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Home My WebLink About17041 CITY OF DIAMOND BAR ^ " -----�'�— DEPARTMENT OF COTRvIUNTI'Y&DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRES$ �%9�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE P / APPLICATION S 3p� PERMIT �DU I p/C o ADDRESS l� DATE v 0 NUMBER I # � �O ,2 ISSUE �+ �. /� TYPE " CC APN Q L TRACT DATE (� � V CONST. GROUP °C OWNER O � �` ADDRESS ` � ZONING SETBACKS 0 w � � FRONT qyy ❑ I Z CITY C� 2 ZI TEL. o APPLICANT �, REAR p � SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE ❑ o ADDRESS CITY ZIP TEL. PROPOSED USE YE�-1 � ��t'�l�13�L ��Lf L,S� w ARCH/ENG/ nS `�� ` �z DESIGNER NO.DWEL. N .``� ��' � a ADDRESS �• � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFlRM UNDER VENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� Gef9 J9/C9fpOR W CENSEUWFORTHEFOILOWINOREA50N(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n C-� COUNTVWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC- w � w TURE,PRIOR TO ITS ISSU/WCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck � STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI� � CENSE UW(CHAPTEfl B(COMMENCINO WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa � FESSqNSCqD�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� V. TION.ANY VKKATKKJ OF SECTION 7031.5 BV ANV APPLICANT FOR A VERMIT SU&lECTS iHE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MORE TNMI FNE HUNDRED DOLLARS(f6oD).): � ❑I,ASONMEROF7HEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATH7N, Q WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BU51- J COfI1ffIBfC16I Z NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF J N PROPER7YNR10BUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � 7HROUGH HIS OR HEROWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSAAE NOT INTENDED OR� m � OFFEREDFORSALEIF,HOWEVERTMEBUILDINaORIMPROVEMENTISSOLDN7THINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I.ASOWNEROFTHE7ROPEHTV,AMEXCLUSIVELVCONTMCTINGWRHLICENSEDCONTRACTORS Q TO CONSTRUCT 7HE VRQIECT(SEC.7oN,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS U� VdIU9tIOf1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOVMEROFAPROPERTVWHOBUILDSORIMPROVES7HEREON,AND = NM1IOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- FEE ~ TORS IJCENSE LAW.). �UANTITY DESCRIPTION Y � ❑I AM EXEMPT UNDER SEC. 8.8 P.C.FOR iH15 REASON Q ?� U � ATE I OWNER /�� F- Z � U � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � � i(COMMENCINO WRH SECTION 7000)OF DIVISION 3 0F 7HE BUSINESS AND PROFESSKKJS CODE,AND Z �� A(Y LICENSE IS IN FULL FORCE AND EFFEC7. m � LICENSE CLASS LIC.NO. � , U DATE CONTRACTOR d I . W � WORKERS'COMPENSATION DECLARATION Q � U N I HEREBV AFFIRM UNDER PENALTV OF PERJUFV ONE OF THE FOLLOWING DECLARATIONS: Z �Z IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORNERS' ¢ Q = COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIqED BV SECTION 37000F THE LABOR CADE.FOR THE PERFORMANCE OF THE WOFN FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION � CARRIER PLAN REVIEW � POLICY NUMBER Zd ELECTRIC � (iMSSEc1ta�NE�ra7eEOJf.�LErIDOFn-IEPEwarsf7�RaNEMN�DRE000uaRs(f�m�oR�Ess� PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF iHE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C,'} SHAIL NOT EMPLOV ANV PERSON INlWY MANNER SOAS TO BECAME SU&IECTTO THE (n WORKERS'COMPENSATIONLAWSOFCALIFORNI/�ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SECTqN 3700 OF THE LABOR �� CODE,I SHAIL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �,� �^ � p DATE: APPLICANT: SMIP W J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTF10U5AND ENERGYPERMIT DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN J SECTpN 37oB OF THE LABOR COOE.INTEPEST,AND ATTORNEV'S FEES. � `,,,� w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY � FOR THE PERFORA/ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LENDER'S NAME F- LENDER'SADDRE55 wI CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CORRECT. TOTAL FE ES i �� I A(3REE TO COMPLV WITH ALL CfTV AND COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDINO � CqNSTRUCTION,ANDHEREBVAUTNORIZEREPRESENTATIVE50FTHISCWNTYTOENTERUPONTHE Z ABOVE�MENTqNED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � �"�J�"-1�"j,"�� D r'/f2 N>�dv�'i�� J m E yI EE NAME(PRINn �, � �L�6��LJ,l2�'Y�7/C1'- JS�� (IO TUR F RMITfEE DAi�'— RECPT.NO. (/ I � PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finence Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy �- ��'`�? �[r [�8�d(��(�� 31,�lf$ - . Of��L�(�(�u��G�1 f�3(E��L�� O[�� 1 oOGYJ DD GJS� �G'� v �C� � ��C' }C�� o '`u� �9�'o o � 4 z. SET BACK FLUOR JO{ST FTGS/FORMS/STEEL FNA REQMTS � _ ELECTRIC GROUND UNDER FLOOR DUCT � GROUND PLUMBING UNDER FLOOR CUt�DUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FiF�EPIACE BOND BEAM WATER SERVICE MiD HT:BOND BEAM � ROOF SHEATHIPVG 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ^ ROUGH HEATING BENCNING AOUGH EIECTRIC ROUGH GRADING ROUGH PLUNIBING FINISH GRADING SHOWER�fUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION � Pt�OL FINAL CEELING IN�uULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER � FiNAL ENG. SEPTIC TANK LANCSCAPE/IRRlG. SEEP PITJLL. ON SITE IMPS. ^ GAS A1R TEST F1NAL ZONING FINAL C�NST. FIRE DEPT. FINA� FINAL HEATING j HEALTH DEPT. FINAL FINAL ELECTRiC DEV. FEES PAID � FINAL PLUMBING ENERGY �� COMiViENl"S SEPTIC TAiVK SIZE SEEP PIT/U SIZE � ,� [�s' � �