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Home My WebLink About17690 (46) CITY OF DIAMOND BAR `� ----�� — DEPARTMENT OF COMNIUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3I17 PRESS ��%_N^��' BUILDING PERMIT APPLICATION FIRMLY } JOBSITE �2�� E� �j��L p��('� ny�, APPLICATIO PERMIT P/C o ADDRESS. DATE O 2� NUMBER� � � # � APN , LOT TRACT ISSUE TYPE OCC DATE CONST. GROUP p OWNER -.. � p ADDRESS � 1 ` "i� t'� ZONING SETBACKS FRONT F{�ry ❑ z CITY..�ic�rx.�"� 'a�Y ZIP TEL. - ❑ � APPLICANT. TEL. ' REAR ¢ SIDE/SIDE STREEf RW ❑ � CONTRACTOR SIDE p � ADDRESS D -� ' /h + �j p 1� �(� � CITY ZIP TEL. PROPOSED USE � oARCH/ENG/ z DESIGNER w NO.DWEL. . NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FROM THE CANTRACTORS LI� G8f8 JB/C8lpOfl � W CENSE UW FORTHE FOLLOWINO qEASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE ANV CITY OR (n U COUNTVNRIICHREOUIRESAPERMITTOCANSTRUCT,AITER,IMPROVE,DEMOlISH,ORREPAIRANVSTRUC- w w lURE,PRIOR TO ITS ISSUANCE,ALSO RC-0UIRES THE APFLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTRACTORS U� � 0 ICENSE LAW(CHAPTER e(COMMENCINO WITH SECTqN]000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB /FESSIONS CODE)OR THAT HE OR SME IS E%EMPT THEREFROM AND THE BASIS FOR THE ALIEGED EXEMP� (� V TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT f-0R A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500�.): � eI.A50WNEROFiHEPROPERTV,ORMYEMPLOVEESWITHWAGE5A5THEIRSOLECOMPENSATION, � COffIrtlBfC18I Z WILL DO THE WORY(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa�,BUSI- J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER Of ? PROPERTV WHO BUILDS OR IMPROVES THEFEON,M1D VA-10 DOES SUCH WORK HIMSELF OR HERSELF OR � THROUQN HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSILEIF,HOWEVER71iEBULLDINOORIMFROVEMENTISSOLDWfTHINONEYEAROFCAMPIE� Z TION,THE OWNER-BUIIDER WILL HAVE TNE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR �. IMPROVE FOR THE W RPOSE OF SALE). • w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSNELVCONTRACTIN6WITHLICENSEDCONTRACTORS Q TO CONSTRUCT THE PROJECT(SEC.7041,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTORS LI� VeIUaSIOfI ..GC�b� ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN OWNEH OFAPROPERTY WHO BUILDS OR IMPROVES THEREON,AND � WIIOCOMRACTSFORSUCHPRQIECTSWI7HACONTMCTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS UCENSE UW.). Q �I AM E%EMPT UNDER SEC. 8.8 P.C.FOR THIS REASON Q � U � DATE Z-2 oWNER F Z U � LICENSED CONTRACTORS DEC RATIO W � I HEREBV AFFIRM UNDER PENN.TV OF PERIURV TMAT I AM IICENSED UNDER PROVISIONS OF CHAPTER � d e(COMMENCINO WITH SECTION 7oao)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CODE,AND Z `X MV LICENSE IS IN FULL FORCE AND EFFECT, m � LICENSE CLASS UC.NO. � . V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � � I NEqEBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' _ Q COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOfi CODE.FOR THE PERF-0RMANCE U Q OF7HE WORK FOR WHICH 7HI5 PERMIT IS ISSUED. � Qw _IHAVEANDWILLMAIMAINWORKERS'CAMPENSATIONINSURANCE.ASREWIREDBVSECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � b � ISSUED.MV WORKEAS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBERAAE: CONSTRUCTION ` � CARRIER PUW REVIEW Z POLICV NUMBER ELECTRIC Q � (iHIssECibNHE�NOreE�nwLEiIDOFnEpEansrlSFOqoNEM1N7FEppq1A{LSKtao�oaLEss} PLUMBING �-ad � �-r ��Q w ��a"Jf`�\ I I ) �J Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I C.�} SHALL NOT EMPLOV ANY PEFSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE I (/� WOR7(ERS'COMPENSATIDN LAWS OF CALIFOFlNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE A f SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � �j CODE.ISH�LLFORTHWITHCOMPLVWITHhqSEPROVISIONS. ISSUANCE � `� � I � p DATE: APPLICANT: SMIP I � I 0 J WARNINO:FlJLURE TO SECURE WORNERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SH/�LL BE ENERGY P/C I�Y� I SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE NUNDRED THOUSAND �—F ---� � DOLLARS(floo.o00�,INPDDI710NTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT � J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. � L OC RETENTION FEE: /. OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRESS w I CERTIFV hUT I HAVE REPD THIS APPIICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES /O�, �� I AQREE i0 COMPLV WITH ALl CITY AND CAUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING � � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPEHTV FOR INSPECTION PURP0.5E5. COMMENTS � /A� � 1V' m PERMITTEE NAME( ItJn �' � Ul' Z'� �—OG. � SIQNATURE OF PERMITTEE DATE � \ RECPT.NO. PAID BY � VALIDATION ITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy (��7 t�[r ��1f�1�1�1� (�� d4��f�l�C��6�f� ��t��(l��9 ° 0 � �� DQS� 0�� OG�� DCQ4C� OG�� o � SET BACK ' FLOOR JOIST FTGS/FORMS/STEEL FHA RE�MTS � ELECTRIC GROUND UNQER FLOOR Dt)CT GR�UND PLUMBING UNDER F OOR CU�IDUIT� ' SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAPu1 ROOF SHEATHING ��p�Z �� 8 F7. BOND BEAM FRAMINGNENTILIATION FINAL BOfJD BEAM ROOF COVER �t'��Z ` PRE-GRADItVG �— ROUGH HEATING SENGHIfVG ROUGN ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH uRADING SH�WERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENGING WALL INSULATION POOL FINAL � CEILING INSULATiON OFF S{TE IMPS. DRYWALL h1AiLING DEDICATIONS SEWER FINAL ENG. '�' SEPTIC TANK , , LANDSCAPE/IRRIG. SEEP PIT/L.L. ` " ON SITE tMPS. GAS AIR TEST FINAL ZONlNG FlNAL COPJST. FIRE DEPT. �INA� FINAL HEATING HEALTH DEPT. FIf�AL FINAL E�ECTRIC DEV. FEES PAID FINAL PLUMBtMG ENERGY C�G�O��. , COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE . � — � � o � � � . .-1 _. . -