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Home My WebLink About10-1204 ^ _�` CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 PRESS �'°�'� BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE 4,.�p �old�s�l s�rrn�s �� APPLICATION ,� 3 PERM �/^�n p/C ADDRESS DATE__ � I I�� NUM l/�� # ISSUE TYPE OCC � APN LOT TRACT DATE f 2�O� ��O CONS�//V�OD��ROUP p OWNER � V�C (J� p ADDRESS �I S ZONING SETBACKS z CITY � I GVYV1 � ZIP � (Gl7 T L.�I�"y-Z�JD-�I.�I FRONT qyy � � APPLICANT TEI. REAR p �� SIDE/SIDE STREET RW ❑ CONTRACTOR � l SIDE p QCDDRESS ZIP TEL. PROPOSED USE �`�I'�a�- Vv 1I�, DWrj SI� j�Gi o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. a ADDRESS NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRAI UNDER PENALTY OF PERAIRV THAT I AA1 E%EMPT FROM THE CONTRACTORS LI- GHf896/CBfPOff W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n C.� CAUNTYWHIC}1REQUIRESAVERMITTOCONSTRUCT,ALTER,IMPiiOVE,DEMOLISH,ORREPAIRANVSTRUG w W NRE.PRpR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w P8�I0/DBCK � STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PHOVISIONS OF THE CONTRACTORS LI� LL � CENSE UW(CHAPTER e(COMMENCINO WI7H SECTION 7ooa)OF DIVISION 3 OF THE BUSINE55 AND PRO- POOI/SP8 ^ FESSIONS CODE)OR THAT HE OR SHE IS E%EAIPT THEREFROM AND THE BASIS FOR THE ALIEOED E%EMP- (� V TION.ANV VIOLATqN OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICMfT TO Z Re-Rool A CML PENALTV OF NOT A/ORE THAN FIVE HUNDRED DOLURS(S5ao).): ~ ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfI1rtIBfCI91 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED Oq OFFERED FOR SALE(SEC.70��,BU51� J N NESS AND P{iOFESSIONS CODE:TiE CANTRACTORS UCENSE LAW DOES NOT APPLY TO Ml OWNER OF � PROPERTV NRIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,FROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m � OFFEREDFORSALEIF,HOWEVEq,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TqN,THE OWNER�BUILDER WILL HAVE TME BURDEN OF PROVIN6 TFUT HE OR SHE DID NOT BUILA OR � IMPROVE FOH THE PURPOSE OF SALE). � W ❑I,ASONMEROFTHEPROPEi7n',AME%CLUSIVELYCANTRACTIN(iWfTHLICENSEDWNTRACTORS � TO CANSTRUCT THE PR0.IECT(SEC.7W/,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS ll- V9IU9�1Of1 � W CENSE lAW DOES NOTAPPIV TO AN ONTJER OF A PHOPERTV WHO BUILDS 0R IMPROVES THERE-0N,AND AD.I.AREA � WMOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOP(5)LICENSEDPURSUANTTOTNECONTRAC- QU(u•JnN DESCRIPTION Y TORS LICENSE LAWJ. FEE � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q ' � U LL DATE � OWNER / ¢ � Z U � UCENSED CONTRACTORS DECLARA ION w � I HEREBV AfFIRM UNDER PENALTY OF PERJURV THAT I AM UCENSED UNDEFl PROVISIONS OF CHAPTER � � e(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSKKJS CODE,AND Z ' LLI MY LICENSE IS IN FULI FORCE AND EFFECT. m � LICENSE CIASS LIC.NO. � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION � . � � U � I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLIOWING DECURATIONS: Z � _I HAVE AND WILI MAMTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' a � _ + COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WORK FOR N7iICH THIS PERMIT IS ISSUED. W � � � _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATbN INSURANCE,AS REQUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF R1E WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CAFlRIER AND POLICY NUMBER ARE: CONST IO jCARRIER PLAN REVIEW Z POUCV NUMBER ELECTAIC Q p (rwsseenonriE�rpieemha�ErE�ocn-EpEp.rrsroqor�runnqEopplpasg�m�pq�Ess} PLUMBING � w Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOq WHICH THIS PERAl1T IS ISSUEO.I MECHANICAL C,�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE � WORNERS'COMPENSATION LAWS OF CALIFORNIA M1D AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUAIECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3]OO OF THE LABOR O COD�7E.ISH FORTHWITNCOMPLVWITHTHOSEP VISIONS. ANCE _ � p DATE: '` � �APPLICANT. v ' IP , �1 w ENERGY P/C � � WARNING FAILUqE TO SECUFE WORKERS'COMPENS ION CAVERAO 5 LAWNL,AND SHALL BE � SU&IECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FINES UP ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f 700,000),IN/�DDITION TO THE COST OF CAMPENSATION,DAMAGES AS PFOVIDED FOR IN � SECTION 3708 Of THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. T . � `"'� V OCONSTRUCTION LENDING AGENCY PR - T FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AOENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.�. Z W � LENDER'S NAME ' f— IENDER'SADDRESS W I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES !/J.3.� � I AOREE TO COMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDINO �' � CONSTqUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTEF U70N THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � � NOl1'lC �G'l� m PERMITTEE NAME(P � � '� (Z 3 za la � SIONATUFE P E D E , � RECPT.NO. PAID VALIDATION WHITE—Department Copy,YELLOW--Flnence Copy,PINK—Assessar Copy,GOLDENROD--File Copy,GREEN—Applk;ant's Copy CI�V OF DIAiViOi�D �AR I�S�[�C�'BOi� ��CORD � :: :OGyJ�p@C�4D0[� : o �.�'C�,.:=� Qa�pL��OG3 . ;: DIYI�P��[�` �� '��'C��; �� <O�I��C� ��.�..f '�?;. 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 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 FtNAL 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 �'t ��` - , B�' . - COMMENTS ' a ' , SEPTIC TANK SIZE SEEP PIT/U S�ZE a � a :;,; a