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Home My WebLink About12-873 �` CITY OF DIAMOND BAR • / DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I� 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7 � PRESS �'°�' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE U (� y- i p o ADDRESS I Q`� -1 � 1"'�,�ifl�D` C�I �f� DATE CATIO 1� � NUMBER'�� q/C V � ISSUE 7yPE �C r° APN LOT TRACT DATE CONST. �� GROUP p OWNER p AD�SS � ZONING SETBACKS z CITY Z� T FRONT qyy � � APPLICANT � � T REAR p ¢ SIDE/SIDE STREET q�ly p � CONTRACTOR LL. l��C SIDE � ADDRE � � CITY Y) `Q ZI _ TEL. `��"j 1 PROPOSED USE � o ARCH/ENG7 z� DESIGNER NO.DWEL. NO. NO. n. ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PEfL1URV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GflfBgB/CefPOR W CENSEUWFORTHEFOLLOWINQREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n C� COUNTVWHICHREWIRESAPERMITTOCONSTAUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC� W patio/Deck �L TURE,PRqR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO iHE PROVISIONS OF THE CONiRACTOPS LI� � CENSE LAW(CHA7TER e(COMMENCINO WITH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO� � POOVSPB ^ FESSIONS CODE)OR THAT HE OR SHE IS EXEMP7 THEREFROM AND THE BASIS FOR THE ALlEOED EXEMP� (� � TION.ANVVIOLATIONOFSECTION7o31.5BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof A CML PENAITV OF NOT MORE T1AN FIVE HUNDRED DOLURS(f5oo�.): 3 � ❑4�a�'�NEROFTHEPROPERTV,ORMYEMPLOVEESWIiHWAdE5A5THEIRSOLECOMPENSATION, 0 COfflfflBfC18I Z WILL DO THE WORI(AND THE STRUCNRE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70ar,BU51� J � NE55 AND PROFESSIONS CODE:TNE CONTRACTORS IICENSE UW DOES NOT APPLV TO AN OWNER OF = PiiOPER7Y WFp BUI�pS OF IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR - � TMROUGH HIS OR HER OWN EMPIOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT WTENDED OR N ' Q OFFEREDFORS�LEIF,FIOWEVER7NEBUILDINOORIMPROVEMENTISSOLDWfTHINONEVEAROFCOMPIE� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OH � IMPROVE FOR THE PURPOSE OF SALE�. �y,� ❑I.AS OWNER OF THE PROPERTV,AM E%CLUSNELV CANTRACTINO WITH IICENSED CONTRACTORS Q TO CONSTRUCT THE PHOJECT(SEC.701�,BUSINESS AND PqOFE5510NS CODE THE CANTFACTORS lJ- VBIU9�lOf1 ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN ONMER OF A PROPERTV WHO BUILDS OR IMPROVES THEHEON,AND � WHOCAHTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTNECONTRAG �UANTITY DESCRIPTION roas ucEHSE uw.�. FEE � � ❑I AM E%EMPT UNDER SEC. 8.8 P.C.FOR THIS REASON � ?� U LL DATE OWNER ~ Z U � � LICENSED CONTRACTORS DECLAAATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � D(COMMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS D,AND Z O MY UCENSE IS W FULI FORCE AND�FFECT. /� ��y^ � 1 � � LICENSE CLASS �( `�J LIC.NO. �J 'C � � ��`/ U DATE l ' CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION � � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLIOWINO DECIARATIONS: � � Z � _I HAVEAND WILL MAINTAIN A CERTIFICATE OF CANSENTTO SELF-INSURE FOR WORKERS' a 2 Q COMPENSATION,AS PROVIDED BV SECTION 3�OOOF TNE LABOR CODE,FOR THE PERFORMMICE U �OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED. w 0 1/ � � V 1 HAVE AND WILL A/AINTAIN WORI(ERS'CqMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE.FOR THE PERFORMMICE OF THE WORK FOF WHICH THIS PERMIT IS � ISSUE�.MV WORKERS'CO Q�NSATION INSURANCE CARR�IE-R.aA..y/p�POLICV NUMBEF ARE: CONSTRUCTION jCARRIER �-�-r � �iT . � ` LfiT�� PLAN REVIEW Z� POLICY NUMBER � ELECTRIC Q � (fFLLSSECTqNNE�NO7BEODA4'LEfmOFTHEPEMYfISFpqONEFIIR�OREDDOlLA1LS(5100)OqLESS) PLUMBING � W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL �J SHAIL NOT EMPLOV ANV VERSON IN ANV MANNER SO AS T B CAME SUv��rT �� (n WORKERS'COMPENSATIONIAWSOFCAIIFORNIAAND A�iFTS�HWLD�BE„ aE INSPECTIONFEE ' SU&IECT TO THE WORKERS'COMPENSATION PRO 7ayg � � O CODE,ISlHALLFO'�RTHWITHCOMPLVWI ONS. ISSUANCE p DAT�rI 1�� C� APPLICANT: SMIP W J WAANINO:FAILUFE TO SECURE WORKERS' NSATION COVERAGE IS UNLAWFUI,AND SHALL BE ENERGY P/C � � SU&IECTANEMPLOVER70CRIMINALPENALTI SANDCNILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT DOLLAAS(5100,oao�,IN ADDITION TO THE COST OF CAMPENSATqN,DAMAGES AS PROVIDED FOR IN J SECTION 37oe OF THE LABOR CODE.INTEREST,AND ATTORNEV'S GEES. OC RETENTION FEE: - OCONSTFiUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIqM UNDEF PENALTV OF PERJURV 7HATTHEHE IS ACONSTRUCTION LENDINO AQENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CN.CJ. Z W � LENDER'S NAME � LENDEF'SADDRESS w ICERTIFYTHATIHAVE�READTHISAPPLICATIONMIDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ` �/ ��^ � I AGREE TO COA/PLV WITH ALL CITY AND CWNTV ORDINANCES AND STATE UWS RElATWO TO BUILDINO \J !/V/ CONS7RUCTION,AND HER BV AUTHORIZE REPRESENTATIVES O THIS CWNTV TO ENTER UPON THE � Z ABOVE�MENTIO D PR FTV FOR INSPE URPOS S. � - - � COMMENTS � J � m PERMITiEE NAME(P � — ' �� Z Q C/) � SIONATU ' ATE � RECPT.NO. PAID BY VALIDATION WHITE—Departrnent Copy,YELLOW�inence Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy cs�v o� ��,�o�� i�s��c�ao� ��co�� .� O�pC�C�4�0[� o �� .�; DI�I�PC��p . , . ' OG'J�3pCC�4�QI�) ` DGQ4C� �G��3pC�C�40f�{.: SET BACK FLO�R 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 HEATIfJG BENCHlNG 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. �L FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ' �o � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a �i7 L . , � �� .� � �- -