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Home My WebLink About10-1068 � ��_ 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 HoNine(909)839-7027 PRESS �'"�' BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE �O�,rf� �a�tlp �� DATEICATION/��/� NUMBE�O"/uCJO #/C ADDRESS v` Ci `r APN LOT . TRACT ISSUE TYPE OCC DATE CONST. e�� GROUP p OWNE��R ��/ � ADDRESS l� ' ZONING SETBACKS Z CITY�� .� IP ' TEL. ' FRONT q�y p o APPUCANT ' TEL��O��G'�� REAR p Z SIDE/SIDE STREET RW p � CONTRACTOR ' N� SIDE p ADDRESS � PROPOSED USE � CITY ZIP ��TEL. w ARCH/ENG/ ,��e„ �,,J�/ z DESIGNER �� '�JYi/ w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � u� DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEHEBV AFFIRM UNDER PENAL7V OF PERIURV THAT I AM EXEMPT FROM THE CONTRAC70R5 LI� G8f0cJ0/CefpOff W CENSEIAWFOHTHEFOLIOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANVCITYOR (n U COUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC- W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CANTRACTORS LI- � CENSE UW(CHAPTEfi 9(CAMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa � FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- C7 V TION.ANV VIOUTION OF SEC710N 7091.5 BY ANY APPLICANT FOR A PERMIT SUBJEC75 THE APPIICANT TO Z Re-Roof l. � A CIVIL ENALTY OF NOT MORE THAN FIVE HUNDRED�OLURS(f5oo).): ZASOWNEROF7HEPROPER7V,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfI1rtIBfClel . WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�/,BUSI� J � NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSEIF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m w OFFEREDFORSALEIF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� � TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE). _ ❑I,ASONMEROFTHEPROPEHTV,AMEXCLUSIVELYCON7RAC71NGWITHLICENSEDCOMRAC70RS W [= TO CONSTRUCT THE PR0.1EC7(SEC,7ot�,BUSINESS AND PROFESSIONS CODE:THE CON7RACTORS LI� V81U8fI0f1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPEPTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y 70RS LICENSE LAW.). � J � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � � U � DATE �✓ ��, OWNER ' v Z W �Q LICENSED CONTRACTORS DECLARATION w 2 I HEREBY AFFIRM UNDER PENI�LTY OF PERJURV THAT I AM LICENSE�UNDER PROVISIONS OF CHAPTER � � 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z � �� MV LICENSE IS IN FULL FORCE AND EFFECT. m .' � LICENSE CLASS LIC.NO. j _ i V DATE CONTRACTOR d � W � WOFiKERS'COMPENSATION DECLARATION a ' � I HEREBV AFFIRM UNDER PENALTV OF PERJUHV ONE OF THE FOLLOWING DECLARATIONS: Z � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUflE FOR WORKERS' _ CAMPENSATION,AS PROVIDED BY SECTION 37000FTHE LABOR CODE,FOR THE 7ERFORMANCE W Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw _I HAVE AND WILL MAINTAIN WOFKERS'CAMPENSATION INSURANCE.AS REOUIRED BV SECTION 3700 OF THE IABOR CO�E.FOR THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS 9 � ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: STRUC (� � � J � CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q � (iHISSECIIONNE�NOTBE00MR.EfEDOFiHEPERMfTISFORONEMNDREDDp1A0.S(f100)ORLESS} PLUMBING Z 1 CEHTIFV THAT IN THE PERFOiiMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C`3 SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECT TO THE WOFKEHS'CAMFENSATION PROVISIONS OF SECTION 37000F THE LABOP CADE,I SHALL FORTHWITH COMPIV WITH THOSE PROVISIONS. UANC � MIP� _� p DATE: APPLICANT: J WARNING FAILURE TO SECURE WOiiKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJEC7AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP 700NE HUNDRED THOUSAND ENERGY PERMIT DOLLAFS(f7oo.o00�.IN PDDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES: TENTI . . OCONSTRUCTION LENDING AGENCY pR�T FEE:� � 1 HEREBYAFFIRM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY �G� FOR THE PERFORMANCE OF THE WORK FOR WFIICH THIS PERMIT IS ISSUED�SEC.3097,CIV.C.). Z W � LENDE(7'S NAME H LENDER'SADDRESS � TOTAL FEES �Z� � � 1 CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS fARRECT. w I AGREE 70 COMPLY WITH ALL CI7V AND COUN7Y OqDINANCES AND STA7E LAWS qEU71NG 70 BUILDING � CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER U�ON THE Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � �Ry y�- J � m PEFiMITTEE NAME(PRINT) � Q �- �o_as-�� SIGNATURE OF PERMITTEE DA7E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy CB�Y �� 4�Vi0�� ff� BNS�f��0Y�9 ff�I�CQ�RD � ��r��a�p�c��ooa o �� , oa�p��oa, - o��p�c��o�: r, . -��7 .,. �a�r��: k��: SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS , ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBWG UNDER FLOOR CONDUIT ' SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC RQUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC 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 PITlL.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 ��a COMMEfVTS �� `/� � SEPTIC TANK SIZE SEEP PIT/U SIZE a � � — ----.----- �� a .