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Home My WebLink About18116 _ .��,!_ CITY OF DIAMOND BAR y � DEPARTMENT OF COMMIJNITY&DEVELOPMENT SERVICES �� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 � PRESS �'%�� BUILDING PERNaT APPLICATION / FIRMLY � JOBSITE � M APPLICATION PERMIT P/C ¢ ADDRESS ��/ , r 2� �t_.-. p DATE NUMBER # � APN 9T/ T ACT D TEE �1-� CONST. GROUP p OWNER � ��,LT p ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT qyy p o APPLICANT TEL. REAR ❑ zd SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE p ADD S � CITY 1 ZIP TEL. �f PROPOSED USE f ' oARCH/ENG/ _ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDFIOOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION 'p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS U� GefB JB/CBfPOA W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.SBUSMESSANDVROFESSIONSCADE:ANVCITVOR (n U �p�JrJTYW�{ICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRMIVSTRUC- w w TURE,PRI017 TO ITS ISSUMICE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI6NED w P8�10/DBCI( � STA7EMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE COMRACTOFS LI� � CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa � FESSIONS CODE)OR THAT HE OH SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOED EXEMP� (!f TION.ANY VqLATqN OF SECTION 7031.5 BV ANV MPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f500)J: � ❑I,ASOWNEROFTHEPFOPERTV,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATqN, � COrt1rtIBfCl81 Z WILL DO THE WORK,AND TiE S7RUCTURE IS NO7INTENDED OR OFFERED FOR SALE(SEC.7oa1,BUSI- J � � NESS M1D PROFESSIONS CODE:7HE COMFiACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEFEON,M1D YA-10 DOES SUq7 WOqK HIMSELF OR HERSELF OR Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIAIPROVEMENTSAAENOTINTENDEDOR m 0 OFFERE�FORS�LEIF,FqWEVERTFIEBUILDINQORIMPROVEMENT45SOLDWfTH1NONEVEAROFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OF SHE DID NOT BUILA Oq � IMPROVEFORTHEPURPOSEOFSALE). �y,� ❑I,ASOWNEROFTHEPROPERlY,AME%CWSIVELVCONTRACTINOWITHLICENSEDCONTRACTORS [= TO CONSTFUCT THE PR0.IECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTAACTORS LI- V81U8I1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOYMEROFAPROPERTVWFqBUILD50RIMPROVESTHEREON,AND � N71000NTRACTSFOqSUCHPR0.IECTSWRHACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y 70R5 LICENSE LAW.). � FEE 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS HEASON Q � G /p U, � U � DATE OWNER ¢ Z U �Q LICENSED CONTRACTOAS DECLARATION w 2 I HEREBV AFFIRM UNDER PENALTY OF PE0.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � . � e(COMMENCINO WITH SECTqN 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSKKJS CODE,AND Z LLl MV UCENSE IS IN FULL FO CE D EFFEC / m � LICENSE CLASS �IC.NO. I�ln�� V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q U � I NEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWINO DECLARATIONS: Z � _I HAVE AND WILL MAINTPJN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR V/ORKERS' a 2 Q COMPENSATION,AS PROVIDED BV SECTION 37ooOF THE LABOR CODE,FOR THE PERFORMMICE U wOF THE WORK FOR WHICH TFIIS PERMIT IS ISSUED. � 1 HAVE M1D WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION Q - 3700 OF THE LABOR CODE.f-0R THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WO MPEN TION INSU CE CARRIER POLICV NUMBER AAE: CONSTRUCTION J j CARRIER PLAN REVIEW ZPOLICV NUMBER ELECTRIC Q � (iFOSSECf10NNE�NOTBE00MPLFfmOFhEPEW.TT15 oriEHuwnEppou�gioo�pq�Ess} PLUMBING W Z I CERTIFV THAT IN 7HE PERFOHAIAfJCE OF THE WOH1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOY ANY VERSON IN ANY M ER SO AS TO BECOME SU&IECT TO THE (/� WORKERS'COMPENSATION I.AWS OF CALIF N10.�ND A(iREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECTTOTHEWORKERS'CAMPENSATIO ROVISIONSOFS ION37000FTHELPBOR O CO I SHALL R)TNWITH�COMPLY WITH SE PROVISION ISSUANCE 'p DATE:� ��VRPPLICANT�� SMIP ��'� JJ J WARNINO:FAILURE TO SECURE WORKERS'COMPENSA ION COVER GE IS UNLAWFUL,AND SHALL BE ENERGY P/C J � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f 100.000),IN ADDITION TO TME COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN � SECTqN370BOFTHELABORCODE.WTEREST,ANDATTOFNEV5FEE5. RETENTIONFEE: OCONSTRUCTION LENDING AGENCY . PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENOING AGENCV � FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO(SEC.3087,CIV.C.). Z W '� LENDER'SNAME � LENDERSADDRESS w I CERTIFV THAT I HAVE READ TFIIS APPLICATION AfJD STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL F E E � I� L /V � 1 AGREE TO COMPLV WITH ALL CITY AND CWNTV ORDINANCES M!D STATE LAWS RELATINO TO BUILDING (, � CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF 7HIS CWNTV TO ENTER UPON THE � � Z ABOVE�MENTIONED PROFERTV FOR INSPECTION PURPoSES. COMMENTS � J � � � � m PEHA/ITTEE E(PRINn � Q � � Uj SIONA E qTE � RECPT.NO. PAID BY VALIDATION WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy II� , (,� (G��'� �� 9�6�i C��R� i�� r6��lt'0��1 �if�� ` -�� '� ��1��l(a-n�� t�� ,IJ o � � flG�`Lt , t � �G� � Q '� ., � SET BACK L FLO�R JOIST FfGS/FORPVIS/STEEL ��27.s, I�C� FNA REQMTS --�--_—_ ELECTRIC GROUND � UNDER FLOOR DUCT GROUND PLUMBWG UNDER FLOOR CUMDUIT SLAB GRADE FIREPtACE FQUNDATION TEMP POWER FIREPLACE BOND BEAM, • WATER SERVICE MID HT. BC�NQ BEAM ' ' ROOF SHEATHING 8 FG BOND BEAM , � FRAMItJGNENTILIATION FINAL BOPVD BEAM ROOF COVER PRE-GRADING� ROUGFi HEATIIVC BENCHING ROUGH ELECTRIC FiOUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/T'UB TEST PUOL ELECTRIC EXT. LATHISIDING POOL FENCING WAL�INSULATION POOL FINAL ! Y CEILING INBULATION� OFF SITE IMPS. '� DRYWALL NAILING DEDICATIONS SEWER FfNAL ENG. SEPTIC TANK LANDSCAPEItRRIG. SEEP PIT/L.L. � ON 5lTE iMPS. � GAS AIR TEST FINAL ZONING FlNAL CONST. � FIRE DEPT. FINAL F1NAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY --� � �� . `/5K IW f �� . ..�� COMNiENTS _��_DC/ ��i��l?��' C� ' � s/_�_� � SEPTIC TANK SIZE SEEP PIT/U SIZE � . � � �� a � � � ,�� _� � �