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Home My WebLink About17324 (25), _ '�. � • �� CITY OF DIAMOND BAR � -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 "� �/��!'�'� �-� d � . �,%,,W �� (909)860-3195 Faz(909)861-3117 PRE$$ �� BUII.DING PERMTT APPLICATION 2�(,� FIRMLY o� JOBSITE �J /��t�� APPLICATION � /^�' PERMIT � P/CO _ ADDRESS �-��t tl DATE v NUMBER # �� APN LOT ACT :S7iZ�� ISSUE TYPE OCC DATE CONST. GROUP °C OWNER � ADDRESS f� FL�' NING SETBACKS � Z CITY Zlp�� TEL9�J�7��S��/� FRONT RW ❑ 4 APPLICANT � TEL. REAR ❑ � SIDE/SIQE STREET RW ❑ CONTRACTOR SIDE ❑ � ADDRESS � CIN ZIP TEL. PROPOSED USE o ARCH/ENG/ � DESIGNER � NO.DWEL. NO.. . NO. ADDRESS UNITS STORIES BEDROOMS � CITY � IP9�n TEL. � y DESCRIPTION SQ.FT. FACTOfi PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER CENALTY OF PE0.NRY THAT I AM EXEMPT FROM THE CON7MCTORS LI- G8f89B/CefPOft ' W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n �J COUMYNR1Ip1REWIHESAPERMRTOCONSTRUCT,�LTER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck W 7UNE,VRIOR TO ITS ISSUANCE.ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT 7HAT HE OR SHE IS LICENSEO PURSUAHT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(QUPTER 0(COMMENCINO WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa FESSqNS COOEJ OH 7HAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- TqN.M1V VpLATqN OF SECTION 7031.6 BY AHYAPPLICANT FOF A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof � ACML PEN�LTY OF NOT MORE THAN FIVE HUNDRED DOLURS(SSoo).): � ❑I,ASONMEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COrt1(I1BfCi01 . � YALL DO THE WORIC,AND THE STRUC7URE IS NOT IHTENDED OR OFGERED FOR SALE(SEC.7oa1,BUSI- J NESS AND PROFESSIONS CODE:THE CONTMCTORS UCENSE UW DOES NO7 APPLV TO AN OWNER OF � � ' � PROPERTYMR108UILDSORIMPROVES7HEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOH � Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIUED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q ,OFFEREDFORSALEIF110WEVERTMEBURDINGORIMPROVEMENTISSqDWRHINONEYEAROFCOMPLE- ' Z TION,iHE ONMER-BUILDER WILL MAVE THE BURDEN OF PROVINO THA7 HE OR SME DID NOT Bl11lD OR �r_ ,n O � IMPROVE FOR THE PURPOSE OF SALE). . ❑I,AS ONMER OF THE PROPERiY,AM E%CLUSIVELV CONTRACTINO WfTH LICENSED CONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.)ON,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8fi011 �O ADJ.AREA � CENSE UW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEHEON,AND I� NM1fOCOHTMCTSFOR5UCH7RQIECTSWITHACOHffUCTOR(S)LICENSEDPURSUANTTOTIECONTMG QUANTITY DESCRIPTION FEE � � TORS LICENSE UW.). 0 ❑I AM E%EA1PT UNDER SEC. B.8 P.4 FOq THIS REASON � � ' L� ,C •� 3 � i � 1. • � � DATE OVMER �' � Z w � L� F UCENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRAI UNDER PENALTY OF PERIUPY THAT I MI LICENSED UNDER PROVISIONS OF CHAPTER � � d Y(COMMENCWO WIh1 SEC710N 7000)OF DNISION 3 0F THE BUSINESS AND PROFESSIONS CADE,AN� Z X 4Y LICENSE IS IN NLL FORCE AND EFFEC7. � A - LLJ � �f � �t- � LICENSE CLASS IIC.NO. SI / � � J Q. C � V DATE � CONTRACTOR a � I W F- � • WORKERS'COMPENSATION DECLARATION Q ,`J� y U ' � I HERE AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECIaRATIONS: Z f �� - 1 HAVE AND WILI MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 I Q�T� ' �� COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE UBOH CODE,FOR THE PERFORMANCE U � F hIE WORK FOR NRiICH THIS PERMIT IS ISSUED. � ; � I HAVE AND WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION q S O 37000F THE LIBOR CODE,FOR THE PENFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ^y i ISSUEO.MY WOR RS'CONFENSATION INSURANCE CARRIER AND POLICV BER AR� CONSTRUCTION � CARRIEH � G ' PLAN REVIEW Z voucr Nuusea ELECTRIC ` � '� Q n � � �X�(rmS�Ne�NOT8EOJI.