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Home My WebLink About15628 _ _T _ _ , . (}, � ., 0' , �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��C, ' w 21660 E.Copley Drive Suite 190 (909)86Q3195 Fax(909)861-3117 PRESS ��'� BUILDING PERMIT APPLICATION �IRMLY o DDRESS �� ` ��v ✓' DATE CATIOI� Q 0 NU B R // #/C �I�/ J � issuE rvPE occ APN LOT T ACT DATE CONST. GROUP p OWNER --�� p ADDRESS � --- S • . � � ZONING SETBACKS w CITY 1 Z P T c{t•-2 1" - � FRONT RW ❑ � APPL CANT r i ..1.� �.� . - REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTOR M G SIDE ❑ Q ADDRESS I 3 11 C. �1t�iu�viAidV 1/ i ��fiAJ � pROPOSED USE �� /''� � � r�L L o CITY G�I�Yur�.tsraa ZIP�i'1'7�-1 1 TELLI� �14�l t wo ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. ... r i ' �� N DESCRIPTION SQ.FT. FACTOR PSE� �• �"'ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM � ...�,�ml � I HEREBV AFFlRM UNDEH PENALTY OF PERNRV THAT I AM EXEMPT FROM THE CONTMCTOHS LI� G8f896/COfpOR ��`�' �r � �.�-�'V'� W CENSEUWFORTHEFOLLOWINGREASON(SEC.7WI.SBUSINESSANDPqOFE5510NSCADE:ANYqTYOR (n w R� COUNTYNh11CHREWIRESAPERMRTOCONSTRUCT.ALTER,IMPpOVE,DEMOLISH,ORREPAIRANYSTRUC- W �d ° ./��'��J ✓•— w TURE.PRpR TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED w Patio/Deck __ --r,".�:�,,,�. ,_,-;�..� � STATEMENT THAT HE OR SHE IS 110ENSED PURSUANT TO THE PROVISIONS OF THE CONTFiACTORS LI- � -�irTy/ ;�;� � � .,� -�;i� ,�;�.- � CEHSE UW(CHA7TER Y(COMMENCINO WITH SECTION 7oD0)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSp2 ,j�g 5 S ,��_ ��.�y 3 � FESSIOHS CODE)OR THAT HE OP SHE IS EXEMPTiHEREFROM M!D THE BASIS FOR THE ALLEGED EXEMP- �y TION.ANVVpUTIONOFSECTION7031.5BVANYAPPLICANTFORAPERMI75U&IECTSTHEAPPLICAN7T0 Z Re-Roof I��,LbJ�� V�✓ � ACMI PENALTV OF NOT MOfiE THAN FNE HUNDRED DOLLARS(f500).): � ❑I,ASOWNEROPTHEPROPERTV.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � Commercial - WILL DO THE WORK,ANU THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BU51- J N NESS AND PiqFESSIONS COOE:THE CONTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERiY NRIO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THFqUOM HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NO71N7ENDED OR m QOFFEAEDPDRSALEIF,FqWEYER7MEBUILDIN�OHIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- Z �'TqN,THE OWNER�UILDER MALL HAVE THE BURDEN OF PROVINO THA7 HE OR SHE OID NO7 BUIID OR � IMPROVE FOR TME PURPOSE OF SALE). W ❑1,AS OVMER OF iHE PROPEHfY.AM EXCLUSIVELY CONTMCTINO N7TH LICENSED CONTRACTOHS [[ TO CONSTRUCT TNE PR0.IECT(SEC.70�a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8f1011 ADJ.AREA W CENSE UW DOES NOTMPLV TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES THEREON,AND F WFIOCONTRACTSFORSUCH7RQIECTSWIhIACOHTRACTOR(S)LICENSEDPURSUAHT707HECONTRAG pUANTITY D CRIPTION FEE � � TORS UCENSE UW.). ` Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q 3 � � � � DATE OWNER V -�G W � LICENSED CONTRACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER PENQTY OF PEFLIURV iHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � - � d Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS ANO PROFESSIONS CODE,AND Z X W LICENSE IS IN FULL FORCE AND EFFECT. . � UCENSECUSS �J LIC.NO. �S 7 G � j � � i/ t � C/ DATE ID I�'I I fU 4 CONTRACTOR a W � WORKERS'COMPENSATION DECLAR TION Q � � I HEREBY AFFIRM UNDER PENALTY OF PERIUFtY ONE OF THE FOLLOWING DECURATIONS: � y Z � � _I HAVE AND WILL MAINTAIN A CEFifIFICA7E OF CONSENT TO SELF-INSURE FOR WOHKERS' 2 � � COMPENSATION,AS PROVIDED BY SECTION 37000F THE UBOR COOE,FOR THE PERWRMANCE W OF hiE WORK FOR WHICH THIS VERAIIT IS ISSUED. � � _I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REOUIRED BY SEC710N / l�/ //�`� Q 370D OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ( �� [V ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER M1D POLICY