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^_ �F� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 PRESS
'� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
'�� BUILDING PERMIT APPLICATION
� JOBSITE APPLICATION� � 1 � � NU BER a�' #/C _�--�
o ADDRESS 23700 Ri,�e Li.vi.e Rd DATE � � `\_ `1
� APN LOT TRACT DA EE �� ���' ' �I ONST. GROUP
� OWNER 1/ni ('lnl nt
� ZONING SETBACKS
o ADDRESS FRONT RW ❑
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� ADDRESS PROPOSEDUSE � CvpY�e�c. Re��.pe �Q-��-X,
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� DESIGNER
NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
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DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM �
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W CENSEUWFOR7HEFOLLOWINOREASON(SEC.7o31.6BUSINESSANDPROFESS40N5CODE:ANVCI7VON (n
U CIXINTVWHICHREOUIRESAFERMITTOCONSTRUCT,ALTER.IMPROVE,DEAIOLISH,ORREPAIRANYSTRUG W P8110/DBCIC
wTURE,PRIOR TO I75 ISSUANCE,AL50 REQUIRES 7HE MPUCANT FOR SUCM PERAl1T TO FILE A SIONE� w
� ST�TEAlEt7T TM�7 HE OR SHE�S UCENSE�PURSUNJ�,TO THE PROVI510N5 OF THE COtdTfV.CTORS U- � POOUSPB
� CENSE UW(C}UPTER e(COMMENCWO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PR6
^ FESSIONSCOO�ORTYIATHEORSHEISEXEMPTTHEREFROMANDTMEBASISFOR7HEALlEOEDEXEMP�
� TFON.ANV VIOUT�ON OF SECTION 7031.5 BY ANY MPUCMfT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Rool
� A CML PEWLLTV OF NOT MORE 7}WJ FNE HUNDRED DOLLARS(S500I.): l
0 ❑I,ASOWNEROFTHEPPOPEAr',ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION. 0 COfRrt18fC181
Z WILL DD THE WORK,AND THE STRUCNRE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7ou,BU51� J
� NESS AND PROFESSIONS CODE hiE CONTRACTORS IICENSE LAW DOES NOT APPLY TO AN OWNER OF j
PROPERN YA10 9U0.DS QR 1MPROVES TMEREON,AND WFiO DOES SUCH WORK NIMSELF OR HERSELF OR m
� TMqDUGH H�9 OR MER OWN EMPLOYEES,PROVIDED 7HAT SUCH tMPROVEMENTS ARE NOT INTENOED OH
QOFFEREDFORSALEIF,IIOWEVEi�THEBUILDINOORIMPROVEMINIISSOLDWITHINONEVEAROFCOMPLE-
Z 710N,THE OWNER�BUILDER WILL HAVE THE WRDEN OF PROVINO T}IAT HE OR SME DID NOT BUILD OR
� IMPROVE FOR THE PUPPOSE OF SN.E�
W ❑I,ASOWNEROFTHEPROPER7Y,M11E%0.USNELYCONTMCTWaWITHUCENSEDC�N7RACTORS
TO CONSTRUCT 7HE PROJECT(SEC.701�,BUSINESS ANO PROFESSIONS CODE:THE CONfRACTOqS LI� V81Ufl1I0�1 ADJ.AREA
� CENSE LAW DOES NOT APPLV TOAN ONRJER OF A PROPERTY WFIO BUIL�S OR IMPROVES THERC-0N.M!D
VhqCONTRACTSFORSUCHPR0.1ECT5WITHACONTRACTOH{5)IICENSEOPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE
70R5 LICENSE LAW.).
O ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
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� DATE ONRJER U
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� LICENSED CONTRACTORS DEGLARATION �
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OC I HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT 1 AM UCENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCIN(I WITH SECTIDN 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSKKJS CODE,AND Z .
X MY UCENSE IS IN FUL��R�E ANO EFFECT. m �
LLf � �2401�86 . . � � - . .
