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Home My WebLink About11-263 CITY OF DIAMOND BAR � -----�` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 PRESS '�``� BUILDING PERMIT APPLICATION FIRMLY N JOBSITE �` � (�^^ � o ADDRES�W._.J RI O �I l/A APPLICATION PERMIT p/C ��E DATE NUMBER p � ISSUE / TYPE � OCC �, I APN LOT TRACT DATE � / CONST. GROUP p OWNER �` ADD SS � ZONING SETBA KS 0 w FRONT � CITY ZI TEL. RW ❑ APPLICANT TEL. REAR p � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADD E�SS 'l_ � CITY ZIP TEL. PROPOSED USE V'i� �;H o ARCWENG/ z DESIGNER a ADDRESS NO.DWEL."�`� �(�� ` O. NO. cn UNITS TORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G9fe9B/C9fpOR W CENSEUWFORTHEFOIIOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n U �JNryW{{�HREOUIRESAPEfiMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANYSTRUC- W w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT F-0q SUCH PERMIT TO FILE A SIONED w P8110/D9Ck � STATEMENT TH�T HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CON7RACTORS LI� � CENSE UW(CHMTER o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PFO� � POOUSPB ^ FE9SIONS COO�OR THAT HE OR SHE IS E%EAIPT THEREFROM AND THE BA515 FOR THE ALLEGED E%EMP- (� � TION.ANV VIOLATqN OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT 5U&IECTS THE APPLICMfT T0 Z RB-ROOI A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(S5a0).): Z~ ❑4�.+^OWNEROFTHEPROPERTV,ORMYEMPLOVEESWITFIWAGESASTHEIRSOLECOMPENSATION, Q WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OP OFFERED FOR SALE(SEC.7W�,BU51� J COfilrtl0fCI81 . � NE55 AND PROFESSIONS CODE:TNE CANTfiACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OP � w THilIXlliF1 HIS OR HEF OWN EMPLOVEES,7ROVIDE�THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREOFOR9�LEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE- Z TION.THE OWNER�BUILDER WILL HAVE THE BUFDEN OF PROVIN�TFIAT ME OR SHE DID NOT BUILD OR � IAIPROVE FOR THE PURPOSE OF SALE). I w ❑I,AS OWNER OF THE PROFERTV,AM E%ClUSNELV CONTMCTIN�WITH UCENSED CONTRACTORS ' � TO CONSTRUCT THE PRQIECT(SEC.7W�,BUSINE55 AND PROFESSIONS CODE THE CONTRACTORS LI- V8W8�1Of1 ADJ.AREA W CENSE lAW DOES NOTAPPIV TOAN OWNER OF A PROPEFTV WHO BUILDS OR IMPROVES THEREON,AND � WFIOCANTqACTSFORSUCHPR0.IECTSWITHACONTRACTOP�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION TORS LICENSE LAW.�. FEE 0 ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON � ?� U � DATE OWNEF � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNOER PENALTV OF PE{iJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ' � G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OG THE BUSINESS AND PROFE55lONS CODE,AND Z ' � �� MV UCENSE IS IN FULI F�Q}p CE AND EFFEC7. m � LICENSE CLASS ]1�_ LIC.NO. � V DATE CONTRACT I a W � WORKERS'COMPENSATION DECLARATION � �' U � I HEREBV AFFIRM UNDER PENALTV OF PERIUFV ONE OFTHE FOLIOWING DECLARATqNS: Z � � _I HAVE AND WILL MAMTAIN A GERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _ � COMPENSATION,AS PROVIDED BV SECTION 7700 OF TXE LABOR CODE,FOR THE PERFORMANCE U ' � OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � � _I HAVEAND WILL MlJNTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION � Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� ISSUED.MV WOR)(E ' OMP NSATIO d$�JRANC CAAqIER AND POLICV NUMBERME: CONSTRUCTION jCARRIER � � PLAN REVIEW ¢ POLICY NUMBER_T��C I� ELECTRIC � (IFlSSEC�ONN�NOTBEOOMPLEfmOFTEPERMTISFOqONEFn,�D{iEDDOLLA0.SK100IORLFSS). PLUMBING W ' Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORX FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � ' SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS 70 BECOME SUBJECT TO THE (/� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ' SU&IECT TO THE WORKERS'COMPENSATqN PROVISIONS OF SECTION 3700 OF THE LABOR ��, S ..CODE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE � / B p DATE: APPLICANT: SMIP W � WARNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(5100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN w SECTION 37oe OF THE LABOR CODE.INTEREST,AND ATTORNE�"S FEES. o�. � RETENTION FEE: O 'CONSTRUCTION�ENDING AGENCY PRE- LT FEE: � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY iHAT THEHE IS A CONSTRUCTION LENDINO AQENCY �� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,qV.C.). Z � W � LENDER'S NAME . H LENDER'SADDRE55 w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATpN IS CARRECT. TOTAL F E ES /�f��/�0(� � � 1 AOREE TO COMPLV WITH ALL CRV AND COUNTY ORDINANCES AND STATE LAWS REUTIN6 TO BUILDINO (� � ! � CONSTRUCTION,AND HEREBV AUTHOiiIZE FEPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS ' 0 J � m PERMITTEE NAME(PR1Nn � � Q � � SIGNANREOFPERMITTEE DATE � � RECPT.NO. PAID BY VALIDATION WHITE—Depertment Copy,VELLOW—Finence Capy,PINK—Assessar Copy,GOLDENR D--File Copy,GREEN—ApplfcanYs Copy CITV O� Dl,�fi�OND �AR II�S�EC�'@ON R�CORD ,��oa�p�c�400a o �� o�i�� 9,. :::=ac��c�4ao� :�c�:�� .o 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 FIREPL,4CE BOND BEAM WATER SERVICE MIQ 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 FINISH GRADIfVG ' 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 QEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY o _�: COPVIMENTS �� -E_��1.-�� SEPTIC TANK SIZE SEEP PIT/U SIZE (� �� ; ��,, '�� , � �� ;. � � � �!' Yw;.. ;� � t �