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Home My WebLink About12-780�� `� • , :^ _�R� CITy�OF DIAMOND BAR ��y��'��3 - ` � 1a DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ; � � • , � . 21810 Copley Drive,Diamond Bar,CA 91765 � , (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��'""'. BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE f�JI I �� '�JCDc:lU �P�f�S � DATE CATION _ NUMBE � #/�7l� �-181� ADDRESS� L� G�� \$ I a. � � ISSUE TYpE �, pCC APN L.�OT Q TRACT DATE CONST. GROUP p OWNER Lf,�.f r.� � �/ �` ADDRESS ZONING SEfBACKS 0 z CITY ZIP TEL. FRONT p�/y p � APPLICANT TEL. REAR p 0 � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS ' � CITY ZIP TEL PROPOSED USE t � � � w ARCWENG(.r,A^,A Z �,tf,�(�� fLJ�a ` �zDESIGNER�C INI/`t NO.DWEL. a ADDRESS NO. NO. v� UNITS STORIES BEDROOMS � CITY . ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' Q �OWNER-BUILDER DECLARATION SF ADD M O p I HEREBV AFFlRM UNDER PENALTY OF FERAIRV THAT 1 AM IXEMFT FROM iHE OONTRACTORS LF C,eragelCarport W CENSEUWFORTHEFOLLOWINOREASON(SEC.70.11.6BUSWESSANbPROFESSiON3CO0EM1YG7VOR (� U COUNfYWI{Ip{qEpUIRESAPERMITTOCONS7RUCT,ALTER,lMPpOVE,DEMOLISH,ORREPAIRANYSTRUG W � W TURE,PRIOR 70 ITS ISSU/JlCE,AL50 REWIRES hiE APPLICANT FOR SUCH PEAMIT TO FlLE A SIOHED W P8f10/DBGk � S7ATEMENT THAT HE OR SNE IS LICENSED PURSUANT TO THE PROVI&ONS OF THE CONTMCTOAS LL LL . � CENSE UW(CHAPTER Y(COMMENCWO WITH SECTION 7000)OF DIVISqN]OF TME BUSINESS AND Pq0- Pool/Spe fE551DNSCOO�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLE6EDE%EMP- � C7 , � TION.ANY VqLAT10N OF SECTION 7031.5 BV ANV APPLICANT�FOR A PERMIT 5U&IECT37HE ACPLICANT T0 Z RB-ROOI F ACIVIL PENN.7Y OF NOT MORE 7HAN.FNE HUNDRED DOLURS(f60D).�: ❑I,ASOVlNEROFTHEPROVEHTI;ORMYEMPLOVEESWITHl4A0ESASTHEIR50LECOMPEN5A7qN, � � COrtIrtIBlCI81 Z WILL DO THE WORK,AND TiE STRUCNRE L4 MOT INTENDED oq OFFEREO FOR SN.E(SEc.7oa�,BUS�- J � "� NESS ANO PROFESSIONS COOE THE CONTRACTORS UCENSE�UW DOES NOT APPLY TO AN OWNER OF ` � 7ROPEHfYWFiDBUILOSORIMPROVE9THEREON,MID'NIIODOESSUCHWORKHWSEIFORHERSELFOR � T ' � TNROUGHWSORHEROWNENPLOVEES,PROVIOEDTHATSUp1WPROVEMENTSARENOTIMENDEDOR m ` /. Q OFFQiIDFORSALEfF,HOWEVER7/iEBULDINOORIMPROVEMEHiISSO�DWfTWNpF1EVEAROFCONPLE' �1\O� �+C1J •.C>'\C � �C� ,0 . T10N.TME�OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR 9HE DID NOT BUILD OR ' � � WPROVE FOR THE PURPOSE OF SALE). " I O L G - � �� '� O.. W