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Home My WebLink About09-172 ��,s ��-�- ��c ^ ��,�_ CITY OF DIAMOND BAR �p p�l � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES C� � � L� �2 � ,�,W , 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS '��'+ BUILDING PERMIT APPLICATION ,a '�"'" FIRMLY t.. ' � JOBSITE ��/ � APPLICATION�'Z�3/�q NUMB R��'-��Z t �l1M ¢ ADDRESS p (�-L��13�Q � DATE I � ISSUE Z/ �—TYPE ':... ._ t�.�(�1CC APN LOT TRACT DATE � (3I a� CONST. GROUP p OWNER �/'"/�/� G " ADDRESS ,�3� a / � /Z. ZONING SETBACKS Z CITY �i�n�wvC/Slr�2 ZIP�[7/S� TEL..��(L �C� FRONT RW ❑ � APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ Q CONTRACTOR s�� v�� / SIDE ❑ ADDRESS �✓� 6lv � � CITY L!fo/.o�v - ZIP� TEL. PROPOSED USE ' o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS U� G8fd90/CBfPOfI W CENSEUWFORTHEFOLLOWINGREASON(SEC.703i.5BUSINESSANDPROFESSIONSCADE:ANVCITVOR (n U COUMVNMICHREOUIRESAPEfiMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8i10/D9Ck w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED w � STATEMENT THA7 HE OR SHE IS LICENSED PURSUAN7 TO THE PHOVISIONS OF THE CON7RAC70R5 LI- � � CENSE UW(CHAPTER 9(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- POOVSPB O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (� V TION.ANVVIOUTIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN7T0 Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSoo).): � OI,ASONRJEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIf1lBfCi81 Z WIIL DO THE WORK,AND 7HE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oN,BU51� J N NESS AND PROFESSIONS CODE:THE CON7RACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF ? VROVEHTY WHO BUILOS OR IMPROVES THEREON,AND NM110 DOES SUCH WORN HIMSELFOR HERSELF OR wTHROUGH HIS OR HER OWN EMPLOYEES,PFiOVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE- Z TION,THE OWNEF-BUILDER WILL HAVE THE BUR�EN OF PqOVING THAT HE OR SHE OID NOT BUILD OR � IMPROVE FOR THE PURVOSE OF SALE). w ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELY CAN7RAC71NG WITH LICENSED CONTRACTORS � TO CANS7RUCT THE PR0.IECT(SEC.70��,BUSINESS AND PqOFE5510N5 CADE:THE CANTRACTORS LI- V81Uet10l1 ADJ.AREA W CENSELAWDOESNO7APPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON,AND � WHOCONTMCTSFOPSUCHPROJECTSWITHACAN7RACTOR(S)LICENSEDPURSUANT70THECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE IAW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � � Z DATE OWNER � � t� � LICENSED CONTRACTORS DECLARATION w �' U tZ [Q, � I HEHEBV AFFIFiM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � , d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X AIY LICENSE IS IN FULL FORCE AND EFFEC7. A m ij� � LICENSE CLASS�/�V VJ� I.IC.NO. ��v �� w,Q j `•/ _ V DATE� O CONTRACTO�f��o�Y//.rLT d W �� WORKERS'COMPENSATION DECLARATION Q i � IHEREBYAFFIRMUNDERFENALTYOFPERIURYONEOFTHEFOLLOWINGDECURA710NS: Z Z �I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSENT TO SELF-INSURE fOR WORKERS' ¢ 2 Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w �I HAVE ANO WILL MA 7AIN WORKERS'CqMPENSATlO INSURANCE.AS{iEOUIRED BV SECTION Q 3700 OF THE LABOR ,,Q9E, R THE ER O NC TH ORK OR WHICH THIS PERMIT IS ISSUED.MV V�RK YC�'1 N�I�NC ICV NUMBER ARE: CONSTRUCTION j CARRIER �� PLAN REVIEW ZPOLICVNUMBER �S��Q�I�S 6I ' � Q � (M1IISSECiK7NNEmNOTBEODMREfEDOFTHEPEMY�ISFORONEHUPDREDDOLL4RS(5100)ORLESS). PLUMBING W 'f � Z I CEFTIFY THAT IN THE PERFOqMANCE OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED,I CHANICA � `� � SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME ECT ON FEE = SUBJEC7 TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTI 370o OF THE LABOR !'� CODE.I HA FORTHWITHCOMPLY WITHTHOSE PROVISIONS. �SSUA �'Y'� �� p DATE: � � APPLICANT: SMIP - J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C � SU&lEC7AN EMPLOVER 70 CRIMINAL PENALTIESAND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY IT DOLURS(S10D.000).IN ADDITION TO THE COST OF COMPENSATtON,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF iHE LA80R CODE.MTEREST,AND ATTORNEV'S FEES. RETENTION FEE: I' �� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNOER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFOfiMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. Z W � LENDEF'S NAME F— LENDER'SADDRESS � TOTAL FEES �qQ-s(7 � I CERTIFV THAT I�HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. w I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING � CONSTRUC710N,AND HEREBY AUTHORIZE REPRESEN7A71VES OF 7HI5 COUNTV 70 EN7ER UPON 7HE � ABOVE-MENTIONED PROPEHTV FOR INSPECTION PURPOSES. Z COMMENTS 0 � Rto a m PERMI77EE AME(P � I a � � � � SIGNATUR PERMITT E ATE p /+ � = RECPT.NO.Z IQZ�� pqlD Bl'�k b ZZ I O VALIDATION ( � ~ WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—Fite Copy,GREEN—Applicant's Copy CB�V OI� DlAiil��l� �Aff� s�s��o�� co�� =k ..aa�p�c�400a o ,`�� : a��c�uoa - oa��4ao� o ��,� . ��#}' 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 P�OL 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�fU�o � — COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � --- - ---- c� � ----- �;: ��a .