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Home My WebLink About17880 (25) EXPIRE� CITY OF DIAMOND BAR �----��`--� DEPARTIv�NT OF COMMUNIT'Y&DEVELOPMENT SERVICES J U N 181002 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS "'%.��»'+ BUILDING PERMIT APPLICATION FIRMLY o DDRIESS �S� ��y /d V � DATE CATION ��(n ,PUMB R ��/C - p�iN � ISSUE TYPE OCC APN-�- LOT TRACT DATE CONST. GROUP °C OWNER Ci(.I�M�� O � ADDRESS L (I ' ZONING SETBACKS Z CITY W �:J7 ZIP J�S~ TEL O� ��Jy" G�^' FRONT RW ❑ o APPLICANT TEL. S DE/SIDE STREET RW ❑ z a CONTRACTOR. C�O�/itG+r- SIDE ❑ ADDRESS 's ' � � CITY /YC/v�SffilJd.� ZIP /V% TEL :�Z"�� PROPOSEDUSE w ARCH/ENG/ z DESIGNER w 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 HEREBV AFFIRM UNDEF PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CANTflACTORS LI- G8f096/CBfpOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o91.5BUSMESSANDPROFESSIONSCADE:ANVCITVOR (n U COUNTYWHICHREOUIFiESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC� � W TU{iE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck ! STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND.PRO- � POOVSp2 � FESSIONS CODE)OR 7HAT HE OR SHE IS EXEMP7 THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� (� V TION.ANVVIOUTIONOFSECTION7031.SBYANYAPPLICANTFOflAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Raof A CIVIL PENAL7Y OF NOT MORE THAN fIVE HUNDRED DOLLARS(f500�J: Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESAS7HEIRSOLECOMGENSATION, � COrt1f110fC181 - WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.704a,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WHO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m QOFFEREDf-0RSALE.IF,HOWEVER,hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OH SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCAN7NAC71NGWITHLICENSEDCAN7MCTORS � TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS AND PROFESSIONS CADE:THE CONTFACTORS U- V9IU8IIOI1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVES7HEREON,AND � WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y 70RS LICENSE LAW.). Q J 0 ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U � � DATE OWNER � Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNOER PENALTV OF PEFJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X MV LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASJS r�G✓� LIC.NO. / �6 �J I j U DATE �/r7 (,I,✓ CONTRACTOR � a W ��r � WORKERS'COMPENSATION DECLARATIO Q v 'Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARA710N5: Z J � � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELF-INSURE FOR WORKERS' 2 Q CAMPENSATION,AS PROVIDED BY SECTION 37oa OF 7HE IAeOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WOHKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR 7HE PERFORMANCE OF 7HE WORK FOH WHICH THIS PERMI715 ISSUED.MV WORNERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION J � CARRIER � PLAN REVIEW �, Z POLICY NUMBER ELECTRIC Q 0 . (fHISSECfqNNEmNOTBENMPLEfEDOFiHEPEMNTISFORONEHUI�DREDDOLLPAS(E100)ORLESS). PLUMBING w �,��D Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR ^� r � �SHAL ORTHWITH COMPLV WITH THOS BLWISIONS. ISSUANCE .i,, � p DATE: /� �L APPIICANT: SMIP J WARNING:FAILURE TO SECURE WORKERS'COMPENS ON COVE AGE IS UNLAWFUL,AND SHALL BE ENERGY P/C LL SU&IECTANEMPLOVERTOCRIMINALPENALTIESAryO CIVILFIN P700NEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(S1ao.0oo),IN A�DITION TO THE COST OF CbMPEf/3A ION,�AMAGES AS PROVIDED FOR IN � SECTION 7708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CqNSTRUCTION LENDING AGENCV FOR THE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENOER'S NAME H LENDER'SADDRESS � TOTAL FEES � , O � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COflRECT. w I AGREE TO CAMPIV WITH ALL qN AND COUNTV OHDINANCES AND STATE IAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPflESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' � ABOVE-MENTIONED PPOPERTV FOR INSPECTION PURPOSES. Z COMMENTS 0 J � . QPER / M6{ � ��fO� N ' Uj SIGNA7UREOFP RMI E �A7E = RECPT.�O. PAID BY VALIDATION ~ ' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant s Copy .... � . .. . . . . . . ... , -� . ... ... ' ., '� a'JiUr.', ..�N�.�...,��,�n . � �L+',� ...li. .. r.�T^'.. , ., ... ..,�- NA�-�F... .. . ... . �. .. .. . . n •. a � ��I�� r�''��I�� a ° ��u u�rv �Ql�l�s^ .. �r��U v�-'-� _ �U�.r�r.r�5�U�A"�tn� � ' T� ��tr'��i ;� � -,---.w. SET BACK � I � ! � , F�.00R J(JIST �, � � -- ---- ------- -- __ _�� ._ _..._. _... __.. _ .. _,_....� ._____ _ _.__ FTGS/FORMS/STEEL � ; FHA REQMTS f ---- --,_...--- - .--- --I_.._._..._..--- --- ----- ELECTRIC GR�UND � � ; UNDER FLOQR DUCT - ------- -- ------- -- - GROUND PLUMBING � UNDER FLOOR CURIDUIT _ __ SLAB GRADE ( ___ _ FIREPLACE FOUNDATION � __ __ TEMP POWER � _._ __ ; FIREPLACE BOND BEAM _ ______ _. -. -- --- -- WATER SERVICE _____. ; ; � MID HT. BOND SEAM __ _ - ---- -- ___. ROO�SHEATHING r' 8 FT. BOND BEAI�IE • ' --i. FRAMIf�G/VENTILIATION -� � ; FINAL BOND BEA►vt v , --- ------ -»- ---- ---------------- -.___..._._..__... ROOF COVER � ` PRE-GRA�ING i ROUGH HEATWG BENCHING ROUGH ELECTRIC j ___� ROUGH GRADfNG _____ ROUGH PLUMBING i FINIShi GRADIt�G ---- ------- ---_---- ------------ ----..__.. ------- SHOWER/TUB TEST � i . POQL ELECTRIC - - ---..__ �._,._..---- -------- -----..__..------- EXT. L4TH/SIDING � ' � PO(�L FENCINC _ —_._..--- -._._._- ---___.._____- WALL IfVSULATIOh1 ; POOL FINAL CEILING IRlSULATION ' OFF SITE IPVIPS. ; DRYUVALL NAILING DEDICATIONS SEWER FINAL EfVG. SEPTIC TANK LANDSCAPE/IRRIG. -- -- — ------....--..-- SEEP PIT/L.L. ; ! ON SITE IMPS. �- _ _ ---___ � _._ ....._--- GAS AIR TEST FINAL ZONING FINAL CONST. � . F�RE DEPT. FINA'-_. FINAL HEATIfVG i HEALTH DEPT. FINAL FINRL ELECTRIC I � DEV. FEES PAID FIIVAL PLUMBING � ; � ENERGY � - � I _.._._- C��O�'� a i CONii�E�TS � SEPTIC TAt�K SiZE SEEP PIT/U SIZE - -� ------ --"�- � --- U�iJ : C� _-____ - ------------- � ' ` � . � ,