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Home My WebLink About18215 (28) �� __ CTTY OF DIAMOND BAR � DEPARTIviENT OF COIvIIv1UNITY&DEVELOPIv�NT SERVICES � 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS ��'%rM� BUILDING PERMIT APPLICATION FIRMLY ¢ ADDRIESS�/ /2/ S'�l.��Qy//�j �I� 1' _V �/�� O�`"� l� r APPLICATION PERMIT P/C o DATE UMBER # � ISSUE� TYPE OCC APN LOT TRACT DATE• �� CONST. �GROUP p OWNE��l7 � �1'�e� � p ADDRESS %�- S /l� ZONING SETBACKS Z CITY,�/�41*�o.t.� �36h0 ZIP TEL� FRONT Ryy ❑ o APPUCANT �,'//,'<vr+� /�o TEL. � — REAR • p dz SIDE/SIDE STREET RW O � CONTRACTOR�7�TED �0��/-4C-/,' o/t� SIDE p ADDRESS 6 !/Ll2 A�/ {� � CITY A�T�S//� ZIP � �� TEL. � •• o— PROPOSED USE o w ARCH%ENG/ z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� GefB JB/CBfPOR W CENSEUWFOR7HEFOLLOWWOREASON(SEC.7o�1.5BUSINESSANDPROFES510NSCODE:PNVCITYOR (n U �JrJn'yhllpiREQUIRESAPERMITTOCONSTRUCT,ALTERIMPROVE,DEMOUSH,ORREPAIRANVSTRUC- w TURE.PRqR TO RS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERAIIT TO FILE A SIONED w P8fi0/DBCK � STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHA7TER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � Pool/Spa O FESSIONSCODE)ORTHATHEORSHEISE%EAIPTTHEREfROMANDTHEBA515FORTHEALLEGEDE%EMP- (!3 V TION.ANVVIOLATIONOFSECT10N7031.SBVANVAPPLICANTFORAPEflMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(5500)J: � ❑I,ASOYMEROFTHEPROPERTV,OFMYEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � CORIffIBfCWI � Z WILL 00 THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC,7W�,BU51- J � NESS AND PROFESSIONS COOE:THE CANTRACTORS IICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERTV VrtiO BUILDS OR IMPROVES THEREQV,ANO VhlO DOES SUCH WORK HIMSEIF OR HERSEIF OR � Q THROU(iH MIS OR HER OWN EMPLOVEES,PPOVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m 0 OFFEREDFORS�LEIF,FIOWEVER711EBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SAIE). w ❑I.AS ONTIER OF THE PROPEHTV,AM E%CLUSNELV CANTRACTINO WfTH LICENSED CONTMCTORS (r TO CONSTFUCT THE PR0.IECT(SEC.7041,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- VBIt18IlOf1 ADJ.AREA ' W CENSE LAW DOES NOTMPLV TO AN OWNER OF A PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAC- � QUANTITY DESCRIPTION Y TORSLICENSEUW.). FEE � ❑1 M1 EXEMPT UNDER SEC, B.8 P.C.FOR THIS REASON Q � O � U � LL DATE OWNER � � Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I MA LICENSED UNDER PROVISIONS OF CHAPTER � � � B(COMMENCINO WlTH SECTION 7000)OF DIVISION 7 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z ' XL� MY LICENSE IS IN FULL FORCE AND EFFECT. m �LLI � LICENSE CLASS LIC.NQ � � U DATE � CONTRACTOH GA a W s � WORKERS'COMPENSATION DECLARATION a � U � I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECIAMTIONS: Z � C � J � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ - COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOR CODE,FOR THE PERFOqMANCE U OF THE WORI(FOR WHICH THIS PERMIT IS ISSUED. w