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Home My WebLink About10-1091 �1 � ��_ CITY OF DIAMOND BAR r/, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �V 21825 Copley Drive,Diamond Bar,CA 91765 ( (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839=70 7 PRESS '°�" BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ��3�<� � r�� d�! / � � APPLICATION PERMIT p/C o ADDRESS DATE NUMBER � APN LOT T T DA EE��a' v�� D CONST. �� GROUP p OWNER � � � p ADDRES L f ZONING SETBACKS z CITY : i _ �, � � � FRONT pyy � � APPLICANT TEL. REAR � ¢ SIDE/SIDE STREET RW ❑ � CONTRACTOR . - , y � �L�� SIDE p ADDRE � O�`7 �. e%t'Gd3c � � CITY � � IP TEL. PROPOSED USE � oARCH/ENG/ � z� DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STOFaIES BEDROOMS � N DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBV AFFIRM UNDER PENALTY OF PERRIRV THAT I AM E%EMPT FROM THE CONTMCTORS LI- GefegO/CBfPOfI W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROfESSIONSCODE:ANYCITVOq (n U Cq1HryWF11CHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W W NRE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W P8�10/DBCI( . � STATEA/ENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- � CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7aoo)OF DIVISION 3 OF THE BUSINE55 AND PRO� � POOUSPB � FESSIONS CODE)OR THAT ME OR SHE IS EXEMPT THEREFROM AN�THE BASIS FOR THE AILEOED E%EMP- � TqN.ANV VIOL.ATION OF SECTION 7a31.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT TO Z Re-Roof A CIVIL PENALT/OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oo)J: � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWI7HWAOESASTHEIRSOLECOMPENSATION, 0 COR1/fIBfC19I Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.701�,BU51� J ' � NE55 AND PROFESSIONS CODE:THE CQNTRACTORS LICEN9E LAW DOES NOT APPLV TO AN OWNER OF j PROPERTY WFIO BUILDS OF IAIPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q TMROU6H NIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,7HEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TqN,7HE OWNER�BUILDEfl WILL HAVE THE BURDEN OF PROVINO THAT HE OR SNE DID NOT BUILD OR � IMPROVE FORTHE PURPOSE oF SALE). � Ly ❑I,AS OWNER OF THE PROPEHTV,AM E%CLUSNELY CONTRACTINO WfTN LICENSED CONTMCTORS ¢ TO CONSTRUCT TME PRQIECT(SEC,70M,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V8IU0SIOf1 ADJ.AREA W CENSEUWDOESNOTAPPIVTOAtJOWNEROFAPROPERTVWHOBUILDSOHIMPROVEShIEREON,ANO '� � WFqCONTRACTSFORSUCNPRQIECTSWITFIACONTMCTOR(S)UCENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION Y TORS LICENSE LAW.). FEE � � O I AM E%EMPT UNDER SEC. 8.8 P.C.FOR THIS REASON � �� U LL DATE OWNER � Z U � LICENSED CONTRACTORS DECLARATION . W � I HEREBY AFFIRAI UNDER PENALTV OF PEfiJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCINCi WRH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULL F E AND EFFECT. � m LlJ � � �� UCENSE C S LIC.NO. � V DATE�� CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION � � 1 HEREBY AFFIRM UNDER VENALTV OF PERJURV ONE OF THE FOLIOWING DECURATIONS: V N Z � _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _ � COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMMICE U OF THE WORK FOR WHIC}i THIS PERMIT IS ISSUED. W � � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN 3�00 OF THE LA80R CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CAARIER PLAN REVIEW Z POLICV NUMBER ELECTRIC ¢ �1l,s v 0 (RaSSEC�qNNE�NO7BE00MR.EfFDpFT1gpERA1�I5FpqpryEMI�OREDDp1AHS�t100IORlESS} PLU BIN� W Z I CERTIFV 7HAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE (n WORKERS'CAMPENSATION UWS OF CAIIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION�7ao OF THE IABOR � CODE.I SHALL FOHTHWITH COMPLV WITH THOSE PROVISIONS. I SU � p DATE: APPLICANT: SMIP W J WARNINO:FAILURE TO SECURE WORNERS'GOMPENSATKKJ CAVERAGE IS UNIAWFUL,ANO SHALL BE ENERGY P/C � J � SUBJECTANEMPLOYERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOIURS(5100,000).IN AD�ITION TO THE C0.ST OF COMPENSATKKJ,DAMAQES AS PROVI�ED FOR IN J SECTION 3708 OF THE LABOq CODE,MTEREST,AND ATTORNEV'S FEES. �C�� OC � TE ION FEE: OCONSTRUCTION LENDING AGENCY pR E: � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV FOR THE PERFORMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUED(SEC.708�,CIV.C.). Z W � LENDER'S NAME � LENDER'S ADORESS � w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CqRRECL TOTAL FE ES � � I AGREE TO CAMPLV WITH ALL CITY AND CWNTV ORDINANCES AND STATE LAWS PEUTIN6 TO BUILDIN6 � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS CAUNTV TO ENTER UVON THE Z ABOVE-MENTIONED PROPERTY FOR'INSPECTION PURPOSES. COMMENTS ' � � I ,�� .{%� � m PERMITTEE NAM /(//� /�j � U� / ( `-� C.�� 51 E DA7E � RECPT.NO. .J PAID B VALIDATIO �\ WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessar Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy � CBTY O� Di�►NiOND ��►R � �, IY�S�I�C�lO� �d(�CORD _ , �.:�Ofi�J�pC C�400[r� � �4C,��°�:`� O(��CPC C�4 oOG,3 �IY1�PL�C��'DOO l� "�L�4C ... ��1�3�C�G`tr o� :. :a 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 FIREPLACE BOND 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 ELECTRIC 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 DEV. FEES PAID FINAL PLUMBING ENERGY C�"1 �o f COIVIMEfVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a �iI Q �.. ,� � �