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Home My WebLink About11-545 �� 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 ¢ AD RIESS I!./Y�10 7(J INTIv D�p �/3 S q >- APPLICATION PERMIT ��_ PR,� p . DATE NUMBER � APN LO . TRACT D TEE ��O�" // CONST.��OUP p OWNER p ADDRESS ZONING SETBACKS Z CITY ZIP TEL - FRONT Ryy � g APPLICANT TEL. a REAR p � J SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRES � CIN ZIP ��G/ TEL. PROPOSED USE V E o ARCH/ENG/ � DESIGNER Lzii NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STOAIES � BEDROOMS � � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION � . p SFR/ADD/REM p I HEREBV AFFIRM UNDER PENAL?Y OF PERri1RV THAT I AM EXEMPT FHOM THE CONTRACTORS ll- G8f99B/COryOR W CENSE LAW FOR THE FOLLOWINO REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR (n C-� COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTELI,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC- w W TURE.PRIOR TO ITS ISSUANCE.AL50 REOUIfiES THE APPLICANT FOR SUpi PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHAPTER Y(COMMENCWO WITH SECTION 7000)Of DIVISION 3 OF THE BUSINESS AND PR6 � PooUSpe FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMF� � TION.ANVVIOUTIONOFSECTION7031.58VANVAPPLICANTFORAPERAIITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE h1AN FIVE HUNDRED DOLLAHS(i500)J: 0 ❑I,ASONRJEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOA/PENSATION, 0 COfflrtlBfCI81 Z WIIL�O THE WORK�ND THE S7RUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7oa1,BU51- J � NESS AND PqOFE5510NS CADE:TME CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEREON,AND NM1iO DOES SUCH WORN HIMSELF OR HERSELF OR Q TMROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,MOWEVER7I�EBUILDINGORIA/PROVEMEMISSOLDWITHINONEVEAqOFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IA/PROVE FOR 7HE PURPOSE OF S/�LEj. �yJ OI,ASOWNEROFTHEPROPEHTV,AME%CLUSNELYCONTRACTINOWRHLICENSEDCONTMCTOHS [[ TO CONSTRUCT THE PFQIECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V8IU8�1Of1 qp�_qqEq W CENSEUWDOESNOTAPPLVTOANON7JEROFAPROPERTVWHOBUILDSORIM7ROVESTHEREON,MlD � W/iOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS LICENSE LAW.). FEE 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � �7 U LL DATE OWNER F— Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PEN�LTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � D(COMMENCIN(3 WITN SECTqN 7000)OF DIVISION 3 OF THE BUSINE55 AN�PROFESSIONS CODE,AND Z � �� YV UCENSE IS IN FULL FORCE AND EFFECT. // m � LICENSE CIAS LIC.NO. (/� i �� V DATE CONTRACTOR /� d W � WORKERS'COMPENSATION DECLARATION � � U N I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECURATIONS: Z � _IHAVEANOWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORNERS' _ COMPENSATION,AS 7ROVIDED BY SECTION 3700 OF THE LABOR CADE.FOR THE PERFORMMICE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION Q 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH T115 PEiUAIT IS � � ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE: CONSTRUCTION jCARRIER ' PLAN REVIEW ZPOLICV NUMBER ELECTRIC ' �j� Q p (n�ss��r�or�r+��r+o7e�oo�.a��rmo�T�p�w,vrswaoHEi+�ror�moauqsK+�la+�Ess} PLUMBING _ (�� - w 7'�� Z I CERTIFY THAT IN THE PERFOqMANCE OF THE M/ORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C}' SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE [/) WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE SU&lECT O THE WORNERS'COMPENSATION G VI S OF SECTIO 370o OF T E UBOR � S CO A ORTHWITHCOMPLYWITHTM P VISIONS. ISSUANCE � p OATE: APPLICA`: � � SMIP W ENERGY P/C � WI1RNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE LL SU&IECTAN EMPLOVEH TO CRIMINAL PENALTIES AND CML FWES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOILAAS(f10o,o00),IN ADDITION TO THE COST OF CqMPEN5AT10N,DAAIAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEI"S FEES. w RETENTION FEE: � O ' CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACQYSTRUCTION LENDINO AOENCV FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS w I CERTIFV THAT I HAVE READ THIS MPLICATION AND STATE THAT THE ABOVE INFORIAATqN IS CORAECT. TOTA L FE ES� � � � I AGREE TO COA/PLV WITH ALL CITV AND COUNTY OqDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7H15 COUNTY TO ENTER UPON THE � Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � � � � m PERMITT AME RINn � � Q � T DAT = RECPT.NO. PAID BY VALIDATION ~ WHITE—De aAment Co YELLOW�inence p py, Copy,PINK—Assessor Copy,CiOLDENRO�File Capy,GREEN—Appli t's Co . PY CETV O� Do,�►MO�lD ��,R Ii�S��C�BOf� �i�CORD � Oa�pf�C�400a DLait L OG�J�3pC��G? ��1�3pC�C�400�I DGJ�` .,�QG]�m C�� .; � _. ,: SET BACK FLOOR JOIST FTGS/FORMS/STEEL. FHA REQMTS ELECTRIC GROUND UNDER FLOOR�DUET GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'L 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 FINAL ENG. SEPTIC TANK � ' LANDSCAPElIRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FfNAL CONST. FIRE DEPT. FINAL FINAL HEATING � HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING � ENERGY C�U C�CoC� COMMEfVTS ' SEPTICTANK SIZE SEEP PIT/U SIZE a � a � �E -��.� n . � - � . � �