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Home My WebLink About15794% ! _!�� CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES Z��o E.coP�ey��s,��o MAY 0 9 2003 PRESS (909)860-3195 Fax(909)861-3117 ��`'H�'� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE >� ��`� �� ] APPLICATION O PERMIT `' P/C /��._ 2 o ADDRESS / �"s DATE NUMBER V # K-t�J $ ISSUE NPE OCC � APN LOT TRACT DATE CONST. GROUP � OWNER O - � ADDRESS i_5 's-.�' .S i C J�� I►� •" ZONING SEBACKS w CITY�,�� J�J LL�. ZIP�� TEL FRONT RW ❑ � APPLICANT ..TE:��.�H TE 5 REAR ❑ � � SIDE/SIDE STREET RW ❑ CONTRACTOR 1� 'S � t/CC SIDE ❑ � ADDRE S 2 'Z-�= '+ ' �G ,_ _ PROPOSED USE CITY C ' Z ZIP ! Z TE� � o ARCH/ENG/ • SZ3 33 3 ` � DESIGNER NO.DWEL. NO. NO. ADDRESS � UN�TS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT fROM 7HE CONTMCTORS LI� GHfBgB/C6fpOR W CENSELAWFORTHEFOILOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCI7VOR (n U COUNTYVMICHRC-0UIHESAPERMRTOCONSTAUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC� W Paf10/DBCk L�O G.�� NRE,PRIOR TO ITS ISSUANCE,ALSO REQUIHES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED W •— STATEMEM THAT HE OR SHE IS 110EN5ED PURSUAHT TO hIE PROVISIONS OF THE CONTMCTORS LI� � CENSE UW(pUPTER Y(COMMENCINO M/ihi SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa FESSqNS CODE)OR hIAT HE OR SHE IS El(EMPT THEREFROM MID THE BASIS FOR hiE ALLEGED EXEMP- TION.ANVVIOLATIONOFSECTION7a71.5BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root � A CIVIL PENALTY OF NOT MORE TMAN FIVE HUNORED DOLURS(i5ao).�: . � ❑I,ASONMEROFTHEPROPERT/,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial - NALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701/,BUSI� J NESS MID PROFESSIONS CODE:THE CON7MC70RS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPENTVWFIOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHM/ORKHIMSEIFORHERSELFOR � Q THROUGH HIS OR HER OMM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � ,OFFEAEDPDRSALEIF,FIOWEVERTMEBUILDINGORIMPROVEMENTISSOIDWfTHINONEYEAflOFCOMPLE- Z 'TqN,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE fOR THE PURPOSE OF SALEJ. w ❑I,tiSOVMEROF7HEPROPERf1',AMEXCLUSIVELYCONTMCTINOWITHLICENSEDCONTMCTORS � TO CONSTRUCT THE PR0.IECT(SEC.7oH,BUSINESS AND PROFESSIONS CODE:7HE CONTRAC70R5 Li� VdIU011Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPER7VWF108UILDSORIMPROVESTHEREON,AND � WIiOCOMMCTSFOHSUCHPRQIECTSWIhIACONfRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG �UANTITY DESCRIP ION ' ��,\ FEE � � NRS LICENSE UW.). e ❑1 AM EXEMPT UHDER SEC. 0.i P.C.FOR THIS REASON Q 3 � � � � � DATE ONMER � � W � LICENSED CONTRACTORS DECLARATION w � 1 NEREBY AFFIfUI UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � , � i(COMMENCWO WRN SECTION)000)OF ONISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CUSS � � LIC.NO. ��'7 S /� �� j ' '��" � J V DATE /LT D-�� '-Q J CONTRACTOR„�� rC-�1 O- .. �J.,.r-�"T.. W .-�� • � WORKERS'COMPENSATION DECLARATION a ,..� N I HEREBY AFFIRM UNDER PENALTV OF PER1UFiY ONE OF THE FOLLOWIHG�ECURATIONS: U ��' � Q . • � _I HAVE AND WILL MAINTAIN A CEfiTIFICA7E OF CONSENTTO SELF-INSURE FOR WORKERS' _ � COMPENSATION,AS PqOVIDED BY SECTION 37000F THE UBOR CODE,FOR THE PERFORMMICE U Q OF 7HE WORK FOR WHIp1 THIS PEfiMIT IS ISSUED. � � W _I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION ^— Q 77o00F THE LABOR CODE.FOR THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS � f�� ISSUED.MV WORKE��iM PENSATION INSUHANCE CARRIER AND POLICY NU ER ARE: CONSTRUCTION � CARRIER � f �SL�� PLAN REVIEW � 0Z POLICV NUMBER��_� 2� �Ci ELECTRIC .