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Home My WebLink About17495 (25) _�� _ CITY OF DIAMOND BAR DEPARTMENT OF COMr�fUNTi'Y 8c DEVELOPMENT SERVICES 21825 E.Copley Drive EX P I R E D (909)860-3195 Fax(909)861-3117 PRESS �9��+ BUILDINGPERMITAPPLICATION J� FIRMLY } JOBSITE /1c APPLICATION f PERMIT n p/C o ADDRESS ��Q �p�"✓Gl✓ �S DATE IZ I ��' I �I NUMBER � 1�_ # � APN LOT� TRACT �SSUE TYPE OCC p OWNER _ �� DATE CONST. GROUP p ADDRESS S �� ZONING SETBACKS z CITY ZIP TEL. FRONT qyy � p APPLICANT ' ' TEL. ��'�� SIDE/SIDESTREET RW ❑ � CONTRACTOR � C EN c�,1. y� - SIDE � � ADDRESS °IJ8�- G M f..+ ` � CIIY _A'Lfp�GG,�IA- ZIPS� � oi TEL. �t K� N�3Y PROPOSED USE �[ � �17't0:4r .�i'�� /-L u d}g oARCH/ENG/ - Z ' ' t�✓S�o�Q-�._ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP EL. UNITS I STORIES Z BEDROOMS 3 � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM EXEMPT FqOM THE CONTRACTORS LI- G218QB/CBfpOfl W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n ZCOUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEAIOLISH,ORREPAIRANYS7RUC- W pytio/DBCk w �NRE,VRIOR TO ITS ISSUANCE,�LSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE COMRACTORS LI� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO� � POOVSPB O FESSIONS CODE)OR THAT HE OR SHE IS EXEMP7 THEREFROM AND 7HE BASIS FOR THE ALLEGED E%EMP- (� V TION.ANV VIOLATION OF SECTION 7071.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z q�q�} 2 A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f5a0).): � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMGLOYEESWITHWAQESASTHEIRSOLECOMPENSATION, � COR1R18fC18I Z WILL DO THE WORK,AND hIE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BUSI� .J � � NESS AND PROFESSIONS CODE:THE CONTflACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY NTiO BUILDS OR IMPFOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUl3Fi HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDEO Oq m � OFFEREDFORS�LEIF,HOWEVERT}1EBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- Z TtON,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT 9UILD OR � IMPROVE FOR THE PURPOSE OF SALE). ' w ❑1.AS ONRJER OF THE PROPEHTV,AM E%p.USNELV CANTqACTING WITH UCENSED CON7RACTOHS � TO CONSTRUCT THE PROJECT(SEC.7oa1,BUSINESS M1D PROFESSIONS CODE:THE CONTRACTORS LI- VeIUOIlOf1 � ADJ.AREA W CENSE LAW DOES NOTAPPLV TOAN OWNER OF A PROPERTY N?10&11LDS OR IMPROVES hIEREON,AND � NMOCONTMCTSFORSUq1Pq0.1ECTSWITHACANTqACTOR(S)LICENSEDPURSUANTTOTHECQNTRAG QUANTITY ESCRIPTION FEE � TORS LICENSE UW.�. 0 ❑I AM EXEMPT UNDER SEC. B.6 P.C. THIS REASON Q 2� U LL" DATE OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATtON w � I HEREBV AFFIRM UNDER PENALTV OF PEFJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d o(COMMENCINO WRH SECTION 7000)OF DNISION 30FTHE BUSINESSAND PROFESSIONS CODE,AN� Z ' X MY LICENSE IS M FULL FORCE AND EFFECT. � LICENSECLASS �+I�� LIC.NO. �'�� V DATE (zT�Ol COPfTRACTOR�� a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIpM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWIN4 DECLARATIONS: Z � _I HAVEMlD WILLMAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOfl WORKERS' a 2 Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LA80R CODE,FOR THE PERFORMANCE U Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � W �I HAVE AND WILL MAlNTA1N WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 370a OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED.MV WORKERS'COqM�P—EN-SATION SURANCE CAR/RIE,�R AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER �I'�� -� l.R SJRL� p�AN REVIEW 0 POLICYNUMBER W L 2��1q '� Cn�-� ELECTRIC z ¢ 0 (iFOSSEC�qNN�NOTBENNPLEfEDOFTHEPEPlMISFORONEFiIN�DFiF.DDOLLAFYSK1o0)ORLESSL PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORN10.FlND AGREE 7HAT IF I SHOULD BECOME INSPECTION FEE = SU&IECTTOTHEWORKERS'COMPENSATKKJPROVISIONSOFSECTION77000FTHELABOR ' COD .I SHALL FORTHWITH COMVLV WITH THOSE PROVISIONS. ISSUANCE � � p DATE: t ( APPLICANT: SMIP „`�� J WARNING FAILURE TO SECURE WOHI(ERS'COMPENS ION COVER IS UNUWFUI.AND SHALLBE ENERGY P/C �y SUflIECTANEMPLOVERTOCRIMINFIPENALTIESMIDCNILFINESU TOONEMUNDREDTHWSAND ENERGYPERMIT DOlLAAS(f 700,000).IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN ¢ SECTqN 37ae OF 7HE LABOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURV TH E IS A CONSTRUCTION LENDINO Aa CV FOR THE PEFFORMANCE OFTHE WORK FOF W THIS PERMIT IS ISSUED(SEC.70G�, . Z W � IENDER'S NAME � LENDER'SADDRESS - w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORAIATION IS CORRECT. TOTAL FE ES � I AGREE TO COMPLV WfTH ALL CRV AND COUNTV ORDINANCES M1D STATE LAWS REUTING TO BUILDING I �� CONSTFUCTION,ANDHEREBVAUTHORI2EREPRESEMATIVE50FTHI5COUNTVTOENTERUPON7HE Z ABOVE-MENTIONED PROPER7V FOR INSPECTION PURPOSES. COMMENTS � V � r �l�W+ ) / m PEHMI7TEE NAME RINn ��„ IL l� � � SIONATU FPERMTTEE DAT , � RECPT.NO. PAID BY � VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy . . . . .�. . - .. � . . . .. ... �- .� .t�_�, . . . _. ` . . .� . . � . . . (GB��'( �(� �fl�f�i1�I�� i�l�[� 0�1�1�[�(��'0�(�i 6-3[�� ` � �� G'a�t � OG�CC t1 a�G3 � [�`��C�� OO �GJ� � _ I�J� o ' $ �°� � SET BACK FLOOR JQIST ,. � FTGS/FORPViS/STEEI j FHA REQMTS ELECTRIC GROUND UN�ER FLOOR DUCT GROUND PLUNPBING UNDER FLOOR CU�IDUIT � SLAB GRADE ^ FlRERL./aCE FOUNDATION � � TEMP POWER ' ' FIREPLACE BOND BEAM � WATER SERVICE �...,..� MID HT. BdND BEAM ROOF SHEATNING ,�3Ct. � 8 F BOND BEAM � FRAMIPVGNENTILIATION FINAL BOND BEAM_ _ __ �— ROOF COVER PRE-GRADING ROUGH HEATIldG BENGHING ROUGH ELEGTRlC ROUGH GRADING ROUGH PLUMBING FINiSH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. [ATH/SIDING POOL FENCING WALL INSULATION POOL FINAL � CEIL�NG INSULATION OFF SITE IMPS. : DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. � SEPTIC TANK LANDSCAPE/IRRiG. SEEP PITILL. • ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. �IRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY _ @G�(��► ��o , . i COiVIiViENTS SEPTIC TAiVK SIZE SEEP PIT/U SIZE � A� [-�-, �