OUCENSE CpLASS UQ NO. �
DATE_,t]../� �/�� CONTRAGTOR A� � a .
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBYAFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLIOWING DECURATIONS: Z I
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� I HAVE AND WILL MAINTAIN A CERTIFiCATE OF CONSENT TO SElFINSURE FOR WORNERS' ' 2 ,
� �COMPENSATION,AS PROVIDED BV SECTION 37000FTHE I.ABOR CODE.FOR THE PERFOqMANCE W '
OF TNE WORK FOR WFIICH THIS PERMIT IS ISSUED. �
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w I HAVE ANU WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS HEQUIRED BV SECTION
Q �3700 OF 7HE LA80R CODE,FOR THE PERFORMANC£OF 7HE WORK FOR WMICH THIS PEFUIIT IS
ISSUED.MV WORKER$}y'�PE 5 TION I UFANCE CARRIER AND 70LICY NUMBEH ARE: CONS7RUCTION
� CAARIER "���a� PLAN REVIEW
�
� POLICY NUAINFF ELECTRIC
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Q (�F0.5SEC110NNE�NOTBEOOMPI.EfEDOFhEPEPMIlSFORONEF4ADFEDDIX1IfLSR�ODI��FSS} PLUMBING �n
W MECHANICAL
Z I CERTIFV THAT IN THE PEFFORMMICE OF THE WORK FOF WHICH THIS PERAl1T IS ISSUED.1
(,�} SHALCNOTEMPLOYANYPERSONINANYAtANNER50A5T08ECOMESU&IECTTOTHE INSPECTIONFEE
� WORNERS'COMPENSATION LAWS OF CAIIFORNIA N�D�OREE 7MAT IF I SHOULD BECOME
= SUBJECT TO THE WORKERS'COMGENSATION PROVISIONS OF SECTqN 3700 0F THE LABOR �SSUANCE "'� �O � ,O
CODE,I SHALL FORTMWITM COMPLV WI7H THOSE PROVISI�NS.
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p DATE: APPIICANL . �
w ENERGY P/C
� WARNINO:FAILUHE TO SECURE WORKER3'COMPENSATION CAVERAGE IS UNLAWFUL,AN�SHALLBE
. � SU&IECT AN EMPLOVER TO CRIMINAL PENAL7IES AND CIVIL FINES UP TOONE NUN�REO THOUSAND ENERGY PERMIT � � �� —
DOLLARS(f100.0oD),IN ADDITION TO THE COST Of CAMPENSATION.DAMAGES AS PROVIDED FOR IN
J SECTpN 37ue OF TME LABOR CODE.INTE0.E5T.AND ATTORNE'f5 FEES. RETENTION FEE: �� �
�
w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENPLTV OF PERIURV THAT THEHE IS A CONSTRUCTION LFNDINO AOENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEfiM1T IS ISSUED(SEC.30W.CIV.C.�.
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� LEN�ER'S NAME
� IENDEH'SADDRESS �p,� ^�(
� I CEPTIFV THAT I HAVE READ TMIS APPLICATION AND STATE THAT THE ABOVE INFORMATNJN IS CORRECT. TOTAL FE ES ^fT lT•CV ��'` • ��
w I AGREE TO CAMPLY WRH ALL CITY AND COUNTY ORD�NANGES AND STATE UWS REUnNO TO BUILDINO
� CONSTRUCTION,AND HERE6�AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE
Z pgpV ED"PRaPERTPFORyNS PURPOSES. '
COMMENTS
PERMI (PRINn � 1 -
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� �ti E E DA7E RECPT.NO. �aT� PAID BY� � aa�fl VALIDATION�
~ � WHITE--Departmenl Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,OREEN—Applicant's Capy
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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 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 �a 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 ELECTRIC DEV. FEES PAID
FINAL PLUMBING ��/� ENERGY
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CONIMEfVTS ��� � a���'�
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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