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Home My WebLink About17733� �� CTI'Y OF DIAMOND BAR j�' `----J�� -- DEPARTNIENT OF COMMUNTI'Y&DEVELOPMENT SERVICES �/� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��%9�^�� BUILDING PERMIT APPLICATION FIRMLY Q DDRIESS f�'I D �/�GN�1�a•V'� D� \ APPUCATION PERMIT P/C p DATE �L' NUMBER��?33 # � ISSUE TYPE OCC APN OT, TRACT DATE CONST. GROUP p OWNER I�I p AODRESS J.- � ZONING SETBACKS 3 FRONT RyV p z CITY ZIP TEL. � ❑ o APPL CA T TEL. S DE/SIDE STREET RW ❑ � CONTRACTOR dL SIDE ❑ ADDRESS ' ,/� u n ��/�� CITY/ ZIP TEL. , PROPOSED USE �V [`-K��/ �!/ Ylv`Ti�� S o ARCH/ENG/ /I��-L- D � S /� (3oA7L� �_ z DESIGNER � ADDRESS NO.DWEL. N . N , � � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I p� OWNER-BUILDER DECLARATION SFR/ADD/REM I O p I HEREBV AFFlRM UNDER PENALTV OF PERIURV 7TiAT I AM E%EMPT FROM THE CONTRACTORS LI- Gel890/C8fF10ft W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n U COUNTyWF{ICHREOUIRESAPERMITTOCONSTRUCT,/�LTER,IMPROVE,DEMOLISH,ORREPAJRANVSTRUC- w W NRE,PRIOR TO ITS ISSUANCE.ALSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w P8I10/DBCK � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � � CENSE LAW(CHAPTER Y(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB � FESSIONSCODE)ORTHATHEOqSHEISEXEMPTTHEREFROMANDTHEBA515FORTHEALLE6EDE%EMP� (� TION.ANV VIOLATqN OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNORED DOLLARS(f5ao).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrt1rt10fCi8I � Z WILL DO THE WORI(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70u,BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BURDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR w THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSPLEIF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOLDWfTHINONEVEAROFC-0MPLE� Z TqN,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). �yJ ❑4ASOWNEROFTHEPROPERTV,AME%QUSIVELVCONTRACTINOWITHLICENSEDCONTRACTORS (� Q TO CONSTRUCT TME PRQIECT(SEC.7Wa,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V91U8fi0l1 O�/ ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONTJEROFAPROPERTYNM1IOBUILDSORIMPROVESTHEREON,MID � WFIOCOMRACTSFORSUCHPRQlECTSWITHACONTMCTOR(5)LICENSEDPURSUMITTOTHECANTRAC- QUANTITY DESCRIPTION Y 70RSUCENSEUW.). FEE � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U �'1" DATE OWNER ¢ Z U � LICENSED CONTRAC'iORS DECLARATION w � 1 HEREBY AFFIRM UNDER PEW�LTY OF PERIUHV THAT I AM LICENSED UNDER PROVISIQ4S OF CNAPTER � � G(COMMENGMO WITH SECTION 7oao)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS W FULL FOHCE AND FECT. m � LICENSE CLA LIC.NO. Z � � J V DATE CONTRACTO W � WORKERS'COMPENSATION DE LARATION a � U � I HEREBV AFFIRM UNDER PENALTY OF PEfiJUFV ONE OF THE FOLLOWINO DECUAATIONS: Z � _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATION,AS PROVIDED BV SECTION 3�00 OF THE L/�BOR CODE,FOR THE PERFORMANCE U Q OF THE WOR)(FOR WHICH THIS PERMIT IS ISSUED. � Qw _I HAVE M1D WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION / 37000F THE LABOR CADE.FOR THE PERFOR/AANCE OF hiE WORK FOR WHICH THIS PERMIT 15 /�/ QO ISSUED.MY WORKERS'COMPENSATION INSURA E CARqIER AND POLICV NUMBER ARE: CONSTRUCTION J j CARRIER PLAN REVIEW Z POLICY NUMBER ELECTRIC Q � (1FBSSECTIONNE�NOTBE, OFhfPEiMTISFOHONEF0.1KNiEDDOLLAKS(St00)ORIESS} PLUMBING �Y-� . Z �CERTIFV THAT IN THE PERFORMMJCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I ,`� l'��^\ I� � I � � �}' SHALL NOT EMPLOV MlY PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE � ^ (n WORICERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE I R�n e. ,�t j SU&IECT TO THE WORKERS'COMPENSATKKJ PROVISIONS OF SECTION 370o OF THE LABOR ` ��H I ) COD,I SH FORTHWITHCOMPLV WITHTHOS PROVISIONS. ISSUANCE 1 1� � ��I��[ O ' � p DA7E: Z ppPLICAt�fT: SMIP I p w ENERGY P/C �-��' I J WARNI :FAIL E TO SECURE WORKERS'COMPEN ATION CAVERAGE IS UNUWFUL,AND SHALL BE J � SU&1 TMl E PLOYER TO CRIMINAL PENALTIES AN�CNIL FMES UP TOONE HUNDRED THOUSAND ENERGY PERMIT � '- " DOl (ft .000�,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PqOVIDED FOR IN — - e J SECTION3708OFTHELABORCODE.INTEREST.ANDATTORNEY'SFEES. aC RETENTION FEE: OCONSTRUCTION LEND�NG AGENCY PRE•ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CANSTRUCTION LENDINa AOENCV FOR THE PERFORMANCE OF THE WORN FOR WHIC}1 iHIS PERMIT IS ISSUED(SEC.Jae7,CIV.C.�. Z W � LENDERS NAME H LENDER'SADDRE55 /✓ w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CARRECT.- TOTAL F E ES /�' ✓� � I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCESlWD STATE LAWS RELATINO TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF TFIIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS �_ �' / � m PE ITT NAME(PRINn . ¢ 3 �� Z � � 5 N E OF PERMI D E � RECPT.NO. PAID BY A S VALIDATION WHITE—Department Copy, LLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy �9T�Y �f� @��l��A�� la16� ��(P'[�CG�'a��l f�L�(�S��:D . L41�J�Jlr�sV u t1��JU�1 IJGJ� �r V U Llit� . UW�I�LS�`9 u U."JIRJ � '� a ' ..., � � � 9 SET BACK FLOOR JOIST'', � I • FTGS/FORMS/STEEL � FHA REQMTS ELECTRIG GROUND UNDER FLOOR DUCT GROUND PLUMBING UNQER,FLOOR CUt�IDUIT SLAB GRADE FIREPLACE FC)UNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICEb MID HT. BOND BEAPvI ROOF SHEATHING _�L _ s 8 FT.�BQND BEAM ' FRAMINGn/ENTfL?ATtON FINAL BaND BEAM ROOF COVER j//3,� PRE-GRADING ROUGH HEA7ING BENCHlfVG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUIVIBIfVG FINISH GRADING SHOWEFi�TUB TEST PDOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILIPIG IfUSULATiOIV OFF SITE IP�iPS. DRYWALL NAIUNG � DEDICATIONS SEWER FINAL ENG. SEPTIC TAfVK LAP�IDSCAPE/IRRIG. SEEP PIT/l..L. � ON SITE IMPS. GAS AIR TEST FINAL ZONING FlNAL CONST. ��Z ��/�/ , FIRE DEPT. FINA� FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID . FINAL PLUMBING � ENERGY°� � . -� — � � �a I — r — __- -.;,-__....,-._ ._. — CUiViMEf�TS � � . � SEPTIC TAI�lK SIZE SEEP PIT/U 51ZE , � .� � �� ° � . ` c� ',1�� .