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Home My WebLink About10-1152 ��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 ' (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS '''""� BUILDING PERMIT APPLICATION FIRMLY � � JOBSITE APPLICATION PERMIT p/C o ADDRESSprI�p`��.� ;S6Ll GRl�_,EII� �O(L DATE NUMBE�� S q � APN � OT TRACT D TE /I�/,�! � ��TMPE �/Qr �C • p OWNER I n� CONST. GROUP o ADDRES ZONING SETBACKS • w CITY ^ IP � TE ^ � I FRONT pyy � � ❑ APPLICANT '� aa TE�. � 32 REAR � � SIDE/SIDE STREET qyy p � CONTRACTOR S G �l� SIDE p � CITY dl��Y�G G � ZIP 9zLy4 TEL � - S S PROPOSED USE Y Q` o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FROM TNE CONTMC70R5 ll� G8f8 0/C0 W CENSE UW FOR THE FOLLOWINO REASON(SEC.7031.6 BUSINESS AND PROFESSIONS CODE:ANV CITYOR (n 9 �rt U �JrJTyWF{ICHREOUIRESAPERMITTOCONSTFiUCT,ALTERIMPROVE,DEMOLISH,ORHEPAIRANVSTRUC- w w TUqE,VRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUpi PERMIT TO FILE A SIONED w Patia/Deck � S7A7EMENT 7HAT HE OR SHE IS LICENSED PURSUAN7 70 THE vROVISIONS OF THE CAN7RACTORS ll� � CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � Pool/Spa FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALlEOEDE%EMP� (� TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&IECT9THEMPLICANTTO Z q�qop� � A CML PENALTV OF NOT MORE TH/JJ FIVE HUNDRED DOLURS(S60o).): � ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � CORIrt10fCI91 Z V.7Ll DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/�,BUSI� J N NESS AND�ROFESSIONS CODE:THE CONTMC70R5 LICENSE LAW DOES NO7 APPIv 70 AN OWNER OF � PROPERTY NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR wTHROUOl1 NIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT WTENDED OR m 0 OFFEREDFORSALEIF,HOWEVER711EBUILDINGORIMPROVEMEMISSOLDWITHINONEVEAAOFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN(3 THAT ME OR SHE DID NOT BUILA OR � IMPROVE FOR THE PURPOSE OF SALE). W ❑I,ASONMEROFTHEPROPERTV.AME%CLUSIVELVCONTRACTINGWITHLICENSEDCONTRAC�ORS � TO CONSTRUCT THE VRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V01U8l1Of1 ADJ.AREA W CENSE LAW DOES NOTAPPLV TO AN ONRJER OFA PROPER7V WHO BUILDS OR IMPROVES THERE-0N,Mtp � WFIOCOMRACTSFOFSUp1PR0.1ECTSWITHACONTRACTOR�S)LICENSEDPURSUMlTTOTMECONTRAC- QUANTITY DESCRIPTION Y TORS LICENSE IAW.�. FEE � ❑i A!A E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q /S/'�/' � U � ,+ T � DATE OWNER ¢ � �2�KG Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRAI UNDER PENALTV OF PERIUFV THAT 1 AM LICENSED UNDEH PROVISKKJS OF CHAPTEii � d D(COMMENCW(I WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESStONS CODE,AND Z �� W LICENSE IS W FULL FORCE AND EFFECT. m � LICENS� LASS LIC.NO. G/��/S ' � V DATE '� CONTRACTOR � G �fr 1( � W � WORKERS'COMPENSATION DECLARATION � � I HEREBV AFFIRM UNDER PENALTV OF PERJUqY ONE OF THE FOLLOWING DECURATIONS: U � Z � _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-INSUREFORWORKEFiS' _ Q COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOq CODE,FOR TME PERFORMANCE U OF TME WORK FOR WHlqi THIS PERMIT IS ISSUED. W � � � _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTqN Q 3]00 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: C RUCT jCARRIER PLAN R IEW Z aa.icrNUMeEa_L I �2�� CTRI ¢ ;� . � (IFCSSECIIONNEIDNOTBEOOf.1PLEfEDOFhEPERAYTISFpRONEFiU�DAEDDOUARS�tt00)OR�ESS} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERIAIT IS ISSUED,I MECHANICAL C,�} SHALL NOT EMPLOV ANY PERSON IN ANV AIANNER SO AS TO BECOME SU&IECT TO THE (n WORKERS'CO/APENSATION LAWS OF CALIFORNIA,AND AOREE THAT I I SHOULD BECOME INSPECTION FEE � S SU&IECTTOTHEWOFKERS'COMPENSATION7ROVISKKJSOFSE 7a0OFTHEUBOR CODE SHALL RTHWITHCOMPLV WITHTHO OVISIOR SUANCE 0 �] � p DATEI I APPLICANE � MIP y w � ENERGY P/C � WARNINO:FAILURE TO SECURE WORKERS' PENSATION CAVERAOE IS UNUWFUL,AND SHALL BE � SUaIECTANEMPLOVERTOCRIMWALPENALIESlWDCIVILFWESUPTOONEHUNDREDTHWSAND EN GYPERMIT DOIURS(f100,o00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PqOVIDED FOR IN � SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. W - O CONSTRUCTION LENDING AGENCY p E- LT FE � 1 HEREBV AFFI{iM UNDER PENALTV OF PERJURY iHAT THEHE IS A CONSTRUCTION LENDINO AGENCV �� , �. � FOR THE PERFORMANCE OF7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LENDER'S NAME F- LENDER'SADDRE55 W I CERTIFY THAT I HAVE READ THIS APPIICATION AND STATE THAT iHE ABOVE INFORMATION IS CORRECT. TOTAL F E ES ,�� / � I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS REUTINO TO BUIL�INO V�d � CONSTRUCTION,AND HEREBV AUTHORI2E REPRESENTATNES OFTHIS CWNTV TO ENTER UPON THE ' Z ABOVE-MENTIONED VROPERTV FOR INSPECTION PURPOSES. COMMENTS ' � J � � m FERMITTEE NAME(PR1NT) ' � Q � • � SI�NATURE OF PERMITTEE DATE � RECPT.NO. PAID B VALIDATION WHITE—Department Copy,YELLOW---Finar�ce Copy,PINK—Aesessw Copy,GOLDENROD—File Copy,GREEN—Appl{cant's Copy CI�V O� DBAiViOR�D �AR INS��IOi� ��COR� �� `oa�p�c�400a �a� °�;, oa�p�c�p oa�p��ooa :: aa�,-�� '�a�c�� s� SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLO�R DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOfdD BEAM WATER SERVICE MID H'T. 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 FINISH GRADING SHOWER/TUB TEST POOL E�ECTRIC 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 '�� ,t p�p DEV. FEES PAID FINAL PLUMBING ENERGY �.�� COIVIMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a �� a �� ,� �� , o .