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Home My WebLink About11-1589 �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7 � PRESS �''"' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE fJc�?/^/// . � � ' � I� �- APPLICATION PERMIT p/C � ADDRESS oS �f%� � � PQ L�, DATE �� NUMBER q � APN OT TRA T ISSUE NPE OCC C DATE CONST.P��m� GROUP p OWNER o ADDRE ZONING S KS z CITY ,�P EL. - FRONT qyy � g APPLICANT TEL. — REAR � � SIDFJSIDE STREET RW p � CONTRACTOR i SIDE 0 � ADDRESS _ � CITY ZIP�Q�L. `P67 c��P PROPOSED USE � l/f� o ARCH/ENG/ ��a� z DESIGNER a ADDRESS NO.DWEL. NO. NO. u� UNITS STORIES BEDROOMS N 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 PERIURV THAT I AM EXEMPT FROM 7HE CONTRACTORS ll- G8f8 B/Ce A W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCIT'OR (n g � U COUNTVWFIICHREOUIRESAPEFiM1TTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W Patlo/Deck < NRE,PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUp1 PERMIT TO FILE A SIGNED W � S7ATEMENT TFU7 HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRAC70RS Lb � CENSE UW(CHAPTER o(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO- � POOUSPO FESSIONS CODE)OR THAT HE OR SHE IS EXEMP77HEREFROM AND THE BASIS FOq 7HE ALLE6ED E%EMP- C7 TION.ANV VIOlAT10N OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Raof A CML PENALTV OF NOT MORE TMAN FNE HUNDRED DOLURS(5500).): � ❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOYEESWI7NWAGESASTHEIRSOIECOMPENSATION, � COrt1RIBfC18I Z WILL DO THE WORIC,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J ' N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPEfm'WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � Q iHROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREDFORSALEIF,FqVJEVE0.711EBUILDINGORIMPROVEMENTI550LDWRHINONEVEAROFCOMPIE� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILO OR � IMPROVE FOR THE PURPOSE OF SALE). � w ❑I,AS OWNER OF THE PROPERn'.AM EXCIUSIVELV COMRACTING WITH LICENSED CONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.7011,BUSINESS ANO PROfE5910NS CODE:THE CANTRACTORS LJ- VBIUflIIOf1 ADJ.AREA CENSE UW DOES NOTAPPLV TO AN ONTJER OF A PROPERTV WHO BUILDS OR UAPqOVE3 THEHEON,AND � WFIOCONTRACTSFORSUCMPRPIECTSWITHACONTRACTOP(S)LICENSEDPURSUANTTOTHECONTiUG OUANTITY DESCRIPTION Y roas ucENSE uw.�. FEE � ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON � � U � DATE OMMER � Z U � LICENSED CONTRACTOFiS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z XL' MY LICENSE IS IN FULL FORCE AND EFFEC7. m LLI � IICENSE CLASS �IC.NO. � � V DATE CONTRACTOR_ d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWINO DECIARATIONS: � � Z �Z _I HAVE ANO WILL MAMTAIN ACERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' a Q COMVENSATION,AS PROVIDED BV SECTION 37ooOF THE LABOR CODE,FOR THE PERFORMANCE U F THE WORK FOR WHlqi iHIS PERMIT IS ISSUED. � � w HAVE AND WILL MAMTAIN WORNERS'COI.IPENSATION INSURANCE.AS FEOUIRED BY SEC710N Q 3700 OF THE IABOR CODE,FOR THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS J ISSUED.MV WORNERS'CAMPENSATfIQ�N IN�SU�flANCE/CAP qIER AND POUCY NUMBER ARE: CONSTRUCTION j CARFIER �� /J!/f/1 Cf— PLAN REVIEW Z POLICV NUMBER g� - � ELECTRIC ¢ 0 (rwssEcmrr��rareEoa.u�.ErmoFn�aEaMrr�swaorrE�ooauasR�ooloa�Ess} PLUMBING � w Z I CERTIFV THAT IN THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMI715 155UED.I MECHANICAL CJ SHA�L NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE (/J WOfU(ERS'COMPENSATION IAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECT TO THE NbRKERS'COMPENSATION 7ROVISIONS OF SECTKKJ 3700 OF THE LABOR . CADE.ISH FORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE � ///v �ATE: APPLICANT: � SMIP w ENERGY P/C "'� WARNINO:FPJLURE TO SECURE WORKEFS'COM NSATION VERAOE IS UNUWFUL,AND SHALL BE J � SU&IECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSMID ENERGY PERMIT OOLLARS(=10o,000J,IN ADDITION TO THE C0.5T OF COAIPENSATION,DAMAGES AS PROVIDED FOR IN J SECTqN 370E OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. �� w RETENTION FEE: _ O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO A(iENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRE55 w I CERTIFY iHAT I HAVE READ TNIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES �j 7 I� � I AGREE TO COMPLV WITH ALL qTV M1D COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILDINQ � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EMER UPON THE � Z ABOVE-MENTIONED VROPERTV FOR INSPECTION PURPOSES. COMMENTS ' � �G�G'i%?Q f��/�dT/G�- ¢ PERMITTEE NAME(PRllfn ' � � .�� //i N SI�NATUREOF I7iEE DATE � RECPT.NO. PAID BY VALIDATION WHITE-0epariment Copy,YELLOW--Finenc;e Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—ApplicanPs Copy CITY OF DIAIVIOND BAR INSPECTIOi� RECORD • � � • - • . • � - 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 HT. BOND BEAM ROOF SHEATNING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlTUB 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 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 e • :/ � �--,P,, COMMENTS '.��.. '�: '��. '�.., , . .. SEPTIC TANK SIZE SEEP PIT/U SIZE t• ��, .,''': � `�� , :�� ;.:"