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Home My WebLink About17551 (17) CITY OF DIAMOND BAR ^----�F�-- DEPARTMENT OF COMMUNTI'I'&DEVELOPMENT SERVICES 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3117 PRESS ' �%9�� BUILDING PERMIT APPLICATION � FI RM LY � JOBSITE �,{� Q a /� >- APPLICATIO I PERMIT ` P/C � ADDRESS `�� Q � l�iOl IruS� DATE O G� NUMBER �J # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER o ADDRESS � Q - ZONING SETBACKS Z CITY ZIP TEL. FRONT qyy p g APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSED USE o ARCWENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLAAATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT 1 AM E%EMPT FROM THE CONTRACTORS LI� G8f9gB/C81POfI W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCIiYOR (n U �qJHJyy�Ip/REWIRESAPERMITTOCONSTPUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRlWYSTRUC� w w TURE,PRIOR TO ITS ISSUANCE,�LSO FE-0UIRES THE APPLICANT FOR SUCH VERMIT TO FILE A SIGNED w Patio/Deck � STATEMEM THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHAPTER B(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPB � FESSIONSCODE)OR7}UTHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� V TION.ANV VIO�ATION OF SECTION 7031.6 8Y ANV APPLICANT FOR A PERMIT SU&IECTS THE APPIICANT T0 Z Re-Root A CML PENALTY OF NOT MOFE hIAN FNE HUNDHED DOILARS(f500).): � ❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSO�ECOMPENSATION, � CORIrtI0fCI81 Z WILL DO THE WORKµD 7HE STRUC7URE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7041,BUSI� J � NE55 AND PROFESSIONS CODE:THE CANTRACTORS UCENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERfV WFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCN WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREDFORSALEIF,FIOWEVERTIIEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE�. I w ❑I,ASOWNEROFTHEPROPEHTI',AME%CLUSIVELYCOMRACTINOWITHLICENSEDCONTRACTORS ¢ TO CqNSTRUCT 7HE PR0.IECT(SEC.7W1,BUSINESS AND PROFESSIONS CODE THE CANTRAC70RS LI- V81U01i0f1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANONTJEROFAPROPERTVWFqBU1LD50RIMPROVESTHEPEON,AND � WHOCANTFiACT5FOR5UCHPRQIECTSWIiHACONTMCTOR�S�LICENSE�PURSUANTTOTMECONTRAC� QUANTITY DESCRIPTION FEE Y TORS UCENSE LAW.). Q ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q ?� U � DATE OWNER � Z U � UCENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRM UNDER PENALTV OF PERIUFV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z Xl, MY LlCENSE IS IN FUL�FORCE AND EFFECT. m L11 � � LICENSE CLASS �IG.NO. � U DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRAI UNDER PENALTV OF PERIUHV ONE OF 7HE f-0LLOWIN6 DECLARATIONS: Z � IHAVEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ¢ ' � CqAPENSATION,AS PROVIDED BV SECTION 3�0o OF THE UBOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR NTiICH THIS PERMIT IS ISSUED. � w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE-0UIRED BY SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS ISSUED.MY WOR)(ERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER PLAN REVIEW � POLICY NUMBER aZ ELECTRIC �. p (rrusSEcraririE�rareEmr.�ErE�oFn�aeFr�vrswaa+erxx�naEorouuts�Siao�oa�Ess�. PLUMBING i V w Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANV MMlNER 50 AS TO BECOME SUBJECT TO THE N WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AGREE THAT IF 1 SFIOULD BECAME INSPECTION FEE ___ S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR I�'F'�`�}��\ ' � � I l� . CODE.I SH41L FOHT}1WITH COMPLV WITH TMOSE PqOVI510N5. ISSUANCE t t�� Q I_ p DATE: APPLICANT: SMIP W J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C j J I I � SU&IECTANEMPLOVERTOCqIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTFiOUSAN� ENEAGYPERMIT DOLLAFiS(f100.000�.IN ADDITION TO THE C0.ST OF COMPENSATpN,DAMAGES AS PROVI�ED FOR IN � I � SECTION3708OFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: T�T. OCONSTRUCTION LENDING AGENCY � PRE-ALT FEE: �--^--- --- - '---"—' � I HEilEBV AFFIRM UNDEH PENALTV OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME � LENDER'SADDRESS w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CqRRECT. TOTAL FE ES �SU � I AGREE TO COMPLV N7TH ALl CITV AND COUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDING � CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCWNTYTOENTERUPONTHE �� Z ABOVE�A/ENTIONED PqOPERTY FOR INSPECTION PURPOSES. COMMENTS � + �". J � m PERMITTEE NAME(PRI � ' f 1� oL N SIONATUFEOFP MI DA7E A, � RECPT.NO. � Z PqID BY lN � � VALIDATION WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appllcant's Copy � ��P �� rf�(0��9� ��f� 06l9�1�1�(��"6�(� f�I�(��(i33iID � �c�ooa� � o �`� � °�c��Y � � or�c�ooa oca�� oa� -c� .� ,� SET BACK FLOOR JOIST FTGS/FORMS/STEEL � I FHA REQMTS � � � �� ELECTRIC GROUND UNDER FLOOR,DUCT GROUND PLUMBING UNDER FLOOR�CU�IDUIT SLAB GRADE FIREP ACE FOU�lDATION ^ TEMP POWER FIREPLACE BbND BEAM WATER SERVICE MID HT. B�ND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMIfVGNENTiLIATION FINAL BOfVD BEAM i ROOF COVER PRE-GRADING l ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNIBING FINISH iaRADING i SHOWER/TUB 7EST POOL ELECTRIC EXT. L4TH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING IN�ULATION QFF SITE IMPS. DRYWALI.NAIUNG �/ DEDICATIONS � SEWER "�Z�OZ �NAL ENG. � , SEPTIC TA(�!K LAPJDSCAPE/IRRlG. SEEP PIT/l..L. ON SITE IMPS. GAS AIR TEST FiNAL ZONING FINAL COP�ST. FiRE DEPT. FiNA� FINAL HEATING HEALTH DEPT. FINAL ' FINA�ELECTRIC DEV. FEES PAID FINA�PLUMBING ENERGY I ��o > GOfVIfi�ENTS SEPTfC TAtVK SIZE SEEP PIT/U SiZE � . � � � � � , ' -- � � �