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Home My WebLink About15-836 f. � � ' 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 (� ¢ ADDRESS C�j O'� � �j C�3 � APPLICATIO v NUMB R �f' #/C p �--�� DATE �I 7`� � ISSUEL, p� TYPE OCC APN LOT TRACT DATE_ 7 f��T V CONST. �� GROUP p OWNER /1'R. ` ' o ADDRESS ZONING SETBACKS z CITY ZIP TEL ' FRONT p�/y p � APPLICANT TEL. ��.�Z,_, REAR p Z �� SIDE/SIDE STREET RW ❑ Q CONTRACTOR /` SIDE p ADDRESS � ' � � CITY '� ZIP '1 TEL. - — PROPOSED USE C,u V' �` �C � w ARCH/ENG/ �3�� z DESIGNER w NO.DWEL. NO. NO. a ADDRESS �n UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTMCTORS LI- G age/Carport W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCI7YOR (n U CpUNryWHICHRE0UIRESAPERMI7TOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIHANYSTRUC- w S � w 7URE,PRIOR TO ITS ISSUANCE,ALSO HE�UIRES THE APPLICANT FOR SUCH PEHMI7 TO FILE A SIGNED W afl 8Ck � STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7.TO THE PROVISIONS OF 7HE CON7RAC70RS LI� � CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPO- � POOUSPB , � FESStONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED E%EMP- C7 V TION.ANVVIOLATIONOFSECTION7o31.5BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN7T0 Z Re-Root � A CML PENAL7V OF NOT MORE 7HAN FIVE HUNDRED DOLURS(f5ao).): 0 ❑I.ASON?JEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSA710N, 0 COfI1rtIBfCl81 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701t,BUSI- J � � N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � -- � PROPEfiTY WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTHROUGH HIS OR HER ON7J EMPIOYEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m Q OFFEREDWHSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMP�E- Z TION,THE OWNER-BUILDER WILL HAVE THE 9UFDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OH � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCANTRACTORS � TO CONSTHUCT THE PRQIECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8IlOf1 ADJ.AREA W CENSELAWDOESNO7APPLV70ANOWNEROFAPROPERTVWHOBUILDSOHIMPROVESTHEREON,AND � = WFiOCANTMCTSFORSUCHPROJECT5WI7HACONTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAG FEE ~' 70RSLICENSELAW.). �UANTITY DESCRIPTION . Y 0 ❑I AM EXEMPT UNDEF SEC. B.8 P.C.FOR 7HIS REASON Q � �JCA � � � � �1� � G � �� DATE OWNER F S�A.�1 � LICENSED CONTRACTORS DECLARATION W �O ,I � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAP7ER � � G(COMMENCING WITH SECTtON 7000)OF DIVISION 3 OF THE BUSMESS AND PROFESSIONS CODE,AND Z XL� MY UCENSE IS IN FULL FORCE D EFFEC7, m 0 5 " 6�� LICENSE CLAS LIC.NO. V DATE �' i CONTRACTOR _ a W � WORKERS'COMPENSATION DECLARATION a � 1 HEREBY AFFIRM UNDER 7ENAL7Y OF PERJURv ONE OF 7HE FOLLOWING DECLARATIONS: U � Z � 1 AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORNERS' _ Q MPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOH CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw _I HAVE AND WILL MAMTAIN WOFKERS'CAMPENSATION INSUfiANCE,AS REOUIRED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMI715 ��/�Q�� ISSUED.MY WORKER' MPENSATION INSURANCE CARRIER AN POUCV NUM�R�e: CONSTRUCTION /� J /j� -1 j CARRIER �1�1 l� I� �� - PLAN REVIEW t�`T'y/ � QPOLICYNUMBER ��L�r� ELECTRIC S� � (IHISSECfpNNE�NOTBE00A�i'I.EfEDOF7HEPEPoMISFORONEFM1Nd%iEDDCLLARS(S100JORLE55} PLUMBING W ' Z I CEHTIFV 7HAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED,1 MECHANICAL . C7 SHA�L NO7 EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJEC7 TO 7HE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGHEETHA7IFISHOULDBECOME INSPECTIONFEE SU&lE �TO 7 WORKERS'COMPENSATION PROVISIONS OF SEC ON 3700 OF THE LAB R / � C9D, SHALL ORTHWITH COMPLV WITH THOSE VISIONS. ISSUANCE � � p DATE: APPLICANT. SMIP � W P- J WARNING:FA URETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND HALLBE ENERGY P/C � J LL SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(51oo.oao),IN ADDITION TO7HE COST OF COMPENSATION,DAMAGES AS PfiOV10ED FOR IN J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. /' w RETENTION FEE: � O CONSTRUCTION LENDING AGENCY PRE-ALTy�FEE: � I HEREBY AFFIRM UNDER PENALTY OF PERJURY 7HAT THERE IS A CONSTRUCTION LENDING AGENCY �r/.I�. �Da FOR THE PERFORMANCE OF THE WORK F(ji WHI�THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). "� W � � LENDER'SNAME N 1— IENDER'SADDRESS u, TOTAL FEES � �7�Q " � I CERTIFY TMA7 I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA7pN IS CAHRECT. 1� 1 AGREE 70 CqMPIY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING i� � CANSTRUCTION,AND HEREBY AUTHOFIZE REPRESENTATIVES OF THIS COUN7Y TO ENTER UPON THE ! I Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS - �`y `. / S� � (..� VYI�. �i4� ►r��o j,)�' J � ` m PERMITTEE NAME(PRIM �. � Q �r � � N SIGNATURE OF PERMITTEE DA E^' � RECPT.NO.� � PAID BY �O �- VALIDATION WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—Applicant's Capy �9Y'1t �� 9�f�l�f�� f�l�1f� •� � . . , �f�� f�f�� ,. . � . , � . . ,_.. ., . . _ . .� � �G�C��I�� ' ' � " � ° . �� • SET BACK FLOOR JOIST FTGS/FORMS/STEEL ( (('„/Z � FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT � SLAB GRADE ,f� I 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 E�ECTRIC L DEV. FEES PAID FINAL PLUMBING _ ;' , fl"� ENERGY ��`r7�� _ _ [�.I�iULy��/-� , �� t � �� 0 COMMENTS ��Gl� ¢�l%��C �,7�J� � � SEPTIC TANK SIZE SEEP PIT/U SIZE �� ` �1 - � �'�� :�� -"�`rt�� ' . �� '� hk t��r- � �'f+�'i � k��.�� k�� ;:� (�y� •; ° �IU�^�'�� `'k�'�� '�" �,�'�t�� '��' �t';'� �3 i��M'r� ta;,.�. . � f .g�� .j�� 's �-�:' t ^ t '�x �'�, T � �' y`��. ,! d j'� J k��''�6 ,!. . �'r^� �,' ;�� *4�f L � �i y�� r��