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Home My WebLink About10-1082 CITY OF DIAMOND BAR ----��— DEPARTMENT OF COMMUNITY&DEVELOP�I��VI�� I � 21825 Copley Drive,Diamond Bar,CA 91765 �� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRE$$ "°^' BUILDING PERMIT APPLICATION FIRMLY o DDRESS $3O D��I p�"1�r �' DATEICATION NUMBE P C o issuE TYpE J�� °in e� `^ Ai'N LOT TRACT DATE /O''�7'��O CONST. 1�-Lrd(� GROUP p OWNER o ADDRESS �JO T' ZONING SETBACKS z CITY ZIP�_ TEL.� SZ' FRONT qyy p o APPLICANT TEL. S DE/SIDE STREET RW ❑ z � CONTRACTOR SIDE p � ADDRESS PROPOSED USE O �(,lQ � � CITY ZIP TEL. w ARCWENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- G818gB/CO�OR W CENSEUWFORTHEFOILOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n U COUN7VWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTiiUG � W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE GONTRACTORS ll� � � CENSE LAW(CHAPTER 8(CAMMENCING WITH SEC710N 7ooa)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUS(78 Q FESSIONS CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� T V TION.ANYVIOLATIONOFSECTION7o31.58YANVAPPLICAN7FORAPERMITSU&IEC75THEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSoo).): Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � CORIlI1BfCl81 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BUSI- J � N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF � PROPERTV WHO BUILOS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m I w OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE� �' 0 TION,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NO7 BUILD OR Z IMPHOVE FOR THE PURPOSE OF SALE). _ ❑I,ASOWNEROFTHEPROPEHTV.AME%CLUSNELYCONTRACTINGWITHLICENSEDCONTRACTORS W Q TO CONSTFiUC7 THE PRQIECT(SEC.7014,BUSINESS AN�PROFESSIONS CODE:THE CONTRACTORS LI- V81U8fI0f1 ADJ.AREA W CENSELAWDOESNOTAPPLY70ANONTJEROFAPROPERTVWHOBUILDSO(iIMPROVES7HEREON,AND � WHOCANTRACTSFORSUCHPROJECTSWITHACONTRAC70R(5)LICENSEDPURSUANTTOTHECONTflAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). �� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q U LL �ATE v � � OWNER � U I �Z W t�Ry�N��R LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENPLTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � B(COMMENqNG WITH SECTION 7000)OF DIVI510N 30F THE BUSINESSAN�PROFE5510NS CODE,AND Z i , �� AIV LICENSE IS IN FULL FOFiCE AND EFFECT. m � � LICENSE CLASS LIC.NO. � �„_, J V DATE CONTRACTOR d W � WOFiKERS'COMPENSATION DECLARATION Q � � I HEREBV AFFIRM UNDEF PENALTV OF PERJURY ONE OF 7HE FOLLOWING DECLARA710N5: Z .� �� 4 Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' a � �� 2 ¢ COMPENSATION,AS PROVIDED BY SECTION 37000F7HE LABOH CODE,FOR 7HE PERFORMANCE U – . -- ..____ _. Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � w 1 HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED 8V SECTION ,(� Q3700 Of THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � �� {/� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: 7�� _1 � CARRIER PLAN REVIEW Z POLICY NUMBER ELECTRIC Q 0 (iHISSEC�IONNE�NOTBECOfM.EfEDOFTHEPERMfTISFORONEHUI�DREDDOLIl�AS(f100)ORLESS). PLUMBING W Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �} SHALL NO7 EMPLOV ANV PERSON IN ANv MANNER SO AS TO BECOME SUBJECT TO THE �/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE IABOR – CAOE,I SHALL FORTHWI7H COMPLv WITH THOSE PqOVISIONS. ISSUP, � p DATE: APPUCANT: 5 S J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C � SU&IECTAN EMPLOYEF TO CfiIMINAL PENALTIES AND CIVIL FINES 11P TOONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(iloo.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ETENTIO [ OCONSTAUCTION LENDING AGENCY PR LT FEE: � I HEREBYAFFIRM UNOER PENALTV OF PERJURY THAT7HERE IS A CONSTRUCTION LENDING AGENCV //(J � FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.Q�. .� �� . �� Z W j LENDER'S NAME � F– LENDER'SADDRESS r � TOTAL FEES / 3 � I CERTIFY THAT I HAVE ilEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. w I AGREE 70 COMPLY WITH ALL CIN AND COUN7Y ORDINANCES AND STA7E IAWS RELATING 70 BUILDING � CONSTRUCTION,ANDHEREBVAUTHORI2EREPRESEN7ATIVESOFTHISCOUNTVTOEN7ERUPONTHE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � A.UU�L �C¢� m PEfiMIiTEE NAME(PRINT) ' � Q � � SI N 7URE OF PERMITTEE DA7E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � CB'Q"Y O� �0�6i�2�� ,�8� � ';'', '' ;:,�;'Bfi�S(�1��'DOf� f�[�C�RD r. . . . ��oa�p�c�400a oa4��= : a��Q�c�4oQ oa�p�c�400� . ' �a4� �� `oa�p�c��1t.. � SET BACK FLOOR JOIST 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 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 --------- ----- ----- -------------- f 1 �o �''� COMMEfVTS F-. .. SEPTIC TANK SIZE SEEP PIT/U SIZE a c� � � �