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Home My WebLink About10-1003 ^ _��_ CITY OF DIAMOND BAR �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES < < � 21825 Copley Drive,Diamond Bar,CA 91765 �� 0 � �j/ (909)839-7020 Fax(909)861-3ll7 Building Iiis��Ci�fiYietli�i8��39-7027 PRESS '�^'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATION ��] (� PERMIT P/C ADDRESS � A � DATE /� / �� " NUMBER D�G� g � ISSUE /`�� j� TYPE OCC APN LOT TRACT DATE CONST.I�►�GROUP p OWNER p ADDRESS 2- O L.' • ZONING SETBACKS z CITY t vCa I t�.�T ZIP TEL. -6 FRONT qyy � � APPLICANT 1ti r.�.1J�rs+-v�rrti.N. TEL. � REAR � SIDE/SIDE STREET RW ❑ � CONTRACTOR '(' � ' SIDE ' O ADDRESS � � CITY �� J!_Q 7� ZIP �TEL. PROPOSED USE o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. a ADDRESS NO. cn UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f8 B/C8 R W CENSELAWFOqTHEFOLLOWINOREASON(SEC.7o3t.6BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n 9 � C� COUNTVWHICHREOUIRESA7ERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- w w 7URE,PRIOR TO ITS 195UANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w Patlo/Deck � STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE lAW(CHAPTER D(COMMENCINQ WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB � FES310N5 CODE)OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALIEGED EXEMP� � TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CML PENALT/OF NpT MORE THAN FIVE HUNDRED DOLLAf1S(f600).): Z ❑I.ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrt1RIBlCI3I WILL�O THE WORK,AND THE STRUCTUPE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�t,BUSI- .J � NESS AND PROFE55lONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY YNfO BUILOS OR IMPROVES THEREON,AND YMO DOES SUG1 WORK HIMSELF OR HERSELF OR Q 7HROUGH HIS OR HER ON?1 EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIFHOWEVERTNEBURDINGOqIMPROVEMENT1550LDWfTI-0NONEVEAROFCOMPLE� Z TqN,THE OWNEF-BUIIAER WILL HAVE THE BURUEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS OWNER OF THE PROPERTY.AM EXQUSIVELV CONTRACTIN6 WfTH LICENSED CONTRACTORS I � TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINE59 ANO PROFE5910N5 CODE:THE CONTRACTORS Ll- V81U8f1Of1 A0.1.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILOSORIMPROVESTHEREON,AND � MM1qCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTNECONTRAP � QUANTITY DESCRIPTION Y roqs uceNSE uw.>. FEE - � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � f -D� �} � U u" DATE OWNER ¢ �� 'C��• U T -t� o � LICENSED CONTqACTORS DECIARATION w � I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM IICENSED UNDER PROVISKKJS OF CHAPTER � S• � B(COMMENCINCi WITH SECTqN 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CADE,AND Z �� AIY LICENSE IS IN FUL�FORCE AND EFFECT. m � LICENSE CLASS ` LIC.NO. b � H ,n � V DATE �n._ ��/ // CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION ¢ � I HEREBY AFFIRM UNDER PENALTV OF 7ERNRY ONE OF 7HE FOLLOWING DECLAAATIONS: � N Z �Z _I HAVE M1D WILL MAINTAIN A CERTIFICATE OF CANSENT TO SEIF�INSURE FOR WOqKERS' ¢ Q COMPENSATpN,AS PROVIDED BV SECTION 37000FTHE LABOR CODE,FOHiHE PERFORMANCE U OF THE WORN FOR WHICH THIS PERAl1T IS ISSUED. w � � Qw _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIqED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS i��,�� ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION � CARRIER �-U4.i[1CG'I.vpl,�S V�,y,Q�P�L.��F�4�w< 't PLANREVIEW � POLICV NUMBER_YT��Z C'I d?. ELECTRIC 0 (iH45SECi%7NNE�NOTBE00lAREfIDOFTY$PEFlMfTlSFpqpNEM1PDFiEDOqiA{iSR�oO)OR�ESSl PLUMBING W Z I CERTIFY 71iNT IN THE PERFORMANCE OF THE WOFK FOR WMICH iH15 PERMIT 4S ISSl1ED.1 MECHANICAL �} SHALLNOT EMPLOV ANY PEFSON INANV MANNER 50AS TO BECOME SU&IECTTO THE (/J N'ORICERS'COMPENSATIONUWSOFCALIFORNIA,ANDAOREETHATIFISHOULDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE IABOR L� ._ _ _ S CODE.ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISrIONS. /� � ISSUANCE ��JQ 'p DATE:�Q-��n APPLICANT: �OI� ✓�-I dUl��l��1� SMIP s � ENERGY P/C � J WARNINO:FAILURE TO SECURE WORKEfiS'COMPENSATION CAVEqAGE IS 11NLAWFUL.AND SHALL BE � SU&IECTANEMPIOVERTOCRIMWALPENALTIESANDCMLFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOILARS(5100,000),IN�ODITION TO THE COST OF CAMPENSATKKJ,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: ,L� � O CONSTRUCTION LENDING AGENCY PR A FEE:� � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THEilE IS ACONSTRUCTION LENDINO AOENCV �� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.�oel,CIV.C.). d Z W � LENDER'S NAME �' � � LENDER'SADDRESS w I CERTIFY THAT I HAVE READ THIS APPLICATION/WD STATE THAT 7HE ABOVE INFORMATION IS CORRECL TOTAL F E ES � / �L� � I A(iREE TO CAAIPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS PEI.ATINO TO BUILDINO � CONSTRUCTION,ANO HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNTV TO ENTER UPON THE Z ABOVE-MENTIONED PROPER FOR INSPECTION PURPOSES. COMMENTS � G � � a � m PERMITTE Nl] � . . ' . . Q ' � � � ' � 51(3NANR O ERMITTEE D�TE � RECPT.NO. • PAID BY G VALJDATION WHITE—DepeRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,OOLDENROD—Fite Copy,GREEN—Applicant's Copy CITV O� DI�iViO�D ��,R _ ; ;��;, ;' ;I,�l�S��C�'BOi�I Rf�CORD � , � _ . ,� , "�` ` O[�13pC�C�400[� QGS'�� G`�pQG40a 01�J�pL�C��00a ;:aL��@ r��"��1�o, .. � ew�.y�` SET BACK � FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUNQ UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. B�ND BEAM ROOF SHEATHING ��-�'�(��0 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER ,i..�� : PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�i'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 PITJL.L. ON S�TE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. � " FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �� - COI�MEIVTS � SEPTIC TANK SIZE SEEP PIT/U SIZE a � a ,z��,�� , � ;