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Home My WebLink About17208 � f, • CTI'1'OF DIAMOND BAR f /, ----��` ---� DEPARTMENT OF COIvA�1UMTY, DEVELOPMENT SERVICES 21825 E.Copley Drive �"`�-i (909)860-3195 Fax(909)861-3117•� � Pf;E$S �"'%�� BUILDING PERMIT APPLICATION FIRMLY QJOBSITE •' / � I'V�/ DATEICIDP_ V �'ll�+ NUMBER #/C ¢ ADDRESS � � ISSUE TYPE OCC APN LOT �RA T DATE CONST. GROUP p OWNER " ADDRESS Y� ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑ I o APPLICANT TEL �� S DE/SIDE STREET RW ❑ z m CONTRACTOR � SIDE ❑ � ADDRESS + e- (1-��(p . � �/y� , � CITY�(,�12l� ZIP qI 7�l TEL. • (o(p�� PROPOSED USE ��h � I 1 1�� o ARC NG/ � iz DESIGNER NO.DWEL. —�- NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENAL7Y OF PERIUHY 7HA71 AM E%EMP7 FROM THE CANTRACTORS LI� G8f892/CBfPOfI W CENSEUWFORTHEFOLIOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCI7VOR (n U CAUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTEH,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- � w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck I STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER V(CAMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- � PooUSpa � FESSIONSCODE)ORTHATHEORSMEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDE%EMP- (� � TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTFiEAPPLICANT70 Z Re-Roo( - A CIVIL PENAL7Y OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): Z ❑I,ASOWNEROFTHEPROPER7V,OHMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COR1mBfCi81 - WILI DO THE WORK,AND 7HE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J � NESS AND PROFESSIONS CODE:THE CONTRAC70R5 LICENSE LAW DOES NO7 APPLV TO AN OWNER OF � ' � PROPERTV NhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSE�F OR Q THROUGH HIS OR HER OWN EMVLOYEES,PROVIDED 7HAT SUCH IMPROVEMEN7S ARE NOT INTENDED OR m � QOFFEREDFORSALE.IF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPIE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OH SHE DID NOT BUILD OR � � IMPROVE FOR THE PURPOSE OF SALE�. � � � J w ❑I,ASOWNEROF7HEPFOPERTV,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PR0.IECT(SEC.701t,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V0IU0�1011 A J.AREA W CENSEUWDOESNOTAPPLVTOANONMEROFAPqOPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOH(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION �F Y TORSLICENSELAW.�. � ❑I AM ExEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q I � � U � Q � � DATE OWNER � Z W � IICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THA7 I AM UCENSED UNDER PROVISIONS OF CHAP7ER � d e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z • X MV UCENSE IS IN FULL fORCE AND EFFEC7. /� /j � � I � LICENSE SS —� LIC.NO. 1 � / I W j � , ~ DATE �U �D CONTRACTOR� �Q�f� d � U w a� WORKERS'COMPENSATION DECLARATION � � ¢ � I HEREBYAFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN7 TO SELF-INSURE FOR WOHKERS' _ � � , COMPENSATION,AS PROVIDED BV SEC710N 370o OFTHE LABOR CODE,FOR THE PERFORMANCE U ¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � I � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION �I QQ 370o OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS Q� ISSUED.MV W�a�ERS'COMPENS ION INSURANCE C AND LICV NUMBERARE: CONSTRUCTION Q ,/y�l�p �/�/�� 1 � CARRIER'%�"1�IP� �J`�I��!