OI,RSOWNEROFTHEPROPERTV,'AME%CLUSNELYCONTMCTIN(iVlfiHLICENSEDCOMTRACTOpS q � TO GONS'fRUC7 THE PR0.IECT(9FC.7a11,BUSINESS AND PROFESSIONS COpE:THE CONTMCTORS LI- V81U9f10l1 ✓ ' W CENSE UW DOES NOTMVLV TOAN OWNEFi OFA PROPERTYNM1ID BURDS OR IAIPROVE3 THEREON,AND ' � YAIOCOMMCTSPoR9Upi7R0.1ECf5WITHACONTRACTOR�S)LICENSED7URSUAMTOTHECONTRAC p�qp�7�7y DESCRIPTI T00.5 LICENSE UW.). FEE � � ❑IAM E%EMPT UNDER 6EC. - B.d P.C.FOR TWS REASON � ' ' O(J �� U LL DA7E � OWNER � � Z U � UCENSED CONTFACTORS DECLARATION � ./ �. � � � � � �.0 _ r I HEREBY AFFlRAI UNDER FENALTY OF PERNRV TNAT IAM LICENSED UNDER PqOVIS10NS Of CFIAPTER � �J � Y(COHMENCWO N77H SECT � 7000)OF DIV4510N 7 OF TNE BUSINESS AND PflOFE5510N5 CODE,AND Z L+ ' O MY LICENSE IS IN FULL FO AND EFFEC7. �/ v_ — ^ "�') � f . 'L / � LICENSE CLASS LtC.NO. � V DATE I COMRACTOR d . . � , , . W � � WORKERS'COMPENSATION DECLARATION Q � � I HEREBv AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: ' Z � ' . � _I HAVE AND WILL/.WNTAIN A CERTIFlCATE OF CONSENT TO SElFaNSURE FOR M/ORI(ERS' , - Q CAAIPEN511TqN,�,4 PROVI�ED BV SECTION 37o00F THE LABOR CODE,FOR THE PERFORMAHCE �� Q OF THE WORN FOR WHICl1 THIS PERMIT IS ISSUED. � . . . Qw _I HAVE AND WLLL AUIMAw WpqKEq3•COMpENSATION INSURANCE;A9 REWIRE-0 BV SECTION 370o OF�THE LABOR CODE,FOR THE PERFORMMICE OF THE WOAK PoR WHICli THIS PEHMR IS +�� 4V �� ISSUEO.MV WORKER5 COIdPEN5AT10N INSURANCE CAARIER'AND.POLICY NUMBER ARE CONSTRUCTION� \ jCARWER PLFW REVIEW �4"�t'O . a�t" I ' �' � I Z ca.icr NUMeEa ELECTRIC t . ¢ o (nuss[cror+r�wraeoor.q�r�ocn+eaaxtrswaor��+uror�ooaupsR�ao)oa�ss} �' PLUMBINO _O w Z 1 CERTIFY TMAT W hiE PERFORA/ANCE OF THE.NpRK FOR WHlpi 1 HIS PERAl1T IS ISSUEO.1 MECHAIJICAL 'Z. � SHALL NOT EMPLOY ANY VERSON M ANY MANNER SOAS TO BECOME SUBJECT TO TNE � � � WOPo(ERS'CAMPENSATqN LAWS OF CAIIFORNIti AND AGREE THA7 IF I SHOULD BECAME INSPEC710N FEE SU&1 T TO E WOPoCERS'COMPENSATIDN PROVISIONS OF SECTION 97a0 OF THE LABOR �- � � � 7 OE s warriwirH coua�r wm�niosE aaohsw�+s. ISSUANCE I _Q p DATE PPLICAN7:� .SMIP . . . .. .G�a �� W ENERGY P/C � . � / . � � ' � WARNW4 FAILURE TO SECURE WORKERS COMPENSATqN COVEMGE IS UNLAWFUL,AND SHALI BE . � SU&IECT AN EMPLOYER TO CRIA1 WAL PENAlTIES M1D CML FINES UP TOOHE HUNDRED THOUSAND ENEROY PERMIT ��{..�'�'�' X C7� DOLLAHS(5700,000),W ADDIMIN TO THE COST OF COMPENSATION,DAM�GES AS PROVIDED FOR IN J SECTION 370E OF THE LABOR CODE,IMEREST,AND ATfORNEY3 FEES. � � � � � � � ¢ . _ � RETENTION FEE: � r✓ ,C7� O� . CONSTRUCTION�LENDING AGENCY .