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Home My WebLink About13-268 �,�,,`_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMtiNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 P�ESS '��'� BUILDING PERMIT APPLICATION FIRMLY N JOBSITE �') �j �/�Q o ADDRES �'/��G� � DATEII �o�v�� NUMB R�!' '�`"V #/C � ISSU TYPE OCC APN LOT TRACT DATE � �WNE—�� CONST. GROUP o ADD S � , ZONING SETBACKS Z CITY � EL. FRONT Ryy p o APPLICANT _ T L. __ REAR p Z / � SIDE/SIDE STREET RW ❑ ¢ CONTRACTO J- � • _ SIDE ❑ o ADDRES - _ � _� . ROPOSED USE Q/ , � CITY ZIP �. TEL. n � w ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREfWALUATION p� OWNER-BUILDER DECLARATION � SFR/ADD/REM I HEREBV AFFIRM UNDER PENALTV OF PE0.IURV THAT I AM E%EMPT FROM THE CONTHACTORS LI- Ga1aJB/C8ff10R W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROfE5S10NSCODE:ANVC1iY0(i (n U CAUNTYWHICHREOUIRESAPERMITTOCANS7RUCT,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W Patio/Deck � w TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIfiES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO THE PHOVISIONS OF THE CANTRACTORS LI- � � CENSE UW(CHAPTER e(COMMENCING WI7H SEC710N 7000)OF DIVISION 30F 7HE BUSINESSAND PRO� POOVSpB � FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- C7 V TION.ANY VIOUTION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPIICANT T0 Z Re•Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(i500).): 0 ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIf1lBfCidl Z WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OH OFFEREO FOR SALE(SEC.70�1,BU51- J � NESS AND PROFESSIONS CADE:THE CAN7RAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPER'iY WHO BUILDS OF IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSEIF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPHOVEMENTS ARE NOT INTENDED OR m � OFFEREOFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPIE- Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PqOVING THAT HE OR SHE DID NO7 BUILD OR � IMPROVE FOR TFIE PURPOSE OF SALE). W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVEIYCON7RACTINGWITHLICENSEDCONTRACTORS Q TO CONSTRUCT THE PROJECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CON7qACTORS LI- V81U8�i0f1 ADJ.AF3EA W CENSE LAW DOES NO7 APPLV 70AN OWNER OFA PROPERN WHO BUILOS OR IMPROVES THE(iEON,AND � NM1iOCONTRACTSFOPSUCHPROJECTSWITHACON7RAC70R(S)LICENSEDPURSUAN7707HECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J � ❑I AM EXEMFT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � ¢ DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � 8(COMMENCING WITH SECTION 7000)OF DIVISION 90F 7HE BUSINESS AND PROFESSIONS CODE,AND Z �� IAV UCENSE IS IN FULL FOqCE AND EFFECT. / / m O � �G�4`�r��C.O � � LICENSE CLA � LIC.NO. � V DATE � CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE Of THE FOLLOWING DECURATIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENT70SELf-INSUREFORWORNERS' _ Q CAMPENSATION,AS PflOVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37o00F THE LABOF CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORK/Eg��'�CA1M9PE�N-S1ATIO INpSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION j CARRIER (�'/ Cl/�'I�` PLAN REVIEW Z POUCV NUMBER ,� �� ELECTPoC Q j/�. � (IHISSECTqNNEmNOTBECOMR_ETEDOFTHEPEPMfTISFORONEHUI�DREDDOLLPRS�S100)ORLESS). PLUMBING G•1'� W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL C'} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � = SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37ooOFTHEU80R CADE, SHA�FORTHWITH COMPLY THOSE PROVISIONS. ISSUANCE p DATE: � APPL NT: - �I / . SMIP J WARNIN :FAIL RE 70 SECURE wORKERS'CO NSATION COVEFAGE IS UNLAWFUL,AND L BE ENERGY P/C � SU&IECTANEMPLOYERTOCRIMINALPEN - SANDCIVILFINESUPTOONEHUNDREDTH SAND ENERGYPERMIT DOLLARS(floo,oa0),IN ADDITION TO THE C 5T OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN � SECTION 37080F THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT7HEHE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORN FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3a87,CIV.C.�. Z W � LENDER'S NAME � LENDER'SADDRESS w� TOTAL FEES I CERTIFV THAT I HAVE NEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. � � I AGREE TO COMPLV WITH AlL CITY AND CAUNTV ORDINANCES AND STATE LAWS REU7ING 70 BUILDING • � CANSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUN7YTOENTERUPONTHE Z ABOVE�M TIONED PROPERTV FOfl INSPECTION PURPOSES. COMMENTS ' � �� c% J � PERMITT PRINn j /� U� � SIG U E OF PERMITTEE � E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Dep ment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOIDENROD--File Copy,GREEN—Applicant's Copy .�. „ . : . .:. . . . , .,. . . , _ C9�V �� DAV1/i06�1� �,�V� 81��6�f��'�OI� I�(��R� �?�`oa�p��400a oa4t�� ` oa��c�oQ oa�p��4oaa o �� aa�� SET BACK FLOOR 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 MIQ HT.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 FIN15H GRADING SHOWER/TUB TEST PQOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK 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 - ----- ---- ------------- �� ` < -._. --.---- ------ COMMEfVTS �o.�'c_CG-es,s l-`o��3 SEPTIC TANK SIZE SEEP PIT/U SIZE a - --- — :� c� �g,:� a .