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Home My WebLink About16811 _1�` _ CTI'1'OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive � � ''�- (909)860-3195 Fax(909)861-3117 PRESS �'%��+ BUILDING PERMIT APPLICATION FI LY � JOBSITE�v o•� (� APPLICATION �r� PERMIT �� P/C o ADDRES \�-�� 1� `� lJ�� DATE � NUMBER # � APN LOT TRACT �SSUE � � TYPE pCC DATE CONST. GROUP p OWNER �� _ � p ADDRESS �G ZONING SETBACKS z CITY ��I p � �- FRONT Ryy p � APPUCANT 6 �"1X, REAR ❑ ¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSED USE I oARCWENG/ z DESIGNER a ADDRESS NO.DWEL. O. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f9g6/CBfPOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.58U51NE5SMlDPROFESSIONSCODE:ANYGTVOF (n U �qJrJJyWF{ICHREWIRESAPERMITTOCONSTRUCT,ALTER�MPROVE,DEMOLISH,ORREPAIRMIVSTRUG w w TURE,PRIOR TO ITS ISSUANCE,AL50 REW IRES iHE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED w P0fI0/DBCK � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO hIE PROVISIONS OF THE CONTMCTORS LI� � CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpe . ^ FESSqNS CADE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND TME BASIS f-0R THE ALLEGED EXEMP� (� V TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CNIL PENALTV OF NOT MORE 7HPN FNE HUNDRED DOLLARS(f5ao)J: � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMVENSATION, � COfi1R10fC18I � Z WILL DO TNE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J � NESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTV NTiO BUILDS OP IMPROVES THEREON,AND NT10 DOES SUCH WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR MER OVM EMPLOVEES,PROVIDED THAT SUCH IMPqOVEMENTS AqE NOT IMENDED OR m 0 OFFEAEDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I.AS OWNER OF THE PROPERTV.AM EXCLUSIVELY COMMCTING WITM LICENSED CONTRACTORS [[ TO CONSTRUCT h1E PR0.IECT(SEC.701a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V01U8l1Of1 ADJ.AREA W CENSE UW DOES NOTAPPLY TO AN ONTJER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPRq1ECTSWITHACONTRA TOR(5)LICENSEDPUR ANTTOTHECONTMC- OUANTITY DESCRIPTION FEE 70R5 LICENSE UW.). pO I AM EXEMPT UNDER SEC. B .C.FOR THIS REASON Q � U � DA � O R F— Z U � LICENSEO CONT CTOR ECLARATION w � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ENSED UNDER PROVISIONS OF CHAPTER � � o(COMMENCIN(3 WfTH SECTqN 7000)OF DMSION 3 OF E BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS IN FULI FORCE AND EFFECT. m � IICENSE CLASS LIC.NO. � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBYAFFIiiM UNDER PENALTV OF PERJURv OtJE OFTHE FOLLOWING DECLARA7qN5: Z Z0 _IHAVEANDWILLAIAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' a Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE IJ�BOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. � w _IHAVEANDWILLMAWTAWWORKERS'COMPENSATIONINSURANCE.ASREOUIREDBYSECTION Q 3700 OF THE LABOR CODE,FOR 7HE PER WRMANCE OF THE WORK FOR WHICH THIS PERMIT IS I�� ISSUED.MY WORKERS'COMPENSATION INSUWWCE CARRIEfl AND POLICY NUMBER ARE: CONSTRUCTION � CMRIER PLAN REVIEW ZPOLICV NUMBER ELECTRIC Q p (�SSEc�iq�r��oTBEo��7IDo�n#p�.�T�st�qor�E�o�ooa.�usR��)�LEss). PLUMBING w Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHIC}i THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE (/� WOHKERS'COMPENSATION LAWS OF CALIFORNI/�AND AOREE THAT IF I SF/OULD BECAME INSPECTION FEE SUBJECT TO THE WORICERS'COMPENSATION PROVISIONS OF SECTKKJ 3700 OF THE LABOR � ~j CADE,I SHALL FOqTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE C � p DATE: APPLICANT. SMIP W J WARNINO:F/JLUflE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C 0 J J� I �y SU&IECTMlEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDflEDTHOUSAND ENEAGYPERMIT , T f DOLIAFS(f100.000).IN ADOITION TO 7HE COST OF COMPENSATION,DAMA(3ES AS PROVIDED FOR IN J SECTION 3�oe OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. � RETENTION FEE: � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: I � I HEREBV AFFIqM UNDER PENALTV OF PERIURV THAT THEFiE IS A CONSTRUCTION LENDING AOENCV FOR THE PERFORMANCE OF THE WORN FOF WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). - W � LENDER'S NAME � � LENDER'SADDRE55 � TOTAL FEES � � I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT iHE ABOVE INFORA/ATION IS CORRECT. w I AOREE TO COMPLV WITH A1L CITY AND COUNTV ORDWPNCES AND STATE UWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTFIORRE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE ZABOVE�MENTIONED PROPERTV FOR INSPECT PURPQSES. • ' 1� A�� COMMENTS �O O DO V.[u � 11 f� 1�� NAME(P - ^�(� ` �` 1 � .�.w.�. �u �l� O — 51 A RE PE DATE � •� RECPT.NO. PAID BY � ALIDATION WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy (CD IT�f �[� [mU��li�� /�,f� Q�lS��"��I f�[�C��i� . � �0��: , DCa� 0 ° �C> a � � � � � � � � � � OGJ�� n a o � .� �° SET BACK " ( FLOOR JOIST _ � _ _ FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLQOR DUCT � - GROUND PLUMBING UNDER FLOOR CUhIDUIT � SLAB GRADE FIREPLACE FC7UNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING � � $ FT. BOND BEAM FRAMIRlG/VENTIUATION � � FINA.L BOND 6EANi ROOF COVER PRE-GRADING � ROUGH HEA7ING BENCNING ROUGH ELECTRIC ROUGH GRADING ROUGH f'LUNIBING FINISH GRADING ` SHOWER/TUB TEST POOL ELECTRIC ' EXT. L4TH/SIDWG POOL FENCING i i� WALL INSULATION POOL FINAL CEIUNG IfVSULATIOfV OFF SITE IMPS. DRYWALL N,41LIfVG DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FlNAL CONST. F1RE DEPT. FINAL FINAL HEATING HEA�TH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FIiVAL PLUMBING ENERGY C�OOf� o � o CONifViEfVTS � SEPTIC TANK SIZE SEEP PIT/U SIZE � � a � :�' a � � � � � � ° . �