,DAMAGES AS PROVIDED FOH IN J SECTION 3708 OF T7E LABOR CODE,INTERES, ATTO s FEEs. RETENTION FEE: a ^� � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIHM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMPNCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7oe7,CIV.C.�. Z W � LENDER'S NAME - 1— LENDER'SADORE55 �' w ICER7IFYTHATIHAVEREADTHISAPPLICATIONANDS7ATE7HAThiEABOVEINFORMATIONISCORRECT. TOTAL FEES � � I AGREE TO CAMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS REU7ING TO BUILDING � CONSTRUC710N,AND HEREBY AUTHORIZE REPRESENTA7IVES OF THIS COUN7Y TO ENTER UPON THE Z ABOVE-MENTIONED PROPEFITY FOR INSPEC710N PURPOSES. COMMENTS � GG�a.,rl.e 5 Sri s��.., _ m PERMI77EE E RI � ¢ $•• �p?�- � N SIGNAT REOF I DATE = RECPT.N0. PAID BY VALIDATION ~ WHITE—Depertment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDEN OD—File Copy,GR N—Applicant's Copy (CB�i( O� ���61l�1��� �e41F� df����C��'S�I� ����3If��:D 1 � �t u, � . � . _ _ , ..,. :. �;:�.. ° � . Q i ��. ° _ �. Q _ . . ,�. � (�( ) -. . '.��� ,.�., . �,,. �f�w M.,.., �,y. a«�., �.� �ro�r ��1r:�' �,.,.Ul���u�) 0 o Q ., � o -,_, �. . . . .� . �>.,; . � - . �,., o� � ,. :�.ra. :-,p SET BACK , �.� I � !. FLOOR JOIST FTGS/FORMS/STEEL . + � FHA REQMTS ' ELECTRIC GROUND � UNDER FLOOR DUCT ,,_ GROUND PLUMBING I - UNDE,.fR� _ ' a��[�]}.�kr�J�l,p I ,; �; .,,.. . .,: � ;', :",-�}'------ .e�r�� �I' ..J✓ 5 ! "�'_."' 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FIPdAL_ � __ __ � ;'i��Ai.ELECTRIC I i DEV. �EES GAID ' ,=1*JA!F'LUMBII�G j ENERGY — — � ----- �------ --- -------- — ; ! _� �."_ �,� � , v�L.i��;:. _ .S" _.. i 1rvJU-- t``, s i �_..._ _ , �,��,, , - -- .`>;:: � �., �,. � ; ----- # 4.�LlYIiNf�IV�J ;.,.� �.i� --• �:�'a'; !�'�'._lr1%�-� ..�; ` k� � ", �_ � \ � � n,-;- , �•... ,,�,�J�»r• =�� -� � :t i�; _ . �._.._ r.K� �:l_ .. -1 �v C�..'S�:''�'=">-3. nJ..J ..__....._._—'— :�.., '.3 t'��,,: �� � :r�.:—. 1 � � - . _ - . 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FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM � O I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM E%EMPT FROM 7HE CONTRAC70R5 LI� G8f2JB/C2fpOft W CENSEUWFORTHEFOLLOWINGREASON(SEC.7077.SBUSINESSANDPROFESSIONSrODE:ANVCI7VOR (n U COUNTYVrt71CHRE0UIqE5APERM�TTOCONSTRUCT,ALTER,IMPROVE.DEMOLISM,ORREPAIRANVSTRUC- w �TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRAC70RS LI� • � CENSE UW(CHAPTER B(COMMENCING WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSpB O FESSIONSCADE)OR7HA7HEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (!3 V TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICAN�FORAPERMRSU&IEC(S'fHEAPPUCANTTO Z Re-Roof - � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(fSOD).): � Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSATiON, � COrt1rtICfCldl WILL DO THE WORK,AND THE STRUCTUf1E IS NO71N7EN�C-D OR OFFERED FOR SALE(SEC.70�1,BUSI� J � NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NO�APPLV TO AN OWNER OF � PROPERTV WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS AfiE NO71N7ENDED OR m w OFFEREDFORSALE,IF,HOWEVERTNEBUILDINGORIMP{iOVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-BUILDER WILL MAVE THE BURDEN OF PROVING'HA7 HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE�. _ ❑I,ASOWNEROFTHEPROPEHTY.AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS W � TO CANS7RUCT THE PR0.JECT(SEC.70l1,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� V81U8f1ol1 � ADJ.AREA W CENSE UW DOES NOTAPP�V TOAN ONMER OFA PROPERTV WHO dUI1,D5 0R IMPROVES THEREON,AND — � WHOCANTRACTSFOHSUCHPR0.IECTSWITMACONTRACTOR(S�LICENSEDPURSURNTTOTHECONTRAC- QUANTITY DESCRIPTION FEE 70RS IICENSE LAW.). � O I AM E%EMP7 UNDER SEC. B.3 P.C.FOR THIS REASON Q V O �/�V,�` O � � U � — OC /!� DATE OWNER � � Z � LICENSED CONTRACTOAS DECLARATION w - ^ � Q � 2 I HEREBYAFFIFiM UNDEH PENAL7Y OF PERIURV TMA7IAM LICENSED UNDER PROVi510N50F CHAPTER � d Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PP.OFESSiONS CODE,AND Z `X MY LICENSE IS M FULI FORCE AND EFFECT. m � � LICENSE CLASS G�I�O LIC.NO. � U DATE�� �� 'O Z CONTRACT d W � � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENALTV OF PEfiIURV ONE OF 7HE FOLLOWING DEClARA710N5: Z � I HAVE AND WILL MAINTAIN ACERTIFICATE OF CANSENTTO SELF�INSURE FOR WOFNERS' a Z a COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE UBOR CODE,FOR THE PERFORMANCE W OF THPWORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 37000F THE 1A80R CODE,FOR THE PERFORMANCE OF THC WORN FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSURAN/CE�CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER S�� GOp��r�/1' �-1F�'v� PLAN REVIEW � Z POLICY NUMBER T� � lJV � /�� ELECTRIC . Q +r � (iHISSECTIONNE�NOTBE001.1PLETFDOF7/frPERMITLSFOFONEMIPDREDDOUPAS�510D)ONLESS). PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL C.�} SHALL NOT EMPLOY ANV GERSON IN ANV MANNER 50 AS TO BECOME SUBJEf.T TO THE �/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE _ '� SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 7700 THE UBOR CODE.I SHALL FORTHWITH COMPLY S VISION ISSUANCE � SMIP p DATE:�b d��PPLICAN J WAPNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAIL BE ENERGY P/C � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(i 100,000),IN ADDITION 70 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 37080F THE LABOR CODE.INTEREST,ANDATfORNEV'S FEES. RETENTION FEE: � � �� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W ? LENDER'S NAME � F- LENOER'SADDRESS � TOTAL FEES J�� , � I CERTIFY THAT I HAVE READ THIS APPIICATION AND SiATE THAT THE ABOVE MFORMATION IS CORRECT. w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATING TO 9UILDING � CONSTFUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � ABOVE�MENTIONED PROPEFiTY FOR INSPECTION PUHPOSES. Z COMMENTS � f V gal — m P I A RINT) I� N ' O Y� N TUREOFPERMIT7EE DATE = RECPT.NO. _ PAID BY VALIDATION ~ WHI —Department Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �G��"�' ��` ���V��3�d� ��6� � � � 8������`�€�� ����f��7 � ��U nQ� �Xr' F��� '�s~��_ A �ll �v� ��i' �Q 0 ��� �}`�+�'�gA �c� � � ��� F��+, r. « " ��' � e: j .i � . :�� '. '� . . • � � -. --- ..