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Home My WebLink About11-1171 r! CITY OF DIAMOND BAR V 4 --��—� DEPARTMENT OP'COMMUNITY&DEVELOPMENT SERVICES � � � 21825 Copley Drive,Diamond Bar,CA 91765 � E$$ � 'c (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027n� ` � �'<9�^�W BUILDING PERMIT APPLICATION � FIRMLY APPLICATION PERMIT P!C o ADDRESS "Z"�17�d �,�,C.�C�L'"''�V S�QI�`25 �� DATE_ ��i 20�1 NUMBE�I �II # (�.�\\- \��1 � Q-�! ISSUE / TYPE OCC APN� LOT� TAACT SOZ( DATE I CONST. GROUP p OWNER G�� S��t� ZONING ETBACKS o ADDRESS �42 � �� R�'�`�� Rdr FRONT RW ❑ gCITY �� ZIP TEL. REAR ❑ APPLICANT ¢�il• NL-ZS�N TEL. 61d 2S �32� SIDE/SIDESTREET RW ❑ � CONTRACTOR � �� C-�`��~� SIDE � oADDRESS "ZZ-�i s P`/�L��Ta� �-`rfl PROPOSED USE �Y'��L� �r`T*�i� �7L�'� o CITY I�C�NAV- '�'` ZIP �ll�Cl TEL. G6lZS1FI3Z1 w ARCWENG/ z DESIGNER Os��`''� '�� NO.DWEL. NO. NO. � ADDRESS � B � �-�'�5 wE �' ��-- UNITS STORIES ( BEDROOMS � CITY „ PASA7.+t'�N� ZIP � � rE�. �'Lb 44y ��i�/ � OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM p I HEREBV AFFIRM UNDER PENAL7Y OF PER.IVRV THAT I AA1 E%EMPT FROM TNE CONTRACTORS LI• Gdf89B/CBfpOfl W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.6BUSINESSANDPROFESSKKJSCOOE:ANVCITYOR (n U Cq1NTVWHiCHRE0U1RE5APERMITTOCONSTRUCT,AL7ER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUG W patlolDeck WTURE,PRIOR TO RS�SSUANCE,ALSO HE�UIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � 3TATEAIENT TNAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CNMTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TME BUSINESS AND PRO� � POOVSPB FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFFOM AND THE BASIS FOR THE ALLEGEO E%EMP- 7�pN,ANV VIOLATKKV OF SECTION 7oa1.5 BY ANY APPLICPNT FOR A PERMIT SU&lECTS THE APPUCMlT TO Z Re-Root � A CML VENALTY OF NOT MORE 717AN FIVE HUNDRED DOlLARS(i500).): r 0 ❑4�+OMMEROFTHEPROPERTV.ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 Commerciat '�}�'U Z VALL DO 7HE W�AK,AND TME STRUCTUFE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7W�,BUSI� J , � NE55 AN�PROFESSIONS CODE:7HE CONTRACTOR5 UCENSE lAW DOES NOT APPLV TO AN OWNER OF PROPEAIVNMOBUIl�50PIMPROVESTNEREON.ANDN/NODOESSUCHWORKHIMSEIFORHERSELFOR m ��'"' +��'� '��^ �� TMROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IAIPROVEMENTS ARE NOT MTENDED OR �,,;r• � QOFFEREDFORSALEIF,HOYlEVEF.TFIEBUILDINQOR�PROVEMEM�SSOLDWRMINONEVEAROFCAAIPLE� Z TION,THE OWNER$UILDEft WILL HAVE n7E BUROEN OF PHOVINQ THAT HE OR SNE OID NOT BURD OR � IMPROVE FOR THE PURPOSE OF SAIE). W ❑I,AS OWNER OF THE PFOPEHTY.AM E%CIUSIVELV CONTMCTINO WI7H UCENSED CONTRACTORS [= TO CONSTRUCT THE PRO.IECT(SEC.7W4,BUSINESS AND PROFESSIONS CODE:TNE CONTMCTORS LI- V81UaliOfl A0.1.AREA � CENSE LAW DOES NOTMPLY TO AN OYMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND W11000NTRACTSFORSUGHPFOJECTSMI�THACONTRACTOH(SJLICENSEDPURSUANTTOTNECONTMC� pUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). O ❑1 AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON U � Q LL' DATE 0`M'�ER V Z W � LICENSED CONTRACTORS DECLARATION -� �Q W CL 1 HEHEBY AFFIRM UNDER PEN�LTY OF PERIUHV THAT 1 AM LICENSED UNDER PROVISKKJS OF CHAPTEN Vr ' � � �(COMMENCING WITM SECTION 7000)OF DIVISION 3 0F h1E BUSINESS AND GROFESSIONS CADE,AND Z X MY LICENSE IS IN FUI.L FOACE AND EFFECT. m lll y1 9 � � LICENSE CIASS �T� LIC.NO., ��'�� • 7 - U DATE I� �ZS i ZO i� CONTRA�Tna E. � t-CSQ��. d W � WORKERS'COMPENSATION DECLARATION � ��- � U � I HEREBV AFFIRM VNpER 7ENALTV OF PERIURV ONE OF TNE FOLIOWING DECLARATIONS: !