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Home My WebLink About10-1057 ^ _f�`_ CITY OF DIAMOND BAR I DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES > 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Faac(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �'°""� BUILDING PERMIT APPLICATION FIRMLY ' � .JOBSITE i7 Q�� '�Q�� f� b R_� APPLICATION PERMIT p/C o ADDRESS DATE NUMBE ��O # � APN LOT TRACT iA/ (�1 �SSUE �D r� /� 7ypE �j� OCC � �C��y � ' DATE_ CONS If✓�G/ C�1'OUP p OWNER p ADDRES O'T W LL� LVD 5� ZONING SETBACKS z CITY �L/��t1�_ ZIP TEL. FRONT Ryy � � APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTOR CAL /,Q�d ,Qp SIDE � ADDRESS � �- rb': � CITY�'.l�-/��h� ZIP��TEL. I :�F3- � PROPOSED USE_ ��%R�� /�G �� XJ� w ARCWENG/ ��f�� z DESIGNER � nW. ADDR S p �s �� NO.DWEL. NO. NO. � CITY ZIP q/o�i TE - UNITS STORIES BEDROOMS � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HER�V AFFIRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8fB9B/CBIPOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANVCITVOR (f� C-� COUNTVWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTEH.IMPROVE,DEMOUSH,ORREPAIRANYSTRUC- . w � W TURE,PRqR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w P8f10/DBCk � � STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CAMRACTORS LI� � CENSE UW(CMAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSP2 FESSIONS CODE)OR h1AT ME OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (� TION.ANY VIOLATION OF SECTION 70.71.6 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oo)J: � ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COff1/fIBfC18I V.7LL DO 7HE WORI(AND 7HE STRUCNRE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.)o��,BUSI� J � NESS AND PROFESSIONS CODE:TME CONTRACTORS IICEN9E LAW DOES NOT APPLV TO AN OWNEH OF j PROPERTY VRiO BUILOS OR IMPqOVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR NERSELF OR � TMROU6H HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVERTNEBUIlDIN40RIMPROVEMEMIS50LDWITHINONEVEAROFCOMP�E� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEWRPoSEOFSALE). w �I,AS OWNER OF THE PROPEflTV,AA1 E%CLUSIVELV CONTqACTINO WITH LICENSED CONTRACTORS Q TO CONSTRUCT 7HE 7RQIECT(SEC.7oa/,BUSINESS AND PROFESSIONS CODE:TIIE CONTRACTORS LI� V8I118f1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPqOFERTVWHOBUILDSORIMPROVESTHEREON,AND � WViOCONTRACTSFOFSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORSLICENSEUWJ. FEE � O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � ?� U � DATE ONMER F- Z U � LICENSED CONTRACTORS DECLAAATION w � I HEREBY AFFIRN UNDEH PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CFIAPTER � � G(COMMENCIN(i WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �j� W UCENSE IS IN FULL FORCE AND EFFECT. //�{, m � LICENSE CLAS/s �� LIC.NO. � �/. /�� V DATE__�DI ZI L� CONTRACTOR � K.�+� d W � WORKERS'COMPENSATION DECLARATION � � U � I HEREBV AFFIqM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z 0Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a Q = COMPENSATqN,AS PROVIDED BV SECTION 3700 OF THE UBOR CODE,FOR THE PERFORMANCE �U OETHE WORK FOfl WHICH THIS PERAIIT IS ISSUED. � � / � ,1� I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� J ISSUED.MV WORKrERS'CqA1PEN5ATION 1 SURANCE CARRIER AND POLICV NUMBER AFiE: CO TRUCTION j CARFIER /'��ST �MP PLAN REVIEW � POIICY NUMBER Zd. ELECTRIC � (RUsSEcila�NE�raieEC0A4'LFrE�oFnlEpEw.iilSFbqp�EHU.DqmppUqqg(S1aplpq�ESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �}' SHALL NOT EMPLOY ANV PERSON W ANY MANNER 50 AS TO BECAME SU&IECT TO THE (/) WORKERS'CAMPENSATION LAWS OF CALIFORN10.AND AGHEE THAT IF I SFIOULD BECAME INSPECTION FEE S SUBJECT TO THE WORKERS'COMPENSATION PR VISIONS OF SECTION 37000F THE LABOR CODE S�/Al/�FORTHWITH COMPLV WITH THO PROVISIONS�/y�A �� 'p DATE:�� 'IU APPLICANT. ��i'�- iP _ /�?� �� J WARNING:FAILURE TO SECUFE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDREO THOUSAND ENERGY PERMIT OOLLARS(f100,000�,IN ADDI710N TO THE COST OF CAMPENSATpN,DAMAGES AS PROVIDED FOR IN � � SECTION 3708 OF THE UBOR CADE,INTEREST,AND ATTO{UJE1"S FEES. ON F •OO O' CONSTRUCTION LENDING AGENCY p��E: ' � I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED(SEC.70G1,CIV.C.). Z W � LENDER'S NM/E � LENDER'SADDRESS w I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES //s % /`f � 1 AGREE TO COMPLY WITH ALL CITY AND CAUNTY ORDINANCES M10 STATE UWS RELATIN6 TO BUILDIN6 . f✓ � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON iHE � Z ABOVE-MEMpNED PR07EFTY FOR INSPECTION PUFPOSES. COMMENTS � 0 J � m PERMITTEE NAME(Pqll�lT) ' � Q � � SIGNATURE OF PERMITTEE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessa Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy ci�v o� �i��o�� ,� i�s��c�Ao� ��co�� . a �, ; .- �. ..;� - �ti� � �L-�C��i'� .C��. G} ,°. '�. '" Q�l�3pCGC�4�G�'� � OG�J�I�L�[�tt�: ° ' � SET BACK - '� FLOOR JOIST � FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT ' GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE B�ND BEAM WATER SERVICE MID H'T. BOND BEAM � ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING � ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONSL FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �� COMMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � �i a .�� a a�� , ��