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Home My WebLink About18203 (25) .�� _ CTI'Y OF DIAMOND BAR DEPARTIv�NT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive "�- (909)860-3195 Fax(909)861-3117 PRE$$ ��'%�� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE APPLICATION f( ✓ � pERMIT � P/C ADDRESS 3 DATE 0�►dUMBER # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDR �S S ZONING SETBACKS z CITY �3L1R= ZI (7 TEL.�'l�-3�{(�R?(� FRONT qyy ❑ � APPLICANT TEI.. REAR ❑ �� SIDE/SIDE STREET RW ❑ CONTRACTOR -- SIDE ❑ ADDRESS � CITY ZIP TEL. PROPOSED USE oARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS U� G8fflJ0/C0fP0li W CENSELAWFORTHEFOLLOWIN�REASON(SEC.7031.6BUSINESSPNDPROFESSKKJSCODE:ANVCITVOR (n C-� COUNTVWHIp1REQUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG w W NRE,PRpR TO ITS ISSUANCE./�LSO REOUIRES 7}1E APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- � CENSE UW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSpe � FESSIONS CODE)OR h1AT HE OR SHE IS E%EMPT THEREFROM ANO THE BA515 FOR THE ALLEOED E%EMP- (!3 V TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z p�Rpp( �/1... A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(f500).): ��V Q ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATqN, � CORIrt18fCldl � Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BUSI- J � NESS ANO VROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PqOPEHTY VhlO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCN IMPROVEMEMS AAE NOT INTENDED OR m Q OFFEREDFORS�LEIF,FpWEVER111EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SAIE). w ❑I,ASOWNEROFTHEPROPERTV,AME%CIUSIVELVCANTRACTINOWITMLICENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.7wa,BUSINESS AND PROFESSIONS CODE THE CONTAACTORS LI- V81UAl10(1 ADJ.AREA W CENSEUWDOESNOTAPPLVTOANONMEROFAPROPERTVWHOBUILDSORIMPHOVESTHEREON,AND � M?1000NTHACTSFORSUCHPRQIECTSWITHACONT{iACTOR�S ICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE IAWJ. QO I AM EXEMPT UNDER SE B.8 P.C.FOR THIS REASON Q � � ' U � DATE � �' OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATI w � 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � � e(COMMENCINO Wlhi SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY LICENSE IS W FULL FORCE AND EFFECT. m � LICENSE CLASS LIC.NO. � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLAMTqNS: Z �Z I HAVE M1D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a Q = COMPENSATION,AS PROVIDED BV SECTION 370a OF THE LABOR CODE.FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w W � _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BV SECTION h +� /' Q 370o OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS X �`\ ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ME: CONSTRUCTION v 1 1J� � CARRIER PLAN REVIEW Z POLICY NUMBER ELECTRIC Q p (1FLLSSECTIONNFIDNOTeENA�REfmOFhfPERMTtSFOHONEMApF7Eppq1qq5(L1ao)ORLESS} PLUMBING � W Z I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �'} SHAlLNOT EMFLOYANV PERSON IN ANV MlWNER SOAS TO BECOME SUBJECTTO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUaIECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3]00 OF THE L4BOR S CODE,I SHN.L FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE • � �� p DATE: APPLICANT: SMIP n W �� J WARNINa:FAILURE TO SECURE MlORKERS'COMPENSATqN COVERAGE IS UNLAWFUL,AND SHAIL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFWESUPTOONEHUNDREDT}KKISAND ENERGYPERMIT DOLURS(f100.000).IN ADDITION TO THE COST OF CAMPENSATION,DAAIAGES AS PROVIDED FOR IN J SECTION 37oB OF THE LABOR CODE,MTEREST,AND ATTORNEV'S FEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THATTHERE IS ACANSTRUCTION LENDIN�AOENCY � FOR THE PERFORMANCE OFTHE WORK FOR WHIp1 THIS PERMIT IS ISSUED(SEC.JOe�,CIV.C.�. Z W � LENDER'S NAME • � LENDERSADDRESS /'� w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES . ' ...L U � I AGREE TO COMPLV WITHlLLL CfTY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING tJ � CqNSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTIONED PROPEfl7V FOR INSPECTIONJ PURPOSES. COMMENTS � �— _ �-/ j�R� m PERA/ITTEE NAME(PRINT) ' Q cn r � SIONATUREOFPERMITTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW—Finence Co PINK—Assessor Co GOLDENRO ile Co GREEN— IicanYs Co P PY. PY, PY. PY. APP PY C��'l �� c��d6�6l�Y� [ffil�� d6l��f�[�t��U°�� [�t��(f�� ooa � �, _ � �� _� � �� o a . p .� �� . 5ET BACK _ FLC�OR J0157 , i . , FTGSIFOR�JIS/STEEL ' FHA REQMTS ELECTRIC GROUND i UNDER FLOOR bUCT GROUND PLUPJiBING ` UNDER FLOOR•CU�IDUIT • ' SLAB GRAQE FIREPLP;CE FOUNQATION ' TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H7. BOND BEANI � ' ' ' ROOF SHEATHING �Z�C � .�� B FT. BONQ BEAM FRAMINGNENTILIATION ' FINAL BOND BEAM ROOF COVER //��•�/�Z �� PRE-GRADING ROUGH HEATING BENCHING ROUGN ELECTRIC � ROUGH GRADING� ROUGH PLUN161iVG FINISH GRADING SHOWERJTUB TEST POOL ELECTRIC EXT. 1�4TH/SIDING POOL FENCIIVG WALL 1NSULATION POOL FINAL CEIUNG INSULATION _ OFF SITE IMPS. j DRYWALL NAIUNG DEDICATIQNS -� SEWER __ FINAL ENG. � SEPTfC TANK LANDSCAPE/IRRIG. SEEP PITlL.L. ON SITE iMPS. GAS AIR TEST FlNAL ZC?NING FiNAL CONST. ��-� �i� , FfRE DEPT. FINAL FINAL HEATING HEALTH DEPT.FINAL � FItJAL ELECTRIC DEV. FEES PAID FItJAL PLUMBIAIG ENERGY � o '�� , ; . COiVliViEf�l'S . - - -- SEPT{C TANK SIZE SEEP PIT/U SIZE � � ; � . � � � � , ', - - � � .��.