� ... .._.. . . � . . - *'� .,.:�� . ... , . .:, . ��.� .. ,"Pi '.� y SET BACK '._. .--------_:.. .__.- --- . ---j! FLUOR 1C)IST ; _.._ _. --- ...._ .�.___. ... ..-- — --� _--._. _....._. _�— FTGSIFORMS(STEEL '; _ ' i E=HA RCQMTS � - ----- --- ---- ------ --., ._.--- -- ---- — � --- - -- ELECTRIC GROUND I ' UNDER FLC�R DUCT , � -- ------ --------- ..._._._��_ l ---- __ _ _ __---- � -- ----- GROUND PLUMBING � ____ __ _ UNDER FLOOR t,UNQUIT_ � , _._. SLAB GRADE � ,_ __ ! _FIREPLAGE Ft7UNDATION I � - " _ _ ___ _ __ - -4--- --- -------- TEMP POWER _i __. '_ � 1 FIREPLACE BOND BEAM � •- ---- ___.-- -._ ._-- — ----- ---� _.. � WATER SERVICE_ _.__ � --.._.___, --- _._} 1 P�11D H1'. E3(7Ni7 E3EAM ------- , --- ---- ROOF SHEATHIN�G_--_. _..-. --..------�--_t 8 FT. BOND B�AM � _ _. _____�_. — -- ---_ __ �._. _. FRAMINGNENTIUATION � FINAI E30ND BEAM � _ ___._ ._M . ___ __ _ _____ � __ _ _. ROOF COVER PRF-GRADING__ ______ � - - --- ---------- _... ___.� .�__. --- _._ ---.... ROUGN HEATING , BENC,HING __ ____ ----� ------- -- ROUGN ELECTRIC � ROUGH GRAQING ------ ._.._.._.. �.__...__..-.. � __. . .._._1 _._� ....._.........___-- ,. ......._.......---- -- -.- .. ......_..._.. ROUGH PLUMBING _ i ____ ___� FINISH �aRADING ____ _ __ _._ SHOWER!TUB TFST � � , POOL ELECTRIC ---_-__-1--_.__._:,-- — � .. ..------- _.....- - ----�---------- --� EXT. �ATHlSIDING I ; POOL FENCING i ---- — -- - __ _...---- _ WALL INSULATION POQL�INAL i ��' — - ----- .. - ---- --- __---- CEILING IN�ULATION � , -OFF SiTE IMPS -- —. __ _ _ ,----._._ ___ ----- ----_..------- -- DRYWALL NAILING , _� � 'JEQIi;;4TIUNS _ _ _ SEWER � ' FINAL ENG. — ----- - ------ ----- __.. ).__._ --- --------------------- - �SEPTIC TANK � �ANDSCAF'EII�iFtIU'. _ _ ___------- — -- SEEP PIT/L.L. �� (?N SITE IMPS. _ .. _ _ _.........__._ .---_..__.._---- ------ -- --� � -- GASAIR TEST , �I�dAL ZONING ---{- ------ ---- FINAL CONSL I' FIRE [�EPT. FIN�t_ - i , ---- — _ ____....---------.---- - ------------__ FINAL HEATING _ _� � ^ _; �H�AL1:H DEP7. FINAL - - -------- - -- FiNAL ELEGTRIC ����. � ; � '; � DEV. FFES PAID _�.—� _ .. -- ,_---------- -__------ -- — --._.._--- FINAL PLUMBING � ! � ENERGY � ---- --__--- _........-- -----------� ----..____. ; ; ....---- -- � .� �z. . � . . CCJNIMENTS _ ___.._+_ --- -- SEPTIC TANK 51ZE SEEP PIT/U SIZE _.�_ ------ --- ----- ----- ------ � --- ---- . — . o �, o ti.� ------ ___.___.___ ..__. -------...-------- ----- 1� ,_.. ,. � , =:�. • � ° --- ----- -- , WALNUT VALLEY L�vIFIED SCHOOL DISTRICT , , � 880 SOUTH LEMON AVEYUE WAL'vUT CA 91789 CERTIFICATE OF COMPLIANCE ' With Fee Provisions of . Government Code Section 65996 DEVELOPER/OWNER �O(L\2o tJ �e1t�C.,1FIL. C�tJs� • "-----'� ADDRESS �..'Zo"l ���A•M�Jb gP,Jz .�1.