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Home My WebLink About17259 (25)✓ . CITY OF DIAMOND BAR EXPIR�D � --��` --- DEPARTMENT OF CONA4UMTY&DEVELOPMENT SERVICES JUN 181001 21825 E.Copley Drive , � (909)860-3195 F�(909)861-3117 �RESS "'-.�N�'� BUILDING PERMIT APPLICATION FIRMLY Q DDRIESS_ T,Lh S , �OC%j ie/��jp APPLICATI� � � PERMIT P/C o UATE 1 NUMBER �� # � ISSUE TYPE OCC °�° APN LOT TRACT DATE CONST. GROUP p OWNER m L " ADDRESS �l/crr ZONING SETBACKS 0 �� Z CITY /✓.`uyrf o++c+� �e,�ZIP��L.��.r'fEL. - - FRONT. RW ❑ � APPLICANT TEL. REAR p Z SIDE/SIDE STREET RW ❑ Q CONTRACTOR SIDE ❑ ADDRESS � ,�E, G�s,�o si��;c7i1 O PROPOSED USE e/^oo o CITY ZIP TEL. —��— 7-- w ARCH/ENG/ z DESIGNER � w NO.DWEL. �NO. NO. a ADDRESS � CITY ZIP TEI. UNITS STORIES BEDROOMS � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFWADD/REM O p I HEREBV AFFIRM UNDER PENALTY OF PERJURV 7HA7 I AM EXEMPT FROM THE CONTRACTOFiS LI� G8fa90/CflfpOft W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCOOE:ANYqTYOR (n U COUNTVWHICHREOUIRESAPERMITTOCANSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w 7URE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMEN7 7HAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CANTRAC70R5 LI- � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa � FESSIONS CADE)OF THAT HE OR SHE IS E%EMPT7HEREFROM AND THE BASIS FOR 7HE ALLEGED E%EMP- (� V 710N.ANV VIOUTION OF SEC710N 7031.5 BV ANVAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS�SSoo).): � � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, Q CORIrt10fC12I - Z WILL DO 7HE WORK,AND THE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.70�d,BUSI� J � NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER Of � PROPERN WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOVEES,PROVIDE�7HA75UCHIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREDf-0RSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAlAPLE� Z TION,THE OWNER�BUILDEFi WILL HAVE THE BUFDEN OF PROVWG THAT HE Ofi SHE DID NOT BUILD OR i � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS ONRJER OF THE PROPERTV,AM EXCLUSIVEIV CAN7RACTING WITH LICENSED CONTRACTORS � 70 CONSTRUCT THE PR0.IECT(SEC.7oa1,BUSINESS AND PROFESSIONS COOE:7HE CONTRAC70R5 LI- VelUefi0fl U ADJ.AREA W CENSEUWDOESNO7APPLY70ANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPUqSUANTTOTHECONTfiAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNOER SEC. 8.6 P.C.FOR Tl115 REASON Q � U LL � — DATE OWNER H 0 w � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � d B(COMMENCING WI7H SEC710N 7000)OF DIVISION 7 0F THE BUSINESS AND PROFESSIONS CODE,AND Z LX AIV LICENSE IS IN FULL FOFiCE AND EFFECT. m � LICENSE CLASS p LIC.NO. C��9-��(/7� � V DATE ��71 -� O� CONTRACTOR T` a w � WORKERS'COMPENSATION DECLARATION Q � � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLIOWING DECLARATIONS: Z Z _IMAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a 2 Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � w _I HAVE AND WILLMAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 37o00F THE LABOR CODE,FOR 7HE PERFORMANCE OFTHE WORK FOR WHICH 7HI5 PERMIT IS Q(�3G ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ,a J j CARRIER PLAN REVIEW � POLICY NUMBER Z ELECTRIC Q � (IFIISSEC�IONNE�NOTBECOMPLEfEDOFiI-IEPERMfTISFORONEMFOREDDOLLPAS�5100)ORIESS? PLUMBING W •��+�� Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL '�.