O � W _IHAVEANDWILIMAINTAINWORKERS'COMPENSATIONINSURANCE.ASREWIREDBYSECTKKJ Q 37000F THE UBOR CODE,FOR THE PERFORA/ANCE OF THE WORK FOR WHICH THIS PERMIT IS Q J ISSUED.MY WORNERS'COMPENSATION INSURANCE CAARIEF AND POLICY NUMBER ARE: CONSTRUCTION j CARRIER � PLAN REVIEW Z �ICY NUMBER �2 0�1 ELECTRIC ¢ O0 �(iHISSECTKXJNE�NOTBE00MREfmOFh¢PEqM14i�${y7qp(��.pq�ppp��lpplpqlESS� PLUMBING W • 1 Z I CERTIFY THAT M THE PEfiFORMAtJCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,l MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO TNE � C1"] (/� WORKERS'COMPENSATIINJ I,AWS OF CALIFORNIq AND AOREE TMAT IF 1 SFIO L�EBECOME INSPECTION FEE ,c SU&IECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37 F THE LABOR /� ~ CODE SH FOR COMPLY WI7H THOSE PROVISbNS. ISSUANCE � � p DA7E: �PPLICANT: "�� SMIP W J WARNING:FPJLURE TO SECURE WORKERS'COMPENSATION CAVER E IS UNUWFUL,AND SHALL BE ENERGY P/C � � , �y SU&IECTMlEMPLOVERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLAAS(f1oo.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE,MTEREST,AND ATTORNEY'S FEES. �� aC RETENTION FEE:(J � OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: ; -1� • � I HEREBV AFFIRM UNDER PENALTV OF PERJUFV THAT THERE IS A CONSTRUCTION LENDING AGENCV � FOR THE PERFORMANCE OFTHE WORN FOR WHICH THIS PEFMIT IS ISSUED(SEC.30o�,CIV.C.). Z W � LENDER'S NAME F— LENDERSADDRESS � w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CORRECT. TOTA L FE ES p oa�a�-I r�o �` � � � � I AOREE TO COMPLV N7TH ALL CITV AND COUNTV ORDINANCESlWD STATE LAWS RELATING TO BUILDING � CONSTRUCT40N,AND HEREBV AUi}IORRE REPRESENTATIVES OF THIS COUNTV TO EN7ER UPON THE � Z ABOVE�MENTbNED PROPEFTV FOR INSPECTION PURPQSES. COMMENTS � �� 'o J �6O � m PERMITTEE NPIAE(PRIPfT) � �� SI(iNANRE OF PERMI DATE � � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy ��r �� o�� a��-�� c��¢� ,. ��C�irD� °`� ° G� ° � ; � � � �-� � � � DD GJ4C� � ' �C�U�L�3 SET BACK � , " FLOC3R JQIST • FTGSIFORMSlSTEEL � FHA RECIMTS ��/� � _� - -_____ ELECTRIC GROUND �__ � �UNDER FLOOR DUC� �__��i GROUND PLUMBING � UNDER FLOOR CU�IDi.fIT SLAB GRADE �_ �_Ze��'� �._ FIFiEPLACE FJUNDATION �Y TEMP POWER ! FIREPLACE BOND B�AM WATER SERVICE MID HT. BOND BEANI RO�F St-lEATHIh1G �� _��%^'�-- 8 FT. BON� BEAM � FRAMINGNENTI�IATiON �f-��_._D��,.� FIfVAL BOND BEAM _ ROOF COVER PRE-GRADlNG ROUGH HEATING �� BENCHING ROUGH ELECTRIC ,) ROUGH GRADING ROUGH PLUNIBING FINISH vRADING SHOWEF�fUB TEST � POO�ELECTRIC E7Cf. LATH/SIDWG� O�i /�_ I POOL FENCWG �%l�l.- � ,— - WALL INSULATION ,� '� � � I PGOL FINA� CEILING INSULATIOl�! --�-! OFF SITE IMPS. DRYWALL NAILING . rf��_ � �f, DEDICATIONS SEWER F�NAL ENG. SEPTlC TANK , �ANDSCAPE/iRRIG. � SEEP PITtL.L. � ON SITE}MPS. GAS AlR TEST i FINAI_Z(�NING ! FINAL CONST. ' � _�= FlRE DEPT. FINA� F�MAL NEATING � , HEALTH DEPT. FINAL FINA�ELECTRIC � DEV. FEES PAID FINAL PLUMBING ` ENERGY ' _�'f�A� ��" _— �o�o�o�� GOiViNlIE{�TS sEPT�c r�n�a� sizE SEEP PiT/U SIZE � Y� :[�; - • � ^ :