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Home My WebLink About10-1148 1�' "� .i� '_�� CITY OF DIAMOND BAR .y� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 6 T, 3 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)Sfi1-3117 Building Inspection Hotline(909)839-702Y PRESS 4'��"� BUILDING PERMIT APPLICATION '�� '�( FIRMLY � JOBSITE y p � APPLICATION / PERMIT p/C o ADDRESS�OO O S�G,P,�ta/D MlE. �D�� C—�j DATE_ l I I I I I I D NUMBEF�D�//S��q � APN LOT TRACT ISSUE �/�/�-�O 7ypE OCC p OWNER jy _�6AG�{r ZIfU. DATE_r CONST.J��'`�`i_ GROUP o ADDRESS ZONING SETBACKS w CITY ZIPqZ/30 TEL • S - FRONT RW O � APPLICANT TEL. • REAR p � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p � ADDRESS �4d � � CITY�/1If�tIO ZIP��7T/./ TEL.�/-�I�I ' OQ PROPOSED USE�� /l/�E TD �w1j�(y oARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. ' a ADDRESS � CITY ZIP TEL. UNITS STORIES Z BEDROOMS � � DESCRIPTION S�.FT. FACTOR PSF ' ADJ.AREANALUATION . p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � � I HEREBV AFFIRM UNDER PEN�L7Y OF PERJURV THAT I AM EXEMPT FFOM THE CONiRACTORS LI- GefegB/CBfPOh W CENSELAWFORTHEFOILOWINOREA50N�SEC.7031.5BUSINESSANDPROGESSIONSCODE:ANYCITYOF (n V COUNTVNMICHREOUIRESAPERMRTOCONSTqUCT,p1TER,IMPROVE.DEMOLISH,ORqEPAIRANYSTRUC� w w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIFES THE APPLICANT FOH SUCH FERMIT 70 FILE A SIQNED W P0fi0/DBCI( g STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO TFIE PROVISIONS OF THE CONTRACTORS LI- � � CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)Of DIVISION 3 OF THE BUSINESS AND PRO- POOUSpO ^ FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALlEOEDE%EMP- (� � TION.ANV VqLAT10N OF SECTION 1031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CML PENAL7V OF NpT MORE THAN FIVE HUNDRED DOLLl�f75(fSOD)J: � OI,ASONRJEROFTHEPROPERTY,ORNVEMPLOVEESWI7HWAOESASTHEIRSOLECOMPENSATION, � CORIRIBfC18I Z WILL DO THE WORN,AND THE S7RUC7URE IS NOT INTENDED oR OFFERED FOR SALE(SEC.7M�,BU51� J � NESS AND PROFESSlONS CA�E:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEHTV NR10 BUILOS ON IMPROVES THEREON,AND NhiO DOES SUCH WORK HIMSELF OR HERSELF OR Q iHROUGH HIS OR HER OWN EMPLOVEES,FROVIDED THAT SUC}1 IMPROVEMEMS ARE NOT WTENDED OR m � OFFEREDFORSALEIF,FIOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPIE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � UAPROVE FOR THE PURPOSE OF SALE). w ❑I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTINO WRH LICENSED CANTRACTORS [[ TO CONSTRUCT THE PRQIECT(SEC.7Wa,BUSINESS AND 7ROFESSIONS CODE:THE CAMMCTORS LI- V81U8fI0f1 O/� ADJ,AREA W CENSEUWDOESNOTAPPLVTOANONRJEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WFpCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS LICENSE LAWJ. FEE � ❑I AM E%EMPT UNDEF SEC. g.8 P.C.FOR THIS REASON � � � U � DATE OWNER � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � � S d B(COMMENCINO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z � MY LICENSE IS IN FULL FOFCElWD EFFECT. !� ' � OX � LICENSE CLAS LIC.NO. �" ��/� �y�� U DATE CONTRACTOR�/UE S//7/"eN/I�/ML d W ` � � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER PENALTV OF PER1Ui7V ONE OF THE FOLLOWING DECIARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' a Q COMPENSATbN,AS PFOVIDED BV SECTION 3�00 OF THE 1A80R CODE,FOR THE PERFORMANCE U Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3]00 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHlpi THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION jCARqIER PLAN REVIEW 0 POLICV NUMBER t°"�Q � ..S p (iHISSECi%JNNE�NOTBEQONi'LEfEDOF7HEPEPMTISFOqONEFiIN�F�Op1lAS(t100)ORLE55} LUM , W Z I CERTIFV THAT IN THE PERFORMANCE OG THE WOfiH FOR WHICH THIS PEWAR IS ISSUED,1 ANICAL _ �T s v L} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU9JECT TO THE � (/) WORKERS'COMPENSATION LAWS OF CALIFORNIq AND AOREE THAT IF I SFIOULD BECOME INSPE�E S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � CODE. SHA FOfiTHWITH COMPLY WITH THOSE PROVI NS. NCE� � �`h'f�� SMIP p DATE: APPLICANP. � � � w ENERGY P/C � WARNIN�:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE � SU&IECTANEMPLOVERTOCRIMINALPENALTIESAtJDCIVILFINESUPTOONEHUNDREDTHWSAtJD ENERGYPERMIT DOLURS(f100,o00�,IN ADDITION TO THE COST OF COMPENSATpN,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOF CODE,INTEREST,AND ATTORNEV'S FEES. TION FEE: / OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: r � I HEREBY AFFIRM UNDER 7ENALTV OF PERJURV THAT THERE IS A CANSTRUCTION IENDING AQENCV � FOR THE PERFORMANCE OF THE WORN FOR WHtCH THIS 7ERMIT IS ISSUED(SEC.30Y7,CIV.CJ. Z W � LENDER'S NAAIE F— LENDER'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE W FORMATION IS CORRECL TOTAL F E ES �� 1 AGFEE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE LAWS PEUTWG TO BUILDINO � CONSTRUCTION,ANDHEREBVAUTHOR2EREPRESENTATIVESOFTHISCWNTYTOENTERUPONTHE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. �COMMENTS ' 0 %y_.� , _ w� ¢ PERMITTEE N (PRIPIT) � � I/ � (n DAT RECPT.NO. ' PAID VALIDATION ~ WHITE—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—ApplicanYs Copy , � � CD�Y O� D1�►MOi�D �AR INS�I�C�BOi� �i�CORD ,. 4��nJ�pC�C�400G�} ��oy�� 4.�^��i��G3��_�J�.C��,C��P�j x��:o ' � 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 FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING Z�' FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT.LATH/SIDIfVG POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. =��, ��.-, t'.��,,.'- •� •� FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �_� � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a £`��i ��a ��,�e_ ,,. �:�� "tyc�'a . . � .t!,�_ . .