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Home My WebLink About17283 (42) _�� _ CTI'Y OF DIAMOND BAR � DEPARTMENT OF COMMUNTTY 8c DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ""-�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE _•7/�� n��,� � APPLICATION q `� 0 r PERMIT p/ r�, o ADDRESS ��7 �c DATE � NUMBER�� #��_ �Y � ISSUE TYPE pCC APN LOT�(� TRACT 3SS�� DATE CONST. GROUP p OWNER k?I`Ac� .ti DrAN� �ta9..+rso•.� p ADDRESS �}f41�Z �Zo,�UA-}� QJ�: ' ZONING SEfBACKS ��mC• FRONT Z cirv �,a C3ea.-ziP �A TE�. y6o �36.� Rw ❑ � APPLICANT �1� /.a�i7L'iS� TEL. �V6A b b'fs' S DE/SIDE STREEf RW ❑ � CONTRACTOR AIZ%�c'f�i/ CJ�+S'� SIDE p ADDRESS "'" . ror.J �a - ,�-�^ � CITY DfA.�no�D ZIP qI�6�TEL. � y PROPOSED USE � S I ( V I � w ARCH/ENG/ . z DESIGNER KC'rv j � ADDRESS NO.DWEL. NO. NO. cn , UNITS STORIES BEDROOMS � CITY ZIP TEL. `1�y S'YH—6? N DESCRIPTION SQ.FT. FACTOR.PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f8A9/CflfPOIS � W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:�M'CITVOR (f� C..� COUNTVWHICHREWIHESAPERMITTOCONSTRUC7,AL7ER,IMPROVE,DEMOLISH,ORHEPAIRANYSTRUG w w TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES hiE APPLICANT FOR SUCH PERMIT TO FI�E A SIGNEO w Patio/Dack � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTMCTORS LI- � CENSE LAW(CHAPTER e(COMMENCINO WITH SECTqN 70Do)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSpe � FESSIONSCODE)ORh1ATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP� (� TION.ANV VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Root A CIVIL PEN/�LTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f6ao�.): � Q ❑I.ASOWNEROFTHEPqOPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COffIfflBfCi81 Z WILL DO TFIE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC,7W�,BU51- J � � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNEF OF � PROPERTV NR10 BUILDS OR IMPROVES THEREON.AND NT10 DOES SUCH WORK HIMSELF OR HERSELF OR Q hIROUGH HIS OR HER OMM EMPLOYEES,7ROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,7HEBUIIDINOORIMPROVEMENTIS50LDWITHINONEVEAROFCAMPLE- , Z TION,THE OWNER-BUILOEF WILL HAVE THE BURDEN OF PROVINQ THAT HE OH SHE DID NOT BUILD OR � � UAPROVE FOR THE PUFPOSE OF SALE). W ❑I,�lS OWNER OF THE PROPERlY,AM EXQUSNELY CANTRACTINO WITH LICENSED CONiRACTORS � TO CONSTFUCT THE PR0.IECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8�i0f1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � NM1IOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPUHSUANTTOTNECONTRAC- QUANTITY DESCRIPTION FEE Y 70RS LICENSE LAW.). � ❑I N.1 EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q Y—<<- a�r' U ` I � DA7E OWNER � J w ��L t z U r�� .+� � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENALTV OF PE0.IURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER ( � e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TFIE BUSINESS AND PROFESSIONS CODE,AND Z � �� O(}� �� MY LICENSE IS IN FULL FOFCE/V!D EFFECT. m , K'�f �j) ;.., k . � UCENSE CGLASS '✓�fT/� ��.No. s`rt�y�l b Z � rL �� U DATE /��7'-OI CON7RACTOR_ M�O��71 �l'�l�S . � S �O' P'�S. � � WORKERS'COMPENSATION DECLARATION -� rV�. _ � �-�,t S � I � I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OF 7HE FOLLOWING DECLARATqNS: � Z �/ l° � ✓ O �Z IHAVEANDWILLMAWTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWOHKERS' ¢ Q = COMPENSATION,AS PROVIDED BV SECTION 3]00 OF THE IJ�BOR CODE,FOR THE 7ERFORMANCE U Q F THE WORK FqR WHICH