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Home My WebLink About17050 i CIT'Y OF DIAMOND BAR , \ , --�---��` --- DEPARTIv�NT OF COIvIIvIUNTI'Y&DEVELOPMENT SERVICES I �:¢ 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS ��'%»�� BUILDING PERMIT APPLICATION F)RM LY i � JOBSITE � i APPLICATION �L.I�� PERMIT P'�� P/C o ADDRESS_ DATE `'' NUMBER�f �j�J V # � ISSUE TYPE OCC , APN LOT TRACT DATE CONST. GROUP p OWNER o ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT RHr ❑ � APPLICANT TEL. REAR ❑ � � SIDE/SIDE STREET RW ❑ z ¢ CONTRACTOR SIDE ❑ ADDRESS � CITY ZIP TEL. PROPOSED USE w ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS = CITY ZIP TEL. UNITS STORIES BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION SFR/ADD/REM (� p I HEREBY AFFIRM UNDER PENAL7Y OF PERIURY THAT I AM EXEMPT FROM THE CONT{iACTORS LI- G8fd90/C2fpOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.58U51NESSANDPROFES510NSCODE:ANYCITYOR (n � U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIPANYSTRUC- � w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll- � CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPB � FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (� U 710N.ANY VIOLATION OF SEC710N 7031.5 BY ANV APPLICANT FOR A PERMI7 SU&IECTS THE APPLICANT TO Z Re-Root � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500J.): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSATION, � CORIrt1BfCi81 -� Z WILL DO THE WOfiK,AND THE S7RUCTURE IS NO7 INTENDED OR OFfERED FOR SALE(SEC.704�,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ? PROPERTV NMO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WOHK HIMSELF OR HEtiSELF OR � THROUGHHISORHEROWNEMPLOYEES,PROVIDED7HA7SUCHIMPROVEMENTSARENO7INTENDEDOR m Q OFFEREDFORSALE.IF,HOWEVER,THEBUI�DINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDE(i WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE�. w ❑I,ASOWNEROF7HEPROPERTV,AMExCLU51VELYCONTRACTINGWI7HLICENSEDCONTRAC70R5 � 70 CONS7RUC7 THE PR0.IECT(SEC.7oI1,BUSINESS AND PROFESSIONS CADE:THE CAN7RACTORS LI� V81U81i0n ADJ.AREA W CENSE UW DOES NOTAPPLV 70 AN ON?JER OF A PROPERN WHO BUILDS OR IMPROVES THEREON,AND � WHOCON7RACTSFORSUCHPRQIECTSWITHACONTRAC70R(S�LICENSEDPURSUANTTO7HECONTRAC- �UANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR 7HI5 REASON Q � U 2 � DATE OWNEFi � � Z W �Q LICENSED CONTRACTORS DEC RATION w 2 I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCMG WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AND PROFESSIONS CODE,AND Z �X MY LICENSE IS IN FULL FOFCE AND EFFEC7. m � � LICENSE CLASS LIC.N0. � U DATE CONTFACTOR a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' a 2 Q CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE.AS REOUIRED BV SECTION ` ' (1 Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS I � ��, v ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION J j CARRIER PLAN REVIEW � POLICV NUMBER Z ELECTRIC ¢ r� � (iHI55ECilONNE�NOTBEGOMPLEfEDOF7HEPEFUMISFORONEHUI�DREDDOl1ARS(f100)ORLESS). PLUMBING v W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (.'} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE �� '\ r } ��\ �/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE /—\� � 1 1 I J J � SU&IECTTOTHEWOFKERS'COM7ENSATIONPROVISIONSOFSECTION77000FTHELABOR �- � CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � SMIP 1 1 I p DATE: APPLICANT: J wARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C I � SUBJECTAN EMPLOYER TO CflIMINAL PENA�TIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT. I r DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN �Y' p� I J� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. . �•>_�--�_-�_._..��._.—'-.a RETENTION FEE: "" a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE I$A CONSTFUCTION LENDING AGENCV FORTHE PERFORMANCE OFTHE WORN FOR WHICH THIS PERMI715155UED(SEC.3oe7,CIV.C.�. . Z W � LENDER'S NAME I-- LENDER'SADDRESS � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECL TOTAL F E ES w I AGFEE TO COMPIY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE UWS REL4TING TO BUILDING I�� , 1 d � CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIONED PROPEfiTV FOR INSPECTION PURPOSES. COMMENTS � J � m PERMITTEE MyE(PRINT) � l�'(n �:�t � �/ fT/ � SIGNA7 OFPER EE DA E = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . .. . ._, .. . .. . . • ... ,.. . . .. ti.q�. ., .. .sto.. .. . . � .... • �� I� i�Q��i�I�J� ��[�3 ��V�� ;OG�'� u/�'�� 0 "a V� � � �J��C� o�r _;�a w�'�`�.r�-�'� �i�° _�� o � ��`. �h`. SET BACK i _ �T� FLOOR JOIST � � _ ------- --- ------ - --._:.------ FTGS/FORMS/STEEL FHA REQMTS I --._ -- ' -..___ ;- ---_—.�.. ..__ __ . . . ___._ __.._ ..._�— ELECTRIC GROUND ; ! ; UNDER FLOOR DUCT _ ._ _.. GROUND PLUMBING ___ ______ µ UNDER FLOOR CU�!DlliT � : --- -- - - ------ --_ �------�-----------.._.....__ SLAB GRADE I -- -_-� �IREPLACE_FC}U�IDATI�}N---„-�- ---- TEMP POWER I. __ � FIREPLACE BC7ND BEAM � _ __ --- - W,4TER SERVICE � �_____ I, MID HT� 8C7ND BEAM --- ------ _.____.__.. .. ____. ___----------- -------- ROOF SHEATHIh1G '� 8 �� ga�� B��« ___—_ ' _._ FRAMING/VENTILIATION _ � FINAL BOPJD.BEAM _ _____ j __ _ -- ROOF COVER i PRE-��AOING � � ----�- ------ ___ ____-�------ ROUGH HE,4TING BENCHING ROUGH ELECTRIC _ ROUGH GRAQlNG ____ RQUGH PLUN161NG ; ; FINISN ^vRADI�lG —. � -- --- -------_...._---- ---..____....._._ SHOWER/TUB TEST i POOL ELECTRIC _ --- EXT. LATHISIDItJG ; POOL FENCING —. _ —._.___.. �------. �__r.___.__.__.__. WALL INSULATION � POOL FINAL I _____ CEILING IfVSULATIOiV i OFF SITE IMPS. � DRYWALL NAILING � OEDIGATIONS I � - ---- -___-�-._..___._._._.-- ---- --- SEWER FINAL ENG. � SEPTIC TANK LANDSCAPElIRRIG. -- -- —.._...__. SEEP PIT/L.L. I ON SIT� iMPS. GAS AIR TEST FINAL ZONING FINAL CONST. � , ; FIRE DEPT. FIPlA� _ FINAL HEATING� ' HEALi H DEPT. �INAL FINAL ELECTRIC ' --�DEV. FEES PAID FINAL PLUMBING ( i ENERGY ---- _....._� __..__------._._.�___ __._..._---. � � �C��C��` Q � i COMNiERITS SEPTIC TAPVK SIZE SEEP PIVU SIZE - -�-�- -- -� � � � - --- -------------- � �---