/'' PLAN REVIEW ��\� ZPOLICY NUMBER�7� " �J� ELECTRIC Q 0 (iHISSECIqNNE�NOTBECI:MPLEfEDOFTHEPERtMISFORONEHUI�DREDDOUARS(5100)ORLE55} PLUMBING W Z I CEFiTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE � WOf1KER5'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECT TO THE WORKERS'COMPENS�P OVISIONS OF SECTION 37000F THE LABOR � CAD/,�I SH LL FOIHTHWITH COMPLV WI T PR visior+s. ISSUANCE p DATE: I V ` APPLICANT: SMIP .-�-� � "�-9' `i i �- �i � /f=\\ I 1 �.� J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEfiAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �J � � SU&IECTANEMPIOYEFTOCFIMINALPENALTIESANDCNILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT 'I DOLLARS(f100.000�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN J SECTION 3708 OF THE LABOR CODE,INTEREST,ANDATTOFNEV'S FEES. RETENTION FEE: Q I � CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY ��r' a- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). p�--��-�___ __ _:._r- .-- � --� . Z W 2 LENDER'S NAME � F— LENDER'SADDRESS � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES w I AGREE TO COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHOR2E REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � �i�l. ��'�-1 J � m PERMIy�,�E N E(PRINT) I pl��1 � � Q � �f� U �I � SIGN R PERMITTEE ATT / = RECPT.�O. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ��rn�•. �. ..:....,.�. . . . . . ..r..�� :r� ++. ..�.+i'l:f�.. ... i•:�.v:�.:^.. '.T,.'. �..:'yG'....��W�ia�y ,., ...• . .�.. 41� . :� + :. y . ... Y:.. ...... .irL• .. ..y�.r� ...�. . . .`L.iY Y � �Y .teY�4�3YtlY�4V� IV:II"11� � �� ` �� . ,�. , --�------�---s. ,�.�--�_�,..�. �.�-�----°��„ �G�� U o �Ql� 0�� U � �,i �G� ° �C�it�Oa �QU� .� ° `Q o .<.,, 5ET BACK � i FLOOR JQIST � I ---- -- .._...______.�_...___ _...__. .._ _��____..._- — __4____--- -...._..-- FT'GS/FORMS/STEEL � I f=HA REQMTS ; W —�------ --- ------ — -- ELECTRIC GROUND � � j UNDER FLO�R DUCT ' - — —...- -- --__--- — - � ---...._-- GROUNC} PLUMBING ( i UND�R FLOOR GUf�IbUIT — --- ----- ---..--- -..............._ � SLABGRADE � FIREPLACEFOUNDRTION__ __ - - -- -� TEMP POWER � ----- ----- - .�_. FIREPLACE BONQ BERM i — -- -._....... ._�.____�._.___._,.___..----__ _ ___._ WATER SERVICE � _ � MID HT. BOND BEAM __ __ ROOF SHEATHIiVG ! S Ff. BOND BEAM __ _-------- -----....__.._-- ---..,._. —_..___ FRAMINGNEN7ILIATION�_ i FINAL BOND BEAM � -- --. i_ ..-- -�----- ----- � ROOF COVER PRE-GRADING � . ROUGH HEATING BENCHIi�G __ _ � _^ ROUGH ELECTRIC ROUGH GRADING � — --- --- ROUGH PLUiV1BING � FINISH GRADING . — -- -- -- -- _.._-- -------...-------..__ _.---......,___._. SHOWER/TUB TEST � � POOL ELECTRIC EXT. LATH/SIDIfVG I POOL FENCING WALL INSULATION ; POOL FINAL CEILIPJG IN�ULATION i OFF SITE IMPS. _� DRYWAL�NAILING ; DEDICATIONS ------ ---_._._ _._.__ �___�___.._—___....___ ________._ SEWER FINAL ENG. � SEPTIC TANK LANDSCAPE/IRRIG. � SEEP PITIL.L. ON SI�TE IMPS. GAS AIR TEST FINAL ZONING i FINAL CONST. G�RE dEPT. FINA� FINAL HEATIIVG � � �HEALTH DEPT. FINAL ^ � FINAL ELECTRIC DEV. FEES PAID --�------ ---_.__._ ------- FINAL PLUMBIMG ^ ENERGY , — ---...--- ---- ��a :�e: � _-- CCJiVifi�ENl"S _ SEPTIC TA�lK SIZE SEEP PIT/U SIZE -- ---_.—.