�" Ap_q�T FEFj. � _ � � PO � 1 HEREBV AFFlRAI UNDER'PENALTV OF PERJURY THAT THERE U^A CANSTRUCTION LENDWO AOENCV (� �''l� '�' � FOR TME PERFORAIANCE OF THE WOFK FOR NTilCi1 THIS PERMIT IS ISSUED(SEC.70W,qV.C.�. �""'�� . Z W �� LENDEF7S WNIE . . . . . . . . � LENDER'SADDRE55 r � w- ICERTIFYTHATI�HAVEREADTHISAPPLICATIONANDSTATE�TiATTHEABOVEINFORMATIONISCORHECT. TOTAL FEES� , J�� • �� ` �� I AOREE 70 COMOLY WITH ALL CT'AND COUNTY ORDWANCES AND STATE lAWS REU7W0 TO BULLDINO � � CONSTRUCTIOIy AND HEREBY AUTHORIZE REPRESENiA7NE5 OF 7HI5 COUH7Y 70 ENiER UPON iHE - Z ABOVE-M_=�P � E�SPECTI N_J�G_��-��R� o COMMENTS� �C�Y� S Qr- �'� � J' � � m PERMI77EE NAME(PRI/fn ' � � � � � 9 b IZ p�G �� a �� SIONATURE OF PERMRTEE pA � � � RECPT.NO. PAID BY O VALIDATION WHITE-Department Copy,YELLOW—Flnence Copy,PINK—Assassw Copy,GOLDENRO le Copy,6REEN—Applkant's Copy � • , CITY �F DIAMOND C�AR � ` �'k ,�-- ' ., " ' . ` . . , • . INSPECTION RECORD . � �. �'�� .� ' :.,�' --�� '� ��..; �. . o . A ... �� . ,., .., o. 0 �, ' ..o , .� ..s SET BACK ;FLOOR JOIST FTGS/FORMS/STEEL � t�' ' d fHA REQMTS ELECTRIC GROUND � �� UNDER FLOOR DUCT GR�UND PLUMBING - UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUtVDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT.BOND BE,4M _ ROOF SHEATNING 8 FT.BOND BEAM fRAMING/VENTILATION FIPlAL BOND BEAM ROOF COVER PRE-GRAQING 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 I!JSULATION OFF SITE IMPS. DRYWALL NAILING �d ti. DEDICATIONS - SEWER FINAL ENG. SEPTICTA(VK � LANDSCAPE/IRRIG. 5EEP PIT/L.L. Old SITE IMPS. GAS AIR TEST FINAL 20NING FINAL CdNST. FIRE DEPT.FINAL FINAL HEATING HEALTH DEPT.FINAL . FINAL ELECTRIC DEV.FEES PAID FINAL PLUMBING ,'' ENERGY FINAL PLANING __�O �� ' FINAL ENGINEERING ' • • �,. .,_.�....�._ ,,,� �� Q�,d�t� ��- ! r`G+/' �' COMMEh1T5 . � !-o � i . +�� j 'a-' .`� � , ("� �Lu �` ./ Q G a :� :�Z- , IG.�.�� ' � --- „ _�' ' b�'- � '� -�� .;-- �� -� �� , �,. � �. �� ►-t }—� -'. �,��- �b (-2.�� p/� ro Z A t, � �L �s � _ 'G�S � Q,ao a Z.. , SEPTICTANK SIZE � �. 4 b 1 d 2. SEEP PIT/U SIZE � , � �� . f U J� � �� i n..": � i .I� �: • L.;ic�"� �' �y , )6 6 �/�J ,�C . ai��v�►� �'.-�h�'►'�--��- r�l�l'� � , _�� W�.-�-•ro- -' i l �� `� . l � �_ '�• ,^ �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' �. 