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Home My WebLink About11-1165 R�'�� 7��.�-�9� _�` _ CITY OF DIAMOND BAR ��/��—� � �c � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES C: / ' j �� , 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 PRESS �'"�'� BUILDING PERMIT APPLICATION � �IIRMLY ' Q JOBSITE ��7'S rn�n('()/17_�� DATE �Z`� l) L `^ �� r �ra� APPL�CATION � PERMIT �T�p/C /�� ¢ ADDRESS NUMBER//�/�YY � I-I I(�./ °� APN LOT TRACT DATE �- /� ONST. �0 ROUP p OWNER ✓' " ADDR SS ON ZONING SETBACKS Z CITY�I�'/{RU71/� ^�- ZIP�/� TEL. '^ - FRONT qyy p p APPLICANT I UF�hO �(��(�TEL.7/l/_, -1l"L7�"l�Irl REAR p ¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR A/ SIDE p ADDRESS �L 11 p�y� � CITY �I�-�� ZIP TEL. � 7y I PROPOSED USE OL �"�"U ��IZ/ LS w ARCH/ENG/ � .Z z DESIGNER � w NO.DWEL. NO. � NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEA DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT fROM THE CONTRACTORS LI- G8f89BIC8fpOf[ W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7037.SBUSINESSANDPROFESSIONSCOOE:ANYCI7YOR (n U COUNTVHM�CHREOUIRESAPERMI7TOCANSTRUCT.ALTEH,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG w TURE,PRIOR 70 I7S ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70R5 ll- � � CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVS(10 Q FESSIONS COOE)OR THA7 HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- (� V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICAN7 FOR A PERMIT SU&lEC7S 7HE APPLICANT TO Z R8-R001 A CIVIL PENAL7V OF NO7 MORE THAN FIVE HUNDRED DOLLARS(SSao).): Z ❑I,ASOWNEROFTHEPROPER7Y,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrtIrtIBfCiel WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED Oq OFFEfiED FOR SALE(SEC.701�,BUSI- J � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPER7Y VhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR 2 TMROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFERE�FORSPLEIF,HOWEVER,T-IE9UILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCAMPLE� Z TION,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SALEJ. ❑1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELV CON7RAC71NG WITH LICENSED CAN7RAC70R5 � TO CONSTRUCT THE PR0.IECT(SEC.7011,BUSINE55 AND PROFESSIONS CADE:7HE CONTMCTORS LI- V81Uflt10 � Q ADJ.AREA W CENSEIAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILD50RIMPROVESTHEREON,AND I � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � TORS LICENSE LAW.). � ❑1 AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � ' � � � �� DATE � OWNER H �� d_ __ Z W �y��E � LICENSED CONTRACTORS DECLARATION w S Vl L �/ Q� � 1 HEREBY AFFIRM UNDER PENPLTV OF PERJURV 7HA7 I AM UCENSED UNDER PROVISIONS OF CHAPTER � - d B(COMMENCING WITH SECTION 7000)OF DIVISION J OF THE BUSINE55 AND PROFESSIONS CADE.AND Z � X MV L�CENSE IS IN FULI FORCE AND EFFECT. m � LICENSE CLASS �y �O LIC.NO. •�'��V�w, � U DATE_�L�Q'�'.I CONTRACTOR !`�� d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAfFIflM UNDER PENALTV OF PERJURY ONE OFTHE FOLLOWINCa DECURATIONS: Z �� Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' a 2 Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U �� OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS RE�UIRED BV SECTION � i Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ) /- ISSUED.MV WO KERS'CAMPENSATION INS A CE CARRIER AND POLICY NUMBEF ARE: CONSTRUCTION y{,�•�QO Q r ��p�J rj CARRIER CG _ � �(�f�" PLAN REVIEW - i - . Z POLICY NUMBER_ L_A..�� '�� ' ELECTRIC Q i � (iHISSECTIONNEmNOTBENA4'LEfEDOFTHEPEPAYTISFORONEHUI�DREDDOLIl�RS(f100)ORLESS} PLUMBING � Z I CEHTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL �} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO 6ECOME SUBJECT TO THE � � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND ACaREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37o00F THE UBOR ' � DE,I 5 LL FORTHWITH COMPLY WI OSE P qvisioNs. ISSUANCE 2 / p DATE: �v�—� APPLICANT: SMIP � � J WARNING:FAILURE TO SECURE WORNERS'COMPENSATIO C ERAGE IS UNIAWFUL,AND SHAIL BE ENERGY P/C � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVI ESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(5700,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHEUBOPCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: [ OCONSTRUCTION LENDING AGENCY PR�•ALT FEE:_ C � 1 HEREBV AFFIRM UNOER PENALTV OF PERJURY THAT THEFE IS A CONSTRUCTION LENDING AGENCY %�%i j�J�� j f a- FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.7097,CIV.C.). '1 Z W � LENDER'S NAME F— LENDER'SADDRESS � TOTAL FEES��3i3 9 � �S-3 � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. w 1 AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UGON THE � ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. ' Z COMMENTS - � t j�pv �b�v�A-�� m PER E E( IN7 � / � � �.�ZVJ�� a 6 � SIGNATU FPE MI EE DATE = RECPT.NO. ID BV VALIDATION ~ WHITE—De artment Co YELLOW�inance Co PINK—Assessor Co GOLDENROD--File Co GREEN— P PY. PY, PY. PY� ApPlicanYs CoPY , ; ,� ... ., ., , � ...�., � .. ..� � .� .. ,. " ).. . . . . .. . . ... . . .. . . . . CB�V �I� DOQ►�I�V�D IS�B� 6NSI�l�C�'�Oi� ff�I�COV�D Oa�3pC��4�0a DQ41� Oa�3pC�C�40a Oa�pGC�400a DGJ4C D�I�pGC�40a 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 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.IATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION j OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPEIIRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING i HEALTH DEPT. FINAL _- -------__.._..----- --------------_._._ ---._...._.---------------------------------- FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY C��oC�.'�' — -- COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � � �