The URL can be used to link to this page

Home My WebLink About10-1170 ��_ CITY OF DIAMOND BAR ,� i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES r `�� 21825 Copley Drive,Diamond Bar,CA 91765 909 839-7020 Fax 909 861 3117 Buildin Ins ec ' 1�' 9 � 27 PRE �.,-v�,��, ( ) ( ) g P �Gz1��L�IS S$ BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � a��i 6 �J �/ o ADDRESS r Y C Y ee k APPLICATION PERMIT � � n p/C DATE NUMBE �f # °r APN LOT TRACT DA EE �/��'V ONST. LYI GROUP p OWNER � r p ADDRESS P� r r�C ZONING SETBACKS Z CITY'�i Gn.�� Q� Z P TEL A(�1)61�-�f FRONT qyy p � APPLICANT TEL. REAR p 0 Z SIDElSIDE STREET RW p ¢ CONTRACTOR � � nM Y�C ar. R � .p SIDE p ADDRESS � � CITY ��a�v ZIP I7b3 TEL. 567�4SY"7�� PROPOSEDUSE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � <n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIFM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FHOM THE CONTRACTOFS LI- G3fegB/CefPOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCINOR (n U CAUNTVWHICHREDUIRESAPEiiMITTOCONSTRUC7,AITER,IMPROVE,DEMOLISH,ORREPAIRANV57RUC� w TURE.PRIOR 70 I75 ISSUANCE,PLSO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED W Patio/Deck � S7ATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70RS LI� � � CENSE LAW(CHAPTER 8(COMMENCING WI7H SEC710N 7000)OF OIVISION 3 OF 7HE BUSINESS AND PRO� POOVSPB Q FESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM ANO THE BASIS FOR THE ALLEGED EXEMV- (!f V 710N.ANVVIOLATIONOFSECTION7o37.5BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENAL7Y OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f5o0�.): 0 ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � COfI1mBfClal Z WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7ou,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF � PROPER7Y NM1iO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMENTS AHE NOT IN7ENDED OR m Q OFFEREDWRSALEIF,HOWEVEi�7HE8U1LDINGORIMPROVEMENTI550LDWITHINONEVEAROFCOMP�E� Z TION,THE OWNER-BUILDEP WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NO7 BUILD OR � IMPROVE FOR THE PURPOSE OF S/�LE). W ❑I,ASOWNEROFTHEPROPER7V.AME%CLUSIVELVCONTRACTINGWI7HLICENSEDCAMRAC70RS Q TO CONSTRUCT THE PRQIECT(SEC.7a4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOfiS LI� V81112fi0� ADJ.AREA W CENSE UW DOES NOTAPPLV TO AN OWNER OF A PflOPERTV WHO BUILDS OR IMPROVES THEREON,AND � WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUPNTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � O I AM EXEMPT UNDER SEC. B.8 P.C.FOR 7HIS REASON Q � U tL � DATE OWNER F O w I � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTY OF PERJURY 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER ' 1� � �(COMMENCING WITH SECTION 7000)OF DIVISION 3 Of THE BUSINESS AND PROFESSIONS CODE,AND Z C O� Q/' Y C / �� 7v t�J►�'��t LV �Y LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSECLASS `�� LIC.NO. d v��d � �JJ r h� yv�Q„� ��'s�Q . V DATE ��'�I ZOi� CONTRACTORAII f�Qr' �d'�1 d � �OS2 n��bf W � WOFKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECLAHATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ ¢ CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE U ' OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. w � � W �I HAVE ANO WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION Q ` � CARRIER SDN��`�� PLAN REVIEW Z POLICV NUMBER U ST v IY L I Z S�'�J � ELECTRIC Q 0 (IHISSECiIONNE�NOTBE�EfEDOFTI�PEPoMISFORONEFNPDRED�0UAR5(f700)ORLESS� N - � Z I CEflTIFY THAT IN THE PERFOqMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL (3 SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSA710NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSP FEE � SUBJEC7 70 THE WORKERS'CAMPENSATION PROVISIONS OF SEC710N J7oo OF THE LABOR 6�� CODE,I SHALL FORTHWITH COMPLV WITH 7HOSE PROVISIONS. _ � SMIP p DATE: APPLICANT: J WARNING:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PE DOLLARS(f100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN � SEC710N 37oB OF THE LABOR CODE,MTEREST,AND ATTORNEY'S FEES. TION �" OCONSTRUCTION LENDING AGENCY PRE/-p��T��FE�E:�/J � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY �//`�.J,v Y FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMI715 ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME i— LENDER'SADORESS ,� TOTAL FEES �� I CERTIFV THAT 1 HAVE READ THIS AP7LICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. � I AGREE TO COMPLV WITH ALL CIN AND COUNTY ORDINANCES AND STA7E LAWS REU7ING 70 BUILDING � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � Z ABOVE�MENTIONED PHOPERTY FOR INSPECTION PURPOSES. COMMENTS � `' _' /'�r��ru...c Sh�cl �/./�{wv� � ¢ PERMI77EE NAME IPRINT) — � � ��/ ' cn / �� 1 7�� N SIGNATUREOFPERMITTEE DATE = RECPT.NO. PAID BY O VALIDATION ~ WHITE—Deparlment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �B�'Y O� DBAiUiON� ��8� I�SV�lE��90� �f�C�IR� _ �`_, 1 �. .. . ��. . . ' 1?�4f-��:A�i n !n�;�.'}i .:Pl Oa�3pC�C�400a D� < `�` �C�C�40G3 Oa�pf�C�4�Oa bQ`�L�'� Da�pC�p = SET BACK FLOQR JOIST FTGSlFORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UtJDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MIQ 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 SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION QFF 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 (�'�" �o � COMMEIVTS __ � .� -• y SEPTIC TANK SIZE SEEP PIT/U SIZE a ---- ---------- � � � ._