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Home My WebLink About11-1618 (5)� _ — — -V �,� CITY OF DIAMOND BAR � _, �✓� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES r 21825 Copley Drive,Diamond Bar,CA 91765 ` PRESS � (909)839-7020 Fax(909)861-3117 Suifding Inspection Hotline(909)839-70ah� FIRMLY ��` BUILDING PERMIT APPLICATION �� JOBSITE 1� C \�� 1l/ � APPLICATIO � NUMB R��/ q/C I o ADDRESS y' � �-� /�o DATE '�� '� � ISSUE �� // TYPE �r� OCC APN LO TRACT DATE �.'__T CONST. C GROUP p OWNER ZONING SETBACKS I o ADD SS I FRONT RW ❑ � CI Z� T ' � REAR ❑ APPLICANT T 'L -0 SIDE/SIDE STREET RW O ¢ - � SIDE ❑ � CONTRACTOR � � ADDRE PROPOSED USE � CITY ZIP T w ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PE0.0.1RV THAT I IVA EXEMPT FROM THE CANTRACTORS LI� GOfflQB/C9f�OlI W CENSEUWFORTHEFOLLOWINOREASON(SEC.703t.6BU5WES5ANDPROFESSKKJSCADE:ANYCITYOR (n C� CpUNiYWHICHRE0UIRES�PERMITTOCQNSTRUCT.ALTEH,IMPROYE.DEMOLISH,ORREPAIRANYSTRUC� W P8�10/DBCk �ZTURE,PRIOR TO ITS�SSUANCE,ALSO NEW IRES 7HE APPLICANT FOR SUCH PEFUIIT TO FILE A SIONED � STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE COMRACTORS LI� � CENSE LAW(CHAPTER e(COAIMENCINO WITH SECTION 7000)OF DIVISION 3 OF TME BUSINESS AND PRO� � POOUSPB ^ FE^��ONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEGED EXEMP- � 7pN,ANY VIOIATION OF SECTION 7031.5 BV ANV APPLICAM FOR A PEFMIT SU&lECTS THE APPI�CANT TO Z Re-Roof � A CML PENALTV OF NOT A/ORE 7HAN FIVE HUN�RED DOLIARS(f500).�: 0 ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPIOVEESWITHWACaESASTHEIR50LECOMPENSATION, Q Cpm�7BfC181 Z WILL DO THE WORK�D THE STRUCT1JFiE IS NOT INTENOED OR OFFERED fOR SALE(SEC.70u,BUSI� J � NE55 AND PROFESSIONS CODE:7HE CONTRACTOR4lICENSE LAW DOES NOT APGLV TO AN OWNER OF � , VROPERTYWFIOBUIlD50RIMPROVESTHEREON,ANDWHO00ES5UCHWORKHIMSELFORHERSELFOR m Q THROlH7H HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCM IMPROVEMENTSARE NOT INTENDEDOR ' QOFFERE�FORSALEIF,HOWEVEFLTHEBUILDWGORiMPROVEAIENTI550LDWfTM�NONEVEAROFCAMPLE� Z TION,iHE OWNER�BUILDER WILL NAVE TME BUflDEN OF PFOVWG TMAT HE OR SHE DID NOT BUIL�OR � IMPFOVE FORTHE PURPOSE OF SALE). w ❑I,AS ON?lER OF THE PROPERlY,AM EXCIUSIVELY CANTFlACTINO WRH LICENSED CONTRACTORS TO CONSTRUCT TME PRR7ECT(SEC.TOa�,BUSINESS ANO PROFESSIONS CODE:Tt1E CONTRACTOR9 U- V81U0�1OT1 ADJ.AREA � CENSE LAW DOES NOT APVLV TO AN OWNER OF A PROPERTV WNO BUILDS OR IMPROVES TNEREON.AND WIiOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDVURSUANTTOTHECONTRAG (]UANTITY DESCRIP710N FEE Y TORS LICENSE UWJ. O ❑I MI EXEMPT UNDER SEC. B.8 P.C.FOfi THIS REASON � � Q � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION � ` W ' Q Q 1 HEREBY AFFIRM UNDER PENN.TY OF PERJUA�THAT I AM LICENSED UNDER PROVISIONS�F CHAPTER Vr » � o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z � AIY LICENSE IS�N FU ORCE AND EFFECT, , m � �/"l � � � UCENS C1LASS T� LIG.NO.