-- --__._--- � � � � _ � , � � � �/ t �rt� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES i 21660 E.Copley Drive Suite 190 � ��p 1�� W (909)860-3195 Faz(909)861-3117 �� , PRESS �y�'� BUII.DING PERMIT APPLICATIOIV 'Z 3 �(�QO FORMLY � JOBSITE ' / APPLICATION ' ,� PERMIT r'�I_ P/ I_ � o ADDRESS �� ! �• DATE �� NUMBER Y�#� � c� ISSUE TYPE OCC APN LOT TRACT DATE CONST.' GROUP p OWNER�'�S//'�IA C.l- � ADDRESS 3 ZONING SETBACKS Z CITY ZIP TEL. REART RW ❑ g APPLICANT TEL. SIDElSIDE STREET RW ❑ � CONTRACTO SIDE ❑ O ADDRESS PROPOSEDUSE t��wl. .yuni�, ' ��/YIIUCZ n[ahl w RCFUENG/ ,'�� l)-r��p�L. -� Q Q C'L� � �� DESIGNER Q NO.DWEL. NO. NO. ADDRESS 2 �C1 _�� UNITS STORIES BEDROOMS � CITY ZIP EL. - N � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILD RATI SFR/ADD/REM O � I NEREBV AFFlRM UNDER PENALTV OF VERNRV 7HA7 I AM E%EMPT FROM THE CONTMCTORS LI- Cigf8g0/C8lp0A W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFES510N5CODE:ANYCITVOR (n U COUNT`/WHICHREWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTAUC- W .P8�10/DBCk u� TUHE,PRIOR TO ITS ISSUANCE,PLSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENt THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI� � � CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 ANO PRO- V' POOVSPO FESSIONS OODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANYVIOUTIONOFSECTION7031.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Fioot � A CIViI FENALTY OF NOT MORE THMI FIVE HUNDRED DOLUfiS(f5oo).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIFSOLECOMPENSA710N, O COrtIR10fClfll � WILL DO THE WOHI(,AND THE STRUCTURE IS NOT INTENDED OH OFFEHED FOR SALE(SEC.toa1,BU51- J N NESS AND PROFESSIONS CODE:THE COHTMCTORS LICENSE UW DOES NOT APPLY TO AN OWNEH OF � PROPERTY WFIO BUILDS OR IMPROVES THEHEON,AND WHO DOES SUCN WORK HIMSELF OR HERSELF OR S THiqUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m QOFFEREDFORSALEIF,IqWEVERTMEBUILDINGORIMPROVEMENTIS50lDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OH SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SAI.E). W ❑I,AS OWNEROFTHE PROPERTY,AM EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7o{I,BUSINESS AND PROFESSIONS CODE:THE CUNTHACTORS ll- VeIllBtiOf1 ADJ.AREA W CENSE UW DOES NOT�PPLV TOAN ONMER OF A PROPERTY WHO BUILDS OR IMPiIOVES THEREON,AND , � NM1qCONiRACTSFORSUCHPR0.IECTSWITHACONiMCTOR(S)LICENSEDPURSUMITTOTNECONTRAG pUANTITY DESCRIPTION . FEE � TO0.5l10ENSE UW.). ❑I AM E7(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON � � � � � I O 3 � � DATE OWNER � . W � LICENSED CONTRACTORS DECLARATION W � 1 HEflEBV AFFIRM UNDER PENALTV Of PERIURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � ' . � 9(COMMENCINO WITH SECTION 7000)OF DIVISIqJ 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS IN fULL FORCE AND EFFECT. (`' m � !� � UCENSE CLASS � �� LIC.NO. �� •V j O v ~ �*�7 .< ' � V DATE I I CONTRACTOR V� a W [� WORKERS'COMPENSATION DECLARATION .� �1,� U "� 'p � � " � I HEREBV AFFIRM UNDER PENAL7V OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Q � �' • � � I HAVE AND WILL MAINT�IN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ - � � ' .� ' ' � �' ' ' � COMPENSATION.AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR NM1iICH THIS PERMIT IS ISSUED. � O _I HAVE ANO WILL MAIMAIN WORI(ERS'COMPENSA710N INSUMNCE,AS RE�l1IRED BY SECTION i' Q 37000F THE LABOR CODE,FOR THE AERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS � �,I ,\ � . ISSUED.MY WORKERS'COMPENSATlON INSUR/W/CE C,�ARRIER,ApND POLICY NUMBE�R A�RE/�: CONSTRUCTION � � CARRIER �,�A� WI'�I/— �U/l1LJ PLANREVIEW � POLICY HUMBER Z 1 ELECTRIC (I � (TlGSSECfqNNE�NOT8EWIF'LEfIDOF7HEPERMfTLSFORONEFhN�[NiED 100)ORLESS) PLUMBING ` y^��. J � w MECHANICAL �d-.