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Home My WebLink About17717 (39) CTTY OF DIAMOND BAR � `---��---- DEPARTMENT OF COIvA�UNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive '�- (909)860-3195 Fax(909)861-3117 � �� I� PRESS ��<��+ BUILDING PERMTT APPLICATION FI RM LY ' I � JOBSITE /� APPLICATION `] PERMIT P/C o ADDRESS�� V� DATE ��NUMB # I � ISSUE TYPE OCC APN LOT TR`,A,C.T' DATE CONST. GROUP p OWNER AYAQI��STG/�i � o ADDRESS ZONING SETBACKS z CITY ZIP TEL. -D FRONT Ryy p � APPLICANT i . TEL. REAR ❑ ¢ SIDE/SIDE STREET RW ❑ � CONTRACT SIDE ❑ ADDRES � CITY ZIP T , PROPOSED USE oARCWENG/ iz DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIURV 7HAT I AM E%EMPT FROM THE CONTRACTORS ll� G8f8gB/Cflf�MfS W CENSEUWFORTHEFOLLOWINOHEASON(SEC.7031.5BUSINESSANDPROFESSKKJSCODE:ANVCITVOR (n C.� COUNTYWHICHREWIRESAPERMITTOCONSTAUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTAUG W Patio/Deck Z NRE,PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w w STATEMENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI- 0� CENSE LAW(CHAPTER e(COMMENCINO WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPB FESSIONS CODE)OR THAT HE OR SHE IS E%EMPTTHEREFROM AND THE BA515 FOP THE ALLEOED EXEMP- (� V TION.ANV VIOLATION OF SECTION 7031.6 BY ANV APPUCANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Root A CIVIL PENALTV OF NOT MOHE THM!FIVE HUNDRED DOLIARS(f5a0�.): � ❑I,ASOMMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAQESASTHEIRSOLECAMPENSATION, � COrtIffI01Ci81 � Z WILL DO THE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE�(SEC.7Wa,WSI� J N NESS AND PROFESSIONS CODE:THE CANTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPEHTY WF10 BUILDS OR IMPROVES THEREON,AND N710 DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVERTIIEBUILDINOORIMPROVEMENTISSOLDWITMINONEYEAROFCOMPIE� Z TqN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOH THE PURPOSE OF 5/�LE). w ❑I,ASOWNEROFTHEPqOPERTV,AME%CLUSIVELVCONTRACTINOWfTHLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.701�,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI� VBIl19N0l1 ADJ.AREA W CENSEUWDOESNOTAPPIYTOANONRJEROFAPROPERTYN?fOBUILD50RIMPROVESiHEREON,AND � N?1000MqACTSFORSUCHPRQIECTSWITHACANTRACTOR�S)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). . 0 ❑I AM E%EMPT UNDER SEC. 8.8 G.C.FOR THIS REASON � � U LL' DATE OWNER ¢ Z U � �¢ LICENSED CONTRACTORS DECLARATION w �i CL I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � D(COMMENCINO WITH SECTION 7oo0)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MV LICENSE IS W FULL FOR AND EFFECT. m � LICENSE C SS LIC.NO. � �O � . U DATE � CONTRACTOR d . W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFlRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWIN6 DECLARATIONS: Z �Z IHAVEANDWILIMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a Q = COMPENSATION,AS PROVIDED BV SECTION 37oa OF THE LABOR CODE.FOR THE PERFOqMANCE U OF hIE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � W _I HAVE AND WILL MAINTPJN WORKERS'COMPENSATION INSURMlCE,AS REOUIRED BV SECTION Q 3700 OF 7HE LABOR CODE,FOR THE PERFOqMANCE OF THE WOiUC FOR WHICH THIS PERMIT IS ISSUED.MV WOR ERS'COMP.EN ION INSU CE CARRIER AIJD POLICY NUMBER ARE: CONSTRUCTION J �t�t�r� _ � CARRIEH PLAN REVIEW Z POLICY NUMBER ELECTRIC Q ` �� (IFUSSEcita�l&�No7eEQ7.�l.Ef�aFn#aEw.srsFoaa+EHl.rnREooa.tais(t�roloal6S�. PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOHIC FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C,'} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECTTO THE WORNERS'COM�ENSATION PROVISIONS OF SECTION 37000F THE LABOR CODE,I S �W.FOR ITH COMPLV WITH aaovisioNs. ISSUANCE ��x � l-�b-Ol�'� Ey�j�� p DA7E: APPLICAN7: IL;`rWV SMIP W J WARNIN(i:FAIWRE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESlWDCIVILFINESl1PTOONEHUNDREDTHWSAND ENERGYPERMIT DOLLARS(f 7 ao,000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN � J SECTION 37oB OF THE L4BOR CODE.INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: O CONSTRUCTION IENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB�,CIV.CJ. Z W � LENDER'S NAME � 'LENDER'SADDRESS � ///� w ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES � J/� � I AOFEE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILOINO � CONSTRUCTION,AND MEREBYAUTHOqIZE REPRESENTATIVES OF THIS CAUNTY TO ENTER UPON THE , Z ABOV ENTqNED PROPERTV FOR INSPECTION PURPOSES. � '/ (1�� COMMENTS J � _ �. m PERMITT (P I r � Q � � SIONATUREOFPERMITTEE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Depertment Copy,YELLOW—Finence Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy t��'�'( �� fIDOl�l6�l(�f�9� �� f�J��',�(��'6�(�l f�i(��I�ii@? 0 p � U o D,.;,.� �C� 0 ° �c o a �41� ° f�� o p � SET BACK • - ' FLOOR JUIST ._; �� FTGS/FORMS/STEEL ` FHA REQMTS - ELECTRIC GROUND � UNDER FLO�R DUCT GROUND PLUMBING UNDER FLOOR CU�IDUIT SLAB GRADE FIREPLACE'FOIJNDATION � TEMP POWER FIREPLAGE BOND BEAM W,4TER SERVICE � MID HT. BUND SEAM � � � ROOF SHEATHIIVG 8 FT.BOND'BEAM� FRAMIfVG/VEM1ITILIATIOfV FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEA7ING BENCHING ROUGH ELECTRIC � ROUGH GRADI�IG ROUGH PLUfVIBING FINISH GRADING � SHOWEFUfUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING W,4L�It�SU�ATIOfV POOL FINAL CEiLING IN�ULATION OFF SITE IMPS. DRYWALL NAIUNG DEDICATIONS SEWER FlNAL ENG. � SEPTIC T�0.NK LAP�lDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINA� FINAL HEATING HEALTH DERT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL P�UMBIMG �/ _ ��sS�" ENERGY G o (n�lr' d . . -'- - �v�, C�IVIIV��I�f�S SEPTIC T/�P�IK SIZE SEEP P17lU SIZE � � � � ��` ! ,, — ---