/� a � 1 HAVE AND N/lLL MAINTAIN ACERTIFICATE OF CONSENT TO SE�F�tNSURE FOR WORKERS' _ � CONPENSATION,AS PROVIDED BV SECTION 370o OF THE I.ABOR CODE,FOR THE PERf-0RM�flCE W OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w ,�,I HAVE AND WILL MAINTAIN WORKERS'COMPENSATbN INSUfUNCE.AS REOUIREO BV SECTION Q 370o OF THE LABOR CODE,FOR THE PERFOR/AANCE OF THE WORK FOR WHlCH 1HI5 PE�IT IS 1,a3� � � ISSUED.MV WORNE�RS'.C.wOMPEN ATION INSURANCE CAFRIER AND POLICV NUMBERME: . CONSTRUCTION ,p /� � CARHIER U�^��7 ` ' PLAN REVIEVJ 1�,�• 6�`� � POLICY NUMBER DCA d,�2S ^ 2JU(O ELECTRIC Q �rr{ss[crnr+r�rioreE�nwere�oFn�aEw�nrr�sFoaor�er�moalaas�siroloa�Ess} PLUMBING � w � MECHANICAL Z I CEHTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED,I C}' SHALLNOT EMPLOV PNV PERSON IN ANY MANNER SOAS TO 6ECOME SU&IECT TOTHE INSPECTION FEE � WORKERS'CAMPENSATION LAWS OF CALIFORNI/�AND�GREE TMAT IF I SHOULD BECOME � SUBJECTTOTNEVJOFKERS'COMPENSATIONPROVISIONSOFSECTION37ooOFTHEUBOR �SSUANCE � � COO£.�SHALL FnORTHVfITH COMPLV WtTH THOSE PRDVIS��S� � p DATE.��.`��,APPLICANT: ��,�Z� �SMIP � � w ENERGY P/C �S� S� J WARNIN�:FAIIURE TO SECUflE WOR)(ERS'COMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE J \,8 ,34- � SUBJECTANEMPLOYERTOCRIMINALPENAITI£SAN�CIVILFWESUPTOON£MUNDREDTHOUS+WD ENERGYPERMIT DOLURS(flao.000).IN ADDITION TO THE COST OF COMPENSATION.DAAIAGES AS PROVIDED FOH�N �+�`A'l J SECTION]708 OF THE LABOR CODE.iNTEREST,AN�ATTOFNEV'S FEES. RETENTION FEE: �� . Q w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a � ��JZ l-3-Q � � 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUC710N LENDINO AGENCV d FOR THE 7ERFORMANCE OF THE WO FOR W ICH TMIS PERMIT IS ISSUED(SEC.7087,C�V.C.). - Z ,f w fdA d � � LEN�ER'S NAME N � LENDER'SAD�RESS ^Q • � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT hIE ABOVE INFOfU/ATK1N IS CARRECT. TOTAL FE ES Ild(,o'� . '_C',O pZ��a. w 1 A�REE TO COMPIY WITH ALl CIN PND COUNT'ORDINANCES AND STATE IAWS PELATWO TO BUILDINQ � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTV FOF INSPECTION 7URPOSES. . COMMENTS � E..x�cr.��• �'�~�' m PE NM�Et� � ,�g._ �\ A /�[;c ZS,'Z,O i 1 (c $ � sia RE OA7E RECPT.NO. PND BY ��VALIDATION 2 � WHITE—DepaAment CoPY.YELLOW��ance Copy.PINK—Assessor Copy.CiOLDENROD—File Copy.GREEN—Applicant's Copy t � . CI�V OF Di�,iViON� �AR � I�S��EO� �3�COF6D .i1�p��1 �� _ � ��-{[� f��,�,-,� n 'UIRJ�JIY��VU�J D '� �� ULfU�V�tSI�U LJ� U�� p ��.: a: =r � m.e a�>>; - 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 �a ' FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC _ � _�� ROUGH GRADING ROUGH PLUMBING ��u FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EX .'�i -I� �� POOL FENCING WALL INSULATION PDOL FINAL CEILING INSULATION l 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 CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC �� DEV. FEES PAID FINAL PLUMBING ENERGY C��i'1 C�OC�� ' �p � - - — COMMEIVTS _PAR�iA� FR�� T�E�a3 cSR��/�-� �(��—�.