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Home My WebLink About11-710 , CITY OF DIAMOND BAR " -��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES / 21825 Copley Drive,Diamond Bar,CA 917fi5 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ��'°^"� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE Y� ` /y p APPLICATION PERMfT /� f D P/C ADDRESS `7 �� DATE NUMBER / # � ISSUE 7yPE �C APN LOT T ACT DATE / CONST.� GROUP p OWNER o ADDRESS ZONING S ACKS Z CITY ZIP TEL. FRONT pyy � g APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ � CONTRACT R � SIDE p ADDRES � CITY - ZIP TEL. PROPOSED USE w ARCH/ENG/ ' �i �z DESIGNER OO�'� NO.DWEL. NO. a ADDRESS NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS c� N DESCAIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM � � I HEREBY AFFIRM UNDER PENALTV OF PE0.0.1RV THAT I AM E%EMPT FROM THE CONTRACTORS LI- Gafe9B/CBfPOff W CENSEUWFORTHEFOLLOWINOREASON(SEC.703t.5BUSWESSANDPROFESSKKJSCODE:ANVCITYOR (n C� CIXINTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTERIAIPpOVE,DEMOUSH,ORREPAIRANVSTRUC- W P8f10/D9CI( �l� T1RE.PRqR TO RS ISSUANCE,ALSO REDUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI� � CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa � FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND 7HE BASIS FOR 7HE ALLE(iED E%EMP- (� TION.ANY VqLATION OF SECTION 7071.5 BV ANY APPLICANT FOR A PERMIT SU&lECTS 7HE APPLICANT T0 Z Re-Roof A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f500).): � ❑I,ASOVMEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 Commercia� Z WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Wa,BUSI� J - � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY NM1iO BUIIDS OR IMPROVES hiEREON,AND YAiO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROU(iH HIS OR HER ONTI EMPLOYEES,PFOVIDED THAT SUCM IMPROVEMENTS AiiE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVERTNEBUILDINQORIMPROVEMEMISSOtDWfTNINONEVEAROFCOMPIE- Z TIDN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS ONMER OF THE PROPERTY,AM E%CLUSIVELV CANTRACTINO WITH LICENSED CONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.70I1,BUSINESS AND PROFESSIONS CODE:TME CONTMCTORS U- V8I118f1Of1 A0.1.AREA W CENSEUWDOESNOTAPPLVTOANONRJEROFAPROPERTYWHOBUILASOflIMPROVESTHEREON,AND � MM1iOCONTRACTSFORSUCHPR0.1ECT5WITHACONTRACTOR(5)IICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y 70RS LICENSE LAWJ. � � FEE � ❑I AM EXEMPT UNDEF SEC. B.8 P.C.FOR THIS REASON Q � U � OATE ONMER H Z U � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIHAI UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDEF PROVISIONS OF CHAPTER � � Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MY LICENSE IS IN FULL FORCE AND EFF T. _ / � UCENSE C S � UC.NO. �///� /: � . V DATE O � CONTRACTOR � . d W � WORKERS'COMPENSATION DECLARATION ¢ � U � I HEREBV AFFIRM UNDER PENALTV OF PERIUfiV ONE OF TFIE FOLLOWINO DECLARATIONS: Z , , , � � _1 HAVE M!D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF TME LAHOR CODE.FOR THE PERFORMANCE ' U OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO. w � � � _IHAVEANDWILLMAINTAINWOW(ERS'COMPENSATIONINSURANCE,ASREWIREDBVSECTION Q 3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ' ISSUED.MY WORKER ' O NSATIO/N�I�c U C AAqIER AND POLICV NUMBERARE: CONSTRUCTION jCAARIER ��, �/ .�� PLAN REVIEW � POLICY NUMBER z Zd ELECTRIC � (iHISSECIIONNE�NDTBE001.1PLETmOFTHEPEW.T(iSFOqONEHIN�DqEppqyplLS(S1pp)pqLFSS} PLUMBING � � � W Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUED,1 '� MECHANICAL C3 SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE (,/) N'OR)(ERS'COMPENSATION LAWS OF CALIFORNI0.M1D AGREE THAT IF I SHOULD BECAME INSPECTION FEE . SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37oa OF THE LABOR � S CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE � p DATE: APPLICANP. SMIP W � WARNINO:FAIWRE TO SECUi7E WOH)(ERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHAIL BE ENERGY P/C � � SUBJECTMIEMPLOVERTOCRIMWALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT DOLLARS(f1o0.o00�,IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN J SECTION 37ae OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. w AETENTION FEE: ...Z�GiO O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNOEf7 PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV FOR THE PERFqRMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.708�,CIV.C.�. Z W � LENDER'S NAME � IENDEF'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT iHE ABOVE INFORMATION IS CARRECT. TOTAL F E ES �s✓v � � I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS REUTWO TO BUILDINO � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA7IVES OF THIS CWNTV TO ENTER UPON THE ' Z ABOVE�MENTIONED PROPER7Y FOR INSPECTION PURPOSES. COMMENTS ' O J � m PERMI77EE NAME(PRIN1) � � Q C/� � SIONATUREOFPERMITTEE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN— Applicant's Copy CITY OF D9�,iViOND �AR IiVSPECYlON �iECORD �� o . 0 - e e � • - 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 H'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING RQUGH 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 LANDSCAPE/IRRIG. SEEP PITlL.L. ON SITE IMPS. ' GAS,4IRTEST FINALZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ,,.. � o � COMMEIVTS �� 6 >:: , SEPTIC TANK SIZE SEEP PIT/U SIZE � �#.�- r � 1 i�E ��a�.��7��I, }, €�� '.�x 8�4 '��: . i� r '�' � ! � � ' � �J v� �j��'� �� t��.��: �+ '4 .� b '*' �y# �V � :, i�. �� w� `. , ... �''+''�'-'t.