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Home My WebLink About17804 �� _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive �/ (909)860.3195 Fax(909)861-3117 � PRESS `'-:�� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE �' APPLICATION "z I"('1 PERMIT �/ P/C(�� G ADDRESS DATE ✓w� v�NUMBER O # v�r I� � - � � APN LOT TRACT D TEE Z Z ONST. GROUP p OWNER �D�D�Af �J��1j(�. � � �fQ7>' . L•e o ADDRESS —�� ZONING SETBACKS Z CITY ZIP O'�3-OTEL.3d — FRONT RW ❑ � APPLICANT ' TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ � CONTRACTOR /✓�S S SIDE ❑ � CITYSSS�rL �/1D/fT�ZIP jTEL. � PROPOSED USE � /�t� w ARCH/ENG/ � z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS u� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDEF PENALTY OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f8JB/C8ry0ft W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n U CAUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRAtJVSTRUC� w � w 7URE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w P8fi0/DBCk � STATEMENT THAT HE OH SHE IS LICENSED WRSUANT TO THE PROVISIONS OF iHE CONTRACTORS LI� � CENSE LAW(CNAPTER e(COMMENCIN�WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� POOUSpB � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (!f U TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z qe-Rool A CNIL PENALTV OF NOT MORE hIAN FIVE HUNDRED DOLLARS(S6o0�.): ~ ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Z WILL DO THE WORK,M1D THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I�,BUSI� J CORIrt1BfCI01 - � NESS AND PROFESSIONS CAOE:iHE CONTRACTORS UCENSE UW DOES NOT APPLY TO AN OWNER OF � PROPEHTV WHO BUfLDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF Oq HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT IMENDED OR m � OFFEREDFORSALEIF,HOWEVERTNEBUILDINOOFIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� Z TION,THE OWNER�BUILDEF WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OH � IMPROVE FOR THE PURP0.SE OF SALE�. w ❑I.ASOWNEROFTHEPROPEHTV,AME%CLUSIVELVCANTRACTIN�WITHLICENSEDCONTPACTOqS � TO CONSTRUCT THE PR0.IECT(SEC.7014,BUSINESS M1D PROFESSIONS CODE:THE CONTRACTORS U- V8IU8110f1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANONRJEROFAPROPERTYWHOBUILDSORIMPROVESTHERE-0N,AND � WFIOCOMMCTSFORSUCHPR0.IECTSWIh1ACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTqAG (]UANTITY DESCFiIPTION FEE Y TORS UCENSELAW.). � ❑I MA E%EM7T UNDER SEC. B.8 P.C.F-0R THIS REASON Q � ( Q�„J "LS �� ?� U � � DATE OWNEH F- Z U O w LICENSED CONTRACTORS DECLARATION � � W I HEREBV AFFIqM UNDER PENALN OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WRH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PROFESSKKJS CADE,AND Z �� MY LICENSE IS W FULL FORCE AND EFFECT. � m ' � LICENSE CLASS G�� LIC.NO. � � V DATE ��jD�D Z� CONTRACTOR a . W �� WORKERS'COMPENSATION D LAAAT Q . � U N I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATqNS: Z � _I HAVE AND WILLMAINTAIN A CERTIFICATE OF CONSENTTO SELF�INSURE FOR WORKERS' a � � COMPENSATION,AS PROVIDED BY SEC110N 370o OF THE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK F-0R WHICH THIS PERMIT IS ISSUEO. � W �I HAVE M1D WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 0F THE LABOR CODE,FOR TFIE PERFORMANCE OF THE.WORK FOR WHICH THIS PERMIT IS I '�� (1JC J ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRi p un pp•�`ICV/N�UMBER ARE: CONSTRUCTION �� \JV j CARRIER_� /�. -� �1/J.J PLAN REVIEW _ POIICV NUMBER / � � ¢ � � ELECTRIC � r O � (iH6SECTpNNE�NOTBENMPIETmOFhfPERAYTISFORONEFUI�DREDOq1A{i5(51o0)ORL6Sy PLUMBING W Z I CERTIFY THAT IN hIE PERfORMANCE OF THE WORN FOR WHICH THIS P MIT IS ISSUED.I MECHANICAL (J SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU ECT TO THE (/J WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAGREE HATIFISIWlDBECOME INSPECTIONFEE SU&IECTTOTHEWORKERS'COMPENSATION7ROVISIONSOF E TION37 OFTHELABOR � /'� � CODE,I SHALL FORhIWITH COAIPLV WITH THOSE PROVISION ISSUANCE �� O LJ � . p DATE: � PPLICANT: SMIP W J WARNINO:FAfLURETOSECUREWORKERS'COMP IONCAVE E AND BE ENERGYP/C ' J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINES DTHOUSA o ENERGYPEAMIT DOLURS(ft00,oao),INADD1710NTOTHECOSTOFCAMPENSATIO , A SA P VIDE�FORIN J SECTION 3]OB OF THE UBOR CODE,INTEREST,AND ATfOWJEV'S FEES. w RETENTION FEE: � ,. �� O CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACANSTRUCTION LENDWG AQENCV FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.308�,qV.C.). Z W � LENDER'S NAME H LENDERSADDRESS w I CERTIFY THAT I HAVE REAO THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES � • � ' I� 1 ��,/ � I AGREE TO COA/PLV N7TH ALL CITY AND CWNTV ORDINANCES AND STATE UWS REUTING TO BUILDINO yy// � Y' � CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE (.,,� � .� Z ABOVE-MENTqNED PROPERTV FOR INSPECTION PURPOSES: COMMENTS J � � � J _� � k m PERMITTEE NAME(PRINT) ¢ �x> -DZ � � SIONA7UREOFPERMI DATE � RECPT.NO. �PAID BY ' ALIDATION E epartment Copy,YELLOW—Finance Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ' ) t�O1T�r �[r �D�f��f�9@� [�� _ ��I�G�'�(��'O�r�l (�[�C��[�� .� U Q ��U� �,%(5 U o �� . �� 11 a �) � ' J� ��° ," o � .� SET BAGK FLOOR JOIST FTGS/FQRMS/STEEL � FHA REC�MTS j ' ELECTRIC GROUNQ , UNDER �LQOR DUCT 1 GROUND PLUMBING UNDER FLOOR CU�IDUIT 1 SLAB GRADE FlREPLACE FOUNDATION ( TEMP POWER � FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING � 8 FT. 60ND BEAM FRAMifVGNENTILtATtOM FINAL BOND BEAM ROOF COVER PRE-GRADING AOUGH NEATING BENCHING ROUGH ELECTRIC FiOUGN GRADING � ROUGH PLUIVIBIfVG FIfVISH uRADING SHOWERlTUB TEST P�OL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION � . POOL FINAL � CEILItUG INSULATICIN OFF SITE IMPS. DRYWALL hIAILING DEDICATIONS SEWER � FINAL ENG. � SEPTIC TANK LANDSCAPE/IRRlG. SEEP P!T/L.L. ' ON S17E IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL. FINAL HEATIfVG HEALTH DEPT. FIN�1L FINAL ELECTRIC T 'i..Lr � DEV. FEES PAID n FINA�PLUMBING � � ' ENERGY � � C�G��OG�OC��'�'- P=� . _ � , CO�/Ii�iENTS ! , SEPTIC TANK SIZE SEEP PIT/U SIZE � ` .� [��-' � �