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Home My WebLink About17519 (25) - . ,� , : . , � �G� �t�.lR`�Y 1� �-4 �u ��/l , _�� CITY OF DIAMOND BAR � DEPARTIvIENT OF COTRvIUNITY&DEVELOPIviENT SERVICES C� ,' �. � _. '"�.'�-V�, � 21825 E.Copley Drive /� - (909)860-3195 Fax(909)861-3117 � 1F�(� PRESS "'-9�'�.w BUILDING PERMIT APPLICATION ��3 �' FIRMLY � JOBSITE �D(�Q �O/�'�/ �>,��I f �. DAPE CATION � �r��•CjINUMB R �J � q/C I o ADDRESS � ISSUE TYPE �� OCC APN LOT TRACT DATE CONST. GROUP p OWNER I o ADDRESS a D �(/tT . (Z,p ZONING SETBACKS z CITY � IP TEL /` FRONT qyy ❑ � � APPLICANT TEL. t� .' REAR ❑ �� SIDE/SIDE STREET RW O CONTRACTOR SIDE ❑ ADDRESS � � � CITY ZIP TEL. PROPOSED USE " L w ARCH/ENG/ /, n / z DESIGNER rl //�.5 C,�N a ADDRESS NO.DWEL. NO. _ NO. � CITY ZIP ' TEL� - UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLAAATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTY OF PERJUHV THAT I AM E%EMPT FROM THE CANTqACTORS U- G9f8J0/CBfPOff W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.6BUSWESSANDPROFESSIONSCODE:ANYCITVOR (n C-� COUNTVWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANVSTRUG w W NRE,PRIOR TO ITS ISSUANCE.AL50 REOUIFES 7HE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED w P8�10/DBCI( � STATEMENT h1AT HE OR SHE IS LICENSED PURSUANT TO hIE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PRO- LL POOUSPB � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP� (� V TION.ANV VIOUTION OF SECTION 70.31.6 BV ANV APPLICM7T FOR A 7ERMIT SU&lECTS TNE APPLICANT TO Z Re-Roof A CML PENALTV OF NOT MORE THPN FNE HUNDRED OOLLARS(f60U).): � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATKKJ, � COrt1rt18�C18I ' Z WILL DO THE WORK�ND THE STRUCTUHE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI- J N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTY WFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF Oq HERSELF OR CC THROUOM HIS OR HER OWN EMPLOVEES,PF70VIDED h1AT SUpi IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,THEBUILDINOORIMPROVEMENiISSOLDWITHINONEYEAROFCOMPLE- Z TION,h7E OWNEREUILDER WILL HAVE THE BURDEN OF PROVINO iHAT HE OF SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERlY,AMEXCLUSNELVCONTRACTINGWRHLICENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE CAMRACTORS LI- VBlllaflOfl ADJ.AREA W CENSEUWDOESNOTMPLVTOANOWNEROFAPROPEflTVWHOBUILD50RIMPROVESiHEREON,AND � WHOCOMMCTSFORSUCHPR0.IECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTMC- QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR 7HIS REASON Q 2� U � DATE OWNER ¢ Z U ' �Q LICENSED CONTRACTORS DECLARATION W 2 I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MY LICENSE IS W NLL FOPCE AND EFFECT. m ' 0 LICENSE CLASS LIC.NO. � V DATE CONTRAGTOR a W � WORKERS'COMPENSATION DECLAAATION � � U � I HEREBV AFFIRAI UNDER PENAITV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a 2 Q COMPENSATION,AS PFOVIDED BV SECTION 37aa OF THE LABOR CODE,FqR THE PERFORMANCE U OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED. w � � w _I MAVE AND WILL MAIMAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIFED BV SECTION Q 37000F THE LABOR CODE,f-0R THE PERFORMANCE OF THE WORK FOF N711CH THIS PERMIT IS � ISSUED.MV WORKERS'COMPENSATJLIN INSU�CE C RIER�P�CY NUMBER ARE: � CONSTRUCTION J j CAARIER � � �' PLAN FEVIEW Z POLICV NUMBER \ ELECTFIC Q 0 (iHISSECTqNNEIDNOTBE07R�LEfIDOFTHEPEPMTISFO{iONEFiIN�REDDOLLARS(flao)ORL,ESS} PLUMBING �Q w Z I CERTIFV THAT W THE PERFORMANCE OF THE WOf7K FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL C.�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50AS TO ECOME SU&IECTTO THE (n'� .WORKERS'COMPENSATqNUWSOFCALIFORNIAANDAGRE THATIFISHWLDBECOME . INSPECT�ONFEE SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSO SECTION370o0 LABOR � l`� OCADE.I SH OR7HWITH COMPLY WITH T SE PROVI510 . ISSUANCE ) p DATE: � O AP SMIP W J WARNING:FAfLURE TO SECURE WORKERS'COMPEN TION VERA E IS UNLAWFU�M!D SHALL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESlWDCIVILFINESUPTOONEHUNDFEDTFKKISAND ENERGYPERMIT DOLLAAS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR1N J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. O w RETENTION FEE: ��^� O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THATTHERE IS ACANSTRUCTION IENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PEFMIT IS ISSUED(SEC.a08],GV.C.). E Z W � LENDER'S NAME H LENDER'SADDRESS � I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TQT�E�� `I _� .G O�O �, S � w I AOREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCESAND STATE UWS RELATIN�TO BUILDINO ` I�� J � � Y� CONSTRUC710N,AND HEFEBY AUh10RIZE REPRESENTAT VES OF THIS CAUNTV TO ENTER UPON THE � Z ABOVE�MEMIONED PROPERTV FOR INS TION PUR ES. COMMENTS � �' // / � ' ¢ PE 1 EE NAME(PRINT) v� �O � 0 -, . ,� � , � SIONAT RE OF PERMI DATE � = RECPT.NO. J PAID BY L� VALIDATION � � ~ WHITE-0epartment Copy,YELLOW—Finence Co PINK—Assessor Co GOLDENROD—File Co GREEN— - PY. PY. PY. ApPlicanYs CoPY i� f•�•:Ji'.i�. \ �./t, -,r-,�. �Lr�-tl-�'V �� 4 Juvll�.dY�1�,�UU�i i�� (�I��C�'��'l.Pi�C��V�{L9� , � :� . . , .,,� � U � �' I ��C U��J"�riS '.. _ `f °�U � a W � '� t ' p � SET BACK � - FLOOF�JdiSTi FTGS/FORMS/STEEL � � FHA�tEQMTS ELECTRIC GROUND ^ UNDER �LOOR DUCT GROUND PLUMBING UNdER FLOpFi�U�IDUIT SLAB GRADE FIREPLA�CE F D TION TEMP POWER FIREPLRCE BOND BEAM WATER SERVICE MID HT. 80NQ BEAM ROOF SHEATHING 8 FT. B�ND BEAM FRAMIfVGNENTILIATION FiNRL B�ND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHIIVG � �� `' ROUGH ELECTRIC ROUGH GR�DING ROUGH PLl1MBING � FW1SH iaRADING SHOWER/TUB TEST PDOL ELECTRIG EXT. LATH/SIDING POOL F�NCiNG WALL INSULATI(�N POOL FINAL. CEILING IIV�ULATION OFF SITE IMPS. DRYWALL NAIL{NG � DEDICATIONS SEWER �INAL ENG. SEPTiC TANK ' LANDSCAPE/IRRIG. SEEP PIT/L,L. ON 5lTE IMPS. GAS AIR TEST ��j Z F1NAL ZtJIVl�1G FINAL CONST. �� FIRE DEPT. FINAL FINAL HEATIIVG f � � HEALTH DEF�T. FiNA� FINAL ELECTRIC � DEV. FEES PAID FIN�AL_PLUM`ING %�� L, �� EN�RGY �� °�..� C��{��S -. - � - ,...._._.._._._._ __ _ — -- - - - -- - �- �� D Z ��eC_��v� � t-�.,- -- ��, A �'-��b �. �T C t/��t�-��D—�-e--- � c:�- c/ __�_ - -- �/ �i Z n�cst� � Cl�' �i``-��2 ____— �' l3 v 2— �1��D �_' . ��_^��-rz-- �'r1�___��!v�T /Q�=,- ��.�=t. � . SEPTIC TANK SIZE SEEP PIT/U S(ZE � � � �� '[�s '�.�� , `, � � -- _�,. : �,, � . .t. - o � • ;•' 1� ••� � � .. � I .`' � , .. �,Y .