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Home My WebLink About12-239� CITY OF DIAMOND BAR ^--"��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 1 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �'A�'� BUILDING PERMIT APPLICATION FIRMLY ¢ DDRESS�/1� /�" Lt."�WI! ��/////��iC� APPUCATIO f PERMIT j Z P/C p DATE / NUMBER # � ISSUE TYPE OCC APN LOT TRAC DATE CONST. GROUP p OWNER p ADDRESS �� ZONING SETBACKS FRONT � CITY i ZIP L{� EL. RW ❑ APPLICANT TEI. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTO, �/C� SIDE � � ADDRESS ,�p � CITY ZIP �P5� L. - - - PROPOSED USE �/ic ! �IS o ARCH/ENG/ QlJ' zW DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 HEREBV AFFIRM UNDER VENAL7V OF PERJURY THAT I AM EXEMPT FAOM hIE CONTRACTORS LI� GefB B/C8 fl W CENSEUWFORTHEFIX.LOWINOREASON(SEC.70.3t.6BUSINESSANOPROFESSIONSCODE:ANVCIlYOH (n 9 � U �pJ�'W{{�{{REWIRESAPEFMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- PatIO/DBCI( Z TURE,PRIOR TO I7S ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED w w STATEAIEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CANTMCTORS LI- � CENSE LAW(CNAPTER V(COMMENCINO WITH SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa �� FESSIONS Co�E)OR hIA7 HE OR SHE IS EXEMP77HEREFROM AND THE BASIS FOR THE ALLE6ED E%EMP- (� TION.ANYVIOLATqNOFSECTION7oa1.5BVANVAPPLICANTFORAPERMITSU&IECT57HEAPPLICANTTO Z Re-Roof � A CML PENALTY OF NOT AqRE THAN FIVE HUNDRED DOLLARS(5500).�: � ❑LASOWNEROF7HEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIq50LECAMPEN5A710N, � COmmBfCi81 Z NALL DO THE WORIC,AND iHE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7M�,BUSI- J N NESS AND PROFESSIONS CODE 7HE CONiMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WHO BUILOS OH IMPROVES THEREON,AND N?10 DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUpi IMPqOVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVER7}1EBUIL�INOORIMPROVEMENTISSOLDWITHINONEVEAqOFCOMPLE- Z TqN.TME OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SNE DID NOT 9UILD OR � IMPROVE FOR h1E PURPOSE OF SALE). � w ❑I,ASOWNEROFTHEPROPERTV.AMEXCLUSNELYCOMRACTINGWITHLICENSEDCOHTPACTORS � TO CONSTRUCT h1E PRQIECT(SEC.70M,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTORS LI- V91U9110f1 ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN OVMER OF A PROPERTV NM1iO BUIIDS OH IMPROVES THEREON,AND � W/qCONTRACTSFORSUCHPRQIECTSWITHACONTMCiOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORS LICENSE LAW.). FEE i � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q �? U � DATE OWNER H Z U F LICENSED CONTRACTORS DE�LARATION W � I HEREBY AFFIiiM UNDER PENALTV OF PEFJURY THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCIN(1 WITH SECTION 7D00)OF DIVISION 3 OF THE BUSINE55 ANO PROFESSIONS CODE.AND Z XL� MY LICENSE IS M FULL FORCE AND EFFECT. m O // � � � LICENSE C SS LIC.NO. � . V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATtO� � � U N I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECLARATIONS: Z O _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOqKERS' _ Q COMPENSATION,AS PFOVI�ED BY SECTION 3�00 OF THE LABOR CADE,FOR THE PERFOFMANCE U THE WORN FOR NM111CH THIS PERMIT IS ISSUEO. W � � � 1/iAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE.FOR THE V FORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WOP S' MPENSA INSURANCE CAR ER AND POLICY NUMBERARE: CONSTRUCTION � CARRIER PLAN REVIEW 0 POLICV NUMBER Zd ELECTRIC � p (1FOSSECTqNNE�NOTBENMRETmOFTEPERMf(ISFORONEFII.lDiiEDOqi/�AS({100)ORLESS} PLUMBING W Z I CERTIFV THAT IN THE PERFOflMANCE Of THE WOFK FOR WHICH iH15 PERMIT IS ISSUED.1 MECHANICAL CS SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNI0.AND AOFEE THAT IF I SHOULD BECAME INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR O COD,I HALL R T CAMPIY WITH E PRQ/�}L5//�j 5. �j�J/�J � ISSUANCE I 1� � ,p DATE: �� I�pLICANT: �/ / (/G U' !(/ (/L/'C/ SMIP . ,_Jj WARNIN6:FAILURE TO SECURE WORKERS'CQNPENSATION CAVEFAOE IS UNIAWFUL,AND SHALL BE ENERGY P/C � � SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FWES UP TO ONE HUNDRED 7HOUSAND ENERGY PERMIT DOILARS(5100.000),W ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIDED FOR IN J SECTION 3�08 OF THE UBOR CODE,INTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: 2� O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDIN(3 AGENCV FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS w I CEFTIFV Th1AT I HAVE READ THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES ��` / L� � 1 AGHEE TO CAMPLY WITH QL CITY AND COUNTV ORDMANCES AND STATE LAWS RELATINO TO BU0.DIN0 { � � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF h115 CAUNTV TO EMER UPON THE � Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. / COMMENTS ' � � �/G f �(/� m PERMITTEE NAME(PRINT) � � � � � � SIGNATURE OF PE DATE � FECPT.NO. P/UD B VALIDATION WHITE—Department Copy,YELLOW—Finance Capy,PINK—Assassor Copy,GOLDENROD--File Copy,GREEN—Appl{canYs Copy C@�V OIF DIA(�1i�3�1� �AR I�IS��C�'VO�1 R�CORD ., `�1�pC�C�400GyJ DG7� J Oi��pC�C�40G3 OG�'J�3p(�C�4D0[�1' DQQG . ._�G�J�{�@C� _�"'�'� :. 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 H'T. BOND BEAM ROOF SHEATHING 8 Ff. 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. LATHlSIDING 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 �d HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL•PLUMBING ENERGY . , — -- - - - � C�OGo � COIVIMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � a �