The URL can be used to link to this page

Home My WebLink About11-1467 1,�` CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES T, 21825 Copley Drive,Diamond Bar,CA 91765 r (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 1 PRESS �'^"' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION � PERMIT J/ � o ADDRESS (L_y ��b b l e �a_re o d D� DATE �� Zy 1� NUMBEd '�� 7 #�c � issue � 1� TYPE occ APN LOT TRACT DATE CONST , ROUP p OWNER .S b H N M�jLy .W DO� o ADDRESS I lA U �el,b)ew�od Dr ZONING SEfBACKS FRONT � CITY � itaw�anc� Hrtl- ZIP y�}l�5 TEL.S�-a�6-3`�•35' REAR RW � APPLICANT TEL. ❑ zd SIDE/SIDE STREET qyy ❑ oCONTRACTOR � 2 l�2 �l$0Y��('y SIDE � ADDRESS�}L�4j� L b S S CY YQ ho S II I d pROPOSED USE W 1 Y� � �L° 1 S' r', w RCFUENG/„e �—s ZIP� TEL.9��l4 5�� W 1,S hC z DESIGNER � +^ew w.0.rv� �YA1 h \ a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � � - DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION � p SFR/ADD/REM p I HEREBY AFFlRM UNDER 7ENALTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI� GefBJB/CB1pOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.703t.58U51NE5SANDPROFESSIONSCODE:ANVCITVOR (f� ZCOUNTVMMICHREOUIRESAPERMITTOCONSTRUCT,ALTEF,IMPROVE.DEMOLISH,ORREPAIRANYSTRUG W Petio/Deck W TURE,PRqR TO ITS IS9UANCE,AL50 REQUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CON7qACTORS U� c CENSE UW(CHMTER G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB `l FESSIONS CODE�OFi THAT HE OR SHE IS E%EMPT THEflEFROM AND THE BASIS FOR THE ALLEGED E%EMP- (� �� TION.ANV VIOLATION OF SECTION 703/.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof r, A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COR1RIBfC19I WILL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I1,BUSI� �J � NESS Ml�PROFESSIONS CADE:TNE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROU(L1 NIS OR HER OWN EMPLOYEES,7ROVIDED THAT SUCH UAPROVEMENTS ARE NOT WTENDED OR m Q OFFEREDFORSALEIF,HOWEVE0.7HEBUIIAINOOqIA/PROVEMENTI550LDWITHINONEVEAROFCAMPLE- Z TION.THE ONTJER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � fMPROVE FOR THE PURPOSE OF SALE). Ly ❑I,/�S OWNEROFTHE PROPEHTV,AM E%CLUSNELV CONTRACTINO WfTH LICENSED CONTRACTORS ¢ TO CONSTRUCT THE PRQIECT(SEC,7041,BUSINESS AND PROFESSIONS CODE:THE CON7RACTOR3 LI- V81U8�1Of1 ADJ.AREA � CENSE UW DOES NO7MPLV TO AN OYMER OF A PROPERTV WHO BUILDS OR I/APROVES THEREON,M1D WFIOCANTRACTSFORSUCHPRQlECTSWITHACONTRACTOR(5)UCENSEDPURSUANiTOTF7ECANTMG QUANTITY ESCRIPTION ioqs ucENSE uw.). FEE 0 O 1 AA1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � DATE OWNER � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ' -. � D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE.AND Z � • ' �� MY LICENSE IS M FUL�FORCE AND EFFECT, � LICENSECLASS L.�1.q LIC.NO. 0� 9�-4. � . wDATE lp-ty-20�( corrrancroa�o�o , _ a .. . � WORKEAS'COMPENSATION DECLARATION � � I HEREBV AFFIRM UNDER PENALTV OF PERIUFV ONE OF THE FOLLOWINO DECLARATIONS: V � Z . . �' ��, IFIAVEANDWILLMAMTAWACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ¢ ' � - . _ • •�' ,.:�_'-'�•'�OMPENSATION,AS PROVUJED BY SECTION 3700 OF THE I.ABOR CODE,FOR THE PERFORMMICE • U • � - " � �OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.' ' W � ; ` � � jL I FIAVE AND WILL MAINTAIN WOR)(ERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION I ��` � Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS' MPENSATION INS CE CARRIER AND POLICY NUMBERARE: CONSTRUCTION � CARRIER �1 YS� CO Y�'1 � PLAN REVIEW � POUCV NUMBER Vt! S(D O L�C� (C .. O � ELECTRIC ^�,� � (THISSEC1bNNE�NOTBE07MP1-ETEDOFTI�PEPMfT4SFORONEFIIA�DRFDDOWIHS(t100)ORLESS} PLUMBING G-�, I.(v 3 W i v Z �CEHTIFY THAT IN THE PERFORMANCE OF THE WOHI(FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C7 SHAI.L NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE (/j WORNERS'COMPENSATION�AW$OF CALIFORNIA�ND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 pF THE IABOR /7� ^ O CODE,I SHALL FORTHWITM CqMPLV WITH THOSE PROVISIONS. ISSUANCE __ N 3: �/ p DATE: APPLICANT: SMIP `�Z� W � WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SU&IECTANEMPLOYERTOCFIMW�LPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOILARS(f 700.000).IN�ODITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN J SECTION3]OBOFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. (L', w RETENTION FEE: �•� � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV , � FOR THE PERFORMANCE OF 7HE WORK FOR WHICH TNIS PERMIT IS ISSUED(SEC.30e7,CIV.C.). �r O� Z W � LENDERS NAME H LEN�ER'SADDRESS w ICERTIFVThIATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATpNISCARRECT. TOTAL FEES � • ,J � � 1 AGREE TO CAMPLV WITN ALL CrtY AND CWNTV ORDINANCES ANO STATE LAW$REUTING TO BUILDINO � CONSTqUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UVON THE Z ABOVE�MENTIONED PR07ERTV FOR INSPECTION PURPOSES. COMMENTS ' � J Q.� o�o(�D Cu.o►..-i� l�Z � m PERMITTEE NAME(PRINT) ' � Q � � �/ j O-.25..Lo� N SIONATUqE OF PEFiMI77EE DATE � RECPT.NO. PAID BY , VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,pINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy , CI�V O� DB�,f1�OND ��►R � IN��C�ION ��COIRD oa�p�c�400a o . .�F � o��oa oa�pr�c�ooa �D��-� �� oa�i� _ o � �� R� SET BACK ��'� FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDl11T SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM ROOF SHEATHIfVG 8 FT. BOND BEAM � FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER � ��- � L•�011��J ROUGH HEATING ��_ _ r P . _ _I_��/� Q� ROUGH ELECTRIC � `' ROUGH PLUMBIPIG FINISH GRADING SHOWER�T'UB TEST POOL ELECTRIC ��_/�- % EXT. LATH/S�DING POOL FENCIfVG 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 1,2 s� c�c��,; ,, COMMENTS G��j�•` U, ��,�ln �,,r/'��_Ls1_trcT_,�•� � � "�z�.,�. a�-��'- SEPTIC TANK SIZE SEEP PIT/U SIZE a c� a ,; . � �, _ �