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Home My WebLink About17469 CTI'Y OF DIAMOND BAR � �---J�� — DEPARTMENT OF COMIvIUNITY&DEVELOPIvfENT SERVICES �� 21825 E.Copley Drive � (909)860.3195 Fax(909)861-3117 PRESS �'�+�� BUILDING PERNIIT APPLICATION FIRMLY o� JOBSITE , ` � � � DATE CATION I �I (,�� U B R �� #/ �C �� ADDRESS 1 �_� � � ISSUE . TYPE OCC APN LOT ' T T ' DATE CONST. GROUP p OWNER o ADDRESS ZONING SETBACKS Z CITY ZIP �TEL. � FRONT Ryy p o APPLICANT � �,� �— TEL. S DE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSED USE V oARCH/ENG/ �Z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FqOM THE CONTRACTORS LI- G8f8g0/CBfPOfI W CENSEUWFORTHEFOLLOWINOHEASON�SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITYOR (n C..� COUNTVNMICHRE-0UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRMIVSTRUC� w w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PEHMIT TO FILE A SIGNED w P8�10/DBCI( � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(qUPTER�(COMMENCIN6 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSpO Q FESSIONSCODE)ORTHATHEOFSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� V TION.ANYVqUT10NOFSECTION7031.5BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOlURS(t500)J: � OI,ASONRJEROFhIEPROPERTV,ORMVEMPLOVEESWITHWAGESASTFIEIRSOIECAMPENSATION, � COrtIrtIBfClal Z WILL DO THE WORN,AND THE S7RUC7URE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7a4,BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES N07 APPLV TO AN OWNER OF � PFOPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OH HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m i 0 OFFEREDFORS/�LEIF,HOWEVER,TiEBUILDIN�ORIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDEF WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE DID NOT Bl11LD OR � IMPROVE FOR TME PURPOSE OF SALE). w ❑I.ASOWNEROFTHEPROPEHTY,AMEXCLUSIVELVCONTRACTINOWfTHLICENSEDCONTRACTOqS � TO CONSTRUCT THE PROJECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE COMRACTORS ll- V8IU8I1011 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANONMEROFAPROPERTVWFqBUILD50RIMPROVESTHEREON,AIJD � WHOCANTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION �E Y TORS LICENSE UWJ. � O I AM EXEMPT UNDER SEC. B.a P.C.FOR THIS REASON Q � U LL DATE O OWNER ¢ Z U � LICENSED CONTRA S DECLARATION w � 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV TMAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCINO WfTH SECTqN 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS COOE.AND Z LLl �Y LICENSE IS W FULL FORCE ANO EFFECT. m � IICENSE CLASS LIC.NO. � ' V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION ¢ � U N I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' ¢ 2 Q COMPENSATION,AS PROVIDED BY SECTION 37oa OF THE UBOR CODE,FOR THE PERFORMANCE U OFTME WOR)(FOR WMICH THIS PERMIT IS ISSUED. w � � Qw _I HAVE ANO WILL IAAIMAIN WORKERS'COMPENSATION INSUqANCE,AS REOUIRED BV SECTION 3700 OF THE L/�BOR CODE,FOR THE PER WRMANCE OF THE WOHI(FOR WHICH THIS PERMIT IS � ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE CONSTRUCTION J �j CARRIER PLAN REVIEW � POUCYNUMBER zd ELECTRIC � (lFCSSECTONNE�NOTBEOOMW�EfEDOFT}EPERAYTISFOqONEFiIN�DFEDDOl1ARS(51ao)OqLESS} PLUMBING W Z I CEFTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERA/1T IS ISSUED,I MECHANICAL U' SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE (/) WORKERS'COMPENSATION LAWS OF CALIFORNIqAND AOREE THAT IF I SHOULD BECAME INSPECTION FEE = SU&IECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR CODE.I SHALL FORTHWITH COMPLV WITH THOSE PqOVI510N5, ISSUANCE � p DATE: APPLICANT: SMIP O W J WARNINO:FAILUHE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SMAIL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALT1ESAtJDCNILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3�a0 OF iHE IABOR CODE,INTEREST,AND ATTORNEV'S FEES. � O� OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B],CIV.C.). Z w � LENDER'S NAME � LENDERSADDRESS w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES (��{ � I AGPEE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDING \\ � CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE � v�O Z /�BOVE-ME�D PROPERTV GOR INSPECTION PURPOSEs. COMMENTS � � J � - m P EENAME(PRItJn Q ` � L � 510 F PE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Deperiment Copy,YELLOW--Finertce Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicent's Copy (��P �f� ��l�f�(�[�9� [��[� Oh�l�f��C��O�Ir� f�[��(�S�➢ � �� DGJ� � tr o � � �Gc'i� � DGJ4� �G� : � 5ET BACK � F�OCJR JOIST _� �f'GS/FORMS/STEEL �,'..--{I-c�( �-- FHA RE(�MTS ELECTRIC GROUND � UNDER FLO(�R DUCT � GROUND PLUMBING UNDER FLOOR CUNDUIT SLAB GRAQE ('(��C --�^ �•��• •�•� •� FIREPLACE'FOUNDATION � TEMP POWER T � FIREPLACE BOhJQ BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMING/VEIVTILIATIOfV FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHlNG ROUGN ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlTUB TEST �___j POOL ELECTRIC EXT. LATHlSIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. ' DRYWALL NAIUNG DEdICATIONS SEWER FINAL ENG. � SEPTIC TANK LANDSCAPE/IRRIG. � SEEP PIT/L.L. ON SlTE IMPS. GAS AIR TEST FIIVAL ZONING FINAL CONST. FIRE DEPT. FINA� FINAL HEATING HEALTH DEPT. F(NAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUP/IBIMG ENERGY C�� o c o , . COiVIi�iEi�TS SEPTIC TANK SIZE SEEP PIT/U SIZE � ��