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Home My WebLink About17149 A c C'X�� Y^� CITY OF DIAMOND BAR `----��` --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I 21825 E.Copley Drive - (909)860-3195 Fax(909)861-3117 ' PRE$$ ' �'-�� BUILDING PERMIT APPLICATION FIRMLY QJOBSITE �Z3`"I US ,��i I)C�/ F��l DATE CATION - a��OINUMB R�� #/C Q ADDRESS � ISSUE TYPE OCC °-° APN LOT TRACT DATE CONST. GROUP p OWNER iaa�E ��s I o ADDRESS 3 S Z ZONING SETBACKS Z CITY ZIP TEL. �SIOD-gS�IZ FRONT RW ❑❑ � APPLICANT TEL.-��'ZS'� REAR Z SIDE/SIDE STREET RW p Q CONTRACTOR � SIDE ❑ ADDRESS ��'� CITY � ZIP�Q TEL._��:�fQ'�2'i�� PROPOSED USE o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � SFR/ADD/REM p I HEREBV AFFIfiM UNDER PENPLTV OF 7ERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f892IC8fpOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n U COUN7VWHICHREOUIRESAPEHMITTOCONSTfiUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG � w TURE,PPIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CON7RACTORS LI� � CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u' POOVSPB Q FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� U TION.ANV VIOLATION OF SECTION 7037.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z qe-Root � A CIVIL PENAL7Y OF NO7 MORE 7HAN FIVE HUNDRED DOLLARS(S5o0).): Z ❑I,ASONRJEHOFTHEPROPERTY.ORMVEMPIOVEE5WI7HWAGESASTHEIRSOLECOMPENSA710N, � CORIffIBfClel - WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a4I,BUSI- J � NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF � PROPERTV WHO BUILDS OR IM PROVES THEREON,AND NT10 DOES SUCH WORK HIMSELF OR HERSELF OR ' Q THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSl1CHIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WI�L HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). �y,� ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELYCON7RAC71NGWITHLICENSEDCONTRAC70RS � TO CONSTRUCT�THE PR0.IECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81112�1Of1 ADJ.AREA W CENSE UW DOES NOTAPPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWITHACON7RAC70R(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE , Y TORS LICENSE LAW.). � ❑I AM E%EMP7 UNDER SEC. B.8 P.C.FOR THIS REASON � l.J�.+ � LL � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERIURY 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER � a e(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS ANO PROFESSIONS CODE,AND Z X IAY LICENSE IS IN FULL FORCE AND EFFECT. a�� w Z � �i � _ �UCENSE CLA S y LIC.NO. � � J U DATE CONTRACTOR � � W � � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE fOLLOWING DECURATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENT70SELF-INSUREFORWORKERS' _ ¢ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � w _I HAVE AND WILLMAINTAIN WORNERS'COMPENSA710N INSURANCE,AS REOUIRED BY SECTION Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 J ISSUED.MV We�OR,,K�ERS'CAMPAE�+1 SATI I�NSU/�RAsNG`E/C�AR�R AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER Y 1 L I IvS��(X`IV/�I/Y, PLANREVIEW ZPOLICV NUMBER � I '1 J ELECTRIC .S Q �y� � (iHI55ECilONNE�NOTBE00fAPLEfFDOFTHEPERMITLSFORONEFNPDRED00LLA0.S(f100)ORLESS). PLUMBING •J V W r-� ` Z I CERTIFV THAT INTHE PEfiFORMANCE OF THE WORK FOR WHICH THIS PERMI715155UED,I MECHANICAL 1�C`I`�-b� /�^� �Z� � (� SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE t� '• � '� � ' � '�d� N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE f � SU&IECT TO THE WORKERS'COMPENSATION PR iVISlO S OF SE TION 3700 O HE LABOR� I C C D � A �n m �� CA ,I SHA FORTHWITH COMPLV WITH T 5 P O SION. ISSUANCE � �a CT !. . p DATE:� �'1 I APPLICANT: � SMIP I V W SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFI ENERGYPERMIT �- �� DOLAIRS�(5700000)TNADDTIONTOTHECOSTMOFCOMPENSATEONUDAM GESASPROVDI�EDFpqNNE ENERGYP/C f��. � SECTION370BOFTHELABORCODE,MTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: � CONSTRUCTION�ENDING AGENCY PRE-ALT FEE: O � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. . Z W � LENDER'S NAME � � LENDER'SADDRESS � TOTAL FEES � I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. w I AGREE TO COMPLV WITH ALl qTV AND CAUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE � ABOVE�MEN710NED PROPEFiTY FOR INSPECTION PURPOSES. � Q ' e��' �� COMMENTS = j� v m PERMITTE @� IN7 � ¢ L �� SIGNATU O P MI E D E = RECPT.NO. PAID BY � VALIDATION ~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy � . . . . . . . ..,. � . , . .. . .... .. . , , . . . . . . ,. .. . . . , . ,. .. ' '�.r ' .,.... ,. . . . .. .. . (�q`�'�7 �I� i�7�l�f�c��J@� f�� kl9�C�'l�(��i ��u`� f��D �JG��G� C�C,��rf� � �[�nJ ' � � � ' � 0� ° ��Y�1 ��.o��`��v ,d��,I�°��1,��=9: :, — — ----- SET BACK ' ; FLOOR JQIST � ' _--- - --_. .._--- ----- �.._._ _.. ____—�___ ------ __. FTGS/FORMSlSTEEL � � . FHA REC�MTS ' � _ - - --� ----- --- --�------------ ---------- ELECTRIC GR�UND � � UNDER FLOOFi DUCT -�-- ------- --__-1---______� ___--- GR�UND PLUMBING __ _ I UNDER F�OOR CU�IDUIT _ -- ---- , SLAB GRADE FIRERLACE F�UNDATION___�_ _ _ - - ---....-- TEMP POWER FIREPLACE BOND BEAM � � WATER SERVICE ' MID HT. BaND BEAM � ROOF SHEATHING • 8 FT. BOND BEAM � FRAMING/VENTILIATION FINAL BOND BEAM ! I ROOF COVER PRE-GRADWG � � ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING ; FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCIPJG � WALL If�SULATIOfV POOL FINAL CEILING IN�ULATION OFF SITE IMPS. _ __ _ � . DRYWALL NAILIfVG DEDICATtOfVS ; SEWER FINAL EPJG. � SEPTIC TANK LANDSCAPE/IRRIG. � SEEP PIT/L.L. ON SITE IMPS. � GAS AIR TEST FINAL ZdIVING ' � FWA�COiVST. . FIRE DEPT. FINA� � Y FINAL HEATING ; HEALTH DEPT. FINAL -- ---- FINAL ELECTRIC I � DEV. FEES PAID , ----- _..---- FINAL PLUMBING � ENERGY � _ _ __._-- C�G�OO G� a � a � GUiVINiEf�TS_ ___ _.____ SEPTIC TAfVK SIZE SEEP PIT/U SiZE --- �— � -- �� -------- � �