�LETS10FhEPERMTISFnRONEFAl1OREDDOU�AS(i100)ORlFSS} PLUMBING `-�.r� � ,� ) w MECHANICAL � V�.1 �1l / Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS�SSUED,I (f} SHALL NOT EMPLOV M1Y VERSON IN ANY MMINER SO AS TO BECAME SUBJECT TO THE . �� , Uj WORKERS'COMPENSATION UWS OF CALIFORNIA M1D AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SECTION 370o OF THE IABOR COOE,I SH'^ALL FORTH)WITH COMPLV WIhITH raovi-s�io7N�s. ' ISSUANCE � s �— � �—� � (/O/ U//� Q�"/G�. SMIP � �� p DA APPLICANT: , . w ENERGY P/C J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE � SU&IEC7 AN EMPLOVER TO CRIMINAL PENALTIES AND CIVII FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN - J SECTION 370!OF THE LABOH CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE: �` � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ��.�� O � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCV ' Z FORTHE PERFORMANC F7HE WOFiK FOR WHICH THIS PER IS SSUED(SEC.70D CIV.C.�. ��n ^ ^I / / � � LENDER'S NAME �/II��/��/+� ��/�� -� � �( �{J � ' F- LENDER'SADDRESS � � 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES ' ` ',} w 1 AGREE 70 CAMPLV N7TH ALL CRY AND CAUN7Y ORDINANCES AND STA7E UWS REU7ING 70 BUILDING 1 Y� � �� CONSTRUCTION,AND HEHEBv AUTHORIZE FEPRESEN7A71VES OF THIS COUN7V TO EMER U70N THE � ZABOVEMEN7KKIED VROPERTY FOR INSP 710N PURPOSES. COMMENTS � � 2� �� ^ J ¢ PERMI E NAME(PRI � ` � s—��-�� -b� � SIG UREOFPER EE DATE � RECPT.NO. • PAID BY VALIDATION WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy I - �B�'�f O� �0�1��1�9� I��(� , . G�IS6°��`��I [�3G��1F�� " � � , ..._ . . � _ _ � ��yy��(+� ( 2j r�;y � ' �� "�, lF .��- f� n1��y �j . : � . . o ,� � �� p � , � � � '` utn�-�U'1-.� , � ,, D • , .ul�l�ana-z,`��.. � . , , �, . .� - �;•,._; .m � � � . :� . . .... . , o � � � � , � ,.� . -, SET BACK ; - OOR JO1Sl" . �� -- - — --...___ �_�� --------- FTGS/FORMS/STEEL _ i� FHA REQMTS .,� _, _ _ ELECTRIC GROUND � UNDER FLOOR DUCT �" '__ ___ GROUND PLUMBING UNDER.FLOOR CUt�IDUIT SLAB GRADE FIREPLACE FOUN�ATION ' TEMP POWER � ' FIREPLACE BONQ BEAM � --- ------=- --- WATER SERVICE ' , - — — --MID HT. BOND BEAM _Y.__._.__,._._...__�___.��.--------------- ROOF SMEATNING �� (��,� 1 8 FT. BC)ND BEA(k�i � FRAMINGNENTILIATION FINAL BOND BEAM { _ �_� �� ._.__._��...__�_�____��___ ROOF COVF_R i PRE-GRADING � ROUGH HEATING .� I BENCHING ROUGH ELECTRIC `�,pz_ ROUGH GRADfNG _ � ROUGH`PLUMBING' � 7��' ! i FINISH GRADING _._.___ _�__._.—_ SI-IOINER/TUB TEST , ��.. POOL ELECTRIC � _ __, EXT. IATHlSIDING � 11 s I ' POOLFENCING_V�-- -�^----i.` WALL INSULATiOIY --l ��2 I POOL FINAL � � �;� �� CEILING INSULATION �_� �} � � OFF SITE IMPS. —T� � , DRYWALL NAILiNG 4�,?c •Z ( ,/�J �_DEDICATIONS ___ SEWER ' � �! .FINA�ENG. SEPTIC TANK , LANDSCAPE/lRRIU. � � _� _ _ __ SEEP PIT/L.�. � , . � � ' � ', � � ; ON SITE IMPS. �,� ��_ .__.�__._ _ __----_._._.__.._ � ��_". GAS AIR TEST 0 FIIVAL ZONING FI�� .�QNS.T — �I - — ( FIRE DEPT. FINA! ----- --__._--.---- ---------,-- .- — _ T_' ' _..._"'_' '. . FINAL HE�ATING � � - � HEALTH DEPT. F{NAL � FiNAL ELECTRIC � ' � _ j DEV, FEES PA1D —�— �_ __ _ FlhlAL PLUMBING i � � ENERGY I .�_ � � � ' — -- --- �----------- _ /��_. , .�y��l.'!7%-�v" - � - -�— �--� -�- --------t ____ _�_____ _ - -- . � � � . ��_ ,��".c',.�`� � �:�:.��..,�.w�.::�.r __'�_""�� M� , 1 , � VOI:JI{VI�LI��J� "__ ' ' , ' _ . ' . ' - __. � - 2-O� .TNSC�c•�'cct�J � ` C_�'L��-L�/�— — ------- --- �j-di— .��vi-�rT,ur� ,r,�c�cp(,�T�- ---- --•----- . . . t . , . �. . _�_�. �_ �.�� ..��. ��.��__,..._..._._..._.__. . . , . . e * , �� , � . . . � ---------- -------- ;a?� ,�^�;'f ---------- , . _ _�_____.__.._..--- -------- -----..___._.._._--- SEPTIC T'ANK SiZE SEEP PIT/U SIZE _^ _____ -----------.---._._------- _. ��;,� �> r _��----- --- Ve� 1� �� ` �� i"'W = '< __� - t � t 'F. � »� '. .`�� ' • � v� � . fJ �tP '� �9 4 __ _ .�_ � �` f � 9 3��j 'y �. �� ,,,� �'��'+.�,s,4L�&� _� .__..._._._.._._ —'__"'.—"'__.__.._.._. y 'v � # �� y 7��yF�3��'�"ry�� {,.��'1" "'"Yl[�„f / F� "'t d. �� i��+n� :�,�f �iy�� '+�„ p i� _._ _� __._.__�__._'___ R � � x� 7`.:N4`s� B. �� v � �L X �''f c""' tY; _�____ �a� � �iF� i'�rj� �� . �, �� -v,