�t-�-A 4 L.��C�r�.�S�� —�� v G�- � �- � i ��/��lt—��cL�Jt1�— l,�.�G�--�'-v'��--�–t N �-�►— — - a.� �— �+n��"��K� -�`�►� �° �`' : ��—� �t � td��-��pruv�� i�es7', r a(l�l i, _ " F �-�.�,wk��_ �s�Ur�_�.��— ►- � �� -9-��- � SEPTIC TANK SIZE SEEP PIT/U SIZE a � a � �� a . �^ _�.�_ CITY OF DIAMOND f3AR . DEPARTMLNT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 Copley Drive,Diamond Bar,CA 91765 PRESS � "� (909}839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ��°+W BUILDING PERMIT APPLICATION � FIRMLY � JOBSITE APPLICATION PERMIT P/C oADDRESS � � O�O �� SQRII��S DATE NUMBER # o ISSUE � � TYPE OCC `r APN LOT TRACT DATE CONST. GROUP I p OWNER 6��- �� , ,L � ZONING S CKS 0 ADDRESS S�2- 1`� �J =�\ FRONT RW ❑ ZIP L TEL. g APPLICANT �'rw TE�. c-..�1 ?5�1"L'Z� S DFJSIDE STREET RW ❑ ¢ CONTRACTOR ��D��p'� SIDE � oADDflESS ZZ(IS P4ACL�2l?U�� -�"� PROPOSED USE �� R�SI@^f '�UITZ.G�LfT cin �.Tt�.�{Ac.c._ ziP� TEL E�CoI ZS�(3Z( .�..�,,,"��_ o ARCH/ENG/ , �r�,� g_u� � z DESIGNER NO.DWEL. NO. NO. � ADDRESS � UNITS STORIES BEDROOMS � CITY �A+S��`xA� C'�►- ZIP 9t(o� TEL. - ' � DESCRIPTION S�.FL FACTOR PSF AOJ.AREANALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/REM I O I � I HEREBY AFFIRM UNDER PENALTY OF VERNRV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GBfeQB/CBfPOf1 W CENSEUWFORTHEFOILOWINOREA50N(SEC.70.3t.6BU51NE5SAN�PROFESSION9CO0E:ANYCITVOfl (n . U COUNTVWHICMRE�UtRESAPERMRTOCONSTRUCT,ALTER,UAPROVE.DEA10LI5H2ORREPAIRANYSTRUC- w P0tI0/DBCI( wNRE,PRIOR TO ITS i55UANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED � STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CANTMCTORS LI- � CENSE UW(CHAPTER e(COMMENCINO WITM SECTION 7ao0)OF DIVISION 30F TML BUSINE55 M1D PRO� � POOUSPB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEOEDE%EMP� TqN.ANV VIOLATION OF SECTION 7a31.5 BV ANY APPLICANT FOR A PEW.�IT SUBJECTS 1}IE APPUCAN7 TO Z R8-ROO� � A CML PENALTV OF NOT MOFE THAN FIVE HVNDRED DOLIANS(f500).): 0 ❑I,ASOWNEROFhIEPROGERTY.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOAIFENSATION, � COfI1fIlBfCIBI Z WIIL DO THE WORK.AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.70u,6U51- J N NE55 AN�PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT AP7LV TO AN OWNER OF ? PROPER7Y N?IO BUILOS OR IM7ROVE5 THEREON,AND WHO DOES SUCH WOFK HIMSELF OR HERSELF OR m Q iHNOUGH HIS OR HER OVM EM7LOYEES,PROVIDED THAT SUCH WPROVEMENTS ARE NOT INTENDED OR QOFFEREDFORSALEIF,HOWEVERTNEBUILAINGORIMPROVEIAENTISSOIDW�THINONEVEAROFCOMPLE- Z TION.THE OWNER-BUILDEF W�LL HAYE THE BURDEN OF PROVWO THAT HE OR SNE DID NOT B111L0 OR � IMPROVE FORTHE PURPOSE OF SALE). ❑I,AS OWNER OF THE PROPEHTV,AM EXClUSNELV CONT W.CTINO WffH LICENSED CONTHACTOFS Q TO CANSTRUCT THE PRQIECT(SEC.�ON.BUSINESS AND PROFESSIONS CODE:THE CONTRACT00.5 LI- V8IU81t0� ADJ.AREA � CENSE UM�DOES NOT APPLV TOAN OWNER OFA 7POPERTV WFIO BUILDS OR IMPROVE9 THEREON,AND y.TqCOMRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE � Y TORS UCENSE LAW.). O �I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS HEASON � � Q � DATE OWNER U Z W � LICENSED CONTRACTORS DECLAAATION -� � W I HEREBY AFFIRM UNDER PEfULTV OF PERJUfiY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Vr d D(COMMENCIN(i WITN SECTION�000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS COOE,AND � X 1AY LICENSE IS W FULL FORCE AND EFFECT. m LLI ♦ � � LICENSE CLASS 7�� IIG.NO. O l Z � � J V DATE OL�T �_�CONTHACTOR a W [� � WORKERS'COMPENSATION DECLARATION � N. V � i HEREBY�FFIRM UNDER FENALTY OF PERIUAY ONE OF TNE f-0LLOWING DECURATqNS: ZQ � _I NAVE AND V.