THIS PERMIT IS ISSUED. � - ,_✓ �A��I w I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LhBOR CODE,FOR THE PERFORMANCE OF hIE WORK FOR WHICH THIS PERMIT IS /p�' ISSUED.MY WOR�K1ERS'CAMjPE�NSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION v� � CAARIER _)�1 A't�w �i/NA PLANREVIEW �Z POLICV NUMBER /(�S�2 S— O� ELECTRIC Q O � (1FGSSECTqNNE�NDTBEODMPLETmOFTfPER�MISFORONEMIN)FiEDDq.WlS(i100)ORlESS} PLUMBING Z I CERTIFV THAT IN THE PEFFOF7MANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL O CJ SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE (/j WORKERS'COMPENSATIONLAWSOFCALIFORNIqANDAOREETHATIFISHOULDBECOME INSPECTIONFEE S SUBJECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 97000F THE UBOR CODE,1 SHALL FORTHWITH COMPLV WITH THOSE PROVISjIONS.r/1 ISSUANCE p DATE: �"I7�OI APPLICANT. �� /��•�� SMIP � WARNING:FPJLURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY F(C '— '��-�-..�. / � SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FMES UP TO ONE HUNDRED THOUSAND � I I,,,�,.N,^� � / r DOLLAAS(f100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAAIAOES AS PHOVI�ED FOR IN ENI�V PERMIT� � I' '� � J SECTION37080FTHELABORCODE,'INTEREST,ANDATTORNEV'SFEES. q� O OC RETENTION�F+EE: [7� V OCONSTRUCTION LENDING AGENCY PRE-ALT�Ei T (- � U U I � � I HEREBV AFFIRA/UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDINQ AGENCV I � � FOR THE PERFORMANCE'OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.90G],CIV.C.). . q Z W � ( j,� � LENDER'S NAME �y ' ' � d+�_..•�------i._�— F-- LENDER'/RESS /� W I CERTIFY THAT I HAVE FEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES �L��• 4� � I AGREE TO CqMPLV WITH ALL CT'AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHOFIZE REPRESENTATIVES OF THIS CWNTYTO ENTER UPON THE r O �j�,/�7 Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS • � D � V(N � r a Dc�ss,' �► m PERMITTEE N^�(PRltfn � �,.,,1 ��..�c�1ii; 9.17-'O/' � SIGNAFI'�R F RIAITTE DATE � RECPT.NO. PAID BY . VALIDATION WHITE-0epartment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy ,��ly_��{{�Tq� //�(��}�.� ,/y ��''yy(� �'p .�]"(�'�"{'�� N11 Y ll �Y/1! LLLULIIY�Y�UV� 1Ll'4-1�I � ��F7�1!'��qr If��UCI �l��o�kJ��'' . �� C t D� �� a � U`�.�- � OG�C��G3 �' �� 1�[�C�� ; � �� [�� a �� :_.. SET BACK FLOOR JOIST FTGS/FORMSISTEEL FHA RECIMTS • --k--'--- --- -- ELECTRIC GROUND �—� i UNQER FLOOR QUCT GROUND PLUMBING _L�j--D� UNDEFt FLOOR CUMDUIT . � SLAB GRADE FiREPLACE FOUNDATIQN TEMP POWER i FIREPLACE BOND BEAM WATER SERVICE �--� •,. MID HT. BO�lD BEAM � � __— ROOF SHEATHING �(�"J.�'�-'� ' ""''�.. 8 FT. BOND BEAM � � FRAMINGNENTILtATION ' � • �'� _FINAL 80ND BEAM ROOF COVER PRE-GRADING ROUGN HE,4TING J •BENCHIt��- ' ' ROUGH ELECTRIC g '""""" , GH GRADING ROUGH PLUiV181NG ' FINISH GRADING SHOWERlTUB�TEST {'OOL ELEGTRIU EXT. LATH/SIDING --� -OZ � POOL FENCING WALL INSULATIOiV _��-OZ _ POOL FINAL ! CEILIIVG INSULATION -�U_OZ OFF SITE IMPS. � � DRYWALL NAIUNG ��j 7J6 Z . .�.�`.:"'-� DEDICATIONS SEWER ��L��UZ ' FINAL ENG. SEPTiC TANK � - LANDSCAPE/IRRfG. SEEP PfT/L,.L. ��' ' ON SITE lMPS. GAS AIR TEST . FINAL ZONING � � FINAL CONST. �r�C..�J' � �-- `�IRE DEPT. FINA� FINAL HEATING �_S..b2, i � ' HEA�TH DEPT. FINAL FINAL ELECTRIC �,��6'z. � DEV. FEES PAID FINAL PLUMBING '��-5� n,; � �. ENERGY ,�L�a� Gtr�/ /L—Zl-�J ��— ---- ---- ------- -- . �_.__��__ ._.�� - ��►' ° �'��" �; C4MNiEiVTS `� �,, SEPTIC TAhIK SIZE SEEP P17/U SIZE � � � � � . , , � � � . ;, , „ c� � , a , ',">