��-:1 /i�� I� I I 1 1 C} SHALLNOT EMPLOYANV PERSON IN ANV MANNER SOAS TO BECOME SUBJEC770THE I "�r'-`�//,"��...' �, � `--+�� q� �- � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECAME INSPECTION FEE /� � SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3�OOOF THE LABOR 1 �C�� 'I �O � CODE.1 SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � I1(�T �I S� I p DATE:I(L��-��APPLICANT. `-' SMIP � ' ENERGY P/C I I J WARNING:FAILURE TO SECURE WORKERS'COMPEN ON CO RAGE IS UNLAWFUL.AND SHALL BE w �� SUBJECTAN EMPLOVER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT � --' ....� } OOLURS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN �� __„_.. ' J� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. 1 S d RETENTION FEE: f OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I NEREBV AFFIRM UNDER PENALTV OF PE0.IURV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W � LENDER'S NAME H LENDER'SADDRESS �� w 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORqECT. TOTAL FE ES / ��, /O � � I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING � ' � CONSTRUCTION,AND HEFEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPEfiTV FOR INSPECTION PUHPOSES. COMMENTS � �ort]l� S . �.9�/e % J � m PERMI�E NAMIE(PRINT) � N z-7'�`--7 ��C' /D-/�- a/ - � SIGNAT F PER EE DATE = RECPT.N0. P '' gY S VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�F" � �:,GREEN—Applicant's Copy t. _; � _ �.� _ � _� —'_.. ��4� �i� `�OI��G�i� ��3 ��I��C�"��t� f�f�� 0�� ir 10[� _ .° 00�� G��'`. ° �� O[� � ��,.��-__._ °` `, z�� ° y�t O 4 9 . .. �.¢p' F'f�.. SET BACK ! ( FLOOFi JOIST � -- � ---- �-- �-=--- ' -------- b ---� - --------- FTGS/FORMw%STEE—�� i � ` ', �1�A !?EQMTS � y -. -- -- - - -____�_ ___._. __. . _.__.____, -- ---- ELECTRIC GROUND ' t j UNDER FLOnR DUCT � _ __ -- ---}---.-�� _ - - � ------ GRUUND PLUMBING �--- _.._-_--- i UNQEi� �LrJUR C.JP�iDlJ3T ' --_.__ —__ __-- ------------- - .......---- SLAB GRADE ' _ � FIREPLACE FOUNQRTION _ __ � ___ , _. _ ... -:- TEMP POWER 1 � I FIREPLAC��NL3 k3EAM � — -- ---�- ---_. —. —.- r___. __--- - ---.._.. WATER SERVICE __ c MID HT. BONd BEAM � . —{— -- ----- -- � --- -- � ---- � � � i g �T.BOND �EAN� � : RC)OF SHEATHING ' , J e� � �- �-----Q.��_ - ----- � ____ ___ ;_--- ----- _--.. �__ , FRAMIf�GNENTILIATIOIV i • � FINAL BOND BEAM I � _ -- --- -�- -- ----_,______.. i ---- _. ROC7�COVER ; I PRE-CaFiADi�G ; ----- - ----.,_.—� ------__... �iOUGH HEATING � BENCHING __ ; _ ____, ROUGH ELEG?'RIC ;___ I F�OUG�-i GR��ING ----- _ _ I — ------ _.__..-- - - — -_._.__. ROUGH PLUM8ING --� FINISH uRADING — --- - — --- -.___. ----------- --------.. SHOWER/TUB TEST j i ['00�ELEGTRI� — - -------- ----.......--- _..._._ __.__---- EXT. LATH/SIDING _ , P(�OL_FENGING i__--.. __ ' _.__..__ WALL IhiSUtATION i i F'OOL FINA� ; � ' CEIUNG IfV�ULATION � ; OFF SITE IMPS. �— ' � � — .—_ — -----r---- ..�-------+— i'�RYVb`ALL NAILING ( _ ' DEDlCATIO�lS __�__ _ �____ SEViIEt� _ FINAL ENG. ; -----� SEP'fiC 7ANK LAND�CAPE/IRRiC. ; � SEEP PIT/L.L. � ON SITE IMPS. � � ----- GAS AIR TEST � FINA.L ZONING FINAL COh1ST. , F!RE DEPT. FINAL FINAL HEATII�G �—� HEALTN OE�T. FI�IAL �INA�ELECTRIC � DEV FEES PAID __ _ ---�.� ----_ ------- ' FINAL PLUMBIPJG �__ _ ! ! �.-,--NE��Y--- � r- ----_.-- -------- , ; � ��T �:(C�G�O�`C�� -- ---- CUiVi�ENTS SEPTIG TA�lK SIZE � S�EP PIT/U SILE __ -- --- V . � — ------- , � . � � - --- � --- ------ ��. � � - _ �---- - � - --- �------ -- -� _ _ :,