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Home My WebLink About16770 (32) � �j �� _ CTI'Y OF DIAMOND BAR DEPARTMENT OF COIvA�UNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3117 - e PRE$$ ��'<�^� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE _I APPLICATI N PERMIT � P/C o ADDRESS ��'�� I�IIAi�.G�n-.. LJ�LL DATE �'� "0 NUMBER � � � ISSUE TYPE OCC APN LOT TRACT DATE � 0 CONST. GROUP °C OWNER /Yr�/� �— O p ADDRESS ��T r.el..:�'�i✓� � ZONING SETBACKS Z CITY .��LFY►��rt.ol �3AR ZIP TEL. FRONT qyy p o APPLICANT � � Cro o ( a. t TEL. _ _ REAR � dz SIDFJSIDE STREEf RW ❑ QCONTRACTOR_ L<�n.-- . �(ti.7 SIDE ❑ ADDRESS 7 c�n n �-/ G � o CITY InJAL. ZIP TEL.��-r�-�(, 3 PROPOSED USE 4 (;�,VL O •S� o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p � SFR/ADD/REM p I HEREBV AFFIRM UNDER PENALTV OF GE0.NRV THAT I AM EXEMPT FROM THE CONTiUCTORS LI� GBfeJB/C91pOfS W CENSEUWFORTHEFOILOWINGREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCITYOH (n U COUNTVWHICHREWIRESAPERMRTOCONSTRUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck w TURE,PqIOH TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIQNED w � STATEMENT THAT HE OR SHE IS LICENSED W RSUANT TO THE PROVISIONS OF THE CONTRACTORS ll� � CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� LL' POOUSPB� � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOED E%EMP- . TION.ANY VIOL,ATION OF SEC710N 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICMIT TO Z Re-Roo( � A CML PENALTY OF NOT A/ORE THMI FNE HUNDRED DOLURS(t5oo).): 0 04��WNEROFTHEPROPER7Y,ORMYEMPLOVEESWI7HWAQESASTHEIRSOLECAMPENSATION, � COR1rtI0fClel Z WILL DO THE WOFi1C,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI� J � � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO Ml OWNER OF � PqOPERTY WFp BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTMROUOM HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� Z TION,THE OWNER-BUILDER WILL HAVE'fHE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE�. w ❑I,ASOWNEROFTHEPROPEHTV,AME%CLUSIVELVCONTRACTINOWfTHUCENSEDCONTRACTORS � Q TO CONSTRUCT THE PR0.IECT(SEC.7oN,BUSINESS AND PROFESSIONS CADE 7HE CONTRACTORS LI� BtlOfl �'�D Z� ADJ.AREA W CENSE UW DOES NOTAPPLV TO AN ON?JER OF A PHOPERTV WHO BUILAS OR IMPHOVES THEflEON,AND � WHOCONTRACTSFOFSUCHPR0.IECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE � Y 70RS LICENSE LAW.). i � �I AM EXEMPT UNDER SEC. B.8 P.C.f-0R THIS REASON � � U � oJhE—n- — � ¢ Z � �-� U � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCINO WITH SECTqN 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MV LICENSE IS IN FULL FORCE ANO EFFECT. m � LICENSE CLASS LIC.NO. �� S U�� U DATET_�7� CONTRAGTOR ��, �J��_ d W � WORKEFS'COMPENSATION DECLARATION Q N U � I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z �Z I HAVE AND WILI MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a Q = COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR iHE PERFORMANCE U OF 7HE WORIC FOR WHICH iHIS PERMIT IS ISSUED. W � � QW _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTpN ///��s� 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS / L � ISSUED.MY WORKERS'C.O/MPENSATION INSURAN/r�_�CAR�RIER,A,N,�D POLICY NUMBER ARE: CONSTRUCTION �{) j CARRIER �/A�� T��J` PLAN REVIEW ' � POLICY NUMBER �� z/� z�,� -- d� ELECTRIC � �� i � (�HISSECf10NNE�NOTBENIrpLETEppFT}EpEWNrISFpqpdEHUPORmD0UAA5(5100)ORLESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL G.'3 SHALL NOT EMPLOY ANV PERSON IN ANV MlWNER SO AS TO BECOME SU&IECT TO THE N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME �NSPECTION FEE I � SU&IECTTOTHEWORKERS'CAMPENSATqNPROVISKKJ50FSECTION37000FTHELABOR � � CODE,I SW�LL FORTHWITH COMPLV WITH THOSE PFOVISIONS. ISSUANCE �" � , � p DATE:�D�/APPLICANT; 6 , � ��(�_��w L SMIP J WARNIN6:FAILURE TO SECURE WOFlKERS'CAMPENSATION CqVEqAGE IS UNUWFIIL,AND SHALLBE ENERGY P/C � J � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLI�RS(f100.000).IN ADDIiION TO THE COST OF COMPENSATION,DAMAGES AS PFOVIDED FOR IN J SECTION 3�oB OF THE LABOR CODE,MTEREST,AND ATfORNEYS FEES. , OC RETENTION FEE: • OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBV AFFIRM UNDER PENALTV OF PEFiJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV ' � FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.708�,CIV.C.). Z w /�y��/� D � LENDER'S NAME /� � F— LENDER'SADDRESS'/Y�� ,�j�,(JL�\ �� n w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATqNISCARRECT. TOTAL FEES � 1 J�� I AGREE TO CAMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS RELATINO TO BUILDING ' � (, � CANSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONED 7ROPERTV FOR INSPECTION PURPOSES. COMMENTS O _' �� o a �--� � � m PERMITfE PRIM) � �a r� � SIQNATUR F PEFMI TE � RECPT.NO. PAID BY ' VALIDATION WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �C�'P'S�l (�� [��[�c�b�i� ��[� ��'fc(��f�l �f��fF��D . e � u o DGQ`t� OG�G�CG� o � O��tr00O a � � tr`�C �� 5Ef BACK FLOOR JOIST FTGB/FORMSISTEEL ---_I—� � : � FHA REQMTS ELECTRIC GROUND , UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CUMDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM W1�TER SERVICE MID HT. BOND BEAM ROOF SHEATHING ` iC.�/ 8 FT. BOND BE.4M FRAMINGNENTILtATtOIV � �` FtNAL BQND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUfV1BING FINISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCiNG UVALL IidSULATION � POOL FINAL CEILIRIG IN�ULATION OFF SITE IMPS. DRYWALL NHILIPVG DEDICATIOP�IS SEWER FINAL ENG. SEPTiC TANK LANDSGAPE/IRRIG. SEEP PIT/L.L. • ON SlTE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE pEPT. FINAL FINAL FiEATiNG HEALTN DEPT. FINAL FINA�ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY �, - — - - - - - - �Cc�,�i�O(�.a _I CQMiViEfVTS _..;;�.� �� C9_rr�'d•�.�� Y�'�`_` . _. 6_�. �'°�'''' � T� - — — _ SEPTIC TAiVK SIZE SEEP PIT/U SIZE � , : � � � ' � _