�-z.n� Signature of Ap licant CITY/ZIP �►�q�p�SZ�,a� c.l�q h m S • The person si ning represents that he/she is au�l�orized � TELEPHONE(��1 43ro�{ �o�c� � to sign on behal of the owner/developer and tha[ �he information provided is true and accurate ro the be�t of his/her knowledge. NEX,V�T ADDRESS , � USE 'O�F BSUI�LDi�ILNG TOTAL SQ. FT. Y �2C2 2_9� esi en i /Commercial/Industrial � . City " • HOME IMPROVEMENT OR REMODELING PROJECT � ADDRESS DESCRIPTION TOTAL SQ. FT. Diamond Bar Walnut (Bedroom, Family Rm., Kitchen, etc.) Signature of Superintendent of Buildings�� � �—������, Date�J I -f I�� TO BE COMPLETED BY SCHOOL DISTRICT FEE SCHEDULE: 1fie development fees levied by the Walnut Valley Unified TOTAL F�ES DUE School District under provision of Government Code §65995 $ //, (p/�, �'� are: (EFF. 8/17/98) Residential Development $1.93/sq. ft. Receipt# � Commercial/Industrial $0.31/sq. ft. Date � � ' Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction rojects OVER 500 sq. feet (eliminating garage or uncovered patio). ' ''.� � � This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. This is to certify that the above described development has been determined to be EXEMPT from the development fees of I� Government Code Section 65995 and a building pemut may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET OTHER _ _ � . .,..��.,.�.��--- Assistant Superintendent Fiscal and Facilities Management ' 1/87 Rev. 2/88; 6/88; 8/89; 1/90; 8/90; 10/90; 8/92; 6/93; 11/93; 8/94; 6/96; 1/97; 8/98 PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF F'EES ON REVERSE SIDE . . � r WATER RECLAMATION SOLID WASTE MANAGEMENT C O U I�I T Y S A N I TAT I O N D I S T R I C T S OF LOS ANGELES COUNTY 1955 Workman Mill Road, Whittier, CA 90601-1400 Mailing Address: P.O. Box 4998, Whittier, CA 90607-4998 JAMES F. STAHL Telephone: (562) 699-741 1, FAX: �562) 699-5422 Chief Engineer and General Manager www.la d.or Counter�ours� 7:00 a.m.- 4:00 p.m.Mon.-Thurs. ' 7:00 a.m.- 3:00 p.m.Fri. , > Account No:i 0405$56 Disfrict No.' 21::.. SEWERAGE SYSTEM CONNECTION FEE Date: April O5, 2002 Property Owner: LEWIS JIA Address of Property: 2828 CRYSTAL RIDGE DIAMOND BAR, CA 91765 Thomas Guide Page: Contact: JERRY YEH Phone: 909-869-6191 Mailing Address: 2828 CRYSTAL RIDGE . DIAMOND BAR, CA 91765 , County Assessor Map Book, Page, and Parcel Number: 8713-052-005 Structure is Proposed. i User Category and Units of Usage: Category: OlA Number of Units: 1 Square Footage: CONNECTION FEE CALCULATION 1.00 X $1,290.00 = $1,290.00 Number of Units of Usage Connection Fee Per Unit of Usage Connection Fee COMMENTS: $1,290.00 ' Connection Fee Due , ;; ; ; ; . ...�. __�.._.----- ; ; ,. >: � � i �� IGI�.D��Ti-iCT� �� Fee Paymenf Received From; i Processed by :LP . "'�?��t A!vGELES COUN?Y i HORIZON PACIFIC CONSTRUCTION INC ; Appro d by ";l� F�������� � Amount $1 290 00 Ck No 05390 , D Ci ;: ; ; ;: I Date iApril O5: 2002 : M,i:,q!'S74HL y' ; ,: _ 1 t,`�-c�.S G�td.i:hC;r E _ .. __.. BUILDING DEPT COPY VALID ONLY WHEN STAMPED �a Recycled Paper � 1