21810 Copley Drive,Diamond Bar,CA 91765 " � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �I ��''"'. BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE APPLICATION PERMIT p/C ADDRESS DATE NUMBER � � ISSUE 7yPE �C APN LOT TRACT DATE CONST. GROUP p OWNER p AODRESS ZONING SEfBACKS z CITY ZIP TEL. FRONT pyy � � APPLICANT TEL. REAR p ¢ SIDElSIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. a ADDRESS NO. cn UNITS STORIES BEDROOMS N CITY ZIP TEL. - � DESCRIPTION SQ.Ff. FACTOR PSF AW.AREANALUATION , � �OWNER-BUILDER DECLARATION SFR/ADD/REM O � p I HEAEBY AFFIqM UNDER�PENALTY OF PE0.)URV THAT I AA/EXEAIPT FROM THE CONTRACTORS LI- G8�0gB/C0lPOfl. W CEPISEUWFORTNEFd.LOWiNORE�SON(SEC.7Nt.6BU51NE5SANDPROFESSIONSCODE:ANVG7YOR (n � " � U COUNTYWHICHREOUIiiESAPEfU1RTOCONSTRUCT.ALTER�PROVE.DEMOLISH.ORREFNRANYSTRUD P8i10/DOCk W TURE,PRIOH TO RS�SSUUANCE,ALSO REpuIqES iHE APPIICANT FOR SUCH PERMI7 TO FiLE A StONED W STATEYEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVI51ON5 OF 7HE CONTMCTORS U. � CENSE UW(qUPTER B(COMMENqIJO WITH SECTION'lD00j OF DMSION 3 OF THE BUSINE59 ANU PRO- V- PooUSpa � - � � , Q FESSIONSCOOE)ORTHATMEOfiSHEISEXEMPT7HEREFROAIANDTHEBA515FORTHEALLEOEDE%EMP- (� V TK)N.ANVVIOLA710NOFSECTION7ait.68vMiYAPPLICANTFORAPERMITSUBJECT9THEMPLICANT70 Z Rg.R001 � ACIVp.PENALiY oF NOT MORE�7HAN ME MUNDRED DOLLARS(fSOD).j: Q ❑I,ASOWIJEROFTNEPROPEHiY,OFMYE1dPLOVEE9WITHYlAGESASTHEIRSOIECOMGENSATqN, � �mmerciat� - z WILL DO hiE WORK,AND TiE STRUCNRE IS NOT INTEN�ED OR OFFERED WR SALE(SEC.7o�I,BU51- �_J ' ' � NESS AND PROFESSIONS CODE:THE COHTRACTORS UCEN9E lAri DOES NOT MVLV TO AN OWNEp OF j '' PROPEHTY W/10 0UIL03 OR IIdPROVES THEREON,AND WHO DOES SUCF1 WORK HIAISELF OR HERSELF oR � 2 THROUGHHISOqHEROWNEMPLOYEES,7ROVIDEDTHATSUq11MPROVEMENTSMENOTINTENDEDOR CD � . LU �EqFpppqSALE1F,HOWEVER7HEBUGDINOORIMPROVEMFMIS;ALDWITMNONEYEAROFCOMPIE- 0 TION,THE ONRJER-BUIIDER WILL HAVE THE BURDEN�OF PROVINO THAT HE OR SHE DID NOT BUILD OR z IMPROVE FOR THE PURVOSE OF SALE} - � ' ' _ ❑I,ASONRlEROFTHEPROPEHTY,AMIXCLUSIVEIYCONTMCTINaWITHIICENSEDCONTRACTORS W . CC 70 CONSTRUC7 7ME PROJECf(SEC.7oaa,BUSINESS AND PROFESSIONS CODE:7HE�COHTRACTOR3-LI- V01Ufltbn� qp,�_qFjEq, ' LU CENSEUWDOESNOTM7LYTOANOWNEROFAPROPERiYYh108ULLDgOqIMPROVE67HERC-0N,MlD ' �� ' � NMOCONTRACT6FORBUCHPROJEC'f5WI7HACpfTMCTOq�S)LICENSEDVURSUAM707HECONTfUG pUANTITY DESCRIPTION � TORS LICENSE LAW.). FEE . � O I AM E%EA1PT UNDER 6EC. B.6 P.C.FOR THIS REASON � � U � DATE OYMER �F- 1, �¢ LICENSED CONTRACTORS DECLARATION �w � - 2 I HEREBYAFFlRAI UNDER PENALTY OF PERIURV THAT IAM UCENSED UNDER PROVISIONS OF