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Home My WebLink About11-619 __ _ ^ ��_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS ''^'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ¢ ADDRESS ? APPLICATION PERMIT �l�/9 P/C p DATE NUMBER q � ISSUE TYPE ('�� OCC APN LOT � TRACT DATE CONST. /� GROUP p OWNER o ADDR S ZONING SETBACKS Z CITY ZIP EL. � RE�ART RW ❑ g APPLICANT TEL. ❑ � SIDE/SIDE STREET RW ❑ � CONTRACTO � SIDE � ADDRESS � CITY ZI , EL - PROPOSED USE i w ARCH/ENG/ � z DESIGNER Op a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEF-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CANTRACTORS LI- GflfB B/Ce OR W CENSE UW FOR THE FOLLOW WO REASON(SEC.7031.5 BUSINESSAN�PROFESSIONS CODE M7Y CITV OR (n 9 � U COUNTVWHICHREQUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAI{iANVSTRUC� w W 7URE,PflIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPUCANT FOR SUCH PEiiM1T TO FILE A SIGNED w PaUo/Deck � STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' POOI/SP8 FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� TION.ANY VIOLATION OF SECTION 70�/.S BV ANV APPLICANT FOR A PEFMIT SU6IECTS THE APPLICANT T0 Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(5500)J: ❑I,ASON?JEROfTHEPROPERTV,ORIAVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSAT70N, � �mmercial Z WILI DO T1E WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED f-0R SALE(SEC.70a1,BUSI- J � � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPENTY VMO BUIIAS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER ONM EMPLOYEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOIDWRHINONEVEAROFCOMPLE� Z TION,7HE OWNER-BUIL�ER WILL HAVE THE BUqDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,AS OWNER OF THE PROPEf7n',AM EXCLUSIVELV CANTRACTINO WITH LICENSED CONTRACTORS � TO CANSTRUCT TME PR0.IECT(SEC.70N,BUSINESS AIJD PROFESSIONS CODE:THE CONTRACTORS LI- V91U9f1Of1 ADJ.AREA W CENSELAWDOESNOTMPLVTOANOWNEROFAPROPERTVWHOBUILASORIMPROVESTHEREON,AND � N'/iOCANTRACTSFORSUCHPR0.1ECT5WITHACANTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS UCENSE LAW.�. FEE � ❑I AM E%EMFT UNDER SEC. B.8 P.C.FOR THIS REASON � ?� U LL' DATE OWNER H Z U �Q LICENSED CONTFACTORS DECLARATION w . 2 I HEREBV AFFIRAI UNDER PENALTY OF PERJURY THAT 1 AM IICENSED UNDER PROVISIONS OF CHAPTEF � � Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OG THE BUSINESS AND PROFESSIONS CADE.AND Z �� MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASS LIC.NO. [ /I � V DA7E�� cONTRACTOR a W � WORKERS'COMPENSATION DECLAFL4TION' � N U � I HEREBV AFFIRM UNDER GENALTV OF PERIUHV ONE OF THE FOLLOWING DECLARATIONS: Z � _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR K'ORKERS' ¢ Q COMPENSATION,AS PPOVIOED BV SECTION 3700 OF THE LABOR fADE,FOR THE PERFORMMICE U F THE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � Qw HAVE/WD WILL MAINTAIN WORKERS'COMPENSATbN INSUHANCE.AS RC-0UIRED BV SECTION 3�D0 OF THE LABOR COOE,FOR THE PERFORMµCE OF NE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORK� P�INSU E CARRIER ANo apucv NUMeEa naE: CONSTRUCTION � CAR{UER � PLAN REVIEW � POLICV NUMBER � � ELECTFiIC � � � (IHISSECiIONI$�NOTBE(7JA�FLEfEDOF7HEPERMTISFOHONEHINDqEpppUl�AS(f10o)OqLESS} PLUMBING i r� W Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C�S SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE (n WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND�akEE THAT IF I SHOULD BECAME INSPECTION FEE O SUBJECTTO THE WORNERS'CAMPENSATION PROVISIONS OF SECTION 37000F THE LABOP , �^. � CODE, SHALL FOHTFIWITN COMPLY WIiH T PROVI IONS. /�� ISSUANCE / I /� /.y�y '/ p DATE; / APPLICANT. �YJf/! / �[ !/ / SMIP W � WARNIMO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL 8E ENERGY P/C J � SU&IECTAN EAIPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TNOUSAND ENERGY PERMIT DOLLARS(5100.000),IN/�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 37oe Of THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. �]`�� w RETENTION FEE: v.c O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIRM UNDER PENALN OF PERJURV THATTHEFE IS ACONSTRUCTION LENDING ACENCY FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). W � LENDEFS NAME F— LENDER'SAD�RE55 � w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT TIE ABOVE INFORMATION IS CORpECT. TOTAL FE ES �� V � I AGREE TO CAMPLY WITH ALl GTV AND COUNTV ORDINANCES AND STATE UWS PEUTIN6 TO BUILOINO ( � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON 7HE ' Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS ' � -��'I� �(�'/I/�6?/'G�-' QPERMI77EE NAME(PRIPIT) � � � / � SIONATUREOFPERMITT DAT � RECPT.NO. PAID BY VALIDATION �WHITE—Department Copy,YELLOW�inence Capy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—Applicant's Copy � CITV O� DIl�NiO�1D �AFi INS��C�ION �i�CORD �`�a�p�c��ooa '� �� - ��r��h� ,� � `��i��c�o��.�� e� � .�� r . . . r. 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 s 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERR'UB 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 C�i' C�� 'h COMMENTS . „ � , SEPTIC TANK SIZE SEEP PIT/U SIZ� ,, a � � �: lt R. �::�G r 5�.:, � � �� - .