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Home My WebLink About12-186 / l., � - _�� CITY OF DIAMOND BAR � ,� � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES N •. : �`.� 21825 Copley Drive,Diamond Bar,CA 91765 � '�� .�,$� 'f � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839�,0�� PRE �'°�' W BUILDING PERMIT APPLICATION �f ,��1Q1u1> ` �21�"tr �� JOBSITE q�/1 , C � APPUCATION'7 � n ` PERMIT 1 � j�i p/C ADDRESS I LI.J DATE L ` NUMBER� # � ISSUE 7yPE y �C APN LOT ACT DATE � CONST.�7 GROUP p OWNER p ADDR S ZONING ETBA KS z CITY ZIP � TEL. FRONT qyy � o APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTOR = SIDE � ADDRE S � � CITY ZIP TEL. - - 2 PROPOSED USE � '— o ARCH/ENG/ — �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFlqM UNDER PENAL7Y OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI� GHfB B/C8 ff W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSMIDPROFESSIONSCODE:MIVCITVOR (n 9 � � COUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W P8�I0/DBCK � NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT 7HAT HE OR SHE IS UCENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHMTER e(COMMENCINO WRH SECTION 7000)OF DIVISION 3 OF TFIE BUSINESS AND PRO- � POOI/Sp0 FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALIEGED E%EMP- (� TION.ANV VIOLATKKJ OF SECTION 70.�1.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): � ❑I.ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATpN, � COrtIR10fC18I . M/ILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Ml,BU51- J � NE55 M1D PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m 0 OFFEREDFORSALEIF,FIOWEVER,THEBUIlAIN00RIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE- Z TION,TNE OWNER-BUILDEfl WILL HAVE THE BURDEN OF PqOVINO THAT HE OR SHE OID NOT BUIID OR � WPROVE FOR THE PURPOSE OF SALE). W �I.ASOWNEROFTHEPROPEHTV.AME%CLUSIVELYCqNTqACTINOWfTHLICENSEDCONTRACTORS � TO CONSTRUCT TME PRQIECT(SEC.70/!,BUSINESS AND PROFESSIONS CODE:THE CANiRACTORS LI- V8IU8�1Of1 ADJ.AREA W CENSE LAW DOES NOTAPPLY TO AN ONRJER OFA PROPERTY WHO BUILDS Ofl IMPROVES THEREON,AND � WFpCOIfrRACTSFOflSUCHPRQIECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECONTFAG QUANTITY DESCRIPTION � TORSUCENSEUW.). FEE � � ❑I AM E%EMPT UNDEF SEC. � B.8 G.C.FOR THIS REASON � ?� U LL DATE OWNER � �Q LICENSED CONTRACTORS DECLAFATION w 2 1 HEREBY AFFI{UA UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHA7TER � � o(COAIMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY UCENSE IS W FULI FO�EFFECT, m � LICENSE SS LIC.NO. � O � U DATE CONTRACTOR � W � WORKERS'COMPENSATION DECLARA ION � Q � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: V P `� z b �2 Ou 0Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-INSUqEFORWORKEflS' a Q COMPENSATION,AS 7ROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. W O � w �I HAVE ANO WILL MAINTAW WORNERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMMICE OF THE WORK FOR WNIC11 THIS PERMIT IS ISSUED.MY WORKERS'COMPENSAT�INSU(7AN E CARRIER M�p POLICV NUMBEHAAE: CONSTRUCTION jCARRIER C�\%A L(J N r PLAN REVIEW � POLICYNUMBER ��,�_�� 1 z� ELECTRIC � (iHISSEC�IONNE�NOTBECOAQt.E�EDOFTHEPEAMTISFpRONEFIIA�OFiEDDOLLARS(f100)ORLESS) PLUMBING W �Z I CEFTIFY THAT IN THE PERFORMANCE OF THE WOR)(FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SU CT TO THE [n WORNERS'COMPENSATIONUWSOFCALIFO 10.ANDAOREETHAT I LDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATIO P VISIONS OF SECT 3 00 F THE UBOR ��•l� O CA I SH FORTHWI7N COMPLY WITH O PROV IONS. ISSUANCE p DATE:� APPLICAN� SMIP � � � ENERGY P/C WARNING FAILURE TO SECURE WORKERS'CAMPENSATqN CAVERAGE IS UNLA L,AND LLBE �y SU&IECTANEMPLOVERTOCRIMIN�IPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT DOLURS(f100.000�.IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 37aB OF THE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: c d� O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AOENCV FOR THE PERFORM/WCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. Z W � LENDER'S NAME � LENDER'SADDRESS w I CERTIFV THAT 1 HAVE READ THIS APPUCATIpN�IJD STATE THAT THE ABOVE WFOqMATqN IS CARRECT. TOTA L FE ES C� // / � � I AGREE TO COMPLV WITH ALL CfTV AND COUNTV ORDINANCES AND STATE LAWS REUTINO TO BUILDING . i � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEMATNES OF THIS COUNTY TO ENTER U70N THE Z ABOV ENTpNED PROPERTV F R INSPECTIO uaaoses. COMMENTS � �, � m PERMITTE E(� NT) � Q UJ N SIO TU M E � DATE � � RECPT.NO. O PAID B VlLLIDATION WHITE—DepeAment Copy,YELLOW--Finence Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREE� Applicant's Copy � � . � �s"�},�. CIT'Y O� D��fViON(3 ��.�i . .:. . ,�, �t •� .��.i��.�`�- lI�S��CTIO�I �iECORD , .. . � r��`�� r::�r� , _. , ��,. i� � ,��t ��aa�pc� �� :o �� a��a� � ��oa��a ��.�c�� SET BACK - FLO�R 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 SHEATHING � 8 FT. BOND BEAM • ' ' � FRAMINGNE(VTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERIfUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL�NSULATION POOL FINAL . CEILING INSULATION OFF SITE IMPS. �, . � DRYWALL NAIL�NG DEDICATIONS ' ' SEWER FINAL ENG. SEPTIC T,4NK 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 C�f�C�oC�..�t, , . � � � . COMMEIVTS `�� C� �� ',�'� (Z , , , � r =.;. , ._ . , : , SEPTIC TANK SIZE SEEP PIT/U SIZE G�J �7: Q �M � �� .