Cl1APTER � � p� Y(COIIMENGNO WITH SECTION 700D)OF DMSION 7 OF THE BUSINESS AND PROFESSIONS CODE,AND Z, `X MY LI(��NSE IS Pl FUIL FORCE AND EFFECT. m 2 (G S � UCENSE CIASS LIC.NO. �� . V DATE CONTRACTOR d . , . _ . W � WORKERS'COMPENSATION DECIARATION . Q �� - � � � �� - - 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLIOWINO DECIARATqNS: � ' ' (� Z � _�NAVE M1D WILL NAINTAW A CERTIFlCATE OF CONSENT TO SEIF-INSURE FOR NqRKERS' � � � � � Q COMPENSATION,AS PROVIDED BY 6EC710N 370o Of THE LABOR CODE,FOR THE PERFOiU1ANCE W�� OFTifr WOfM FOq WHIC}I THIS PERMIT IS ISSUED. � � ' � � _�MAVE AND WILL AWNTAW.WORICERS'COMPENSATION INSURANCE;AS REOUIRED BV SECTION Q 3700 OF-THE LABOR CADE,FOR THE PERFORMM10E�oF THE WORK WR WFllpi THIS PERMR IS, ISSUFD.MV WOPo(ERS'COMPENSA710N INSURANCE CARRIER AND POLICV NUMBER ME: �CONSTRUCTION�� jCAARIER PLAN REVIEW . 0 POLICV�NUMBER ' . . . Zd ELECTRIC p (nass�cr�or+r+�IDwTe�mn��TmaFt�a�rswaor+E�ooun�R+oo1a+� PLUMBING ' w Z 1 CERTIFY hNT IN THE FERFORMANCE OF THE WORI(FOR WHICli THIS PERIAIT IS ISSUEO,1 �MECHANICAL' C� SHALL NOT EMPLOY ANV VERSON W ANY AIMlNER SOAS TO BECAME SUBJECT TO THE � (q WORNERS'COMPENSATIONLAWSOFCALIFORNIAMIDAGREETHA7IFISHOVLOBECAME INSPECTIONFEE� SUBJECT TO THE V10RKERS COMFENSATION PROVISIONS OF SECTION 3700 OF THE LABOR - -rj cooE,i sruu w�rr�n�coraa�v wm�nwsE arrov�sroNs. ISSUANCE � O p DATE: � APPLICANF -SMIP W J WARNW(3:FALURE TO SECURE WORKERS'COMPENSATION COVEqAGE IS UNLAWFUL,AND SHAI.L BE ENERGY�P/C J , � SUAIECTAN EMPLOYER TO CRIMUJAL PENALTIES AND CML FlNES UP TO ONE HUNDRED 7HOUSANp ENERGY PERMIT DOLLAR9(5100,0o0),�IN ADDITION TO THE COST OF CAMPENSATqN,DNM6E3 AS PqOVIDED FOR W J 6ECTION 3708 OF THE LABOR CODE,IMEREST,ANDATTORNEY'S FEES. � � ' � � W RETENTION FEE: O , CONSTRUCTION LENDING AGENCY � �PRE-ALT FEE � 1 HEREBY AFFlRM UI�ER PEW�LTV OF PERNRV THAT THERE IS ACONS7RUCT10N LENDMO A�ENCY � FOR 7HE PERFORAIANCE OF THE WOR1(FOR WH1CH THIS PERMR IS ISSUED�SEC.�3oW,qV.C.). Z W �� LENDERSNPME . . . . , h- LENDERSADDRESS ' . �� ICERTIFYTiATI�HAVEREADTHI9MPLICATIONANDSTATETHATTiEABOVEINFORMATIONI9CORRECT. TOTAL FEES � � 1 AQREE TO COMPLV WITH ALL C1TY AND COUNTY OqD WANCES AND STATE UWS REU7 W6 70 BUILD WO � , � CANSTRUCTION,ANDHEREBYAUTNORIZEREPRESENTATNESOFTHISCOUNTYTOEMfERUPONTHE ' ' , Z ABOVE-MEMqNEDPROCERTVFORINSPECTIONVURPO5E5. COMMENTS ' 0 . J' � m PERMRTEE NAAIE(PRINn � Q � �/j SIONA7URE OF PERMI7TEE DATE � RECPT.NO. PAID BY VALIDATFON WHITE-Department Copy,YELLOW—Flnence Copy,PINK—Assessor Copy,60LDENROD--File C.opy,GREEI�Applk:anYs Copy � . . � , ' CITY OF DIAMOND BAR �. � � '. � '� INSO'ECTIOPV RECORD ' ' , .