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Home My WebLink About12-831 _�,� CITY OF DIAMOND BAR - / DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES V 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 �' PRESS ��"^' BUILDING PERMIT APPLICATION FIRMLY oN JOBSITE 1` ��0.� �1 DATE � ` ��UMBER Z-�I # ADDRESS j�( q ►"IC�Vf APPLICATION PERMIT p/C ISSUE �'7 � /]1� � � APN LOT TRACT DATE C/(.' � ONST./' '�GROUP p OWNER �C`c1G� ��r.vv. o ADDRESS_I�I�1 Nbura Ir�ss�1 ZONING SETBACKS z CITY ZIP 17 ' TEL.40�Q-L'6Q-3iS� FRONT pyy � . � APPUCANT levc�n y�h�niere!' TEL.4S1-2�11-b37L REAR � ¢ SIDE/SIDE STREET RW p � CONTRACTOR " v� SIDE p ADDRESS�ZZQ►� � CITY Vbrl�c. Lin��' ZIP �32f?87TEL� -717-7�I PROPOSED USE o ARCH/ENG/ z DESIGNER � ADDRESS NO.DWEL. NO. , � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFR/AD�/REM p 1 HEREBV AFFlRM UNDER PENALTY OF PEfLNRY THAT I AM EXEMPT FROM THE WNiRACTORS L,F Garage/Carport W CENSEWYFORTHE�OILOWWOREASON(SEC.7N1.6BUSINESSANDPROFESSION9COOEAHI'CRYOR (n C� COl1NTYWHIGIREOUIHESAPERMITTOCONSTAUCT,AITER,WPROVE,DEMOUSH,ORREVAIRANVSTRUG W P8II0✓D9C1( < NRE.VRIOA TO RS�SSUANCE,ALSO qEOU1RES THE APPIICANT FOR SUCH PERMIT TO FlLE A SK3NED w � STATEYENT THA7 HE OR SFiE IS LICENSED FURSUANT TO THE PROVI510N5 OF THE�COMqACTOR9 LI- . . � CEP15E UW(CHAVTEH B(COMMENCINO V.7TH SECTION 7000)OF DiVISION J OF THE BUSINE59 AND PRo- �'1' POOUSpB , � FESS�ONSCOOEjORTHATHEORSHEISEXEMPT7HEREFROMANDTHEeA515FOR7HEALLEOEDE%EMP• C7 V TION.ANV.VIOIATIONOFSECTION7071.6BYANYMVLICANTFORAPERMI75U&IECTSTHEAPPLICANTTO . Z pg-ROOf � A CMI.PENALTV OF NpT AqpE THAN.FIVE HUNDRED DOILARS(36oD)J: � Z ❑1A50WNEROF.THEPROPERiY,ORMYEMPLOVEESNTTHY✓Al3E3ASTHEIRSOLECOMPENSATION, � O Cq�mBfClal� � WILL DO THE WORK,AND THE STAUCTUR£19 NOT INTENDED OR OFFERED FOR SALE(SEC.7ws,BUSF J � � NESS AND PROFESSIONS CO�E:THE CONTiUC70RS UCENSE UW DOES NO7 APVLY 70 AN OWNEH OF � ' - PROPEHTy WFq BU�LOS OR IM7ROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR W THAOUGHWSOpHEROWNEMPLOYEES,PROVIDEDTHATSUp11MPROVEMENTSARENOTMTENOEDOR � m . 0 OFFERmPDRSALEIF,HOWEVER7MEBUN.DINOORIMPROVEMENTISSOLDWfTHINONEVEAROFCOMFLE- � . Z. TION..THE�ONT�ER-BUILDER VALL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BUILD pq . � IMPROVE FOR 7HE PURP0.SE OF SALE). � � w ❑�I,ASOWNEROF.7HEPROPERTY,AME%CLUSIVELYCON7RACTINOWfTHUCENSEDCONTRACTORS � TO CONSiRUCT THE PROJECT(SEC.7wI,BUSINESS AND PROFESSIONS CODE:TME CONTMCTORS ll- VBIU0t10l1� ADJ.AREA � CENSEUWOOESNO7MPLY70ANOWHEROFAPROPERTVWFID&IiDSORIMPROVESTHEREON,AND ' � \MrOCOtt�RACTSFOP6UCHPROJECTSWfTHACONTMC70R�S)LICENSEDPUR6UANTTOTHECONTRAC Q�J(NJj�Ty DESCRIPl1ON �� ra�s uceNse uw.�. FEE � ❑I AM E7(EMPT UNDER 6EC. . B.d P.C.FOR 1HIS REASON Q ' U � OATE � ONMER �� UCENSED CONTRACTORS DECLARATION W � � � � � � � I HEREBY AFFIRM UNDER PENALTY OF PERp1RV TMAT 1 AM LiCENSED UNDER PROVISIONS Of CMAPTER � - ' - d. Y(COMAIENCINO WITM SECr10N 7000)OF DIVISION 7 OF 7HE BUSINESS�ND PROFESSIONS CODE,AND Z X �(Y LICENSE IS W FULL FORCE AND EFFECT. m � UCENSE IASS � LIC.NO.