�LL MAINTAIN A CERTIFICATE OF CANSENT TO SElFINSURE FOR WORKERS' S Q C',OMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PER WRMANCE w � OF THE WORK FOR NM1iICH THIS PERMIT IS ISSUEO. � � � W 1 HAVE AND WILL MAINTAIN WORKERS'COAIPENSATION INSURANCE.AS REOUIiiED BV SECTION Q 3700 OF THE LABOf1 CADE�FOR THE PERFOqMANCE OF THE WORK FOR WHICH THIS PERMIT IS � ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION j CARRIER s`T147�� _ PLAN REVIEW _T �� POLICYNUMBER ''Z„�a'� �'�' � 7d�fl ELECTRIC 0 Rrussccnor+r+E�r+oreE�rEooFn��aHrr�sr�oaae+EMan�+moo�l�a�(siool°R��ss). PLUMBING W MECHANICAL ' Z I CERTIFV THAT IN THE PEAFORMANCE OF THE WORN FOF WHICN THIS PERMIT IS ISSUED,I (� SHALL NOT EMPLOV ANV 7ERSON IN ANY AIANNEP SO A$TO BECOME SU6JECT TO THE N WORNERS'COMVENSATION LAWS OF CALIFORNIq AND�OREE THAT IF I SH ECOME INSPECTION FEE SUBJECT TO THE WORNERS'COM7ENSATION P ONS OF SECT 7 OF TPIE LABOR ISSUANCE s COOE,�SHALL FORTHWITH COA1PLv WITH THOSE PRO 5. � �yTw � DATE: �L%J�� ICANT: SMIP w ENERGY P/C J WARNINO:FAILUFE TO SECLRE WORNERS'COMPENSATION COVERAOE IS UNUWFUL.AND SHALL BE J SUBJECT AN EMPLOYER TO CRIMINAL PEMALTIES ANO CNII FWES UP TOONE MUNOHED TMOUSMIO � DOLLAHS(f1a0.000),�N/�DDITION TO THE COST OF CAMPENSATION.DAMAGES AS PROVIDED FOR IN ENERGY PERMIT J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTOHNEI"S FEES. �'1ETENTION FEE: . Q w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: d O � 1 HEREBV AFFIRM UNDER PENALTV OF VERJURV THAT THERE IS A CONSTRUCTION LENDINa AGENCV FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC.70G7.CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRESS � I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE�NFORMATION IS CORRECT. TOTAL FE ES w I AGREE TO CAMPL�WITH ALL CITV AND COUNTV OROINANCES AND S7ATE UWS FlEUTING TO BUILOIN6 � CONSTRUCTION.AND HEREBV AUT1iOR2E REPRESENTATIVES OF THIS CWNTV TO ENTER UPON THE ZABOVE-MEMIONED PROPERTY FOR INSPECTION PU aosEs. COMMENTS ' o �'�� J � m PERMI NAME(PRI � � C�C- � 20�� a RE q DATE RECPT.NO. PAID BY VALIDATION � WHITE—DepaAment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,GREEN—ApplicanPs Copy CBTV O� DI�►MOND ��,R ' ' . I�1S��'10� �ECORt3 oa�p��400a oa�� oa�p�c�4oa aa�pc��ooa . a��. da D�� _�� - � _ D , o.. O �� O D � O . � 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 BOND BEAPA WATER SERVICE MID H'T. BOND BEAM ROOF SHEATHING �—{ � 8 FT. BOND BEAM FRAMINGNENTILATION ��1 1�. � FINAL BOND BEAM ROOF COVER ( PRE-GRADING ROUGH HEATING BENCHING R�UGH 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 CONST. l FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL PLUMBING 1 ENERGY C�fdCf�C� l COIVIMEiVTS , - � `' / �. . - - v�� - �1 (��,� K4-1L� 7-_l_�r+i�—_�__,/e-��G-��' — i` 1 ` ` \ SEPTIC TANK SIZE SEEP PIT/U SIZE a , e� � � � : t°', .