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Home My WebLink About16828 (25) CITY OF DIAMOND BAR ��(PIR�� --� --J�� --- DEPARTMENT OF COMIvfUNITY&DEVELOPMENT SERVICES I 21825 E.Copley Drive ,IUN 1� �� (909)860-3195 Fax(909)861-3117 PRESS `��-��+ BUILDING PERMIT APPLICATION FIR o DDRIESS�!� s. Pg I o C'edro U�� DATE CATION � I� D NUMBER�� #/C � ISSUE J-'� /� TYPE OCC APN--}�, LOT TRACT DATE b U CONST. GROUP p OWNER .J Ll�I Es I E p ADDRESS ZONING SETBACKS Z CITY ZIP TEL FRONT RW ❑ o APPLICANT TEL. SI�SIDE STREET RW O z ¢ CONTRACT � � SIDE ❑ � ADDRESS � CITY ZIP O ZTEL PROPOSED USE oARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECIARATION SFR/ADD/REM O I HEREBV AFFIfiM UNDER PENALTV OF PERIUHY 7HA7 I AM EXEMP7 FROM THE CON7RAC70RS LI� Gef8J0/CBfpOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n U CAUNTVWHICHREQUIRESAPEFMI7TOCANSTRUCT,ALTER,IM7ROVE,DEMOLISH,ORREPAIRANYSTRUC- w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70RS LI� � � CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSPB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEMP� C7 TION.ANY VIOLA710N OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&lEC7S 7HE APPLICANT T0 Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).J: Z ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIfilOfdal - WILL 00 THE WOFK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa�,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � GROPERTY NRiO BUILDS OR IMPROVES THEfiEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMEN75ARENOTINTENDEDOR m QOFFEREDFORSALE.IF,HOWEVEF�THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDEFi WILL HAVE iHE BURDEN OF PROVING 7HA7 HE OR SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCON7RAC71NGWI7HLICENSEDCONTRACTORS � TO CANSTFUCT THE PRQIEC7(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTqAC70R5 LI� VelUOSiOn ADJ.AREA W CENSE UW DOES NOT APPLY TO AN OMMER OFA PROPEHTV WHO BUILDS OR IMPFiOVES THEREON,AND F WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE Y TOHS LICENSE LAW.). � ❑I AM EJ(EMP7 UNDER SEC. B.8 P.C.FOR THIS FEASON Q � U ti � DATE OWNER � � Z w � UCENSED CONTRACTORS DECLARATION w - � I HEREBY AFFIRM UNDER PENAL7Y OF PERJURV THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �r � C B � I � d 9(COMMENCING WITH SECTION 7000)OF DIVI510N 3 0F THE BUSINESS AND PROFESSIONS CODE.AND Z X AIY LICENSE IS IN FULL FOnqCE AND EFFECT. � LICENSE CLASS �/ LIC.NO. / j � J V DATE CONTRACTOR � d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLAFiATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ Q COMPENSA710N,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE w OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � 0 W I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS tiEOUIRED BV SEC710N Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERM17 15 � ISSUED.MY WO S'CAMP NS N INSU CE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ¢ �ZI.Y-��Y� � CARRIER _ _ .� PLAN REVIEW ZPOLICY NUMBER . ELECTRIC Q � (fHLSSECiIONNE�NOTBE00AW_ETEDOFTHEPERAYTISFORONEHUPDREDOOlLARS(L100)ORLESS). PLUMBING� 1 W Z I CEFiTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C.� SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE N WORKERS'COMPENSATIONUWSOFCALIFOflNIA,ANDAGREETHATIFISHOULDBECAME INSPECTIONFEE � SUBJEC770 THE WOFIKERS'COMPENSATION PROVISIONS OF SEC710N 37a00F THE UBOR CADE, SHALLFORTHWITHCOMPLVWITH OSEPROISIONS. / ISSUANCE � / • p DATE: � � O� APPLICANT: , �/��L� SMIP J WAPNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C � LL SUBJECTANEMPLOVERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f1o0,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEYSFEES. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HEPEBV AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WNICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W � LENDEF'S NAME F— LENDER'SADDRESS � I CERTIFY THAT I HAVE flEAD THIS APPLICATION ANO STATE THAT THE A90VE INFORMATION IS CARRECT. TOTAL F E ES �� W I AGREE TO COMPIV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING d � CONSTRUCTION,AND HEREBV AU7HORIZE REPRESENTATIVES OF 7HI5 COUNTV TO ENTER UPON THE Z ABOVE� ENTIONED PROPERTV FOR INSPEC710N PURPOSES. COMMENTS � r S' _ m PE TTEE NAM (PFiINT) Cn / / � �J NAUREOFPERMITTEE DATE ) = RECPT.NO. '/� PAID BY VALIDATION ~ WHITE—Department Co YELLOW—Finance Co PINK—Assessor Copy,GOLDENRO�File Co GREEN—A licant's Co PY. PY. PY. PP PY — � . , . ...,. ,. ... . .: .. ... . . . . . ... . , r�. '�`...J,'.7''"' .., -'--ti.,,?a_;�- ��-'�� ,� ,w. .. l �d��'l �G� ��lPa(I�'��1�D I�1'�1� 6[��C�u QOo fr�i G�C�C�(��i� Oa�� D/�� DG�f�G�i�G3 OL��CG�VOOa DCaS� D ° � . o � � SET BACK ---_� i_� FLOOR JQ151". ___--- � ---- FTGS/F�RMS/STEEL ; � FHA REC]MTS --- ---- -------- --.:..._..___- --_._.— �...._._�_ E�ECTRiC GFiOUND � � � UNDER FLOOR DUCI- � GROUND PLUMBING _ ___ : UNDER FLOOR CUt�IDUiT j ___ _____ SLAB GRADE FIREPLACE FOUNDATIOR! - -- ------�— -- TEMP POWER FIREPLACE BOND BEAh� - ------ _... WATER SERVICE ' � MID HT. BOI��D BEF�M --- -- ---...--- --..._.._.. ------- ROOF SHEATHIiVG � 8 FT. SOND BEAM �-- - ---- ' ---- FRAMINGNENTIUATION � FINAL BONQ BEAM , - - ---_ .__._.._._�___ ...------- -----.....--- ROOF COVER � PRE-GRADING I ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING � � -- -- -. ROUGH PLUMBING , FINISH GRADWG -- ...- ---..,. -- --__.__�. ----....._.----__. __.._.____...._. SHOWER/TUB 7EST POOL ELEGTRIC EXT. LATH/SIDING � ! POOL FENCING -- --- - -- -------- _-_ ---------- WALL INSULATION � POOL FINAL I CEILIiVG INSULATION _� j OFF SITE IMPS. _ _ DRYWALL NAILING ' DEDICATIO►VS SEWER � FINAL ENG.- --------- - SEPTIC TANK l�NDSCAP�/IRRIC. SEEP PIT/LL ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. �IRE DEPT. FINA� FINAI HEATING � HEALTH DEPT. FIfVAL �__.-. ____ -_.._-- FINAL ELECTRIC ' DEV. FEES PAID FINAL PLUMBING ; ENERGY -- - --- ----- -------...---;--- -----.._..__.. ' I _— �__�_ , C�G�Of�OC�o :. ----___L -- ------- CONiiViENT'S , SEPTIC TAfVK SIZE � SEEP PIT/U SIZE — - � � �s _ � �