- � ..� _.� �.•.� � . ,�,� . �• �� ., '.�. , o � ` . ,.. �.� ." � ° -� Q o SET BACK FLOORJOIST_ FTGS/FORMS/STEEL FHA REQMTS __ ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BQND BEAM WATER SERVICE MID HT.BOND BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION 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 IIJSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS ' SEWER FINAL ENG. SEPTICTAtdK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. _ GAS AIRTEST I FINAL ZONING FINAL CONST. FIRE DEPT.FINAL FINAL HEATING HEALTH DEPT.FINAL FINAL ELECTRIC �DEV.FEES PAID FINAL PLUMBING i ENERGY FINAL PLANING FINAL ENGINEERING ' �• � -- COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE � ' • ��* CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' , ' 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��'°^'� BUILDING PERMIT APPLICATLON �. (Z� �gi �. FIRMLY ¢ DDRIESS� �� ( �� ISKJ�I�L 5�2��,,�j�'j APPLICATIO� , PERMIT p/C � o �v(d DATE I o�� I�e�l-- NUMBER q �o�-"'"�QgZ � ISSUE TYpE pCC APN LOT T CT DATE CONST. ��. GROUP p OWNER p ADDRESS ZONING SEBACKS z CITY �P EL. T FRONT pyy p � APPLICAN TEL. REAR p �� SIDE/SIDE STREET RW ❑ CONTRACTOR SIDE p o ADDRESS CITY ZIP TEL PROPOSED USE��i U(�� i�I�L ��.�'71/'rY�� /N oARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � �n DESCAIPTION TO ADJ.AREA/VALUATION p�� OWNER-BUILDER DECLARATION SFFVADD/REM � O p I HEREHY AFFlMI UNDER PEN�I.TY OF PERIURV THAT I AM EXEMPT FROM TME CONTRACTORS LL Garage/Carport W CENSEUWFORTHEFpLLOWWppEA5q1(gEC.7031.6BUSWESSANDPqOFES510N5CODEANI'CITYOR (n C-� COUNTYWHIGiREOWRESAPERM/TTOCONSTAUCT,ALTER�OROVE,DEMOUSH,ORRE7MHANYSTRUG W � w NRE.PRqR TO RS ISSUAHCE,AL50 REOUTAES THE ADttICAN�WR SUCH pERAl17 TO F1LE A SIONED w Patio/Dack � ' � STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS Ll � P / � � CENSE UW(CHAPTER Y(COMMENpN[i VATH SECTION 7000)OF�IVISION 7 OF T1E BUSINE59 AND PRD- POOUS 0 i/ � FESSqNSCOD�OqTHATHEORSHEISEXEMPTTHERFFROMAND7HE9A515FOfiiHEALLE4EDEXEMP- (� ` /� V TION.ANY VIOLATION OF SEC710N 7031.6 BV ANY A7PLICAM fOR A PERMIT 5U&IECT9 THE APPIICANT T0 Z RB-ROOI � � Z s ACML PENALTY OF NOT MORE THAN FIVE HUNDREO DOLLARS(fsoo).