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Home My WebLink About17677 (42) `J�� ,�a�a��- �� {�6�d—9�8—��8� � ^ _�� _ CITY OF DIAMOND BAR DEPARTIvIENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS ��"�.9�` BUILDING PERMIT APPLICATION FIRMLY QJOBSITE 6y ��/ ��` DATE CATION��,,. �- �NU BER �Y� #lC�� 0 ¢ ADDRESS �•r � � ISSUE _ , -F� TYPE OCC APN LOT RA DATE V CONST. GROUP °C OWNER � O o ADDRESS b _ ZONING SETBACKS Z CITY L• Z�p DOYD TEL. O FRONT qyy ❑ g APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ ADDRESS _I � CITY ZIP TEL. PROPOSED USE S F�� w ARCH/ENG/ z DESIGNER D � ' w NO.DWEL. NO. NO. a ADDR SS I � CITY ZIP TEL _ UNITS STORIES � BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O •' � I HEREBV AFFlRM UNDER PENALTY OF PERNRV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gflf9gB/CBfpOfl I W CENSE LAW FOR THE FOLLOWINO REASON(SEC.7031.6 BUSINESS AND PROFESSIONS CODE:ANV CITY OR (n U COUNTYNMICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W w NRE,PRIOR TO ITS ISSUANCE.ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck , � STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI- � � CENSE UW(CHAPTER e(COMMENCIN�WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PR6 PooUSpa � FESSIONS CODE�OR THAT HE OR SHE IS E7(EMPT 7HEREFROM AND THE BA515 FOR THE ALLEGED EXEMP� � U TION.ANY VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS 7HE�PPLICANT TO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOILARS(f5ao).): � ❑I.ASOWNEROFTHEPROPERTY,ORMVEMPIOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIrtl0fCi01 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BU51� J � � NESS AND PROFESSIONS CODE:THE CANTMCTORS UCENSE UW DOES NOT A7PLV TO A7J OWNER OG � PROPEHTY NR10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR wTHROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMVROVEMENTS ARE NOT WTENOED OR m � OFFEREDFORSALEIF,HOWEVERT1iEBUILDIN00RIMPROVEMENTIS50lDWITHINONEYEAqOFCOMPIE- Z TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � � IMPROVE FOR THE PURP0.5E OF SALE). w ❑I,AS OWNER OF THE PROPEHTY,AA/E%CIUSNELV CONTRACTINO WRH LICENSED CONTMCTORS � TO CONSTRUCT THE PR0.IECT(SEC.70a1,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTORS U- V8IU8�10 ADJ.AREA . W CENSE LAW OOES NOT MPLV TO AN OVMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND � WMOCONTRACTSFORSUCNPROJECTSWITHACONTRACTOF(5)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DE CRIPTION FEE Y TOFiS LICENSE UW.). 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � � Z DATE OWNER w /� T �^ , O l.1 U �V \ � LICENSED CONTRACTORS DECLARATION –� � I HEREBY AFFIfUA UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � ` O � e(COMMENCINO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z �Y� LLI MY LICENSE IS IN FULL FORCE AND EFFECT. m I � � LICENSE LASS LIC.NO. � � V- � V DATE � CONTRACTOR a. � 1 O`� 1 �RKERS'COMPENSATION DECLARATION Q � �A �V � I HEREBV AFFIRM UNDER PENALTV OF 7ERIURV ONE OF THE FOLLOWING DE0.ARATIONS: Z O _I HAVE AND WILL MAINTPJN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' _ '� COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOF COOE,FOR THE PERFORMANCE U Q OF TME WORK FOR WMICM THIS PERMIT IS ISSUED. � Qw �I HAVE M1D WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIFED BV SECTqN 370o OF THEFABOR CODE,FOR THE PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS � ISSUED.MV R S'CAMPE ATION 1 SURANC CARRIER P V NUMBER AA� CONSTRUCTION Q �1� ] CAARIER W PLAN REVIEW � POLICV NUMBER O - Z . ELECTRIC � Q � (IFtlSSECTIONNEmNOTBECOMPLEfEDOF7HEPEMYTISPJRpNEHUIJ)REDDq1AR5�L�ao)ORLE55} PLUMBING W Z 1 CERTIFY THAT W 7HE PERFORMANCE OF hIE M/ORN FOR WHICH THIS PERMIT IS ISSUEO.I MECHANICAL � U' SHALL NOT EMPLOV ANY PERSON Ild ANV MANNER SO AS 70 BECAME SU&IECT TO THE l _ (/� WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAGREETHATIFISHWLDBECAME �NSPECTIONFEE � /� SU&IECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTqN 37000F THE LABOR �,J � �j CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � � SMIP p DATE: APPLICANT: J WA�ING: AILU �CURE WORKERS'COMPENSATION CAVERAOE IS UNLAWF L,AND SHALL BE ENERGY P/C r a �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESl1PTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f1a0,o0o),IN ADDITION TO THE C0.ST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. ^ ,� aC RETENTION FEE: ��/ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT7HERE IS ACANSTRUCTION IENDING AGENCV n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe],CIV.CJ. Z W � LENDER'S NAME - / F— LENDER'SADDRESS w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEEy� AT� ��L.� � � I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDING ,/V•=� / � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HI5 CAUNTV TO ENTER UPON THE ABOVE�MENTIONED PROPEFTV FOR INSPECT N PURPOSES. 0 � �� C��$ � � _ � � � ��j� , � � m PERMITTEENAME RINT) Q (n / / �J � SKiN OFP 1 ` DATE � RECPT.NO. PAID BY VALIDATION � ' - WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fila Copy,GREEN—Appli nt's Copy � �, _.t�' '1' � '\ \'.'', • �s0��, �� Q�I�� `�� iiIICJ�I��Ls fl D�atl W��Lo�tril� �� GQ 1� ��° o C� �(S�U�OG�J D �`t� � a p �" 5El"BACK � ' FL.00R JCIST � �. FTGS/FORMS/STEEL j � � FHA REQMTS � ELECTRIC GROUND ' ! UNCER FLOQR QUCT , GROUND PLUMBING UNDER FLOOR CUf�IDUiT SLAB GRADE � � FIREPLAGE�F'OUNbATfON TEMP POWER FIREPLACE BdND BEAM WATEFi SERVICE MID NT. B'4Nd BEAM ROOF SHEATHI(VG �� 8 Ff. BOND BEAM FRAM(NG/VENTILIA710N ('2 2U0z � ` FINAL BOND BEAM ROOF COVER PRE-GRADING' ' ROUGH HEATING BEPJCNlN� ` '•• ROUGH ELECTRIC � ROUGH GRADING �iOUGH PLUMB�NG p� � FINISH uRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATI�N POOL FINAL CEILING INSULATlON ' OFF SITE lMPS. DRYWALL iVAILItVG o22'�7�Z DEDICATIONS SEWER FINAL ENG. SEPTIC TANK '� LANDSCAPE/IRRiG. SEEP PIT/L..L, i ' • ' , ON S1TE IMPS. GAS,41R TEST ,=� � FlNAL ZONING FINAL CONST. ' ; r'`; , F1RE DEPT. FINA!� FINAI�"NEATI1iiG �? b_ � �� HEALTH DEPT. FINAL FINAL ELECTRIC � � {• . � �� DEV. FEES PAID FINAI.PLUMBIMG �-t �! -T . ENERGY � � i C��OG��o ___� CO�lIf�iEi�TS � ' _ - � � � � � . . , ' � i SEPTIC TANK SIZE SEEP PIT/U SI�E - � � (s�' — . - , r c� �, - . _