�� Q � 0 (fFC55ECfqNNFIDNoi8Ea0A�L6fIDOFnfPEwAisFORONEHUnORmDa1NLS(flao)oaLEss} PLUMBING �" ' � W � 7t� Z I CERTIFY THA71N 7HE PEHFORMANCE OF 7HE WORK FOR WHICH 7HI5 PERMI715ISSUED,I MECHANICAL � 61 T7 1'IY.1 (r} �SHALL NOT EMPIOY ANY PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE � `'�-L�11J/ y WORKERS'COMPENSATION UWS OF C/�LIFORNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE S SUBJECT TO THE VfORKERS'COMPENSATION ROVISIONS OF SECTION 370o OF THE LABOR - CODE,ISH�W.FOifTHWITHCOMPLVWIT/ visioNs. ISSUANCE �� p DATE: I��-I��APPLICANL �� / SMIP i�u� � �> >nnn p� w ENEFiGY P/C CTTR!�,�c�r. �o,.,,.,�.. � WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL.AND SHQL BE --� � va ut�1.1aAV1 V L J7i ij[ � SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT KZF TY"P 9rsr.r. . r DOLLARS(f10o,o00�.IN IDDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN —��y�l��j��!- ,/� J SECTpN 37oe OF THE LABOR CODE,INTEREST,ANO ATTORNEY'S FEES. � RETENTION FEE: ,.V O �� 2 OCONSTRUCTION LENDING AGENCY PRE-ALT F E: � / � I HEREBV AFFIRM UNDER PENALTV OF PERIUHV THAT THERE IS A CANSTRUCTION LENDING AGENCY J FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30�7,CIV.C.�. Z W � LENDER'S NAME � H LENDER'SADORE55 � t CERTIFV 7HAT I HAVE READ THIS APPLICATroN AND STATE THAT THE ABOVE INFORMA7qN IS CORRECT. TOTAL FE ES l� e �3 � , w I AGREE TO CAMPLV WITH ALL CI7V AND COUPfn'ORDINANCES AND S7A7E LAWS REUTING 70 BUILDING �.,/ � CONS7RUCTION,AND HEREBY AUTHOfiIZE REPRESEN7ATIVES OF 7HI5 COUN7Y TO ENTER UPON THE � �/ ZABOVE-MENTIONED VROPERTV FOR INSPECTION PUHPOSES. /' CO MENTS ' �� _ ,� �./� �.�ri1 /�l.! /'1/1/ /'t ` m PERMI7TE AME(PRINT) ¢ � - — c) J v� ` � SIGNATU O ATE • � RECPT.NO. PAID BY VALIDATION WHITE-0epaAment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Appticant's Copy .0. .... . • , . .. .. �. .. �. . .. , . � ^ .� .�.� . ' . . _' . . r ., � �.i �"i:f_Y;�..�:`;, \./� i tl O� ��YH�OOtl� �� . . B�➢S�EC�UC�h�I f�l��R� '.ii'•j` :� ;t ��ij�� ,..., . �,. ry �,,� . - , , .,. , � �, ,. J.. , ;�; " p ��s , p � - ° � + ' :- ° 0 i D '� ,U��l'�U LJLnJ , � �� , . � .. �., , . .^��. �,�€ . � . . ,. . :_ � r< . �� SET BACK. �..; '' . � I FLOOR JOIST • • __ FTGS/FORMS/STEEL t ' j_� FHA REQMTS_ _ _ __ � — — - __. ELECTRIC GROUND i UNDER F�OOR DUCT � --- — -- —------ �--- ----_� __._._._.._..._..:. GR�UND PLUMBING ; UNDER FLOOR GU��DUIT __ _ � _______ SLAB GRADE FIREPLACE FOUNDATION '� � TEMP POWER FIREPLACE BONQ BEAM WATER SERVICE MID HT. BOND BEAM � ROOF SHEATHING • � 8 FT. BONd BEAM � FRAMING/VENTIUATION � FINAL BOND BEAM ROOF COVER PRE-GRAD�NG ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING � FINISH GRADING ` __u � SHOWER/TUB TEST f'OOL ELECTRIC EXl'. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL •CEILING INS�LATION OFF SITE IMPS. DRYWAL.L NAIUNG DEDIC,4TIONS SEWER FINAL ENG. SEPTIC TANK % LANDSCAPE/IRRIG. � SEEP PITlL.L. � ON SITE IMPS. ''' ' GAS AIR TEST FINAL ZONING � � FINAL CONST. ' FIRE DEPT. FINAL �� —T�__� Y�_��__ — � FINAL HEATiNG � ' • i HEALTH DEPT. FiNAL v FINAL ELECTRIC DEV. FEES PAID � l=1i�AL,_PLUMBING ' ' ENERGY _ _ � . 1 (O�� :�� i �--,-� .;a_:; ,,,.�• � . . --- -- � M, <. �i�� 1 .7�_i-�=��-�/`� , ' `��' - � � „ :�� —�.`.'�- — ----- � �,1` �. �....�i. __` . , , ' • � . � + ��'--' � SEPTIC TANK SIZE � SEEP PiT/U SIZE . --------- .�---------- t� . _ �� ' � , � . � a .ey� r � � � '� ----_____ � �f,� .� . � ��t t . N . a ��. j �* � S:. A� ��t� . . __ ...._.._...... '�., � 4 � �Y #^a�d cqy . �`g+lf Y F ba �t h' R.�'AH "p. • ' • � . ri� � y d . �`A1 '� '# '.,Y� { `�.� �--va �� _.__._.... ��` �y�-q��}� � k..Y�i�q-.' . . • ' �' � L:/ 13 ,q�`.��.� ( � ___ _