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Home My WebLink About17479 (25)� - : �� CTTY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPIv�NT SERVICES ��P'�� 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS �'�9��r� BUILDING PERMIT APPLICATION JUN 1$ �� FIRMLY I � JOBSITE '1 APPLICATION PERMIT P/C o ADDRESS � � C 1. ' DATE 2 I Z O l NUMBER�2��9 # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER • P� o ADDRESS ��r��/��iYl �iJf� �� ZONING SETBACKS I z CITY �� ik�'� ZIP A��rjTEL. FRONT qyy p o APPLICANT TEL. 42�%P4f�f'Li REAR p I z¢ ��"� SIDE/SIDE STREET RW ❑ � CONTRACTOR � ; �/ SIDE p ADDRESS � - .a J /� � CITY ZIP Q�7��TEL. u'� � - PROPOSED USE +O ` a//c oARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM � � I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� Geffl 0/C8 ft W CENSEUWFOATHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPflOFESSIONSCODE:ANVCITVOR (n 9 � C-� COUNTYWHICHREWIRESAPERMRTOCONSTRUCT,ALTEF,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- w w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w P8f10/DBCI( � STATEMEM THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF TME CONTRACTORS LI� � CENSE LAW(CHAPTER D(COMMENCINQ WITH SECTION]ooa)OF DIVISION 3 OF THE BUSINESS AN�PRO- � PooUSpa � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEQED E%EMP- C7 TION.ANVVIOLATIONOFSECTION7o31.5BVANVAPPLICAN7FORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CML PENALTY OF NOT MORE THAN FIVE HUNDFED DOLURS(f5o0�J: � ❑I.ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, 0 COrtIrtIBfCl81 Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�4,BUSI- J N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTY NT10 BUILAS OR IM VROVES THEREON./V!D YAiO DOES SUCH WORK HIMSELF OR HEFlSELF OR wTNROUGH HIS OR HER OWN EMPLOVEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSN.EIF,HOWEVER,7HEBUILDINGOqIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPFOVE FOR hIE PURP0.5E OF SALE). �y„� ❑I,AS ONTJER OF THE PROPERTV,AM E%CLUSIVELY CONTRACTIN�WRH LICENSED CONTRACTORS [[ TO CONSTRUCT THE PR0.IECT(SEC.7W1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8I10l1 ADJ.AREA W CENSE LAW DOES NOTAPPLV TO AN ONTJER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND = NM1IOCONTMCTSFORSUCHPROJECTSWIiHACONTRACTOR�S)LICENSEOPURSUANTTOTHECANTRAG FEE ~ TORS LICENSE LAW.). QUANTITY DESCRIPTION Y � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR TNIS REASON Q 7` .G � U � DA7E OWNER ¢ Z U �Q LICENSED CONTRACTORS DECLARATION W [L I HEREBV AFFIRAI UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE.AND Z X MY LICENSE IS IN FULL FORCE AND EFFECT. m ; � �.� � , �6 L�I �'(/ �i � � UCENSE CLASS � G� LIC,NO._T�'6�0 / � V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWINO DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' � � COMPENSATION,AS 7ROVIDED BV SECTION 7700 OF THE LABOR CODE,FOF THE PERFORMANCE U Q OF THE WORK FOR WMICH THIS PERMIT IS ISSUED. � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ' Q 3700 OF THE LABOR CODE.FOR TiE PERFORMANCE OF THE WORK FOR WHICH THI$PERMIT IS ISSUED.MV WORKERS'COMP SATION INSURANCE CARRIER D POLICY NUMBEFAAE: CONSTRUCTION jCARRIER ��e �.s'�!� PLAN REVIEW 0 POLICVNUMBER��n"'7 ;� ELECTAIC Q 'T � (IFISSECTqNNEIDNOTBE00MPLEfIDOF71-IEPEPAMISFOqONEHUN7FiEDDOUA{iS(t1a0IORlESS} PLUMBING ��-1^.�•f-r-"' �=;-. --^- �. � w f� � �-_..\ I I I�_�� Z I CERTIFV THAT M THE PERFORMANCE OF THE MlORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL / C.�} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE � (n WORKERS'C-0MPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHWLD BECOME INSPECTION FEE � �C�/� � t� 7/�r�� = SU&IECT TO THE WORKEFS'COMPENSATION PROVISIONS OF SECTqN 370o OF THE UBOfl I v L t N I � CODE,I SHALL FOqTHWITH COAIPLV WITH hbSE fROVI510NS. ISSUANCE . � p DATE: APPLICANT: �� G� SMIP I � J WAANINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C I_��r--__ I J � SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT � DOLLARS(5100,000),IN ADDI710N TO THE COSTOF CAMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF 7HE UBOR CODE,INTEREST,AND ATTORNEI"S FEES. AETENTION FEE: • OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: � I HEREBV AFFIFM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDINO AOENCY � FOR THE PERFORMANCE OF THE WORN FOR WHICN iHIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NM/E H LEN�ER'S ADDHE55 w I CERTIFY TMAT I HAVE READ 7HI5 APPLICATqN AND STATE THAT THE ABOVE MFORMATION IS CqRRECT. TOTAL F E ES / � � � I AGREE TO CAMPLV WITH A�L CITV AND COUNTV ORDINANCES AND STATE UWS RELATIN6 TO BUILDINO �,7 � CONSTRUCTION,AND HEREBY AUTHORIZE REPflESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � J � m PERMITTEE NAME(PRIIfT) � �� N SIONATURE PER EE J DATE' � RECPT.NO. PAID B VALIDATION HITE—DepaAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy . 6��1i'�,? �fr �8!^��il(�� G�l(� ' D��ifa�C��O�P� f�C��6� � 0�� DL�`U� OG�C� , � ° C51r o o .� o �� 5ET BACK _ FLOUR JOIS7 � FTGS/FORP/IS/STEEL FHA RE�MTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLQOR CUt�IDUIT SLAB GRADE FIREPLACE FOUNDATION TEhlIP POWER FIREPLACE BOND BEAt+,1 WATER SERVICE MfD HT. BOND BEAM ROOF SHEATHING 8 hT BONQ BEAM ' FRAMINGNEh1TILIATiON FINAL BOND BEAfVi ROOF COVER ' PRE-GRADlNG ROUGH HEATING BENCHING j ROUGH ELECTRIC ROUGH GRADING ROUGH PLUfVIBING FfNISH uRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATHlSIDING POQL FENCING WALL INSULATION POOL FINAL ( CEILING INBULATION OFF SITE IMPS. DRYWALI.NAILING DEDICATIONS i SEWER FINAL ENG. SEPTIC TAMK LANDSCAPE/IRRlG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAI.ZONING FINAL CONST. � �IRE DcPT. FINAL FINAL HEATIIVG HEAL7H DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �� Q o C��5 _ __._ �. SEPTIC T�,t�1K SIZE SEEP PIT/U SIZE � � � � ��`;