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Home My WebLink About10-1188 � �� CITY OF DIAMOND BAR , DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ''"'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �j ��y� A , APPLICATION PERMIT �^� I��/C o ADDRESS -'! d �G�'V DATE NUMBER � APN T TRACT ISSUE n� p� TYpE OCC �� DATE ' V v CONST.-� GROUP p OWNER �Ue 1\PCH�.C� o ADD ESS �l ZONING SETBACKS w FRONT � CI TEL. REAR RW � APPL CANT TEL SIDE/SIDE STREET RW ❑ . � CONTRACTOR i SIDE � ADDRES � � CITY 'E ZI TEL PROPOSED USE L� d� o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- GflfB B/Ce OR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.68USWESSANDPROFESSKKJSCODE:ANYCITYOR (n 9 � C� COUNTVWHICNREWIRESAPERMILTOCONSTRUCT,ALTEfl,IMPROVE,DEAqUSH,ORREPAIRANVSTqUC� W P8�I0/DBCK �< TUqE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w � STATEMENT THAT HE OR SHE IS LJCENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' POOUSPB � FESSIONSCODE)OqTHATNEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALlEOEDEXEMP� � TION.ANV VIOLATION OF SECTION 70.91.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roaf A CML PENALT/OF NOT MORE 7HAN FIVE HUNDRED DOLLAqS(5500)J: 0 ❑I,ASONRJEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COlf1fIlBfCIaI Z WILL DO THE WORK�ND 7HE S7RUCTURE IS NO7 IMENDED OR OFFERED FOR SALE(SEC.7oat,BU51- J N NESS AND PROFESSIONS CADE:THE CONTRACTOflS LICENSE LAW DOES NOT APPLV TO AN OWNER OF j PROPEHTV WFIO BUILOS OR IMPROVES hIERC-0N,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THRIXIGH H�S OR HER OWN EM7LOVEES,PROVIDED THAT SUCM IMPROVEMENTS ARE NOT INTENDED OR N Q OFFEREDFORSALEIF,HOWEVER7NEBUILDINGORIAIPROVEMENTISSOIDWRHINONEVEAROFCAMPIE� Z TIDN,THE OWNEi7-BUILDER WILL HAVE THE BUROEN OF PROVIN6 THAT HE OR SHE DID NOT BUILD OR � IMPROVE f-0R THE PURPOSE OF SALE). � W ❑I,AS ONTJER OF THE PROPEH7Y,AM E%QUSIVELY CONTRACTINO WITH UCENSED CONTRACTOqS � TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V01UflflOfl A0.1.AREA W CENSE LAW DOES NOTAPPLV TOAN OVMER OF A PROPERTV WNO BUILDS OR IMPROVES THEREON.AND Z WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR�S)LICENSEDFURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE Y 70RS LICENSE UW.). � ❑I AM EXEMPT UNOER SEC. B.8 P.C.FOR THIS REASON � � U u" DATE OWNER � � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ��1, � �(COMMENCIMO WfTH SECTION 7000)OF OIVISION 3 OF THE BUSINESS ANO PROFESSIONS CODE,AND Z �1J W UCENSE IS W FULL FORCE AND EFFECT, m � LICENSE CLA LIC.NO. � V DATE - � CONTFACTOR d W � WORKERS'COMPENSATION DECLARATION � N I HEREBV AfFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: V � Z � I FIAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _ � PENSATION,AS PqOVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQIIIqED BV SECTION Q 370a OF THE LABOq CODE,FOR THE PERFORMAN E OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.MV WORKERS'COMPENSAT RAN CARRIER AND POLICV NUNBER ARE: CONSTRUCTION � CAARIER PLAN REVIEW � POLICYNUMBER � ELECT � (IFIISSECt10NNEIDNOTBE00f.WI.EfEDOFhEPEFi4R1$Fpqp.lEFh,�•pqEpppl,l,ppg(flpp�pqLFSS� L MBING �� Z 1 CERTIFV THAT IN THE PERFOFiMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C!S SHAI.L NOT EMPLOV ANV PEPSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE (n WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECT TO THE WORNERS'COMPENSATqN PROVISIONS OF SECTION 370o OF THE LABOR � O CODE,I SHALL FOHTHWITH COMPLV WITH THOSE PROVISIONS. ANCE- p DATE: APPLICANT. SMIP W J WMNIN6:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � J � SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AN�CNIL FINES UP TOONE HUNDRED 7HOUSAND ENERGY P DOLLAFiS(ftao,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEHEST,AND ATTORNEV'S FEES. N. N FEE: t�O W O CONSTRUCTION LENDING AGENCY p � I HEREBV AFFIRM UNDER VENALTY OF PERJURV THATTHERE IS ACONSTRUCTION LENDINO AGENCV FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�. Z W � LENDER'S NAME � � LENDER'SADDRESS w I CERTIFV THAT I HAVE flEAD THIS APPLICATIONAND STATE THATTHEABOVE WFORMATqN IS CORRECT. TOTAL FEES ��I O,• � 1 AGREE TO CAMPLV WITH ALL CIiY AN COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING /� � CONSTRUCTION,AND REBV A IZE REPRESENTATIVES THIS COUN TO ENTER UPON THE ' Z ABOVE�MENTIONED P GER OR INSPECTION PURPO COMMENTS � � J � m P ITTEE N E(PRl 7 � � Q � Cn Sb� D 7E � RECPT.NO. PAID BY VALIDATION WHITE—DepaAme�t Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN— Applicanl's Copy CITV O� DIANiOi�D �AR INSP�CYEO� ��CORD oa�p�c�400a �d�� oa�pr�c�a aa�p�c�o�a � �r�a�� oa��c�� 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 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 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. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ^ ► ! ENERGY C�ft��o � ' � COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE - � a � a �