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Home My WebLink About10-1191 -- � ^ �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES l 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS 4'°�'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE u �(� APPLICATION PERMIT ADDRESS � 1 ' � ��1�� /i� DATE ��/I� NUMBER�O (I�I #/C � APN LOT TRACT DA EE �� NPE OCC p OWNER I��n'� CONST.�_ GROUP p ADDF3€SS � � � ZONING SETBACKS z c�TvJti�oMD rI TE . � REART RW ❑ g APPLICANT' TE . 6 34'-0 Fl SIDE/SIDE STREET q�ry p � CONTRACTOR KE � A N� 1.^� SIDE p ADD SS� C �6�1Ks'p+ AVR: � CI��"� ZIP TE IU 4' — PROPOSED USE w ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � N DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I NEREBV AFFlRM UNDER PENALTV OF PE0.0.1RV THAT 1 NA E%EMPT FROM THE CONiRACTORS ll- G8f8 B/Ce A W CENSELAWFORTHEFOLLOWIN6HEASON(SEC.7031.6BUSWESSANDPROFESSIONSCODE:ANYCIT`/OH (n 9 � U COUNTyWHICHREOUIRESAPERMITTOCONS7RUC7,ALTER,IMPROVE,DEMOLISH,ORRE7AIRANVSTRUC� W W TURE.PRIOR TO ITS ISSUANCE.ALSO REW IRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIONED W P8�I0/DBCK � � STATEMENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PqOVI510N5 OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PqO� � POOVSPB FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEOEDE%EMP- C7 TION.ANV VqLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z. Re-Roaf A CML PENAL7Y OF NOT MORE 7HAN FIVE HUNORED DOLLqAS(fsoo).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWA6ESASTHEIRSOLECOMPENSAiION, � CORI�I1BfC18I Z N7LL DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51� J N NESS AND PROFESSIONS CODE:THE CONTRACTOFS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � GROPERTV WFiO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q TNROUGH HIS OR HER ONTI EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFE{iEDWRSALEIF,HOWEVER7T1E6UILDINOORIA/PROVEMENTISSOIDWITHINONEVEAROFCOMPLE- I Z TIDN,THE OWNER�UILDER WILL HAVE THE BURDEN OF PROVIN�THAT HE OR SHE DID NOT BUILD OP � IM7ROVE f-0R h1E PURPOSE OF SALE). � w ❑I,ASOWNEROFTHEPROPERTY,AME%ClUSNELYCONTRACTINOWfTHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.)OM,BUSINESS AND PROFESSIONS CODE THE CANTRACTORS LI- V81U9�1Of1 ADJ.AREA W CENSE UW DOES NOTAPPLY TO AN ONRJER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,hND � WHOCANTRACTSf-0RSUCHPRQIECTSWITHACONTRACTOH�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION TORS LICENSE LAWJ. FEE � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q U ` LL' DATE ONMER F � ^ -rr `( � LICENSED CONTRACTORS DECLARATION w i � �`� ``� � Q'W 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CFiAPTER � d 9(COMMENGNO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z — ' X IAY LICENSE IS IN FULL FO E AND�EFFE/CT. J� m � LICENSE CLAS - �/�/ UC.NO. v��I-(D � V DATE 30 /O corrrrucroalLl/�� l✓1�N� a w • � WORKERS'COMPENSATION DECLARATION a N U � I HEREBV AFFIRM UNDER PENALTV OF PEqJUqV ONE OF THE FOLLOWING DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMMlCE U OFTHE WORK FOH WHICH THIS PEFMIT IS ISSUEO. W Q � � I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3�00 OF THE LABOR COOE.FOR THE PERFORAIANCE OF THE WORN FOR WHICH THIS PERAl1T IS ISSUED.MV WOR)(ERS'CqAW�(ISATIO)J INSURAryryry AqRIGR D POLICY NUMBERAAE: CONSTRUCTION jCARRIER J�� PLAN REVIEW Z POUCY NUMBER ELECTRIC Q � (nassecnaaNEIDnioieeoor.w�FrmoFnEVEanrrtswaoriE�uoaEODavasK�mlat��ssl � PLUMB�NG w - � Z I CERTIFV THAT IN THE PERFORMANCE O N FOR WHICH THIS PERMI ED,I MECHANICAL � SHAIL NOT EMPLOV ANV FERSON 1 AIANNER 50 AS TO BECOME SU&IECT TO TH [/� WORKERS'COMPENSATION LA f CALIFORN10.AND AGREE THAT IF I SHWLD BEC-0ME INSPECTION FEE SU&IECT THE RKERS' PENSATIONPROVISIONSOFSECTION37000FTHE O CO��1 2A/LL1FO♦HWITH MPLV WITH7HOSEPROVISIONS. SUANCE p DATE: � `�� (O APPLICANT: SMI � W J WARNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS 11NLAWFUL,AND SHALL BE ENERGY P/C J �y SU&IECTANEMPLOVERTOCRIMINALPENAITIESANDCIVILFWESUPTOONEMUNDREDTNOUSAND ENERGYPERMIT DOILARS(5100,000),IN ADDITION TO THE COST OF COMPENSATKKJ,DAMAGES AS PROVIDED FOR IN � SECTION 37080f THE LABOR CODE,INTEREST,ANDATTORNEI^S FEES. ETENTION F O OCONSTRUCTION LENDING AGENCY PRE-ALT EE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS ACANSTRUCTION LENDING AOENCY �� O� FOR THE PERFOPMANCE OF THE WOFK FOR WFIICH THIS PERMIT IS ISSUED(SEC.70G7,CIV.C.). Z W �Z LENDER'S NAME i F- LENDER'SAD�RESS � � �� n � TIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT iHE ABOVE MFORMATION IS CARRECL TOTAL F E ES W I AOF E TO CAMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS PELATINO TO BUILDINO � CONS RUCTION,ANO HEREBV A E REPRESENTATNES OF THIS COUNTYTO ENTER UPON THE ZABO -MENTIONED PROPERTV R INS CTION PUq ES. 0 /�p n COMMENTS J �/LI.JL� ,J� � m PERMIT7EE J -�h � C/J // .J�/ � 1C1NA7URE OF PERMITTEE DA7E � FECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—ApplicanYs Copy CITY O� DIAiWOND ��,R I�S�{�C�IOi� R�CORD .. - � _ - ��,x._ �- . � �� Oa�pC�C�400a o ��'``� OGYJ�P@�G3 OG��PC�C�400�i �.>��o��QG�.� Il�f�C�C� � : .. .«. __ . . 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 FIREPLP,CE BOND BEAM WATER SERVICE MID 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 / p FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING ro 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 �� COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a _ � � 0