}. � ❑I,ASOWNEROFTHE�ROPERTY,ORMYEMPLOVEESWfTHWAGESASTHFJR50LECOMPENSATION, � CORIf118lCIaI � �1 Z MALL DO THE WOR1(,AND THE STqUCNRE IS NOT IMFNDED OR OFFERED FOR SH.E(SEC.7Ws,&15F J � NESS ANO PpOFES510N5 CODE THE CONiRACTOR3 UCENSE UW DOES NOT APPLV TO M!OWNER OF j PROPERiY W11D&11L0.S OH IMPROVE9 THEREON,AND WHO DOES SUCN WORK HIMSELF OR HERSELF OR � wTMROU(iH HIS OR HEROWN EMFLOYEE3,7ROVIDED 7NAT SUq1 INVROVEMENTS ME NOT INTENDED OR m � � OFFEREDFORS�LEIF,HOWEVERTHEBUIIDINOORIMPROVEMENTISSOLDM7TMNONEVEAROFCOM%.E• Z TION.TME OWNER�BUILDER WILL HAVE THE BURDEN OF VROVINO hiAT ME OR SHE OID NOT&IIID OR � 1MPROVE FOR TFIE PURP0.5E OF SALE} � ( W ❑I,AS OWNER OF 7HE PROPEHTV,AM E%CLUSNELY COHT{UCTIN(i WITH LICENSED CONTRACTORS Q TO CONSTRUC7 7}�E PRQIECT(SEC.7aa/,BUSINE55 MlD PROFESSIONS CODE THE CONTMCTOR3 U- V81U0�IOf1 • ADJ.AREA ' � W CENSE lAW DOES NOTMPIV TOAN ONMER OFA PROPERTY WFIO BUILDS OR NIPFWES THEREON,AND � NRIOCOHTRACTSFOFSUCHPRQIECTSWT7ACONTRACTOR(S7LICENSEDPURSUANTTOTHECONTRAG QU�nTr TORS UCENSE LAW.�. J Q ❑I AM E7fEMPT UNDEH SEC. B.6 P.C.FOR 7YIIS REASON Q .�? U LL DATE ONMER L— Z -- U � � LICENSED CONTRACTORS DECLAAATION W � I HEREBY AFFIRM UNDER PENALTY OF PERNqY THAT IMI LICENSED UNDER PROVI$Ipf15 OF CHAPTER � � Y(COMMENCENO WITN SECTION 7000)OF DIVISqN 30F THE BUSINESS NiD PROFESSIONS OppE,/UJp Z i L1J �LICENSE IS IN FULL FORCE AND EFFECT. m � UCENSE CLASS LIC,NO. j II V DATE CONTRACTOR � d i W � WORKEFS'COMPENSATION DECLARATION � � �i � U N 1 HERFBY AFFIRM UNDER PENALTY OF PERNqY ONE OF 7HE FOLLOW W6 DECIAAATqNS: Z �0 _IHAVEANDWILL�IAWTAINACEATIFlCATEOFCANSENTTOSEIF-INSUqEFORN9H1(ERS s1 � CONVENSATpN,AS PROYID�BY SEC7ION J7000F THE LABOR CODE,FOp THE PERFORMANCE l.7 Q OF THE WOH!(FOR NMICH 7HI5 PEAAUT 19 ISSUED. � . Qw _IHAVEANUWILLAWNTAWWORNERS'COM7ENSATIONINSUqANCE,A3qEWIREDBYSECTION J70o OF THE LABOR CODE,FOfl THE PERFORMANCE OF THE WORN FOR WHKS1 h115 PERAIIT IS �ssueo.r.nwoaxEns�ca,�v�rror+wsuwvaceawaEAuaovoucrraun�e��ae: CONSTRUCTION �G j �aER PL.AN REVIEW �1 S, ZO — 0 POLICV MUMBER Z ELECTRIC ¢ _ � (�*�sEcrarar�wrsemns�rmoFn+ev�w.rrsra�orieMxa�ooaluis�sivaea�Essl PLUMBING w Z �CERTIFY 7HAT M THE PERFORW.NCE OF THE WORK FOR WHlpl THIS GERMIT IS ISSUED,1 MECHANICAL ' CS SHALL NOT EMFLOY PNY PERSON W ANY MANNER 50 A3 TO BECAME SUBJECT 70 THE (/� WORNERS'COMPENSAT10NUw50FCAlIFORM1pNDM3REE71iA71F15HOULDBECOME INSPECTIONFEE SUBJECTTO THE WOAKERS'COMPENSA7IDN PROVISqNS OF SECTION a7o0 OF THE IABOR � cooE,i sruil roarHvnn�ca,ir�v winr n�wsE PAov�sar+s. ISSUANCE O p DA'T� APPLICANT. �SMIP W � WARNINO:FAq11RE TO SEQIRE WORKERS'COMPENSATION COVEMGE IS UNUWFUL,AND SHALL 8E ENERGY P/C � SU&1ECT AN EMPLOYER TO CRIMINAL VENALTIESlWD GVIL FlNES 4P TOONE HUNDRED TMOUSAN� �ERGY PERMIT DOLLAHS(5100,000),IN ADDITION TO TT1E COST OF COMPENSATION,DA1.1h�E5 AS PROVIOEU FDR iN ¢ SECTION 37oe OF 7HE LABOft CODE,WTEREST.AND ATfORNEY3 FEES. ' RETENTION FEE: O� CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � � 1 HEREBY AFFlRM UNDEH PENALTY OF PERIURY THAT THERE IS ACANSTAUCTION LENDINO AOENCV Z FOR THE PEAFORMANCE OF THE WOPoC FOR WHICN TMIS PERAUT IS ISSUED fSEC.3097.CfV.G} W � LENDERSNAME . F— LENDERSADDRE �1 � ICERTIFY IHAVER/ $ ,GmsT�renurn+e�eovewcow,ur�a+iscorwEcr. TOTAL FEES � IA6REET PLYWI OROWANCESMIDSTATEUWSfiELATWOTOBU0.DW0 � � CONST �ON,AND� E I RI E FRESEN7ATNE5 OF TH45 COUNTV 70 EHfER UPON THE , Z nBFSVE- ED PE TY � PE 7qN GUHPOSES CpMMENTS � � /: � m �RMI EE NAME(PRIt4T) ' ^ Q ��J I / / � N REOFPERNfffEE v �DATE' 1�� r�ca�o � 4�� RECPT.NO. PAID BY VALIDATlON WHfTE�epartment Copy.YELLOW—Finance Copy.PINK—Assessor Copy.Gp�pENROD--FlIe Copy;GREEI�Appl{canCs�Copy ' i ' �.w� 5 a� �i.`i�' �J 3 J�=a��F�,��j'i j+_� '9L.3a�l i d . � , �• ' . �7 V��"'��4,. 9,J Z.i�U�'i s"��'!,r'+.�•�f�i�� . � . ��r� r.i�`,�c�v.l Y �.,.'��r�{�� i= �� ;}{$��-��"'�1':.��...; _ _r.�:..�?—� �.�., - ��q�. .T,_ ?F:''ft.,. Lr["n :'�:t t't�` 5 ?�vc--T.�u, . ,� --.-r, - '=i� � k � "Y'M }j�' r �+—y.r,y �'2�'� 1 y*' Y`{Pix`� ��I'�v�-' x ��e`1 ti'i1.. '��j"��.� uI,� �IF�`��, I� �, '�"7 V� Y'1 `,� �' "�/' �+ �r 1� t 6;�,ti � ��I 1 ia:..,�`�'^rK�t+i�,�„��.+ 1`�:�Fh '.. ^^r��i��'7z`�SGI ,V� �s�e `.�J*1,h,,��..�� i�� x� s J� r�+i 7'^�--e:.F�n_p�� :S°I»��j� if: .-. � .. �,._... P �.�_ �t.��._�r 46- '.$�'+ �-`� �i i} � ;M�+ ,,xr_'-�'.� ''� �� . ' _�.,,�.:,' �.:,.;..�:�.....�� x _ , _4'_ SET BACK � FLOOR JOIST I �� --- . �-_.,_ �_�,.--- - _.. -- I_— .. _ _ __. ___ ____ _ __ _ _ ., _ . __.._. -- _. 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DR'lU�IALL Pd,41LING f DEDICATIOiVS SEV�/ER--------- --------- ----------- ,FIPIAL ENG. ------- -------------------- _----- ---------------- ' -------- ----.._..__-- SEPTICTANK _ _ _ _ __ _, LANGSCAPE/fRRIG. __ SEEP PIT;L.L. ON SITE I�V1P5. GAS AIR TEST Ff NAL ZONlNG FINAL C�NST. �fIRE DEPT.FINAL FIhJAL HEATING �HEALTH DEPT.FINAL � — FINAL ELECTRIC DEV.FEES PAID FINAL PLIJP/IBING EMERGY FINAL RLANING FINAL E�JGII�IEERING . "p �� — COMMENTS SEPTICT�NKSIZE _ . SEEP PIT/U SIZE - �1 a �.�` . 3 , . ! F..,