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Home My WebLink About17426 _ _�� _ CITY OF DIAMOND BAR DEPARTIv�NT OF CONA�UNTI'Y 8c DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 - P(;ES$ ��'<��^� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ) � �� APPLICATION PERMIT P/C o ADDRESS ��G� .�/� 1KDSA�� /o�C DATE � � NUMBER /7 y.Z� # � ISSUE TYPE pCC APN LOT TRACT DATE CONST. GROUP p OWNER tn p ADDRESS �r � ZONING SETBACKS Z CITY ZI TEL. � �� FRONT Ryy ❑ o APPLICANT EL. REAR ❑ z¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ O ADDRESS PROPOSED USE .✓� /¢ /�.t�.�i ,i IcC "--i✓8 CITY ZIP TEL. w ARCH/ENG/ !��''�' �z DESIGNER NO.DWEL. � NO.� �A/r NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f090/COfPOR W CENSE LAW FORTHE FOLLOWINO REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITV OR (n U CWNTVWHICHREWIFESAPERMITTOCONSTRUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYSTRUC- w w NRE,PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Pgtio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � � CENSE UW(CHAPTER e(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- PooUSpe ^ FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM ANO THE BA515 FOR 7HE ALLEGED E%EMP� C7 V TION.ANY VIOUTqN OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CML PENALTV OF NOT MORE THAN FNE HUNDRED DOLLAAS(f5o0)J: � �I,ASON?JEROFTHEPROPERTV,ORMVEMPIOYEESWITHWA0ESA5THEIfl50LECOMPENSATqN, 0 COrtIrtIBfCiel - Z WILL DO THE WOHI(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�a,BU51� J � NESS AND VROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEHTV NTiO BUILDS OR IMPROVES THEFEON,M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTMROUGH HIS OR HER ONM EMPLOVEES,PROVIOED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSILLEIF,HOWEVERTMEBUIL�INOORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE� Z TION,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMP VE FOq 7HE PURPOSE OF SALE). w ASOWNEROF7HEPROPERTV.AMEXCIUSIVELYCANTMCTINGWITHLICENSEDCONTRACTORS � TO STRUCT THE PRQIECT(SEC.7M�,BUSINE55 AND PROFESSIONS CADE:iHE CONTRACTOFS ll- V8IU8�1011 qp�,qqEq � W CENSEUWDOESNOTAPPLVTOANONRJEROFAPROPERTVWFIOBUILDSORIMPROVE57HEREON,/�ND � VhqCANTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS 110ENSE UW.). � ❑I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U - LL DATE oNTJER ¢ Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PEN/�LTV OF PERIURV 7HAT I AM LICENSED UNDER PflOVISKKJS OF CHAPTER � ' � � �(COMMENCWO WITH SECTqN 7000)OF DIVISION J OF 7HE BUSINESS AND PROFESSIONS CODE,AND Z . �� MY UCENSE IS IN FULL FORCE AND EFFECT. m � IICENSE CLASS LIC.NO. � V DATE CONTRACTOR d W � � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z � _I�HAVEANDWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-INSUREFORWORKERS' a 2 COMPENSATpN,AS PROVIDED BY SECTION 37000F TNE LABOR CADE.FOR THE PERFqRMANCE U OF 7HE WOFK FOR WHICH THIS PERMIT IS ISSUED. . W � � � w _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN Q 3�OOOF THE LABOR CO�E.f-0R THE PERFORMANCE OF THE WORK FOH WHICH THIS PERMIT IS ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBEF ARE: CONSTRUCTION J j CARRIER PLAN REVIEW � POLICV NUMBER zd ELECTRIC { ^ � (nissEcnaar��ra7eEmn,v�rIDOFn�v�w.rrswaoraerurna�000u.utsgim�at�Ess} PLUMBING 1 i t —�- ---.. w �. , Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORH FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL - � C� SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME �NSPECT�ON FEE � �� Q � (1'1 = SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37a00F THE UBOR � ` ^' L' L V � �. O CODE,I SHALL FORTHWIhI COMPLV WITH THOSE PROVI510N5. ISSUANCE � p DATE: APPLICANT. SMIP J!1-__ w ENERGY P/C ` � � � WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE �y SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCMLFMESUPTOONEHUNDREDT}KKISAND ENERGYPERMIT DOLLARS(f 100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION�7080FTHEL/�BORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIUFY THAT THERE IS A CONSTRUCTION LENDWG AGENCV �- FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ. Z W � LENDER'S NAME F— LENDERSADDRE55 w I CERTIFY THAT I HAVE HEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES � V., C � I AGREE TO COMPLV WITH ALL CfTY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTFIORRE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON THE � Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � ` r L,� �c�1 C�l m PERMITTE E(PRI U� 1 � � � SIGNANR ERMITfEE DATE � RECPT.NO. PAID BY " cS� VALIDATION WHI --Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �9�'� �[� ��l�1��99� �1,�� 86i��I�I�(�d�� I�� r ° � 0 1� �p�;C�u o G3 ��G� t�IOO a DD G\`� ,OG� a ' SET BACK FLOOR JOIST FTGS/FORMS/STEEL � FHA REQMTS ELECTRIC GROUND UNaER FLOOR DUCT GROUND PLUMBING � UNDER FLOOR GU�IDUIT � SLAB GRADE FIREPLACE FOUNDATION � TEMP POWER FIREPLACE BOND BEAM , WATER SERVICE MID HT. BQND BEAM ROOF SHEATHING 8 FT. BOND BF�4M ` FRAMiNGNENT1LtATION FINAL BOPJD BEAM � ROOF COVER PRE-GRAUING ROUGH NEATING BENCHiNG ROUGH ELECTRIC ROUGFi GRAQING ROUGH PLUIVIBiNG FINISH GRADING SH�WER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING` WALL INSULATIOh! POOL FINAL CEILING IN�ULATION OFF S17E IMPS. DRYWA�L NAILI(�!G DEDICATIONS • SEWER FtNAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. . SEEP PIT/I�.L. ON SITE IMPS~ � GAS AIR TEST FINAL ZONING FINAL COP�lST. G!RE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAI.ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY � � �� ' , �� COM�IiEiVTS _ . - - � .� _ � � SEPTIC TAfVK SIZE SEEP P17/U SIZE — �. � ° [, �