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Home My WebLink About16958 (25) .�a� CITY OF DIAMOND BAR - ^----�F�---- DEPARTIv�NT OF COIvIIv1UNITY&DEVELOPMENT SERVICES E�P�RED 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRE$$ ��9�� BUILDING PERMIT APPLICATION JUN .� 7 ZQOZ FIRMLY � JOBSITE Q APPLICATION Q� � l PERMIT c p/C o ADDRESS 7 22- G O L D E PR.��6S DATE U ' I� � 1 NUMBER ��u # NPE OCC � APN LOT �RACT D TEE CONST. GROUP p OWNER d p ADDRESS ZZ D4 D ZONING SETBACKS z CITY . • ZIP ' TEL.3 6- FRONT qyy � o APPLICANT SIc TEL. REAR � � SIDE/SIDE STREET qyy p � CONTRACTO s! SIDE � � ADDRESS � CITY ��PLAA�1 ZIP l TE PROPOSED USE E� OLE OD� S oARCH/ENG/ � z DESIGNER a ADDRESS NO.DWEL. / NO. 2 NO. _ � UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION O SFR/ADD/REM � I HEREBV AFFlRM UNDER PENALTV OF PEfiJURV THAT I AM E%EMPT FROM iHE CONTRACTOFiS LI� G8f8 B/CH fI W CENSEUWFOR7HEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:PNVCITVOR (n g � U CWNTVWHICHREWIRESAPERMITTOCONS7RUCT,AL7ER,IMPROVE,DEMOl1$H2ORREPAIRANVSTAUG W P8fi0/DeCk < TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll- � CENSE lAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOUSPa ^ FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EMP� (!i V TKKJ.ANV VIOLATqN OF SECTION 7031,6 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Root � A CIVIL PEN�LTV OF NOT MORE TW�N FNE HUNDRED DOLURS(5600).): � ❑4�OWNEROFTHEPROPERTY,OHMVEMPLOYEESWITHWA�ESASTHEIRSOLECOMPENSATION, � COffIR1BfC18I Z WILL DO THE WORK,AND THE S7RUC7URE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7a�,BUSI- J � � NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTV NMO BUILDS OR IMPROVES THEREON,AND WHO W ES SUCH WORK HIMSELF OR HERSELF OR w THROUGH HIS OR HER ONM EMPLOVEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDEO OR m . Q OFFEREDFORSALEIF,FIOWEVER�MEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPIE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE f-0R THE PUqPOSE OF SALE). w ❑I,AS ONMER OF THE PROPEHTV,AM EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS ¢ TO CONSTRUCT hiE PRQIECT(SEC.7W/,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U- V01U8I10l1 ADJ.AREA W CENSEUWDOESNOTMPLVTOANOWNEROFAPROPERTYWHOBUIIDSORIMPROVESiHEREON,AND = WFIOCONTRACTSFORSUCHPR0.IECTSWITiACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG FEE ~ ioas ucer+sE uw.�. �UANTITY DESCRIPTION Y � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � OATE OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATION ' W � I HEHEBV AFFIRAI UNDER PENALTV OF PERWRV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AND PROFES IONS CODE,AND Z �� MV IICENSE IS IN FULL D EFFECT. /'�� m � LICENSE CLASS � LIC.NO. ' I � � V DA CONTRACTOR i a w � WORKERS'COMPENSATION DECLARATION a � I HEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWINO DECLARATKKJS: Z � _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOHKERS' _ Q COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE U OF TNE WORK FOR WHICH 7HIS PERMIT IS ISSUED. w � � Qw _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION //''�� 3700 OF THE LABOR CODE.FOR THE PERFOiiMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS �lP� I o ISSUED.MV WORICERS'CAMPENSATION INSURANCE CARRIEF AND POLICY NUMBERARE: CONSTRUCTION � CARRIER PLAN REVIEW � POLICY NUMBER Z ELECTRIC ¢ � (1}I65EC110NN�NOTBENMPI.EfIDOFhfPERAiriSFOqONEHUK7(iEDOq.LPAS(t100)OqLESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL U' . SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AQREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORI(ERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR /� -�+ �y':�'�^� (� `O CODE,I SHNl FORTHWITH COMPLV WIT1 OSE PROVISIONS. �SSUANCE � /'p�\ 1 1 I �1\ .v p DATE: 6 �-a� APPLICANT. SM�P ~•,Y � J WARNINO:FAILURE TO SECURE WORNERS'CO ENSATpN COVEMOE IS UNLAWFUL,M1D SHALL BE ENERGY P/C i � SU6IECTAN EMPLOVER TO CRIMINAL PEN/�1.T S AND CML FINES 11P TOONE HUNDRED T110USAND ENERGY PERMIT DOLLARS(5700,000J,IN ADDITION TO THE COS OF COMPENSATqN,DM/AGES AS PROVIDED FOR IN J SECTqN 3708 OF 7HE LABOR CODE,INTEREST,AND ATTORNEVS FEES. p� RETENTION FEE: - I O . CONSTRUCTION LENDING AGENCY PREALT FEE: ---_��"-� -� � I HEREBV AFFIRA/UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDWG AGENCY FORTHE PERFORMANCE OFTFiE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB1,CIV.CJ. Z W � LENDER'S NAME F- LENDERSADDRESS � TOTAL FEES � ��, � � � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE A90VE INFORA/ATION IS CARRECT. w I AOREE TO CAMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESEMATIVES OF THIS COUNTV TO ENTER UPON THE � ABOVE�MENTIONED PROPERTY FOR INSPECTqN PURPOSES. Z COMMENTS � /� = TD/✓A X1VAi+/ !1� O,�L� m PE ITTEE NAME(PRIIJn � �l d � S NATUREOFPERMITfEE DAT � � RECPT.NO. PAID BV VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicenYs Copy . . . . ��: . .,.. , . , . . ,. , ,. , , .�.�., ;,,. .�_,. .... . , . . . , , , . . (C�1T�'l �� 'D0�6i��➢ �1�� (�I�f�[�c�`�"0�� i��(�Q�� G�� .�� . Dp G'�1� �. ; � � ' �; SET BACK FLOOR JOIST �_ FTGS/FORM5/STEEL FHA REQMTS _� ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CU�IQUIT SLAB GRADE FIREPLACE FOUNDATI�N TEMP POWER FIREPLACE BOND BEAM WATER BERVICE � MID HT, BOND BEAM ROOF SHEATHlNG • 8 FT. BOND BEAM FRAMlNGNENTILIATION FINAL BOND BEAM ROOF C�VER PRE-GRADING ROUGH HEATING BENCHING RQUGH ELECTRIC ROUGH GRADING ROt1GH PLUiV1BING FINISH uRADING SHOWER/TUB TEST POOL ELECTR(C ' �XT. LA7H/SIDING POOL FENCING WALL IPISULATION POOL FINAL CEILING tNSULATION ' OFF S17E lMPS. DRYWALL NAILIfVG DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. • ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBIMG ENERGY ��a � co�,��Ts SEPTIC TAPVK SIZE .. SEEP PIT/U SIZE � � � � S�J P ' �