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Home My WebLink About12-187 .__��_ CITY OF DIAMOND BAR - �� I � DEPARTMENT OF COMMUNTTY&DEVELOPMENT SER � �� : 21810 Copley Dri`G,,�iacc•�nd Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection IIot nc(909 839-70 ��$ :�''"'. BULLDING PERMIT APPLICATION FIRMLY a DDRESS_I�� •w- �/�� APPLICATION PERMIT /�_ %�//�jC o DATE NUMBER L f d ]� � APN LOT TRACT �SSUE '/„ f� TypE p�C DATE �l� / CONST.��GROUP p OWNER _12R'`f C3?EC�{eu_D o ADDRESS .s�-.r--- ZONING SETB CKS Z CITY ZIP TEL.9Di?'d�-cl 24 FRONT pyy � . g APPLICANT TEL. A�R O zd SIDE/SIDE STREET RW D � CONTRACTOR /� ' TRi� SIDE � p� ADDRESS .� �4___S l��l�r � CITY _ �ll A�•�U I,� ZIP �� TEL Z . 3s7-s37� PROPOSED USE 0 � � f�- � D U C'j—� o ARCH/ENG/ z DESIGNER ►+� NO.DWEL. NO. a ADDRESS NO. I � UNITS STORIES BEDROOMS N CITY ZIP TEL. I � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER•BUILDER DECLARATION p SFR/ADD/REM p ,I HEREBY AFFlRM UNDER PENALTY,OF PERAIRV THA7 I AM EXEMPT FROM THE CON7pA�7pq,g�H GflfB B/C9 fl W CENSEUWFORTHEFOLLOWINpqEASON(SEC.7o31.6BU5INE5SMIDPROFESSION50DDE:ANYCrtVOR (n �g � U COUNTyW!{IpiRE0UWE5APERMITTOCON57RUCT.AL7ER,lA1PROVE.DEMOIISH.ORREPAIRANV97RUG P811WDBCk W TURE.PRIOR TO RS ISSUANCE,ALSO REWIRES THE APPLICANi FOR SUCH pERM1T TO FILE A SIONED w � STATEYEM THAT HE OH SHE IS LICENSED PUASUANT TO 7HE PROVISIONS OF THE CONTRACTORS�4 � CENSE UW(CHADTER Y(COMMENCWO WI717 SECTION 7000)OF DIVISION 3 OF TME BUSME59 AND'7RO. � POOVSpB � _ � FESSIONSCOOt�ORTHATHEORSHEISE%EMPT7HEREFROMANDTHEBASISFORTHEALLE6EDE%EMP- � (� V TION.ANY VpLATION OF SECTION 703t.5 BYANY APPLICAMT FpR A PERMI7 SU&IECTS THE APPLICANT T0 Z RB-ROOf � ACML VENALTY OF rypT MORE THAN.FNE HUNDRED DOLLARS(i50D)J: � ❑AtiSONMEROF7HEPpOVER7Y,ORMYEMPLOVEESV/fTH1VAGESASTHEIRSOLECOMPENSATION, � (`,pmmBlCl�� Z WILL DO THE WORI(,AND THE 9TRUCTURE IS NOT INTENDED,Oq OFFERED FOR SALE(SEC.7ou,BU54 J ' � � NESS ANO PROFESSIONS CODE:THE CONTMCTORS LICENSE LAW DOES NOT MFLY 70 AN ONRlER OF � �� PROPEHfY NM110 BUILOS OR IMPROVES THEREON,AND WHO OOES SUCl7 NORK H WSELF OR HERSFIF OR w 7HROU6H WS OR HER ONRI EMPLOYEES,CROVIDED THAT SUCH IMPROVEAfEM3 ARE NOT INTENDED OR m - Q OFFFAmFOR3AL.EIF,FqWEVEq,T/{EBULDIN(30RIMPROVEAIENTI$SOLpW�7�qNONEVEAAOFCqMpLE- Z T10N.THE OWNER-BUILDER WILL HAVE TME BURDEN OF 7ROVW0 THA7�HE OR SHE DID NOT HUILD Oq . . � IMPROVE FOR THE PURPOSE OF SALE): . . . W ❑I.ASOWNEROF�THEPROPERTV,AMD(CLUSlVELYCONTMCTWOVffTHLICENSEDCONTRACTpHS � TO CONSTRUCT THE VRQIECT(SEC.70N,BUSINE59 ANO PROFESSIONS CODE:THE CONTRACTORS�LI- V81UHl{Dfl' /�QJ.(�� ' CENSEUWDOESNOTAPPLYTOANOWNEROFAVflOPERTYWHOBUI�pgORIMPROVESTHEiiEON,AND ' �- � NM1�OCONTiUCTSf-0RSUCHPR0.1ECfSWfTHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTMG p�qNT�7Y � DESCRIPTION FEE � TORS LICENSE UWJ. 0 O 1 AM El(EMPT UNDEfi SEG B.6 P.C.FOR THIS REASOfJ � � �S�O�'I N,Q G � U LL DATE OWNER �� UCENSED CONTRACTORS DECLARATION w - - � � � 1 HEREBV AfFIRM UNDER PENPLTY OF PERIURV THAT I AM'LICENSED UNDEH PROVISIONS OF CHAPTER � ' � � o(COMNENCINO WI7H SECTION 7000)OF OMSION 30F THE BUSINESS M1D PROFESSIONS CODE,AND Z �� W LICENSE IS RJ FULL FORCE AND EFFECT. � LICENSECLASS C� ^� p2 2� � . F LIC.NO. °� �o �. .. , � onrE Z- l6•C Z coNrancroa /�7R-7?2� a � WOAKERS'COMPENSATION DECLARATION � �� , � H,v�{–� �� I HEREBV AFFUiM UNDER PENALTV OF pER1UHY ONE OF 7HE PoI.LAWW(3 DEqAfUT10N5: / - � ��/l.��S� . . 0 _I HAVE AND WILL MNNTAIN A CERTIFICATE OF CqNSENT TO SELFINSURE FOR NpRI(Eq5 � � � COMPENSA710N,AS PRpV�DED BY SECTION 37000F THE LABOR CODE,FOR TNE PERFORMMICE � � e-S OF 7HE WORK FOR N7iICH 7HI,g pERMIT IS ISSUED. W 0 � � �YE AND WILL MAINTAIN WORKERS'�COMPENSATION INSUqANCE,qg REWUiED BY SECTION . . . Q -37000F THE LABOR CODE,FOR THE'VERFOqAIANCE OF THE WpqK FOR WMICli THIS PERMIT IS, �SSUED.MY WORKEA5 COMPENSA7ION INSURANCE CARRIER AND.POIICY NUMBERARE: 'CONSTRUCTION�� IUhT U�L<o/v > CAARIER PLAN REVIEW Z vaicrr�unmEa w� G2b �iS 7 L ELECTRIC _ rj Z'7'3 ¢ p f�s�t�ia+r�IDr+oTe�oo�-ET�o�n�a�w�Ts�or+a�t+�v��000u.wsg+oo)a+�ss� .PLUMBING � w Z �CERTIFY TMAT IN THE PERFOHAAANCE OF THE WORI(FOR W/iipi THI$PERA/IT IS ISSUED,1 MECHANICAL� � ��.. C7 6HALL NOT EM%.OY ANV vER.AN IN AHV MANNER 50 AS 70 BECAME SU&IECT 70 THE � (q WORKERS'COIdPEN5AT10N LAWS OF CA�iFOqNI.�AND AGREE THA7 IF I SHOULD BECOME INSPECTION FEE � SUBJECT TO THE WOPo(ERS'COMPENSATqN GqpV1510NS OF SECTION 77000F THE UBOR � �U cooe,i sw/ui coarriwirn cour�r Nnnr r v�sror�s. ISSUANCE p DATE ��r �^r 2 APPLICANf: �SMIP � . . � _ . . . W J WARNINO:FAIIURE TO SECURE WORKERS COMPENSAT�ON COVEMGE IS 11NUWFUL,AND SHALL BE ENERGY P/C � J SU&IECT AN EMPLOYER TO CAUAINAL PENALTIES AIJD CML FWES UP TOONE HUN�RED 7HOUSAND J� DOLLMS(S10o,00D),IN PDDITON TO THE COST OF COMPENSATION,DMIA�ES AS PROVIDED FOR M ENERGY PERMIT SECTIDN 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEVS FEES. � � - " ' � w � RETENTION�FEE: � �.�0 0 CONSTRUCTION LENDING AGEN6Y PRE•ALT FEE: � 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THA7 THERE IS ACONSTRUCTION LENDINO AOENCY d �FOR THE PERFORMANCE OF TNE WORI((-0R NM1i1CH THIg pERMR IS ISSUED(SEC:�30H7,qV.C.). Z W ��. LENDER'SNMIE . . ` F"- IENDER'SAODRE55 - �� ICERTIFYTHATIHAVEREADTHISMPLICATIONANDSTATETHATTHEABOVEINFORMATIONI9CORRECT. TOTAL FEES � 3� �� I AOREE TO COAIPLY N7TH ALL CITY AND COUNTY ORp W AN(�5 AND STATE UWS fiEUTINO Tp 9UR_pW O � CONS7RUCT10N,AND HEREBv AUTHORRE REPRESENTATIVES OF TH15 COUNTY 70 ENTER U�ON THE � Z ABOVE-MENTIONED PROPERTV FOR INSPECTION VURPOSES. COMMENTS � � P�-� ��-s�� m PERMITTEE I � ' � "�'��-a� 2_/�_�2 �/j 'SKiNATURE pF PERNITf� DATE � RECPT..NO. U PAID BY ALIDATION WHITE—DepaNnent Copy,YELLOW—Finarwe Copy,PINK—Assessor Copy,GOLDENROD--Flle Copy;GREEN—ApplicanYa Copy �`��" � �� `�' ^ -`�� C1�'Y OF DIAMOPlD BAR �q�� ;� . .. ;��b��;,�� If�SPECTlON REC�4F2Cl�' . � _. , . : , .�. ., 0 6i D � p �� a�� p � :i�" `o �-m ,a� . . : .. ; .:, � _, .; SET BACK _ __ i FLOORJOIST 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 I WI�D HT.BOND BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER __ i PRE-GRADING ROUGH HEATING i BENCHING ROUGH ELECTRIC �ROUGH GRADING ROUGH PLUMBING FINISH GRAOING SHOWER/TUB TEST POOL ELECTRIC EXf.LATH/SIDING �POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/1RRIG. SEEP PIT/L.L. ON SITE IMPS. i ` GAS AIRTEST FINAL ZONING FINAL CONST. FIRE DEPT.FINAL FINAL HEATING HEALTH DEPT.FINAL FINAL ELECTRIC DEV.FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING � • e p , connnnErvTs - 3 " � SEPTlCTANK SIZE SEEP PIT/U SIZE - '' i — - ��