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Home My WebLink About16697 (25) -------��---- CITY OF DIAMOND BAR EX�'IRED DEPARTMENT OF COMIvIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive �Li e, - (909)860-3195 Fax(909)861-3117 17 ��1 PRESS ��"%�� BUILDING PERMIT APPLICATION FIRMLY o DDRIESS L'�� 1 �/_ ,�M11R.�: \/�. DATE `�J��1 NUMBER W�� # >- APPLICATION � PERMIT P/C � ISSUE TYPE OCC � APN OT j T DATE CONST. GROUP p OWNER 0� G U Y �� p ADDRESS�I..I ZONING SETBACKS Z CITY [�:�1M.W�aI (5a/ ZIP��rTEL. 6 '� FRONT R1p/ ❑ � APPLICANT TEL. REAR ❑ Z SIDFJSIDE STREET RW ❑ ¢ CONTRACTOR SIDE p ADDRESS � � CITY ZIP TEL. PROPOSED USE 6 o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PERIURY 7HAT I AM ExEMPT FROM THE CONTRACTORS ll� G8f898/CBf�JOff W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.58USINE55ANDPROFESSIONSCODE:ANYCITVOR (J� U COUNTVWHICHRE�UIRESAPERMI77000NSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYS7RUC� � w TURE.PRIOR TO ITS ISSUANCE,ALSO REOUIfiES THE APPUCANT FOR SUCH PERMIT TO FILE A SICaNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI� � � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPB � FESSIONSCODE)ORTHATHEORSHEISE%EMPT7HEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (� V TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(3500).): � ❑I,ASONMEROFTHEPROPERN,ORMVEMPLOYEESWI7HWAGESASTHEIRSOLECAMPENSATION, � COrtIrtIBfCiel - Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704I,BU51- J � NESS AND PROFESSIONS CADE:THE CANTRACTOF75 LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON.AND NM1iO DOES SUCH WORK HIMSELF OR HERSELF OR 2 THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m � OFFEREDFORSALEIF.HOWEVERTFIEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNEFi�BUILDEFi WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROF7HEPROPERTV,AMExCLU51VELYCONTRACTINGWI7HLICENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.70I1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8I10l1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONMEROFAPROPERTVWHOBUILDSORIMPFOVESTHEHEON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWI7HACANTRAC70R(S)LICENSEDPURSUAN770THECONTFAC� QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. .6 P.C.FOR 7HIS REASON J O a � r., -- U L� ¢ DATE OWNER F- � , 0 W F LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z LX MY LICENSE IS IN FULL FORCE AND EFFEC7. m � UCENSE CLASS LIC.NO. j ~ J i V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATI (� ;�i � �� 1 HEREBV AFFIRM UNDER PENALT/OF PE0.IURV ONE OF THE FOLLOWING DECIAR I 5� Z ' Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR RS' 2 ¢ CAMPENSA710N,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMAN U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � W _I HAVE AND WILL MAINTAIN WORKERS'COMFENSATION INSURANCE,AS REOUIRED BY SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 J ISSUED.MV WOpRI(�ERS'COMyp�ENSATION INSURANCE CARflIER AND POLICV NUMBER ARE: CONSTRUCTION ��.� , j CARRIER V T1 PLAN REVIEW � POLICYNUMBER ELECTRIC Z Q � (THISSECiIONNE�NOTBECOR1PLEfEDOFhIEPEW.1frISFORONEFNI�DREDDq1A0.S(E100)ORLESS). PLUMBING Z I CER7IFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMI715 15SUED,I MECHANICAL �J SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE = SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR CO�E,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �i � SMIP .�� p DATE: APPLICANT: JENERGY P/C ��"' WARNING:FAILURE TO SECURE WORNERS'COMPENSA710N COVERAGE IS UNLAWFUL,AN�SHALL BE t � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFMESUP700NEHUNDREDTHOUSAND ENERGYPERMIT �� '��`��! DOLURS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC710N37a80F7HEUBOflCODE,IN7EREST,ANDATTOFNEYSFEES. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENAL7Y OF PERJUPV 7HAT THERE IS A CONSTRUCTION LENDING RGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). �� I� Z W - � LENDER'S NAME �-"-�� F- LENDER'S ADDRESS � TOTAL FEES O� D � I CERTIFY THAT I HAVE HEAD THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. w 1 AGREE TO CAMPLV WITH ALL CITV AND COUNTV ORDINANCES ANO STATE LAWS REUTING TO BUILOING d � CONSTRUC710N,AND HEREBV AUTHORIZE REPRESENTAT VES OF THIS COUNTV TO ENTER UPON THE � Z ABOVE-MENTI NED PR R FOR INSPECTI N vuaao Es. COMMENTS � Q� 1 � m PE I AME( INT) /� ¢ \.J � N 5 ATU OFPE DATE = RECPT.N0. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . . , . :. . , � ,.:T. „�..... . . . . .. .. .. .. " . .. . . . . �,. . _ _ h . . � . �� I�� '�`�� ( � A�e " j�- e� "q c a �.,��}��4 �� w � a��. �a�lr''L�'-��IJiJ a ��r�l�'�— ;�;1��(C' �' w��.,��C � � � �a� w�� `� < . . �"i � , �� u m� �"��° � ��-��r r�a�"�:�''��`� 3�9 � . ,� „��. .a �� -��.� � a�� SET BACK ` �� ( � �Li;Qi� JC�IS�� ____.._ -- - - -- — __.---� — -_ __ _� —� _ FTGSIFORMSiSTEEL _ ; � Fi-�A Fi�"Q�viT� _ -- ___� _._� __ . ___ — j -- - �ELECTR4C GRC)Ut�ID � �f UN.�'J.:€-t F��OR �?1�i�i� -- �____ --- ___ _ --- �--- _ �-- __ _-----— _ _�_. j_ __ _ .____ GR04JND PLUMBING i ; UNDE�� t�l.00R Gt"J��fe}l)'T� , _---_ — - -___ _ ,_ _ �� -- __. SLAB GRADE � ---- 1 �iF�EPLACE_FC�IJt�E�ATCQl� ` ; , __._,.. �___--- .__. ______ �.... TEMP POWER i � ? FiFtEPLAC�� B�N�} ��A�vi — - --- - - __ _. �_ _ __ ___ — _�_ WATER SEFiViCE_- --- ; _ � MII� MT. �GNC��A�� _ - ___ ....___�____ --- �.� �_� ROOF SHEATH(NG _ I __ 8 FT. BO;�C� F3F_AM ' �- -- - — - - _ __ - � -- -- � --�__. ...__ FRA�UIfNGNENTILIATION I � ____.� �INR��GE�I3 B�A�I � —,,--- ---- __._ �_ ___ __ � .____ .__ ____ -- ROO�COVER � �'��-�� ` �- ------� -� _�- — �__ � FiOUGH HEATING �E�� ' -- - - _ �_ �___�� __.__.__�__---�_ R(]UGN ELECTRIG �� ?��'� ` _. ___--_-- -..--- — _____�__ _.__._.___ ___ R(�FJGH PLUMBIN� ; ' F{NiSH i�RA(�INt� �._ - -- � -- - — _ —_--•�---- �---��---- __._ _____ __ SHC7WERITUB TEST � � ; I P�JOL�LECTRIC �� _ _�— ,� -�--- --- - -- _ ____ EX7. LATHISIDING ' POOL�ENCING � � -- WALL INSULAT(ON � ��-- � POt?L.�I�lAL __� _ _____ � — •-- _ _� ____ —...----_— GEILING lNSULATIC}N j � OF�SITE IiV?PS. � __ -- ----1--- — . _.._ --- �--�__ . � DRYWALL NA(UP�G I ' f�E�lGkT[O�VS , SEWEFi �_ _._� FiNAL E�SG..._._..__ -- -r�—�- ----�-- --_----- � _ _____ _ _— �.__�_.____.._.__� � SEPTIC TANK , �-•� l�ANDS�APJ�€�RI�. j __�_._._..--- -----......--- SEEP PITILL. ( �'_�. �. i ON StTE IMPS. ; GAS AIR TEST �� F#NAL�t"JNING _.____ __._--. __� --- -----�--- FINAL Ct)NST. � I �IRE DEP�: Fli�AL � � FINAL HEATING �—� ' �--.____ —. _ �_�_______ __ _�___.� � � I HEALTH DEPT._FINA� , -- - '-i----- `--___--- — _ �INAL ELEGTRIC I, --� �_j DEV, FEES PAID -------._ _ � —___ FINAL PLUMBfNG i j E��` � -�- -- --____ __ _ .___.__.._�� -- - � .�.�� 6 �(� �.� W��,�� '_'_�._.__._'_ _ __'_^ �� I � �� -� \}�p�]d ppp �}+�_/'''�'____.____--._.�__-__.___-___..___"_. _�� . �V I Y 11 Y I�� 1 V ' .-�-..� �_._.�_ 1 SEPTIC TANK SiZE � � . SEER P!T/U 51ZE _. --�� ----- —_� —__�_ � � � ._— _ --- , �------ 0 4 0 . .�.�_� �,�.��..,_"_.._._.�._.�..�_.�._»�______ �.� _ � ��,7�,J o �., �� ' � ' . ..^_ _._._._.._._.._._._.._._._._�. �"_____.�._._ ...�,,.� . .�._.r._..'_'"..._.__.__� ` � ___..�._....__._._�_ � , i ' , J � : ,\ .