NUMBER ARE: CONSTRUCTION � S�T r{-T C �V�� PLAN REVIEW � CARRIER � POLICV NUMBER ��`I 4 G U I N ^ 0 O ELECTRIC _ 0 (I}USSF.CiIONNE�NOTBECAA/R.EfEDOFTHEPERMT6Fi7HaNEFAN�DREDDOl1l�1L5(f100)ORLESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE MIORN FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL (} SHALL NOi EMPLO7 ANY PERSON IN ANY MANNER O AS TO BECAME SU&IECT TO THE � WORKERS'COMPENSATION UWS OF CALIFORNIA ND AGREE TH T IF I SHOULD BECAM „ INSPECTION FEE S SUBJECT TO THE WORKERS'COMPENSAipN PRO SIONS OF SE ION 370o OF T CODE,1 SHALL FORTHWITH COMPIV WITH THOSE P OVISIONS. ISSUANCE < � SMIP � DATE: rc l y I'� APPUCANT. W WARNINO:FAILURE TO SECURE WORKEHS'COMPENSATIO COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � J �y SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILfINESUPT00NEHUNDREDTHOUSANO ENERGYPERMIT OOLLARS(l100.000).IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOP IN ' J SECTION 370E OF hiE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � OCONSTRUCTIONLENDINGAGENCY PRE-�LTpEF: pL � I HEREBY AFFIRM UNDER PENALTY OF PERIURV THA77HERE IS A CONSTRUC710N LENDING AGENCV ��f'r FOR THE PERFORAIANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED(SEC.30Y7,CIV.C.). Z W � LENDER'S NAME 1_-� LENDER'SADDRESS � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COPRECL TOTAL FE� I 1 � I AGREE TO COMPIY WITH ALI.q7Y AND CAUN7Y ORDINANCES AND STATE UWS REUTING TO BUILDING � ��G� CANSTRUCTION,AND HEREBY AUT IZE REPRESENT IVES OF THIS COUNTY TO ENTER UPON THE ZABO E�MENTIONED PROPER7V FOR I SPECTION PUR sEs. OMMENTS o � , � _ _ m PE MI77EE NAAIE(PRI �� Q /y � V N SIGNATURE OF PEfiMITTEE ' DATE � � �,� V� RECPT.NO. PAID BY VALIDATION � WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GO ENROD--File Copy,GREEN—Appli nt's Copy ' ' ' .. . .♦ . .� .. - . .. . . . . � . � �_ • �. � ♦ . � � �� Y �� ll1lY0Y�YV� �l('V� • �Y V�Y ��V V ��1J0.YY U� 4... / ti�.1`. K /-� . � r��r.��/�., ^: '.. .�� .�� ^Y . . OV V I=JU��l�y�V`lU V ,, o. �.I I11t1V U�—J P .O �'"� ��1��0�� ,a'"i"9 �� '�1 %�b�'.w"� a �� s+`b. � rTl7 JU1J � � m �t � * � -. 6' �e ._ ,� � .. �.._a... � � -__ w: .1C �r a��n � ♦ ... _.' . °n iA Na..�u5t.��_.._a.S�. SET BAC� / . I FLOOR JOIST � ` � ' FTGS/FORMS/STEEL f O �Z lD!� ' FHA RE�MTS - —! � , - ELECTRIC GROUND / � UNDER FLOOR DUCT _-; _ • ti,, - _ GROUND PLUMBING � D_.j/A� � � UNDER FLOOR CUMDU�T .,i� • - _ ,____ _�_ SLAB GRADE �Z�o� ��_ � �IREPLACE FCtJNDAT�ON �_,��=>. ----- TEMP PQWER � FIREPLACE BO�I�+BEAM � `~ � ___ WATER SERVICE MID HT. BOND BEAM � ROOF`SHE�ATNItVG~ �•` G0�31•q� � ' 8 FT. 80ND,BEAN1 � ' � _�t�. '�j FINALBONDBEAM � -_----- FRAMINGII/ENTILIATION g..�> � , ROOF COVLR � � � PRE-GRADINfi� � �_ � �_ ROUGH HERTING C`v BENCHING __ ' ROUGH E�ECTRIC ' 3 ROUGH GRADING � ,�.; - ROUGH PLUNIBI(VG \ � ! FINISH uRAQ1NG SMOVVER/TUB TEST I POOL ELECTRlC EXT. LATH/51DING E�-q-o� � POOL FENCING r— --- — - -- ---�--- ----._�.__ WALL INSUL.A�ION -0� � POOL FINAL � - - - -----__._._.:•. CEILING tNSULATION 1��$ ; OFF SITE IMPS. __ , DRYWALL NAILIi�G �_��_� DEDICATIONS _ SEWcR FINAL ENG. S�-'�-?�i£TANK �� i�- -�, �_� LANDSCAPE/iRRlG�_, � �__ ,�__ SEEP PITIL.L. � ON SI�TE IMPS. • � ' GAS A!R TEST �^j3/g f FlNA�ZONING ^ FINAL CONST. // �� FIRE DEPT. FfNAL � • FIfVAL HEATING p�� HEALTH DEPT. FINAL FfNAL ELECTRIC `,�� /iA'/ � � DEV. FEES PAlD __ __ ________. � �I�!�!PL4�f�8�NG . � - "•. i�NERGY � �- r___._ � __. � ____--- __�._�__ , . .. _.Sc��k� —��.a� � G � � - ------- t� � ��OQ G�'�X�a� � — I � — Cf�Ni�UIENTS �� e��-�---� �Z�- ��?� �-_ ---_._________-�----�------- -------- _ 10-3 � �T. S�4� c�� , s��. S�- P�Ec.S N-D _ ��S �-�-�-o c�oc�b� SIQ� . � - - � - ----- -- . ___- SEPTiC T�NK SI�E - -- -------- ---- SEEP PiT/U SIZE - — — ____._ ____��____- --_.__--- � -- o,. . , -- ----------- J�i . �: ' ' ��, ------ � �_ . , .._ — ----- - � � i /�.