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Home My WebLink About16752 CITY OF DIAMOND BAR ` � \ ��---�� — DEPARTMENT OF COIvA�IUNITY 8c DEVELOPMENT SERVICES U` 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��<�� BUILDING PERMIT APPLICATION FIR LY � JOBSITE �/� APPLICATION /� PERMIT II,��S�IC o ADDRESS�I �� G Y 1 DATE ✓ O I NUMBER V� � ISSUE TYPE OCC APN L T�7 _, ,� TRACT . DATE CONST. GROUP p OWNER � I�Iti Y YY��I �� .�' o ADDRESS ZONING SETBACKS Z CITY ZIP E FRONT Ryy ❑ � APPLICANT �5 TE . '�j REAR ❑ �� SIDE/SIDE STREET RW ❑ CONTRACTOR SIDE � ADDRESS � V � � CITY ZIP TEL. PROPOSED USE oARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cr� N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I NEREBV AFFlRM UNDER PENALTV OF PERNRV THAT 1 AM EXEMPT FROM THE CONTRACTORS LI� G8f8 B/C8 ft W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESS/WDPROFESSIONSCODE:ANVGTVOR (n 9 � ZCOUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W P8I10/DBCK w NRE,PRIOq TO ITS ISSUANCE.ALSO REW IRES 7HE APPLICANT FOR SUpi PERMIT TO FILE A SIONED w � STATEMENT hiAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF iHE CONTMCTORS LI� � CENSE LAW(CHAPTER D(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PR0. � POOUSPB � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� U TION.ANV VKK.ATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof A CIVIL 7ENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f500�.): � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATKKJ, � COrtIffIBfC18I � Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SN.E(SEC.70�a,BU51- J � NESS AND PROFESSIONS CODE:THE CONTfiACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV NM110 BUILDS OR IMPqOVES THEREON,AND WHO DOES SUp1 WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR HER OWN EMPLOYEES,PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDf-0RSALEIF,HOWEVER,THEBUILDIN�ORIMPROVEMEMISSOLDWITHINONEVEAROFCOM7LE- r� Z 710N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUIID OR � � IMPROVE FOR 7HE PURPOSE OF SALE). V �y,� ❑I,ASOWNEROFTHEPROPER7Y.AME%CIUSIVELVCON7MCTINOWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.70/a,BUSINESS AND PROFESSIONS CODE:THE CONTqACTORS LI� VBIUe�lOf1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONTJEROFAPROPER7YWF70BUIlDSORIMPROVEShiEflEON,AND � WHOCONTMCTSf-0RSUCHPFOJECTSWITHACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION TORS LICENSE UW.). FEE � O I AM EXEMPT UNDER SEC. B.8 v.C.FOR THIS REASON Q � � U � DATE O OWNER ¢ Z U � LICENSED CONTRACTOFS DECLARATION w � 1 HEREBV AFFIfiM UNOER PENALTY OF FERfURY TMAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND z X A(Y LICENSE IS W FULL FORCE AND EFFECT. m L�I � LICENSE CLASS LIC.NO. � U DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLANATION a U � I HEREBV AFFlRM UNDER PENALTV OF PERJURY ONE OF 7HE FOLLOWINO DEqARATIONS: Z � _I NAVE ANO WILL AWNTAIN A CERTIFICATE OF CONSENT TO SELF-INSU(7E FOR WOqKERS' a S Q COMPENSATION,AS PROVIDED BV SECTION 3]OOOF THE LABOR CODE,FOR THE PERFORMMICE U OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED. W W � _I HAVE AND WILLMAINTAUI WORNERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION �� 0 Q 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.MY WORKERS'COA/PENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION i jcr�RiER PLAN REVIEW Z POLICV NUMBER ELECTRIC - Q � (IMSSECi%7NNE�NOTBEOOMPLFfIDOFT/EPEFARISFOqONEF0.1�pFiEppqlqRS(S100JORLESSy PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE (/� WORKERS'CAMPENSATqN LAWS OF CALIFORN10.AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION77000FTHELABOR OCODE.I SH/�LL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE __ � U JJ p DATE: APPLICANT: SMIP ?j� W J WARNIMO:FAILUFE TO SEWRE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOVERTOCRIMINALPENPITIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(f100.000).W ADDITION TO THE COST OF CAMPENSATION,DAA/AGES AS PROVIDED FOR IN J SECTqN37080FTHELABORCODE.WTEREST,ANDATTORNEI"SFEES. . �c.�-� w RETENTION FEE: i � O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIqM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV FOR THE PERf-0RMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.�087,CIV.C.). Z W � LENDER'S NAME f-- LENDER'SADDRESS � I CERTIFY THAT I HAVE READ 7HIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES ' � , � � � I AGREE TO CqMPIV WITH ALL CITV AND COUNTY ORDINANCES AND STATE L4W5 RELATING TO BUILDING CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEMATIVES OF THIS COUNTV TO EMER UPON THE ' � ? ABOVE-MENj10NE�FTV FOR INSPECTION PURPOSES. �, COMMENTS ' � Y � J m' EE NAME �f Q. . N Uj 5 A RE O P DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy cC�'11'lf �� D1��1��D ��f� al�l�(�C�C��'��Ir� ff�f��ff��D � �"�iaAJ�ir'��U UL�JIN � `� UU'!�� l'.�U I1.uJIN . � �� ul1tJ�YLS`V� U l`-_',1nt'��<�� SET BACK FLOOR JOIST � . FTGS/FORMS/STEEL FHA REC]MTS 1� i� ELECTRIC GROUND UND�R FL(�OR DUCT GROUND PLUMBING � UNDER FLOOR CU�IDUIT SLAB GR�4DE FIREPLACE.FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE � MID HT. BOND BEAM ROOF SHEATHING 8 �. BONQ BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHiNG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNiBING FINISH GRADING SHdWER/TUB TEST POOL ELECTRIG EXT. LA7H/SIDWG POQL FENCING WALL INSULATION POOL FINA� CEILING INSULATION QFF SITE IMPS. v DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. � SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L..L. ON SITE IMPS. ` GAS AIR TEST FINAL ZONING FINAL CONST. F1RE DEPT. FINAL FlNAL HEATING HEAL7H DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID F1NAL PLUMSING ENERGY ��o . � C��5 SEPTIC TAiVK S)CE � SEEP PIT/U SIZE � J�J : . [� - . 4 ... � . _ . . �_� _ .; ,-- .