� Z I CERTIFV THAT IN TME PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I ('J SWLLI NOT EMPLOY ANY VERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE � WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE `l S SU&lEC7 TO 7HE NfORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF TME IABOR ISSUANCE C�O i v v CODE,I SHALL FON7HW17H COMPLY WITM TNOSE PROVISIONS. i C� � SMIP 1 .73 v p DATE: APPLICANT: . � ENERGY P/C J WARNING FAILURE 70 SECURE WORKERS'CAMPENSATION CAVEHAGE IS UNUWFUL.AND SHALL BE � SU&lEC7ANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(i1o0,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN (� � SECTION 370E OF h1E LABOR CODE,INTEREST,AND Al"fORNEY'S FEES. RETENTION FEE: �/ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � Q I HEREBV AFFIqM UNDER PENAL7V OF PERIUHV THAT THERE IS ACONSTRUCTION IENDING AGENCV � FOR TME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30V7,CIV.C.). Z W � LENDER'S NAME F_ LENDER'SADDRESS . j� w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CAfiRECT. TOTAL FE ES ,1 , �y /�,�b � I AGREE 70 CAMPLV WITH ALL CI7V AN�COUN7V ORDINANCES AND S7A7E LAWS REUTING TO BUILDING �� CONS7RUCTION,AND HEREBV AUTHOR2E REPRESENTA7IVES OF 7HI5 COUNTV TO ENTER UPON 7HE Z ABOVE-MENTIONED VROVERTV FOR I CTION PURPOSES. , COM NTS �� l � c � �,�n.�J �� n, m PERMITTEE NAME(PRIN Q � Uj SIGNATUREOFPE EE DATE _ .. REC T.NO. PAID BY � VALIDATION ~ WHITE—DepeAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy I , � ' ;: . � _. . � . , . . . . . .. - , .. .. . . . . . C��ll �� OFl��tlCf� lfl1�Ul1 �'s Of�1�ff�f�C��f"0�(� f�3[��O�QD �� ;4� � ' � ° �� . � QGQ4� lJ�l�,° . a � 0 � �C�tr o ° �� Oa ° �C� SET BAGK � FLOOR JOIST ------ F7GS/FORMS/STEEL ��r- FHA REC�MTS ' ` � .__._ --- .___ _--- ._ . ELECTRIC GROUND �� _ � UNDER FLOOR DUCT � --- -_ • _ .... GROUND PLUMBING� ` " UNDER FLQOR CUhIDUIT � ^ ---1 -. __ _.._. SLAB GRADE; FIREPLAGE FOUNDATION ' ____.____ TEMP POWER FIREPLACE BOND BEAM WATER SERUICE MID HT. BOND BEAM • ROOF SMEqTMING ' � 8 FT. BOND BEAM � � - • FRAMINGNENTILIATION • ' � FINAL BOND B;EAM � ROOF COVER PRE-GRADIN� • � � ROUGH HEATING BENCHING � ROUGH ELECTRIG ROUGH GRADING ; , ; ' � , ROUGH PLUPVIBING • FINISH GRADING SHOWER/TUB TEST POOL-ELECTRIC EXT. LATH/SIDING , - , POOL FENCING - WALL fNSUL'ATIOI� POOL FWAL CEILING I�:SULATION OFF SITE IMPS. � ' QRYWAL.L NAI1..�fNG DEDICATIONS ��1�iE{� FINAL E�JG. SEPTIC l'ANK � LANDSCAPE/IRRIG. -- ------__._.___._.. -----.- SEEP PIT/L.L. ON SITE IMPS. � GAS FlIR TEST ��--(6-p r FINAL ZONING` FIN�4L.CONST. , � ' � FIRE DEPT. FIi�AL FIPJAL HEATING ' ' • HEALTH DEPT. FINAL �INAL ELECTRIC DEV. FEES PAID _-- � i �'�lAL PLUMBIRIG , ENERGY _ ._. -__ � S ._- - � . , . , �L 4..._........- �. . ' , __ .___. .-.s- ��, � �_ ^ ''.�__ _,_.. - �«. � �.....�� r I ��F� 5..� L.�� . � . . � . � _ . _ . . - . . . __. .. . _ �� ' __"' . ......��,�._.. ._'_"_' COfi�iViEi�7'V ' ' 1 �� Y� �� ` ��c-.r� � �___I�—�_o-��'~c_P�—� _ , - SEPTIC TANK SIZE SEEP PIT/U SIZE __^___� ' -"---4�----- � �- - ----________ ------�- .. � � -- �. ------ �