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Home My WebLink About11-096 (5) �� CITY OF DIAMOND BAR � . DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ' 21825 Copley Drive,Diamond Bar,CA 91765 ` (909)839-7020 Fax(909)861-3117 Bailding Inspection Hotline(909)839-7027 PRESS ��'°""� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE f APPUCATION PERMIT /� P/C � ADDRESS ��O � - DATE NUMBER l, D . p D TEE ��I/ ONE � OCC � APN LOT TRACT ��/ � p OWNER C�OUP o ADDRESS ZONING SETBACKS � z CITY ZIP TEL. FRONT qyy � � APPLICANT TEL. REAR � ¢ - SIDE/SIDE STREET qyy p � CONTRACTO �� e SIDE � ADDRESS � � CITY ZIP �,L�.. EL. �F�OPOSED USE .�si �� , oARCH/ENG/ __��' "'/ d�- ��r-e� � �+/ . . / � �z DESIGNER NO.DWEL. NO. NO. a ADDRESS = CITY ZIP TEL. UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDEH PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CANTRACTORS ll� G0f89B/C9fpOR W CENSE lAW FOR THE FOLLOWINO HEASON(SEC.7031.5 BUSINESSAND PiiOFE5S10NS CODE:PNV GTV OR (n C-� COUNT`/WHICHREIXIIRESAPERMRTOCONSTRUCT,ALTER.UAPROVE,DEMOLISH,ORFEPAIRANVSTAUC- w � W TURE.PRqR TO ITS ISSUANCE,ALSO REIXIIRES TNE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED w Patlo/Deck � STATEMINT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS U� � CENSE LAW(CHAVTER G(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROAIANDTHEBASISFORTHEALLEGE�EXEMP- (� TION.ANVVpLATIONOFSECTION7031.5BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICMfTTO Z Re-Raof � A CML PENALTV OF NpT MORE THAN FIVE HUNDRED DOLLARS(f500�.): � OI,ASOWNEROFTHEPROPERTY,ORAIVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, COrtI(fIBfC18I WIIL DO 7HE WORK�ND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a�,BUSI� � � NESS AND PROFESSlONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT APPLV TO AN OWNER OF ? VROPERTY NM1iO BUILOS OR IMPROVES THEREON,AND YAiO DOES SUCH WORK HIMSELF OR HERSELF Oq w THRIXIOH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDINOOHIMPROVEMEMISSOIDWITHINONEVEAAOFCOMPLE- � Z TION,THE OWNER�BUILDER WILL HAVE THE BUfiDEN OF PqOVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,AS OWNER OF THE PROPERTV,AM E%CLUSIVELV CONTRACTING WfTH LICENSED CONTMCTOqS � TO CONSTRUCT THE PR0.IECT(SEC.70I1,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� V01U8t1Of1 ADJ.ARE11 W CENSE UW DOES NOTAPPLV TO AN ON7JER OFA PROPEHTY WHO BUIIAS OH IMPROVES THEREON,AND � WFIOCONTRACTSFORSUp1PRQ1ECT5WITHACANTRACTOR(S)UCENSEDPURSUANTTOTMECONTRAP QUANTITY DESCRIPTION rau ucENse uw.�. FEE 0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U LL DATE OWNER � � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRIA UNDER PENALTV OF PEFUURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � � G(COMMENCING WITH SECTION 7000)OF DNISION 3 OF THE BUSINE55 AND PROFESSKKJS CODE,AND Z �� MY LICENSE IS M FULL F-0FCE AND EFFECT. L m � UCENSE ClAS37 l ✓ LIC.NO._ �� U DATE ��5�� `�C-�� CONTRAGTOR C� a W � WORKERS'COMPENSATION DECLARATION ¢ . � U � I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATqNS: Z . , � _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR NbRNERS' ¢ 2 COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMMlCE U OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED. W � � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTbN Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSURANCE CAHRIER AND POLICV NUMBER ARE: CONSTRUCTION jCARRIER PLAN REVIEW � POLICY NUMBER 7d.. ELECTRIC � (lHLSSECiIONNE�NOTBECOR6iEfEDOFTF�PEW.YTISFORONEFAIPI7REDD0UAR5(5100)ORLESu} PLUMBING W Z I CERTIFV hiAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE (/� WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE = SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTqN 37000F THE LABOP + �� COOE,I SHALL FORTHWITN COMPIV WITH THOSE�PROVISIONS. ISSUANCE O f � O p DATE:/� � ��I APPLICANT: �1-K � L SMIP � W J WARNINCi:FAILURE TO SECURE WORKERS'CqMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � J � SUBJECTMIEMPLOVERTOCRIMINAIPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS({700,000),IN�ODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: _ . OQ O CONSTRUCTION LENDING AGENCY PR/F7J��ALT FEED: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCY _/�/aSA� /� Q FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z w � LENDER'S NAME H LENDER'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE iliAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES /� OL � � I AGREE TO CAMPLY WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATINO TO BUILDINO � CONSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATNES OF THIS COUNTY TO ENTEH UPON THE ' Z A80VE�MENTIONED PROPERTV FOR INSPECTqN PUFPOSES. COMMENTS ' 0 J �o�� . ,E��,�;�.z..� � m EflMIT7EE NAME(PqINi) '' . � � ` `l . y SIO URE OF PE EE DA7E � � RECPt NO. PAID BY V/WDATION WHITE—Depanment Capy,YELLOW�Inance Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—ApplicanYs Copy .: COT'Y O� DI�fUiOi�D �AR 4 ��S��Ci�� L.�{�� , , -4. t t °ot��p�c�400a o .�.: kx;b�� oa��t�� 0 �. :��F:�� SET BACK FLODR 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 H'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlTUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTlC TANK LANDSCAPE/IRRlG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINA� FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ��o ��o ��: ;�_ COMMENTS ��,�„4� SEPTIC TANK SIZE SEEP PIT/U SIZE a __,;, � � r;� �r rs" �' a�� i: