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Home My WebLink About11-928 ' ---��— DE ARTM NT OF COMMUNITY&DEVELOPMENT SE V� �� 21825 Copley Drive,Diamond Bar,CA 91765 �� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702� �� $ ''"' BUILDING PERMIT APPLICATION �� JOBSITE �j ^� y�,�� _I ¢ ADDRESS/�7�/O 1'�IU'{�UWLQN La� (1]� Uh�� APPUCATION PERMIT �p/C p �� DATE NUMBER�l- 9� # � ISSUE 7yPE �C APN LOT TRACT DATE / p OWNE� CONST. ��_ GROUP p ADD�S V t') ZONING ETBACK Z CITY ZIP EL - P FRONT pyy p � APPLICANT +^ TELQD��-�t3�I REAR p ¢ SIDE/SIDE STREET RW O � CONTRACTO SIDE p ADDR . � � CITY ZIP T . PROPOSED USE e, oARCH/ENG/ z� DESIGNER NO.DWEL. NO. NO. � ADDRESS v� UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFlRM UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CANTRACTORS LI- G3f8QB/CBfpOfl W CENSEUWFORTHEFOLLOWWaREA50N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n C-� CAUNTYVAi1CHRE�UIRESAPERMITTOCONSTRUCT,ALTER�MPROVE,DEMOLISH,ORREPAIRANYSTFUG w W TURE.PRqR TO ITS ISSUANCE,�LSO HEDUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT TFUT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� � CENSE UW(CHMTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOUSPB FESSIONSCODE)ORTHATHEOFSHEISEXEMP7THEREFROMANDTHEBASISFORTHEALIEGEDExEMP- (� TqN.ANV VIOl,AT10N OF SECTION 7031.5 BV ANY MPLICANT FOR A PERMIT 5U&IECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALT'OF NOT MORE THAN FIVE HUNDRED OOLLARS(t6ao�.): 0 ❑I,ASOWNEROFTHEPROPER7Y,ORMYEMPLOVEESWIiHWAQESASTHEIRSOLECOMPENSATION, 0 COrt1rt18fC18I Z N7LL DO THE WORK,M1D THE STRUCNRE IS NOT INTENDED OR OFFEHED FOH SALE(SEC.7a�,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPER7Y Nh10 BUILDS OR IMPqOVES THEREON,M1D NM1IO DOES SUCH WORK HIMSEIF OR HERSELF Oq Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDIN40f11MPROVEMENTI550lDWITHINONEVEAROFCOMPLE- Z TION,iHE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE DID NOT 6UILD OR � IMPROVE FOq TFIE PURPOSE OF SALE). - �y,� ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTIN6WfTTiLICENSEDCONTMCTORS [t TO CONSTRUCT THE PR0.IECT(SEC.70N,BUSINE55 ANO PROFESSIONS CODE THE CONTRACTORS LI- V0W9�lOf1 ADJ.qREA W CENSE LAW DOES NOTMPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMPROVE9 THEREON,AND = NM1IOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(SjLICENSEDPURSUANTTOTHECONTiUG FEE � roas uc�se uw.�. ��T�n' DESCRIPTION Y � ❑I AM EXEMPT UNDEfi SEC, B.6 P.C.FOR THIS REASON � ?� U � DATE OWNEF ¢ Z U � LICENSED CONTFACTORS DECLAAATION w � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM IICENSED UNDER PROVISIONS OF CHAPTER � � G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MY LICENSE IS IN FULL FORCE M1D EFFEC7. �+ m � LICENSE CLASS L'��CO LIC.NO. J O 4 J� • � V DATE CONTRACTOR a. W � WORKERS'COMPENSATION DECLARATION � � U � I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECIAAATIONS: Z � Q � � _I HAVE MJD WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORKERS' _ Q COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. W 0 � � _I HAVE AND WILL MAINTAW WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTKKJ Q 3700 OF THE LABOH CODE.FOR THE PERFORAUNCE OF 7HE WORK FOR WHICH THIS PERMI7 IS � ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER AAE: CONSTRUCTION � CAARIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q 0 (iHLSSECiIONNE�NOTBEODMR.ETmOFhEPER1.TTi5FpRpNEMR�OqEpppLL/.AS(5100)OqLESS} PLUMBING W � � Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR LS ISSUED,I MECHANICAL C� SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE [/� WORNERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THA71F I SHOULD BECAME INSPECTION FEE SU&IECTTOTHEWOR)(ERS'COMPENSATIONPROVISIONSOFSECTIONJ7000FTHELABOR A � �� O CODE,I SHALL FOflTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE e� p DATE: APPLICANP. SMIP W J WAANINO:FAILURE TO SECURE WORKERS'COMPENSATqN CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � J �y SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEMUNDREDTHOUSAND ENEROYPERMIT DOlLARS(5700.000).IN�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3]OB OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: ..(�t7' O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIRM UNDER VENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AOENCY FOR THE PERf-0RMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70G7,CIV.CJ. Z W • � LENDER'S NMIE H LENDERSADDRESS � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CARRECT. TOTAL FE ES •�`�� /� � I AdREE TO COMPLV WI7H ALL CITY AND CAUNlY ORDINANCES AND STATE UWS REUTINO TO BUILDINO CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF THIS CWNTV TO EMER UGON iHE �� ABOVE-MENTqNED PROPERTV FOR INSPECTION PURPOSES. Z 0 COMMENTS -' k _ m PER AM (PHINn . (/� 7� � N SI REO ERMITT DATE � RECPT.NO. PAID BY � VALIDATION I WHITE—Depertm�t Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,OOLDENROD—File Copy,GREEN—ApplicanYs Copy ��.�� .;��;�. `�'1�:. ��j' CITV OI� DI�,f1�0�lD BAR .. , � � '" �;��"„�; ' .,°'y"�C ' INS�EC'B'10� �ECORD ��:,�,��,��. � D �pC�C�400O fi�J :,� .`��:t =��J�G�C�C�� , DG�1�3�L�540 00�']' � o ''t�C� ' 0�}�pC��G3�"'� SET BACK FLOOR JOIST FTGS/FORMS/STEEL • FHA REGIMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HL 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 SHOWER/TUB TEST POOL 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. GA5 AIR TEST FINAI ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY C�T�o COMMENTS � ��' �� L - SEPTIC TANK SIZE SEEP PIT/U SIZE , a m a �. a -- �� .