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Home My WebLink About17638 (25) CITY OF DIAMOND BAR -�---�� ---- DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS '"%��` BUILDING PEI2MIT APPLICATION FIRMLY } JOBSITE � ' APPLICATION PERMIT , P/C �1 .qp o ADDRES � -N � C� DATE :� 0 Z- NUMBER� # O h � .J 0 � ISSUE TYPE OCC APN �O rTRACT DATE CONST. GROUP p OWNER �l �� ' " ADD �S ZONING SETBACKS Z CITY ZIP � TEL. FRONT Ryy ❑ � APPLICANT � TE REAR Z SIDE/SIDE STREET RW O ¢ CONTRACT � SIDE ❑ O ADDRE S G�'� PROPOSED USE 06 S !i- '�j/'��' CITY ZIP E w ARCH/ENG/ /1 ,,1 � - z DESIGNER ��V/`F w � NO.DWEL. NO. NO. � CITY E 'J ZIP TE UNITS STORIES BEDROOMS v� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM E%EMP7 FROM THE CONTRACTORS LI� G8f890/COfpOfS W CENSEUWFORTHEFOILOWINGREA50N(SEC.7031.50USINESSANDPROFESSIONSCODE:ANYqTYOR (n U COUNT/WHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORHEPAIRANYSTRUC- w TURE,PRIOR TO I75 ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF 7HE CONTRACTORS LI- � CENSE LAW(CHAPTER B(COMMENCING WI7FI SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSpB i 0 FESSIONS CODE)OR 7HAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- (!� V TION.ANY VIOLATION OF SECTION 7037.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof � A CIVIL 7ENALTV Of NOT MORE THAN FIVE HUNDRED DOLURS(5500).): � ❑I,ASONRJEROFTHEPROPERTV,ORMYEMPIOYEESWITHWAGESASTHEIRSOLECOMPENSA�ION, ❑ COrt1rt18fCldl �- Z WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oad,BUSI� J � NESS AND PROFESSIONS CODE:7HE CONTRAC70R5 LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF � — PROPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFOPHERSELFOR � THROUGH HIS OR HEF OWN EMPLOVEES,PROVIDED THAT SUCH'IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALE.IF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOlDWI7HINONEYEAROFCOMPLE- Z 710N,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE�. w ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELY CON7RACTING WI7H LICENSED CONTFiACTORS � TO CANSTRUCT THE PR0.IECT(SEC.7oa1,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70RS LI- V81118SIOf1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPFOPEPTVWHOBUIIDSORIMPROVESTHEREON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR�S)LICENSEDPURSUANT70THECONTRAC- �UANTITY DESCflIPTION FEE Y 70R5 LICENSE LAW.). , Q ❑I AM E%EMPT UNDER SEC. B.6 P.Q FOR THIS REASON Q �� U � � ¢ DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W � I HEHEBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER . d Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z / X MV LICENSE IS IN FULL FORCE ANO EFFECT. w � - T/p ' i � LICENS LAS LIC.NO. � � �• V DAT � CONTRACTOR 1 d � � � W ' � WORKERS'COMPENSATION DECLARATION ,j� 7j%�� U N I HEREBV AFFIflM UNDER PENALN OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: � Z � IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' _ �// Q CAMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE GERFOf1MANCE W �' v Q OFTME WORN FOR WHICH THIS PERMIT IS ISSUED. � � Qw _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION ^ 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS �� , -� ISSUED.MY WORKEFiS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION � J j CARRIER PLAN REVIEW p � POLICYNUMBER ELECTRIC ` Z Q /� � (iHISSECiNJNNE�NOTBECOMREfEDOFTHEPERAYTISFORIXJEHUPDREDDOU/�HS(f100)ORLESS} PLUMBING ��' �v w _ ' __ _' .. y� Z I CERTIFV THAT INTHE PEfiFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �`— �� -- � . �!/ (3 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE � � - � , � � , (n WORKERS'COMPENSATION LAWS OF CAUFO A,A AGREE T T IF I SHOULD BECAME INSPECTION FEE I� - � SUBJECT TO THE WORKERS'COMPENSATI P OV ONS OF C ION 3700 0F THE LABOR �) DE,I SHAL O�j WITH COMPLV WIT H E OVISION '� � ISSUANCE I r r.. n r: �' ✓ ' � �� SMIP t r r_ v r <<�u� �� p DATE APPLICANT: � . � ENERGY P/C I � WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, ND SHALLBE � SUBJECTANEMPLOVER70CRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDREDTHOUSAND �- re DOLLARS(f100,o00),INADDI710N70THECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT •�7 � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � .•�� !�� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: '� O � I HEREBV AFFIRM UNDER PENALTV OF PER1UfiV THAT THERE IS A CONSTRUCTION LENDING AGENCY Z FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMI7IS ISSUE�(SEC.3ae7,CIV.C.�. v . W � LENDER'S NAME � OO i H LENDER'S ADDRE55 � � TOTAL FEES 3� � o? � I CERTIFV THAT I HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE INFORMATION IS CARRECT. w I EE TO COMPLY WITH ALl CITY AND CAUNTV ORDINANCES STATE LAWS RELATING TO BUILDING ! � ONS CTION,AND HEREBYAUTH RIZE REPRESEN7ATIVES F HIS COUNTV TO ENTER UPON THE '/'] � t,� ZBOVE- NTIO E PfiOPERTV FOR SPECTION PURPOSES. p COMMENTS � " �� ` J � � � m FER E Nf�ME RIN7) Q � � 7 � GNATUR OFPERMITTEE E _ � RECPT.NO. PAID BY / VALIDATION ~ WHITE—Department Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A py, py, py, py, pp icant's Copy r�o�� o� �Q�a�o�� c�-��o�� _ ____ _.._� a �; � o��c� o�� oa� ° �� o�� .:m : oa�..a .: oa�r�� Q a �.e � --- ---- SET BACK �FLOOR JOlST � = -- ---- FTGS/F�RMS/STEEL__ Z�y�� _ ---- � --7---- ----- , i � FHA RECIMTS � _ -- --- _.__ _ _--- ------ ELECTRIC GROUND ��GS�,�UZ_ . � ' ' �NDER FLOQR aUC�f � ; _ .i---- --+-- �-- --..... __ � ._......_.� � _ ------ GROUND PLUMBING I � UNDER FLOQR CCJ��DUIT � _ __ SLAB GRADE Y FIREPL'ACE FOUNDATION , TEMP POWER � i FIREPLACE B�ND B�AM _ _�_ - ---r..__. ---- -�---. _._. WATER SERVICE _„__, � _,._ I � MiD HT. E30NG BEAM � __---- - --.....+..<_ ._____..__.y _._.._ _ ..----. __.__,_ _ _____�_ . ROOF SHEATHING __ ; 8 Fi. 8C)ND BERM ____ • � ___ FRAMIiVG/VENTILIATION FINAL BOND BEAM ROOF COVER --r PRE-GRADING. � - ; --- ROUGH HEATING _ ____ BENCHING ___ i ____ ROUGH ELECTRIC ,. � � RC�UGH GRAE�INC � -— --r--- _. - ---_....._.._ _.._..__._._._ __..__._..__._� ROUGH PLUMBING ��'j`;_� I ��SH uRADING ___ _ -- - SHOWER/TUB TEST I —r POOL ELECTRIC ��'Z __, _ "' " ' --- --- - � EXT. LATH/SIDING _ I PC�OL FENCING S D�Dli� - - ----- ---_.._.._ WALL INSULATION ; FOOL F4NAL 5�0 �' -- ---- -------- ----- --__...._....---- CEILING IN�ULATION � OFF SITE IMPS. ' � ; DRYWALL IV,4ILING QEDIC,4TIOfVS �— ' SEWER FINAL ENG. ' - - ' - - ------ SEPTIC TANK . LANDSCAPE/IRRIG. — ��_.__ � -------- �......� —_� ___._ SEEP P(TlI.L. _ � _ _� ON SITE IN1PS. _� � GAS AIR TEST ��'��Z FINAL ZONING FIPlAL CONST. . �!RE DEPT. FtNAL FINAL HEATING � HEAI.TH DEPT. FlNA� -------- FINAL ELECTRIC � �-� DEV. FEES PA!D FINAL PLUMBING I r ENERCaY � � � � — -i ---- I o � o� o ; -- ; _ . E CC3��Pvi��l"� . . -- - -- ____-- ---- ---- I SEPTIC TAfVK SIZE SEEP PIT/U SIZE � — ---- -- _.__.._ __.._----- � � � � � � � �----- � . , _....._