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Home My WebLink About18350 � �X��Y'�� CITY OF DIAMOND BAR --�� -�-� DEPARTME?�T OF COIvA�IUNti1'&�DEVELOPMENT SERVICES I 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3117 PRESS ''%»�� BUILDING PERMIT APPLdCATION FIRMLY o� JOBSITE -� /D� 1 J��j ��/ . DATECATION � 2 � NU B R�..��,y�' o',� #/C I ADDRESS �-�'v r- i� t �� ISSUE �7 TYPE OCC I APN LOT TRACT _ DATE � v�' CONST. GROUP � OWNER �" �I� O 0 ADDRESS ZONING SETBACKS Z CITY ZIP 7EL. v P FRONT RW ❑ � APPLICANT TEL._ r REAR ❑ � SIDE/SIDE STREET RW ❑ z Q CONTRACTOR ��'h � SIDE ❑ � ADDRESS G PROPOSED USE fi/YI � CITY a. ZI �"�`a"/TEL. po � o ARCWENG/ I �z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TFL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PE0.IURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G2l2Q0/CBfPOfI W CENSEUWFORTHEFOLLOWINGHEASON(SEC.7037.SBUSINESSANDFqOFESSiONSrODE:ANYCI7YOR (n U COUN7YWHICHqE�UIRESAPERMI7TOCONSTFiUCT,ALTER.IMPROVE.DEMOUSH,ORqE7AIRANV,iRUC- W Patio/Deck Z TURE.PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APCLICANT FOR SUCH PEFMI7 70 FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PUFSUAN7 TO TME PROVISIONS OF THE CONTRACTORS LI� � w � CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB fESSIONSCODE)ORTHA7HEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� � � TION.ANV VIOUTION OF SECTION 7071.5 BY ANV APPUCAN�FOR A PERMIT SUBJEC�S THE APPIICANT TO Z Re-Roof Z� � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500�.): � Z ❑I,ASONMEROFTHEPROPERTV.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA7iON, 0 COmm0fG21 WILL DO THE WORK,AND THE STRUCTURE IS NO71N i ENDED OR OFFERED FOR SALE(SEC.704l,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'APPLV TO AN OWNER OF � PROPER7V WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m � w OFFEREDFORSPLE.IF,HOWEVER,THEBUILDINGOHIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'HA7 HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PUFiPOSE OF SALE�. _ ❑I,ASOWNEROFTHEPROPEHTY,AMEXCLUSIVELVCONTRACTINGWI'fHLICENSEDCONTRACTOFS W [[ TO CONSTRUCT THE PR0.JECT(SECJoa�,BUSINESS AND PROFESSIUNS CODE:THE CONTRAC70R5 LI- V8W0�i0n � ADJ.AREA - W CENSEUWDOESNO7APP�Y70ANOWNEROFAPROPER7VWHOdUII.DSORIMPPOVESTHEHEON,ANO — � NM1IOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�1.ICENSEDPURSUANTTOTHECON7HAC� QUANTITY DESCRIPTION FEE Y TORSLICENSEUW.). ¢ ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS FEASON Q � U � — OC DATE OWNER � � Z W � LICENSED CONTRACTORS DECI.ARATION W � I HEREBV AFFIRM UNDER PENALTV OF PERJURV TMAT IAM UCENSED UNDER PROVISIONS OF CHA7TER � d 9(COMMENqNG WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PP.OFE5510N5 CODE,AND X MY LICENSE IS IN FULL FORCE AND EFFECT, z I � LICENSE CLASS G LIC.NO. C/ � � j V DATE�I�4SL CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION a N1 HEREBV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FON WOfiKEflS' a Z ¢ CAMPENSATION,ASPROVIDEDBVSECTION37000FTHEUBORCODE.FORTHEPERFORMANCE w OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �2U� �D ISSUED.MV WORKERS'CO PENSATION INSURANCE CARRIER AND POIICV NUMBER ARE: CONSTRUCTION J � CARRIER e ��d PLAN REVIEW � Z POLICYNUMOER �Z,3'IZ _ ELECTRIC Q � (iHISSECTIONNEmNDTBE00MPLEfEDOF7FIEPERMfTISFO{'i0NEM1t�DREDDOLLARS(5100)OFiLESS). PLUMBING Z I CERTIFV THAT IN TNE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL (!3 SHALL NOT EMPLOYANY 7ERSON IN ANV MANNER SOAS TO BECOME SUBJEC7 TO7HE �/j WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INS?ECTION FEE ? SUBJECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR CODE.I SHALI FORTMWITM COMPLV WITH THOSE PROVISIONS. ISSUANCE 1 � '�' SMIP p DATE: � �L' APPLICANT: D%A/haA� � J WAqNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERACE IS UNUWFUL,AND SHALLBE ENERGY P/C � SU&IECTANEMPLOVERTOCf11MINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT I DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 37080F THE LABOR CODE.INTEREST,ANDATfOHNEV'S FEES. RETENTION FEE: I � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' i O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDMG AGENCY n- FOR THE PEf1FORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC,3087,CIV.C.�. Z W S LENDER'S NAME � � LENDER'SADDRESS ' � I CERTIFY THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES •�� w I AGFEE TO COMPLV WITH ALL qTY AND COUNTV ORDINANCES AND STATE LAWS REUTINC,TO BUILDING I� � CONSTRUCTION,AND HERE6V AUTHORIZE REPRESENTATIVES OF THIS COUNTV Tp ENTER UPON THE � ABOVE�MENTIONED PROPERTVFORINSPECTION PURPOSES. Z COMMENTS � -��,,� HQ ��k � m PERMITTEE NAME(PRINT) � ,�j�a ��i'�q i N SIGNATUqEOFPERMITT � '� un�e = RECPT.YO. AID BY VALIDATION ~ WHITE—De artment Co YELt.OW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A IicanYs Co P PY. PY, PY� PY, PP PY �6�'�' �� I�i��°I� �A6� � Bil��€'��G�9 3��Ca�� . � � , � , , : .. . o�� r, ry�n , �. �� - � ' �� f�n']�� ,�} � ��A,�� .:,�*,' tt`� :D�C�� _- ,; y .� � a � �$ . --. . .. . _ :. .,. . � - ., .. , o � � SET BACK ' � ; FLGQR JOIST � � _.__ _— —:. _ ._ —.---- --_ --- ---I-- - ------ FTGS/FORMS/STEEL � ' FNA REQMTS ' � - �-- _....__.�.—.._ -- -....---- ----. ------ __ __ _._ --r ----- ELEC7RIC GROUND � I .__ __ � ; _. ----_ , : UNDERfLO � ---- ______t— ._ ...__ .._. . � _..--- GROUND PLUMBING __ .__ ----- ---._�' U'VC3+ R FLOOR CUf�iDUIT_ � -! ... . _- ----;--_._ _. __ SLAB GRADE � FlI�Ff'LPCE FCJUNDATION � _-- -- ' -_ _- ------- --- --.._ _. _---- TEMP POWER ______ I � i�IRE}'LACE F3UND BEAM _ i _ � _ _�:— ._ { ____. . _ - WATER SERVICE__ � _ ; � I MID H'T. BOND BEAM ___ _ � i - �� p -- -- - -- .. - ------ ROOF SHEATHING�;t�,o�- �_/`t=a�_ ` g �� BdND BEAM _ .__ ____i -- ; ------- FRAMINGNENTILIATION; � FINAI F30ND BEAM � ROOF COVER _ � � PRc-GRA�ING __� __ j _ ROUGH HEATING � BENC;HING ! _ -�-----._.....-- --- - - ROUGH ELECTRIC ; ' I ROUGH GRAOING � --- ----�------- — -? --- __... _._._. --- - -- --.. ROUGH PLUMBING � ' FINfSH �aRADING -- ---- �_�__._._—�._.. ...._ ------------- ---- -- --.. SHOWER/TUB TEST_ �1 ; � POOL ELECTRIC _ ------ -� _. ------- — EXT. LATH/51DING -�_ ! F'aOL FENCING I __. ---._.. _ —_ —___----- — WALL iNSUTATION i -�--J-�-- ---�--_�. --�-- - i f'�OL FINAL I � ---- - � --. .._ ... _.._ .____�.. _ _..-------- _.. CEILING IN�ULATION i C�F�SITE IMPS. � ----- --- .._.__ �------. --- -- ------_ .__..---E--- DRYWALL NAILING ; E . OEDICATI�NS -- -- _._.__.._..----�- ------ ---�------- SEWER � FINAL ENG. �_ _ _ __ ------ -�� _. _ . SEPTIC TANK __ j � LANDSCAPEtIRRIG. � SEEP PITlL.L. ON SITE IMPS. � — ' - ---- _.---- GAS AIR TEST ' F4NAL ZONING i - --- � -- - - --._._ FINAI.CONST. � I � FiRE DEPT. FINAL --• _ --- ---- ----- FINAL HEATING �—Y— J HEALTH D�P"C FINAL — --- ? ----- ------ .._.... ------------- FiNA�ELECTRIC i � ' DEV. rFES PAID , . _--- ---...___. ,_��_:__._._.___.___ __..._..._---------- ------ ---._.._. ---- FINAL P�UMBING j '; ��E��' .__ _._ ..__ __ _ ------�---- - - .. _ _.._ ----- - --- _ � -�- y �,� ,��a � _ m � a �, � CUMMEfVTS -.------- SEPTIC TANK SIZE SEEP PIT/U SIZE -- — --- --- -- � — --- ----- — ------ . o. . ----- � ,• a� ---_.______--- ---- .__ __.____--------- ------ ,, , .p. � � �4 �.`� � o ---- - —