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Home My WebLink About11-1295� _ ��` CITY OF DIAMOND BAR � _ / ' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ;j i , 21825 Copley Drive,Diamond Bar,CA 91765 .� ; � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7 � PRESS �''�"'� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE „.� ? /! �f APPLICATION PERMIT � � ADDRESS 2c=+7SG /T/G OlI /TE�/� DATE NUMBER p � � ISSUE TYPE OCC APN LOT T CT DATE CONST.�_ GROUP p OWNER D p ADDRESS - P1Z. ZONING SEfBACKS z CITY ZIP TEL.✓ S FRONT qyy � o APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTO � T / (/ SIDE p ADDR S e�� CITY ZIP TEL. PROPOSED USE �+�CJc�F L�l/�� U� c o ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTMCTORS LI- G9fegB/CBfPOh W CENSEUWFORTHEFOLLOWINOREASON(SEC.70.31.6BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n C.� COUNTVWHICHR£WIRESAPERMITTOCONSTRUCT,ALTER,UAPROVE,DEMOLISH,ORREPAIRANVSTRUC� W w TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPUCNfT FOR SUCH PERMIT TO FILE A SIONED W P8�10/DBCI( � STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTRACTOR3 LI� � CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TFIE BUSINESS AND PRO• � POOUS 0 FESSIONSCODE)ORTHATHEORSHEISEXEMPT7HEREFROM/JlDTHEBASISFORTHEALLEGEDE%EMP� C7 TION.ANV VIOLATION OF SECTION 7o3t.5 BV ANY APPUCANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof � A CML PENAL7Y OF NOT MORE THAN FIVE HUNORED DOLLARS(f500).): � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � Ort1rtIBfCI9I Z WILI DO THE WORK�D THE STRUCTURE IS NOT IMEN�ED OR OFFERED FOR SALE(SEC.701r,BUSI�' J � NESS AND PFOFE55lONS CODE:TME CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF j 7ROPERTV WHO BUILDS OR IMPROVES THEREON,AND NTiO DOES SUCH WORK HIMSELF OR HERSELF OR w THROU(3H HIS OR HER OWN EMPLOVEES,PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVERTMEBUILDWGOqIMPROVEMENTI550lDWRHINONEVEAROFCOMPLE� Z TION,TME OWNER�BUIIDER WILL HAVE TME BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OP � IMPROVE FOR T}1E PURPOSE OF SALE). �yJ ❑4�.+`OWNEROFTHEPROPEHTV,MIEXQUSIVELVCOMRACTINGWfTHLICENSEDCON7RACTORS Q TO CONSTRUCT THE PRQIECT(SEC.70�1,BUSINESS AND PPOFESSIONS CADE:THE CONTRACTOPS U� V8IU8flOf1 A0.1.AREA W CENSE UW DOES NOTMPLV TOAN OWNER OFAPROPERTV WHO BUILDS OR IMPROVES THEREON,AND � � WFIOCONTRACTSFOqSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG , QUANTITY DESCAIPTION� Y TORS UCENSE UW.). FEE y^. 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON y Q ?� U LL DATE OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATION W � I HEHEBV AFFIHIA UNDER PENALTV OF PERJURY TNAT I AM LICENSED UNDEF PROVISIONS OF CHAPTER � � i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PROFESSIONS CADE,AND Z � �� AIY LICENSE IS W FULL FORCE ANO EFFECT. m � ICENSEC)L�AjSS� C�•�/ �IC.NO. Cf/ l7�// � V �ATE /G ' � '�� CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q I HEREBV AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECUFATIONS: � � Z �Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ Q = COMPENSATqN,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOP THE PERFORMANCE U 7HE WORN FOH NM1iICH THIS PERMIT IS ISSUED. W � � I HAVE AND WILI MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REW IRED BV SECTION Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS ISSUED.MV WOHI(ERS'COMPENSATION INSURANCE CAARIER AND POLICV NUMBERARE: CONSTRUCTION j `� CARRIER�,/�S INJSU�/(J � PLANREVIEW Z �� aa.icr NUMeE�_��OC��^e�f�f/� ELECTRIC ¢ � (ni�sSECilOrlrlE�rlOieEm�.sLE�EpOFnEpEqMitSWqpraEFpa.p��Eppp�U�SR+pp)oRlESS1 PLUMBING W Z I CERTIFV 7HAT INTHE PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMIT IS ISSUED,I MECHANICAL G.7 SHALL NOT EMPLOV ANV PERSON IN ANV MANNEfl SOAS TO BECOME SU&IECTTO THE (,/� WORNERS'CAMPENSATION L4WS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE � SU6IECTTO THE WORKERS'COMPENSATqN PROVISIONS OF SECTb7J 37000F THE L/�BOR � CODE,I SHALL FORTHWITH COMPLV WI THOSE OVISIONS ISSUANCE � r p �ATE:�1 qPPLICANT: � (�� SMIP W J WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPIOVERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIOED FOR IN J SECTqN 37aa OF 7HE UBOF COOE,INTEREST,AND ATTORNEV'S FEES. �'+ (1 w RETENTION FEE: __ p I O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDINO AOENCV �� FOR THE PERFORMANCE OF 7HE WORK f-0R WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�. Z W � LENDER'S NAME F— LENDER'SADDRE55 w ICERTIFVTHATIHAVEREADTHISAPFLICATIONANDSTATETHATTHEABOVEINFORMATqNISCARRECT. TOTAL FEES ��/y� � 1 AGREE TO CAMPIV WITH ALL CRV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUfLDINO � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO EMER UPON THE Z ABOVE�MENTbNED PROPERTV FOR INSPECTION PURPOSES. � COMMENTS ' ' � 7��D �il��c�5dn� . m P (PRINT) ' � N `3'-2/ -// N SIONANHE OF PERMfTTEE DATE �. RECPT.N0. � PAID BY VALIDATION � WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Asaessor Copy,GOLDENRO�Ie Copy,GREEN—ApplicanYs Copy CO�V OIF D9AiVi(7ND �AR I�IS��GO� �iIECOFiD " , , . . ._ . , � � ., _ . , , �� oa�Q��400a - ��a� -�� oa�p�c�a � � �a�p�c�aoa � �o ��: ..��'� � � SET BACK ' FLOOR JOIST � FTGS/FORMS/STEEL • �� FH,4 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 � (,l � 8 FT. BOND BEAM FRAMINGNENTILATION � FINAL BOND BEAM ROOF COVER��/N�L �2 '/Z �CG PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING PQOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION QFF 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. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ��` � COMMEiVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � a a