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Home My WebLink About11-1593 �\ CITY OF DIAMOND BAR i, � � ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 Copley Drive,Diamond Bar,CA 91765 � � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 � - PRESS I �'9"'` BUILDING PERMIT APPLICATION FIRMLY } JOBSITE �y APPLICATION � PERMIT p/C o ADDRESS � � �/�r �� 1 DATE �� //� NUMBER )I-i � # , � APN LOT TRACT �SSUE 7yPE �C /� DATE I CONST.� GROUP p OWNER p ADDRE S � ZONING SETBACKS w FRONT � CITY ZIP EL. RW ❑ APPLICANT TEL. � REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTO� _ Q' SIDE � o CDDRES �� Z�P EL. ' �� PROPOSED USE � � , o ARCH/ENG/ 41�1C �/l/fjr� ' � DESIGNER NO.DWEL. NO. NO. a ADDRESS u� UN ITS STORI ES BED ROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEA DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERtt1RV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8I89B/CBfPOfS W CENSELAWFORTHEFOLLOWINOREASON(SEC.703t.5BUSINESSANDPROGESSIONSCOOE:ANYCIiVOR (f� U CpUNryWF11CHRE0UIRESAPERMITTOCONSTAUCT,ALTER.IMPROVE,OEMOLISH,ORAEPAIRANVSTRUC- w w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO w Patla/Deck � STATEMENT lHAT HE OR SHE IS LICENSED PURSUANT TO hiE PROVISIONS OF THE CONTRACTOFS LI- � CENSE UW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � PooUSpe � -FESSIONSCODE)ORTHATNEORSHEISE7(EMPTTHEREFROMANDTHEBASISFORTHEALlEOEDEXEMP� � TION.ANVVIOLATIONOFSECTION7037.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVIL 7ENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS({500�.); Z~ ❑I,ASOWNEROFTHEPROPERT',ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATqN, Q WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a{,BUSI- J COfTIRIBfCiBI � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF � Fi70PERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR w THROUGH HIS OR HER OWN EMPLOVEES,VROVIDED THAT SUCH IA/PROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVE{ZTHEBUILDIN(30RIMPHOVEMENTISSOLDWfTHINONEVEAROFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS ONMER OF THE PROPERTY,AM EXCLUSNELV CONTRACTINO WfTH LICENSED CONTRACTORS [[ TO CONSTRUCT TME PR0.IECT(SEC.70/1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU9�1Of1 ADJ.AREA � CENSE LAW DOES NOTAPPLV TO AN ON7JEfl OFA PROPEflTV WHO BUILDS OR IMPROVES THERE-0N,M!p N?1000NTRACTSFORSUCHPRQIECTSWITHACONTPACTOR(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORS LICENSE LAW.). FEE � � ❑I AM E%EMPT UNDEfi SEC. B.8 P.C.FOR THIS REASON Q ?� U LL �ATE OWNEq � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER � � Y(COMAIENCINO WITH SECTION 7000)OF DIVISION�OF 7HE BUSINESS AND PROFESSKKJS CADE,AND Z �� YV LICENSE IS W FULL FORCE AND EFFECT. � LICENSE CLASS �/✓�� LIC.NO. /��/7 � U DATE �I�j�/ CONTRACTOR d � LLJ � WORKERS'COMPENSATION DECLARATI� Q I HEREBV AfFIHM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWING DECLAAATIONS: U (� Z .. � _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ � CONVENSATION,AS PROVIDED BV SECTION 3)0o OF THE UBOR CADE,FOR THE PERFORMANCE U THE WORI(FOR WHICH THIS PERMIT IS ISSUED. W � � � � HAVE AND WILL MAINTAW WORKERS'CAMPENSATION INSURANCE,AS REQUIPED BV SECTION Q 370a OF THE LABOP CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS . ISSUED.MV WOR S'CpMPENS �I}ON INSU CE CARRIER AN�D/PqLICV NUMBER ARE: CONSTRUCTION � CARRIER 'G- /Gf' PLAN REVIEW �Z POLICY NUMBER _��_��y,�� ELECTRIC Q 0 (iHISSECIIONNE�NOTBE00MREfEDOFT}gPERAYTI3FpqpryEFil,�pREppp��AfiS�t�pp�pqLESS} PLUMBING �j 3 W Z I CERTIFV THAT IN THE PERFORMANCE OF THE N'ORK FOR WHIGi THIS PERMIT IS ISSUED,I MECHANICAL C} SHALLNOT EMPLOYANV PERSON INANV MANNER SOAS TO BECOME SU&IECTTO THE [/) WOFKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTKKJ 3700 0F iHE LABOR �� / S CODE,I S LL FO THWITH COMPLV WITH SE PROV�g IONS. ISSUANCE o � /m//�' ��7/ p DATE:� APPLICANT: � LLL( ��/U(/ '�� SMIP W � WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT DOLURS(5100.000).IN/�DDITION TO THE COST OF CAMPENSATqN,DAMAGES AS PROVIDED FOR IN J SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. w RETENTION FEE: �r�, O CONSTRUCTION IENDING AGENCY PRE-ALT FEE: Q I HEREBY AFFIqM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO AOENCV � FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS w I CERTIFY THAT I HAVE READ THIS MPLICATION AND STATE THAT THE ABOVE WFORMATqN IS CORAECT. TOTAL FE ES � / 7 3 � I AGREE TO CAMPIV WITH ALL ClTV AND COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILDINQ � CONSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS COUNTV TO ENTEfl UPON THE ' Z ABOVE-MENTpNED PROPERTY f-0fi INSPECTION PURPOSES. COMMENTS � '��'�� %� �/�GL- J � - m PE{iMfTTEE N (PRINTJ � N // z/i � SIONANRE OF P EE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,(3pLDENROD—File Copy,GREEN—Applicant's Copy ci�v o� �s��o�� i�s��c�-oo� ��co�� , '=;��G]�pCC�400U] C�GQ4C� Oa�p@C�4QG3 Oa£�3p[�E'400f�: DGQtt`�'�_ �O[til�pC�C�40G��";`�`: SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBtNG UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. 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 SHOWERfTUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCIfVG WALL INSULATION POOL FINAL CEI�ING INSU�ATION OFF SITE IMPS. DRYWALL tJAiLING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE!lRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEA�TH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID � FINAL PLUMBING ENERGY �� CO M M E N TS „„_�w.�{-1.�,-o�,v�-.6`�,,,,.,,,� �Z�z,t/�� / � SEPTIC TANK SIZE SEEP PIT/U SIZE a e� � �:�. � _�.