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Home My WebLink About11-256 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)839-7027 PRESS �'°^'� BUILDING PERMiT APPLICATION FIRMLY � JOBSITE � ��_� o ADDRESS ��C'��_��V_��. �� APPLICATION PERMIT //,� ^�/�/C � _ DATE NUMBER�Jq � APN—��LO�T� TRACT DA EE � � �/ CONST. e-�v V GROUP �� p OWNER �"`UVYf��(� �(�t1�LJ�M4„�� o ADDRESS ZONING SETBACKS o APPLICA T '��A` � 1J �O�� TEL. � - REART RW ❑� dz SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE � ADDR SS � CITY ZIP TEL. PROPOSED USE o ARCWENG/ � z DESIGNER a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FROM THE CONTRACTORS U� G8l88B/CBfPOf1 W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPqOFE5S10N5CODE:ANVGTVOR (f� U CAUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTEi1,IMPqOVE,DEMOLISH,ORREPAIRANV9TRUC- PatlO/DBCk w TURE,PRIOR 70 ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIONED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� � CENSE LAW(CFUPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TFIE BUSINESS AND PRO- u' Paal/Spe � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEGED E%EMP- � TION.ANVVIOLATIONOFSECTION7o3t.6BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENAL7V OF NO7 MORE THAN FIVE HUNORED DOLL4R5(Ssoo).): � ❑I,ASOWNEROFhIEPROPERTY,ORMVEMPIOYEESWITHWA0E5ASTHEIqSOLECOMPENSATION, COR1rtIBfCl81 . WILL DO THE WORI�ANO THE STRUCTURE IS NOT INTENOED OR OFFEFED FOR SALE(SEC.7M�,BUSI- � � NESS/WD VROFESSIONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT A7P�V TO AN OWNER OF � PROPERTY WHO BUILOS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER ONM EMPLOVEES,7ROVIDED THAT SIX:H IMPROVEMENTS ARE NOT INTENDED OP m 0 OFFEREDFORSALEIF,HOWEVERTNEBUILDINQOqIMPROVEMENTIS50LDWRHINONEVEAROFCOM7LE- Z T10N,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PqOVING THAT HE OR SHE DID NOT 9UILD OR � � W PROVE FOR THE 7UHPOSE OF SALE). �y,� ❑I,AS ONTlER OF THE PROPERTY,AM EX0.USIVEIV CONTRACTINO WRM LICENSED CONTMCTORS I Q TO CONSTRUCT THE 7RQIECT(SEC.704/,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V0W8�1Of1 ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVN7iOBUILD50HIMPROVESTHERE-0N,ANp � WFIOCONTMCTSFOHSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTMECONTRAC- QUANTITY DESCRIPTION Y TORS LICENSE LAWJ. FEE � ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q - � U � DATE OWNER H Z U � LICENSED CONTRACTOfiS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � d G(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z X AIY LICENSE IS IN FULL FOflCE AND EFFECT. m LLI �� LICENSE CLASS�� LIC.NO. � � wDATE��yZ. CONTRACTOR ' d � WORKEFS'COMPENSAT�ON DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLAAATIONS: � ' � • Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' a 2 Q COMPENSATION,AS FROVIDED BV SECTION 37ao OF THE lAeOq CODE.FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED. W � �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION � Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHIp1 THIS PERMR IS `��/�/ ISSUED.MV WORKERS'CAMPENSATION INSURAN E CAqRIEP AND FOIICV NUAIBERARE: CONSTRUCTION ��-7�� J j CARRIER e_ P,�,RE�,�, � POLICV NUMBER �� Zd ELECTRIC � (irnsSEcrqrar��tao78E�ErEooFn-�pEw,vr�sFoqor�EMraraE000u,ws�slm)oqLEss� PLUMBING w Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE (,/) VIORKERS'COMPENSATION LAWS OF CALIFORNIq AND AGREE iHAT IF I SHOUID BECAME INSPECTION FEE SU&IECTTOTHEWOW(ERS'COMPENSATIONPFOVISIONSOFSECTKKJ37ooOFTHEIABOR w � S CODE.I SHALL FOHTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �J p DATE:��_ qppLICANT: 1��ICKYV V Y VW� SMIP _ �� W J WARNINO:FAfLUqE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C � J � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTMWSAND ENERGYPERMIT DOLLARS(f100.000�.IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN J SECTIDN 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEVS FEES. w RETENTION FEE: s� O CONSTRUCTION LENDING AGENCY PF�-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCY �h/]/.O � � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.CJ. ��/'I+ �`' Z W � LENOER'S NAME H LENDERSADDRESS w I CERTIFY TMAT I HAVE FEAO THIS APPLICATION AND STATE TIiAT THE ABOVE INFORAIATION IS CORRECT. TOTAL FE ES � y J�J � I AOREE TO COMPLV WITH ALl CITY AND COUNTY ORDINANCES AND STATE LP.WS RELATING TO BUILDINO I� � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO EMER UPON THE Z ABOVE�MENTqNED PROPERTV FOR INSPECTION PURPOSES. COMMENTS o ,..C_"�.�-c�cv� v1(��.. _ m PERMITTEEN R `�� ¢ ,-,� .3 � � SIONATURE P� DATE � RECPT.NO. PAID BY! � VALIDATION WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appllcant's Copy CI�Y C)� DIANiOi�D �AF3 INS�ECTIOf� RECORD � ��1�[�� =' � � � ��C�C��'� � � ` �� ° ' �� SI}�I�G�CC�U�G�� . z _.� : . � � , . . . .. o e es ,..� �, � . . � . � ,� _ �. � :> - �< <. � �.� .� _�,s . . ,.. �.�, .n � , 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 HT. BOND BEAM ROOF SHEATHING /„ 8 FT. BOND BEAM • FRAMINGNENTILATION l �� 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 _ CEIUNG INSULATION OFF SITE IMPS. DRYWALL NAILING QEDICATIONS SEWER FINA�ENG. _ SEPTIC TANK LANDSCAPE/�RRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. F�NAL _ FINAL ELECTRIC DEV. FEES PAID _ __ FINAL PLUMBING ENERGY -- -- ��o �� _, - � COMMENTS �� •. -�� - �� SEPTIC TANK SIZE SEEP PIT/U SIZE [�I_ �� . �� ,� .� . i �,-� - - . , � � �: }�2