�—1�I�0 � � V DATE� L CONTRACTOR �— � d _ W T � WORKEHS'COMPENSATION DECLARATION � � � „j,v r � I HEREBY AFFIRM IINDER PENAL7V OF PERtt1RY ONE OF THE FOLLOW WG DECtAAATIDNS: U � � , z C ar dv"�- � _I HAVE�AND WILL MAINTAIN A CERTIFlCA7E OF CONSENT TO SELF-INSURE FOR VpRKERS � � � � COMVENSATION,AS PROVmEp BV SECTION 3�OOOF THE UBOR CODE,FOR iHE PERFORMANCE W OF THE N/ORK FOR WHICH TH�g pERMIT 19 ISSUED. � � �HAVE AND WILL MNNTAIN WORKERS'COMPEH$A170N WgURANCE,AS REWIRED BV SECTION � � Q 370o OF�THE LABOR CODE,FOR 7HE PERFORMANCE OF TME WORK FOR WMp/THIS VERMT IS IS.I`1m.MY/WO�R�KERS COAIPENSATION IN RANCE CMRIER AND POLICV NUMBER ARE �CONSTRUCTION� j CARRIER��1,�,�bOtti� PLAN REVIEW . . o vo��cYr+uMeER_�� C_ iO2SO1Z a7 ELECTRIC p" (�s�.'na+r+��'pTs��rIDa�n�a�w.r�swaa��ocuu�sR��oAtEssl PLUMBING � w • Z I CERTIFY.THAT IN hiE PERFORMANCE OF 7HE WORK FOR WHICH 7HI5 DERMIT IS ISSUED.1 MECHANICAL� �. C7 SHALL NOT EMPLOV ANY VERSON P!AN'(MMINER SOAS 70 BEWME SUOJECT 70 THE � (/j YIORNERS'COMPENSATIONUWSOFCALIFORNIqANDAGiiEE7HATiFISNOULDBECOME INSPECTIONFEE SUBJECT TO THE WOAKERS COMVENSATqN PROVISIONS OF SECTION 7700 OF THE LABOR - '-� ' - � • � s �coo�E.�.i s�rw,��.w��ar�n�coua�v wirH nwsE Paov�sroNs, ISSUANCE �� p DATEWIl�11'If— qvpucu�rr:: �� SMIP . . w T T— � WARNW4�FAILURE TO SECURE wOPoCERS COMPENSA710N COVERAGE IS UNUWFUL,AND SHALL 8E ENERGY�P/C � � SUB.IECT AN EMPLOYER 70 CRIMWAL PENALTIES ANO CNfL FlNES UP TOONE HUNDHED 7TIOUiANO ENERGY PERMIT DOLLMi3,(f10o,o0D),�W ADDITON TO THE COST OF COMPENSATIDN,OAAU6ES AS VROVIDED FOR IN J SECTpN 37oe OF 7HE LA80R COD�WTEqEST.AND ATTORNEr'S FEES. � � � � � � _ w . . � HETENTION�FEE: � CONSTRUCTION LENOING AGENCY PRE-ALT FEE � 1 HER�Y AFFIRM UNDER PENAL7V OF PERIURV THAT THERE IS A CONSTRUCTION I.ENDWO AOENCV FOR THE PERFORMANCE OF hIE WORK FOR WH1CH Til9 PERMII IS ISSUED(SEC.309],CIV.C.} Z w ��. LENDEf75�NM1E � . F— LENDER'SADDRE55 ' - . �� ICERTIFY7HATIHAVEREADTMI9APP�ICATIONANDSTATETIATTHEABOVEMFORA/ATqN19CORHECT. TOTAL FEES O�'/ � � 1 AUREE TO CAMPLV N77H ALL CT'AND COUNTV ORDINANCES AND STATE UWS REUTWO TO BURDINO 9 _� CONSTHUCTION,MH7 HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EMER UPON THE ' . Z ABOVE-MEMIONED FROPER7Y FOR INSPECTION 7URP0.SE5. COMMENTS �- 0. � ��e�IL�h ��.�n��rG� m GE Ti�E NAME(VRRfT) ' � � �� • �� . Uj �51ONANRE OF PERMfTTEE . DA7 .—Z� � RECPT.NO. PfUD BY VALIDATION WHITE—Depertment Copy,YELLOW—Flnence Copy,PINK—Assessor Copy,GOLpENRO�FlIe Copy,GREEt�AppllcanYe Copy CITY 4F DIANiOfVD �AR ' �. �, . I11�SPECTION RECORD �:k,. .. . . � . ; rj � � .0 � I . .7.J� .' �..�::. ,. . . '4 ' .-� e o y s � �,i°_- � � �� ,�e:z'�'':�.: o �.� SET BACK �FLOOR J015T FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE F�UNOATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT.BOP10 BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHIldG ROUGH ELECTRIC ^ ROUGH GRADING ROUGH PLUMBING FINISH GRADlNG SHOWERlTUB TEST POOL ELECTRIC EXT.LATHJSIOING POOL FENCING WALL INSULATION POOL FIN,4L CEILING INSULATION OFF SITE IMPS. DRYWALL NAILIPIG DEDICATIONS SEWER FINAL ENG. SEPTI�TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL�ONST. FIRE DEPT.FlNAL FINAL HEATING •;;,..,,,;,.. � g Z � , / �. y�,_ HEALTFi DEPT.FINAL FINAL ELECTRIC � �EV.FEES PAID FINAL PLUMBING ENERGY FINAL PLANING � FINAL ENGINEERING . � p , COMMENTS � SEPTICTANKSIZE SEEP PITlU SIZE i