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Home My WebLink About18088 (25) �--Q, ' ) V � C1TY OF DIAMOND BAR � --��--��`` — DEPARTIv1ENT OF COMMLJMTY&DEVELOPIviENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS �"'-9��' BUILDING PERMIT APPLICATION FIRMLY o ADDRESS oC i�0� `�I��I.at�_�. ��JF[� �r.J�! DATE CATION�� NUMB R IO �O a p/C � ISSUE TypE pCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT R�ry p � APPLICANT TEL. REAR p �� SIDE/SIDE STREET RW ❑ CONTRACTOR� SIDE p � CIT`f '�.a7foFlt ZIP�a.�u_ TE � ��/,� PROPOSED USE_�I�C-✓�^i!a I `,p:�,�i�y,',a � (f.�,� oARCWENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS = CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn . DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I NEREBV AFFIRM UNDER PENALTV OF PERRIRV THAT I AM E%EMPT FROM THE CONTMCTORS LI� G8f8 J0/CBfPOh W CENSEUWFORTHEFOLLOWINOREASON(SEC.7071.6BUSINESSANDPROFESSIONSCOOE:ANYCITYOR (n U �p�J�.7TYWHICHREOUIRESAPERMITTOCANSTRUCT,�ITER,IMPROVE,DEMOLISH,ORREPAIR/WVSTRUC� w w NRE.PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI� � � CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVS(78 � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEdEDE%EMP- (� V TION.ANVVIOLATIONOFSECTION7031.SBVANYAPPLICANTFOFAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDFED DOLLAFS(f5o0).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, Q WILL DO THE WORK,M1D THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Wd,BU51- J COrt1ff1BfC18I - Z NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO!W OWNER OF N PROPERTVWFIOBUILDSORIMPqOVESTHEREON.ANDWHODOESSUCNWORNHIMSELFORHERSELFOR � Q THRWOH HIS OR HER OWN EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMENTS ARE NOT IMENOED OR m 0 OFFEREDFORSALEIF,HOWEVER,THEBUIIAINGORIMPROVEMENTI550LDWITHINONEVEAROFCAMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR TME PURPOSE OF SAIE�. . w ❑I,ASOWNEROFTHE PROPERTV,AM E%ClU51VELV CANTRACTINO WITH LICENSED CONTRACTORS Q TO CONSTRUCT THE PRQIECT(SEC.7M4,BUSINESS!WD PROFESSVONS CODE:THE CONTRACTORS LI� ValUeliOfl ADJ.AREA W CENSEUWDOESNOTAPPLVTOANON?JEROFAPROPEHTYWhiOBUILD50RIMPROVESTHEREON,AND � WFqCANTRACTSFORSUCHPRQIECTSWITHACON7qACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION � FEE Y TORS 110ENSE UW.). � ❑I AA1 EXEMPT UNDER SEC. B.6 P.C.FOR TMIS REASON Q � �O �J � � I.6:. � DATE OWNER � I^� � Z W ` 't i,4 � LICENSED CONTRACTORS DECLARATION � �~ w ' TTa» �7^` I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISKKJS OF CHAPTER V. ,�� A. / �` �j;y � e(COMMENCINO WITH SECTION 7000)OF DIVISION 30FTHE BUSINESSAND PROFESSIONS CADE,AND Z /T � / LLI MV LICENSE IS W FULL FORCE AND EFFECT. m � LICENSE CLASS C 'I D LIC.NO. f" � V DATE S 2'/-O 2 CONTRACTOR .QG�'fEC,if( E��t�C a w � WORKERS'COMPENSATION DECLARATION Q � U N 1 HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECLARATIONS: Z 0 _IHAVEMlDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' _ � COMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CODE,FOR THE PEFFORMANCE U Q OF THE WORK FOR WHICH�HIS PEFMIT IS ISSUED. � � _I HAVE AND WILL MAINTAIN WORKERS'CQMPENSATION INSURANCE,AS REWIqED BV SECTpN Q 37aa OFTHE LABOR CADE,FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION jCARRIER PLAN REVIEW � POLICV NUMBER Z ELECTRIC ��_ ¢ � (iHISSECiIONNE�NOTBE001vPLEfmOFT1-EPEFi1.YTISFORONEFiIN�DHEDDOLLARS(L1ao)ORLESS} PLUMBING �►a� Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORI(FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � � L->>] � Tr- C'} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SOAS TO BECAME SU&IECTTO THE I�� /"-'��\ � � �' ,1 p� WORICERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ,...,�� O SU&IECT TO THE WORKERS'COMPENSATbN PROVISIONS OF SECTION 37ao OF THE LABOR n^� Y I �Q � �j CODE.1 SNALL FORTMYITH COMPLV WITH THOSE PROVISIONS. ISSUANCE I li� [) �l .� n p DATE: APPLICANT: SMIP , � � I w ENERGY P/C I.-..._ � � "'� WARNINO:FAILURE TO SECURE WORNERS'COMPENSATION CAVEFAOE IS UNLAWFUL,AND SHALL BE J LL SU&IECTAN EMPLOVER TO CflIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND �..�_ I DOLLARS(flao,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN ENERGY PERMIT � SECTION 37080F THE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. RETENTION FEE: � '---'}��I f W � O CONSTRUCTION LEND�NG AGENCY PRE-ALT FEE: � I HEREBV AFFIRAI UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AQENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED(SEC.7087,CIV.C.�. Z W � LENDEH'S NAME � LENDERSADDRESS w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES � �� •O � I AOREE TO COAIPLV WfTH ALL CITY AND COUNTV ORDINANCES AN�STATE IAWS PELATINO TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HI5 COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � V�/ � m PERMI NAME(PRINT) ¢ 12-- � ,�° c L � � SIONA F PERMITTEE DAT � RECPT.NO. � PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �91�'� ��' �9�aGl��@� [��f� ��f�[��u�4�(�I f�fLt�m7[F�i� 0� V o DQ r-� OG'�' � � � � U fl DGGQ4C� 0 ° �� 5El'BACK � FLOOR JOI$T FTGS/FORMS/STEEL � FHA REOMTS ELECTRIC GROUND ` UNDER FLOOR DUCT GROUND PLUMBING i UNDER FLOOR CUMDUIT SLAB GRADE � �IR� EPLACE FOUNDATIOfV ! TEMP POWER _� A�_ _ �FIREPLAGE BC7NQ BEAM ___�_______ WATER SERVICE �� MID HT. BOND BEAM � ROOF SHEATHING � ' 8 FT. BONQ�EiEAM. FRAMINGNEh1TILIATION FtNAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATIt�1G BENCHltJG ROUGH ELECTRIC ROUGH GRADING ROUGH P�UiVIBING f FINISH uRADING SHOWER/TUB TEST POOL ELECTRIC EXT. 1�4TH/SIDING � POOL FENCING WALL INSULATION ' � POOL FINAL GEILING INSULATION ! QFF S1TE IMPS. DRYWALL NAIUNG } � DEDICATIONS SEWER FINAL ENG. � � SEPTIC TAIVK LANDSCAPE/1RRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING F►NAL CONST. FlRE DEPT. FINA� FINAL HEATING ' HEALTH DEPT. FINAL FINAI ELECTRIC bEV. FEES PAID FINAL PLUMBING � ENERGY : ?" ��. .. - CQ�� SEPTIC 7ANK SIZE SEEP PIT/U SIZE � ,� � � .