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Home My WebLink About11-978 _�`_ CITY OF DIAMOND BAR �/ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� I T,w , 21825 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 RESS '•"' BUILDING PERMIT APPLICATION FIffiMLY N JOBSITE APPL�CATION PERMIT / C��/C o ADDRESS � ��2��'�� ~ DATE NUMBER i�� / / " # � ISSUE / TYPE OCC APN LOT TRACT DATE Q ' /� CONST.�e�v GROUP °C OWNER O " ADDRESS ZONING SETBACKS � FRONT pyy p Z CITY ZIP TEL. o APPLICANT TEL. REAR p Z SIDE/SIDE STREET RW ❑ ¢ CONT.RACTOR � SIDE p ADD SS. PROPOSED USE o CITY ZIP TEL. - 7 � o ARCWENG/ I a ADD ESS NO.DWEL. NO. NO. �� CITY ZIP TEL. UNITS STORIES BEDROOMS � c� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENALTV OF PERJURY THA7 I AM ExEMPT FROM THE CONTRACTORS LI- GefdA6/CefpOft W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSAN�PROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w TURE.PRIOR TO ITS ISSUANCE,ALSO REQUINES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CANTRACTORS LI- � CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� LL' POOVSPB . 0 FESSIONS CADE)OR 7HA7 HE OR SHE IS EXEMPT THEREfROM AND THE BASIS FOR THE ALLEGED EXEMP- (rJ V 710N.ANV VIOUTION OF SECTION 7071.5 BV ANV APPLICAN7 FOR A PERMIT SU&lEC7S THE APPLICAN7 70 Z Re-ROOf Z � A CIVIL PENALTY OF NO7 MORE THAN FIVE HUNDRED DOLLARS(S5oD).): ❑I,AS ONRJER OF THE PROPER7V,OR MV EMGLOVEES W ITH WAGES AS THEIR SOLE COMPENSA710N, Z 0 Commercia� WILL DO THE WORK,AND THE STRUCTURE IS NO7 INTENDED OR OFFEREO FOR SALE(SEC.7a�,BUSI� J � NESS M!D PROFESSIONS CADE:7HE CONTRACTORS UCENSE LAW DOES NO7 APPLV TO AN OWNER OF = I PROPERTY WHO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CL THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m ' Q OFFEREDFORSPLE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNEF7-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID�NOT BUILD OR � IMPROVE FOR THE PUFPOSE OF SALE). � w ❑I,AS ONMER OF THE PROPERTV,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Q TO CANSTRUCT THE PR0.IECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- � V8IU8SIOf1 ADJ.AREA i W CENSEl.4WDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVE57HEREON,AND � NM1iOCONTRACTSFOHSUCHPROJECTSWI7HACAN7qACTOR(S�LICENSEDPURSUAN7TOTHECONTFAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER F- Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIF7M UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FUL�F RCE AND EFFECT. m LLI �O / � � LICENSE C SS LIC.NO. � � . V DATE CONTRACTOR 'J a W � � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDEF VENALTY OF PERJURY ONE OF 7HE FOLLOWING DECLARATIONS: Z Z _I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' a 2 Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 70o OF THE IABOR CODE.FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS //�, ISSUED.MV WO S'CAMPENSATION INS�/g�w CE CARRIER AND POLICV NUMBERARE: CONSTRUCTION ( ¢ CARRIER_��7Ai/�i i-J)iC/n PLAN REVIEW � ZPOLICV NUMBER V �Q�� ELECTRIC Q � (i}iISSEC�IONNE�NOTBE�Of.W.EfEDOFTHEPERMfTISFORONEHUPDRED00LLARS(5100)ORlE55). PLUMBING Z I CERTIFV THAT IN THE PERFOPMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (3 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE Uj WORKERS'COMPENSATIONLAWSOFCALIFOR ANDAGREETHATIFI OULDBECOME INSPECTIONFEE = SU&lE 7 T0 E WORKERS'COMPENSA710 O ISIONS OF SECTI �37 o OF THE LABOR ��. COD ISHA FOR7HWI7HCOMPLVWITHT E ROVIS�IO1NS. ISSUANCE � /�- SMIP �7� p DATE: I APPLICANT: . /� J WARNING:FAILURE TO SECUFiE WORKERS'COMPENSA710N COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PEFiMIT DOLLARS(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN n � SEC710N 37oe OF THE LABOR CODE,IN7ERE5T,AND ATTORNEV'S FEES. RETENTION FEE: �{�-� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY �. �� L FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HIS FERMIT IS ISSUED(SEC.3oe7,CIV.C.�. t` Z W � LENDER'S NAME ' • F- LENDER'SADDRESS .../ wICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES /S�/ ( O � I AGilEE TO COMPLV WIT LL CITY AND COUNTY OHDINANCES AND STATE LAWS REUTING TO BUILDING � CANSTRUCTION,AN BY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONE O R7Y FOR INSPECT vuaaosEs. COMMENTS � � � m PERMI77EE NAM P IN7) - ) � f/� / // N SIGNATURE OF PERMIT7EE DATE � = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy \\ �� o�v �� u�u�� B�SI�I�� ff�(��IR� �,..-Da�3�CC�400a QQ4C� Oa�pC�C�40G3 Oa�3pC�C��Oa �' o *�`�C'' �F�}�� o;l�ar�� SET BACK FLOOR JOIST FTGS/FORMS/STEEL • FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING 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 ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�f UB 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 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 i FINAL PLUMBING ENERGY i ------ ----------I ---- - -- — - --- c�c�� .-------�.------ -- — COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � , �