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Home My WebLink About17059 ��cp�r� CITY OF DIAMOND BAR ----��`--- DEPARTMENT OF CONA�IUNTTY&DEVELOPIv�NT SERVICES I I 21825 E.Copley I?rive �`- (909)860-3195 Fax(909)861-3117 - PRE$S "'�.��>'' BUILDING PERMIT APPLICATION FIRMLY I i o� JOBSITE 2 yk yy �f��a �tr`91�� . DATEICATION��-O) NUMB R I�os r �lC ADDRESS � ISSUE TYPE OCC � APN LOT TRACT DATE CONST. GROUP p OWNER fLfi-� -�f v� '4.�}r��.-i-.� o ADDRESS � CA-M.F ZONING SETBACKS Z CITY ,Q� � ZIP l�"�,,�TEL. Y��iC�-lj fo FRONT RW ❑ o APPLICANT _�{-V wOs,.r�v' TEL. �/+�� REAR ❑ Z SIDE/SIDE STREET RW ❑ Q CONTRACTOR SIDE p ADDRESS 1 U � CITY ZIP TEL. PROPOSED USE ��`��'JDL IJ 6 F'�'-7/� w ARCH/ENG/ z DESIGNER �' I �� w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS N cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIfiM UNDER PENALT/OF PERJURV 7HA7 I AM EXEMPT FROM 7HE CONTRACTORS LI- G8f896/CBfpOfl W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31.58U51NE55ANDPROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OFREPAIRANYSTRUC� w O � w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PEFMIT TO FILE A SIGNED w Patio/DeaN-� S7ATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- u' POOVS(78 � fESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (� V TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof � A CIVIL P NALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oo).�: Z ,ASONMEROF7HEPROPERN,ORMVEM7LOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COrt1rtIBfCiel � WILL THE WORK,AND THE STRUC7URE IS NOT INTENDED OH OFFERED FOR SALE(SEC.70��,BU51� J N NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF ? — PROPERN WHO BUILDS OR IMPROVES 7HEREON,AND VMO DOES SUCH WORK HIMSELFOR HERSELF OR � iHROUGH HIS OR HER ON?J EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m � OFFEREDFORSALE.IF,HOWEVEi�7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR , � IMPROVE FOR THE PURPOSE OF SALE). ❑I,AS OWNER OF THE PROPERTV,AM EXCIUSIVELV CONTRACTING WITH LICENSED CONTMCTORS � TO CANSTRUCT THE PROJECT(SEC.70�1,BUSINESS AND PROFESSIONS CODE:7HE CONTRAC70RS LI- V81U81i0f1 �D� ADJ.AREA W CENSEUWDOESNO7APPLV70ANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFOHSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.6 P.Q FOR THIS REASON Q I � U � � DATE OWNER � Z ^ W � LICENSED CONTRACTO DECLAAATION , w � I HEREBV AFFIRM UNOER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER a Y(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE,AND Z I X MV LICENSE IS IN FULL FORCE AND EFFECT. W � I� LICENSE CLASS LIC.NO. � U DATE CON7RACTOR d W � WORKERS'COMPENSATION DECLARATION Q � � 1 HEREBV AFFIRM UNDER PENALN OF PERJURV ONE OF 7HE FOLLOWING DECURATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ ¢ CAMPENSATION,AS PROVIDED BV SECTION 37ooOF THE LABOR CODE,FORTNE PERFORMANCE ,U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE AND WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION Q' 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� O� > ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION• `��.. J ` CARRIER PLAN REVIEW Z POLICYNUMBER ELECTAIC Q � (THLSSECTIONNE�NOTBE0.�MPLEfEDOFiHEPERMfTISFORONEHUI�DREDD0UJ13S(E100)ORLESS). PLUMBING W Z I CERTIFYTHAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL (� SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE �/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE �?� ./��1 �T T'i"�� R.� SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHElABOR �T ��"'1� �� I L�( � � CODE,ISHALLFORTMWITHCOMPLYWITHTHOSEPROVISIONS. ISSUANCE �.7 � SMIP � C��p � �n n� i 5.�- p DATE: APPLICANT: J WARNING:FAILURE TO SECUiiE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C I L ` I � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT I DOLLARS(5100,000�,IN ADDITION 70 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN o-'� � SECTION37080FTHELABORCODE,INTEFIEST,ANDATTORNEV'SFEES. RETENTIONFEE: �~ _ _ I I '� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEFEBV AFFIRM UNDER PENALTY OF PERIURY THATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,qV.C.). Z W ? LENDEfi'S NAME � � LENDER'SADDRESS � I CERTIFY iHAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �� .�� w I AGREE TO COMPIV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE � ABOVE�MENTIONED PROPERN FOR INSPEC710N PURPOSES. Z COMMENTS � P�� G�� F� m PERMITTEE N (PRINT) � �� L✓�-�.. `�-.5-D/ � SIGNA7URE�OF MITTEE DATE 1 / = RECPT.NO. G'7 �7 PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENFOD—File Copy,GREEN—Applicant's Copy . . ...-: :, n. . . ... ,Wu.T.i1-Rl ..,av, , ,a,: .. -. . , ... .. . . , n t:...;P:�Lu'w�H::e• - � „iln?,6 M. ., �t'� ,. . . , ,p,,�� , . , . ti� . ;i a S..�:h,d� . . � .. �Q��J t�� a��1� ��a�� Q�'l��i�'�[�� 0� U o O/�tt� D�� J�� D��I � �G�`tt� OG� Q � ��° � � SET BACK � �� ' FLOOR JOiST j •---- ; _.._.__._ __--- ' ---�---------- FTGSIFORMS/STEE� ��; � H F ti TS �— � _ ELECTRIC GROUND 'i '' � ' � UNDER FLOOR DUCT � � - -- -- -- ---: j---- , GROUND PLUMBING ,,/`�__ __ UNDER FLOJR CU��DUIT i i ___ _ SLAB GRADE , FIREPLACE FOUNDATION ! - ---+-- TEMP POWER _� FIREP�ACE BdND BEAM _ WATER SERVICE I MID HT. BONG BEAM ___ _ ___ ROOF SHEATHIfVG , 8 FT. BOND BEAM i __ FRAMINGNENTILIATION _�FINAL BOND BEAM _ ______ ROOF COVER PRE-GRADING � ROUGH HE,4TING BENCHING I ROUGH ELECTRIC ej"�� _� ' ft UGH GRADlNG ____ __ ROUGH PLUMBWG I FINISH uRRpING __._*. .- ---- — -- ------____ SHOWER/TUB TEST i POOL E!�CTRIC �'��.D _ EXT. LATHISIDING ' r PO{JL FENGING ' --- � ----- ------ ----..._- WALL INSULATIOfV � POC}L�INAL I, _ __ v___._.- ------ -..------ CEILING IN�UI_ATION-�-� _ ___�OFF 8(TE 1MPS. � --- -- — - -.--.__ _..... ...__ . _V DRYWAL�IL'AILING ' DEGICAT3UNS ��_ _ --- --- - . . - ___ --- -- ___..� SEWER rINAL E��r I � __ _ ------ -- �__�_ —..�._....._._____ ____ SEP71C TANK LANDSCA��lI'Rt�(G. -- ---- - ------ --- -----..._.— �SEEP PIT/LL. C�i�!SITE Itu�PS. �� GAS AIR TEST � � �INA�ZQNII��G_-� --- -----__.__ ---•- - ---� ____ FIN,4L CONST. � � ��RE DEPT. FINA� � �_�_.----- ---- FINFlL HEA7ING ��--� HEA�TH [�CFT. FINRL FINAL ELECTRIC ! � DEV. FEES PAID {_;—___ _...---- - FINP,L PLUfVIBING � ; ENERGY I _ � __ _ � C�G�O�C�X�a I C0�lIfi�Ef�TS SEPTIC TANK SIZE __ SEE� PIT/U SI�E — ---- _.__._..---- ----------- � - ------ ---- �-----�------�- "� � - -- — --------------- � ---