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Home My WebLink About11-643 ^�_, _�`_ CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� \Y/ Q 21825 Copley Drive,Diamond Bar,CA 91765 Q «-' (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS '""'� BUILDING PERMIT APPLICATION P FIRMLY N JOBSITE �, � C � APPLICATION PERMIT ___��_� P/C ¢ ADDRESS rr p DATE NUMBER// y # � ISSUE TYPE �f OCC `T APN LOT TRACT DATE �, I CONST. I '��G� GROUP p OWNER ��f � !' p ADDR S � ZONING SETBACKS z CITY 'L• ZIP ' TEL. D� FRONT RW ❑ � APPLICANT . TEL.' ,7o REAR � aSIDE/SIDE STREET RW ❑ � CONTRACTOR � H ' r� SIDE ❑ ADDRES � � CITY ZIP�v`` �O EL. I - PROPOSED USE o ARC NG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIqM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- % G31egB/CefpOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.5BU51NESSANDPROFESSIONSCODE:ANYCITYOR,%� (n U CAUNTVWHICHRE�UIRESAPEFMITTOCONSTfiUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W patio/Deck w TURE,PRIOR TO ITS ISSUMICE,ALSO REOUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A.SIGNED w � STATEMENT 7HAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTFAC70R5 LI- � � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSPB 0 FESSIONSCADE)ORTHATHEORSHEISEXEMP77HEREFROMANDTHEBASISFOR,THEALIEGEDExEMP- (� V TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICAN7 FOR A PERMIT SUBJECTS THE APPUCAN7 TO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):,�r� Z ❑I,ASOVlNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCiel WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR'OFFERED FOR SALE(SEC.70II,BUSI� J � NESS AND PROFESSIONS CADE:THE CONTRAC70R5 LICENSE LAW DOES NOT APPLY 70 AN OWNER OF ? PqOPERN WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HEii OWN EMPLOYEES,PROVIDED�TFiA7 SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDF-0RSALEIF,HOWEVER,THEBUILDINGOFiIMPROVEMENTIS50LDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE'BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SAL�)./� � ❑I,AS O WNER OF THE PROPE�V AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS � TO CONSTHUC7 THE PR0.IECT(�EC.7o�a,BUSINESS AND PROFESSIONS CODE:THE CON7MCTORS LI- V81U81i0l1 ADJ.AREA W CENSE UW DOES NOTAPGLY TO AN OWNER OFA 7HOPEHTY WHO BUIlDS 0R IMPROVES THEREON,AND � WHOCON7RACTSFO�bGCHPR0.1EC7SWITNACANTfiAC70R(S�LICENSEDPUFSUANT70THECONTRAC- QUANTITY DESCRIPTION FEE 70RS LICENSE IJ�Vfj � � ❑I AM'EXEMPT UNDER SEC. B.8 P.C.FOR 7HI5 REASON Q � �.''� U LL rDATE OWNER ~ � w � LICENSED CONTfiACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERJUtiV THAT I AM LICENSED UNDEFl PROVISIONS OF CHAP7ER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z X MY UCENSE IS IN FUL CE AND EFFECT. � m LLI � � UCENSE CLASS ' "� LIC.NO. � V DATE '— — CONTRACTOR E a w � WORKERS'COMPENSATION D LARATION Q c � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z � Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE fOR WORKERS' a _ Q CAMPENSATION,AS PFOVIDED BY SECTION 3700 OF THE LABOH CODE.FOR THE PERFORMANCE U Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � w _I FIAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SEC710N Q3700 OF THE LA80R CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ' ISSUED.MV WORKERS'COMPENSATIO INSURAN RIER AND OLICV NUMBERARE: CONSTRUCTION ¢ s�.�.�.� . � ¢ CARRIER�/� N _ PLAN REVIEW � POLICV NUMBER �_�r Cr- ELECTAIC � (f}iISSEC�qNNE�NOTBEC�OMR.ETEDOFTHEPEWMISFORONEMNOREDD0IJAAS�S100)ORLESS) PLUMBING W Z I CEfiTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL s� � (3 SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370 F THE UBOR J � C�O/DE.I SHALL FORTHWITH COMPLY WITH THOS ROVISIONS. ISSUANCE � /j � � 7'L�// � SMIP p DATE: APPLICANT: J WARNING:FAILURE TO SECURE WORKERS'C�O ENSAT COVERAGE IS UNLAWFUL,AND SHAIL BE ENERGY P/C � SU&IECTAN EMP�OYER TO CRIMINAL PENA ES AND CIVIL FINES UP TOONE HUN�RED THOUSAND ENERGY PERMIT DOLLARS(5100.000),IN ADDITION TO THE ST OF CAMPENSATION,DAMAGES AS PROVIDED FOP IN J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTOflNEV'S FEES. �. p� RETENTION FEE: OCONSTFUCTION LENDING AGENCV PRE-ALT FEE: � I HEREBV AFFIRM UNOER PENALTV OF PERJURV THA7 THERE IS A CONSTRUCTION LEN�ING AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME � LENDER'S ADDRE55 w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES 71l��/� � I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE L4W5 REUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MEN710NED GROPERTY FOF INSPEC710N PURPOSES. COMMENTS � J � m PERMITTEE NAME(PRIN7) � Q � � SIGNA7UREOFPERMITTEE DATE �' = RECPT.NO. PAID BY. O. VALIDATION ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �B�V ��r ��aVlf��l� ��ff� . I��I�I�� iI��OR� �*�:r��p�c�u aQ�K� a��.. ; :;..pa��c��4oa oa�r��c�� .,��a.`�;�W "��i��=.; , SET BACK FLOOR JOIST FTGS/FORMS/STEEL , FHA REOMTS 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 FT. BOND BEAM � FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING R�UGH HEATWG BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING 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 � C��OoC�L'� COMMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a ,�� Q :�::. � � � � � ��; :,