� J V DA7E � Y^ �� 1 CONTRACT d W � � WORKERS'COMPENSATI N TION Q � U � 1 NEREBY AFFIRM UNDER PENALTV OF PERIUPY ONE OF THE FOLLOWINO OECLARATIONS: � Z Q � _I HAVE MID WILL MAINTAIN A CEATIFICATE OF CANSENT TO SELF-INSURE fOR WORKERS' S Q COMPENSATION,AS PflOViDED BY SECTION 37000F TME LABOR CODE,FOR THE PERf-0RMANCE W OF THE WORH FOF WHICN THIS PERMIT IS ISSUED. � 0 w I HAVE AND WILL A/AINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOq THE PERFORMANCE OF THE WO K FOR WHICH THIS PERMIT IS . ISSUED.MY WO°�y�-''�C(O�M�PEN�SA SURANGE CA NUMBERARE: CONSTRUCTION � CARRIER V�Y✓ilJ/�� PLAN REVIEW 0 POLICV NUMBER ELECTRIC Z Q � (INxsEcrqNrlE�No7eEmARE7EDOFnEPEaMrsFORa+EMN�7E�DOLIAfLSK+�)��`�1 PLUMBING � - -- w MECHANICAL Z 1 CERTIFY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI ISSUED,I (,�} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO B F�5 UBy THE � VrURNERS'COMPENSATIONLAWSOFCALIFORNIA.ANDAO rt'Y�FISHOU � " iNSPECTIONFEE S SUBJECTTO THE WORNEFiS'COMPENSATION PRO��Sq ECT� ISSUANCE �/� / j�'�£ 5 Ll FORTHWITH COMPLV MATH THOSE P 1 _ O J/+�� SMIP p DAT�:� APPLICANT: , � w ENERGY P/C --� WARNINO:FAILURE TO SECURE NK)RKERS'COM NS VERAOE IS UNLAWFUL,AND SHALL BE J � SU&IECT AN EMPLOYER TO CRIMINAL PENALTI CIVIL FINES UP TO ON£NUNOREO THOUSMlO ENERGY PERMIT OOLLARS(1100.000),IN/�DDITION TO THE CQS COMPENSATION,DAMAGES AS VROVI�ED FOR IN � � J SECTION 3708 OF iNE LABOR COOE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � � Q w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I�HEREBYAFFIRMUNDERPENALTYOFFEPJURVTHATTHEREISACONSTRUC710NlENDINOAGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS GERMIT IS ISSUED(SEC,7aB7,CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRESS � I CERTIFY THAT I HAVE READ TM�S APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES � �� w 1 AGREE 70 COMPLV WITH ALL CITV AfJD COUNTV ORDINANCES AND STATE IAWS RELATINO TO BULLOING � CONSTRUCTION, D HEREBY AUTMOR12E ENTATIV S THIS COUNTV TO EMER UPON THE � ABOVE ENT DPROPERTVFORIN` C URPOS ' Z COMMENTS � J � � m PE I E N P � Q �r "� C!J � NATURE P DATE RECPT.NO. PAID BY YALIDATION� � WHITE—Department Copy,YELLOW—Flnence Copy.PINK—Assessor Copy,GOLDENROD—File Copy.GREEN--ApplicanYs Copy CITV OI� D6,�f�liO�D �AR 16�S��C�'BO� ff�[�CORD � ��oa�p�c�400a �a4c� oa�p�c�4oa oa�p��4aoa �� nt��-� � :qa � � - I� � �SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND - UNDER FLOOR DUCT ' GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPL,4CE 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/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 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 � FINAL PLUMBING � � �-- ENERGY - �"U�� . COIVrMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � a �� .