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Home My WebLink About16945 (25) CITY OF DIAMOND BAR ��51�� ---��— DEPARTIv�NT OF COMMUNITY&DEVELOPIv�NT SERVICES � I 21825 E.Copley Drive (909)860-3195 F�(909)861-3117 PRESS ��%�M� BUILDING PERMIT APPLICATION FIRMLY I N JOBSITE \ APPLICATION _. I u (IIPERMIT P/C I o ADDRESS DATE I v NUMBER # I � APN L T TRACy ISSUE TYPE OCC DATE CONST. GROUP p OWNER �/ \`7 p ADDRESS ZONING SETBACKS FRONT Ryy p z CITY �A-�- ZIP TE . � Q ❑ o APPLICA T TEL. S DE/SIDE STREET RW ❑ I � CONTRACTOR SIDE ❑ ADDRESS � CI7Y ZIP TEL. PROPOSED USE o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFlRM UNDER PENALTV OF PERJURV TFIAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f9(JB/C9f(1011 I W CENSELAWFORTHEFOLLOWWOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODEANYCITYOR (n U COUNTVWHICNREOUIRESAPERMITTOCONSTRUCT,ALTERIMPROVE,DEMOLJSH,ORREPAIRANVSTRUC� w w NRE,PRqR TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patfo/Deck � STATEMENT THAT HE OR SHE IS LICENSED WFSUANT TO iHE PROVISIONS OF THE CONTRACTORS LI- � � CENSE UW(C1IMTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PqO� POOVSPB � FESSIONS COD�OR THAT HE OR SHE IS E%EMPT 7HEREFROM AND 7HE BA515 FOF THE ALLEQED E%EMP• (� TqN.ANVVIOLATqNOFSECTION7031.6BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE TH/Jl FIVE HUNDRED OOLLARS(5500).): � ❑I,ASONTJEROFTHEPROPERTY.ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � CORIrtIBfCI01 � Z WILI DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�a,BUSI- J � N NE55 M1D PROFESSlONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUIlDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELf OR w THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUpi IMPROVEMENTS ARE NOT INTENDED OR m � OFFEAEDFORSALEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWITMINONEYEAROFCOMPLE- Z TqN,hIE OWNER�BUIIDER WILL HAVE TME 9UROEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w OI,ASOWNEROFTHEPROPERTV,AMEXCIUSIVELVCONTRACTINOWITNLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7041,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� V8IU8flOf1 ADJ.AREA W CENSEUWDOESNOTAPPIVTOMIOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCNPRQIECTSWITHACANTRACTOR(S)LtCENSEDPURSUANTTOTHECONTAAG QUANTITY DESCRIPTION FEE TORS LICENSE LAWJ. � ❑I AM EXEMPT UNDER SEC. B.8 P,C.FOR THIS REASON Q � U � DATE OwNER F— Z U � � UCENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRAI UNDER PENALTV OF PERIURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAPTER d Y(COMMENCINO WfTH SECTqN 7000)OF DMSION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z / ' X MV IICENSE IS IN FULL FORCE ANO EFFECT. m LLI � LICENSE CLASS LIC.NO. � .V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q N U � I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWINO DECLARATIONS: Z � _I HAVE AND WILL AUMTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a . 2 COMPENSATION,AS PROVIDED BV SECTION 37000FTHE LABOR CODE,FOF THE PERFORMANCE U Q OF THE WOqK FOR WHIq1 THIS PERMIT IS ISSUED. � Qw _I HAVEAND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS qEWIRED BV SECTION 37000FhIE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ' J ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE CONSTFUCTION j CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC Q ` � (RassECIqNNE�Mo7BEOQMP�ETmOFnEaEwAffISFaFOMEFII.rUREDOalutS(ftoo)oqLESS} PLUMBING ( � W � �- Z I CERTIFY THAT W THE PERFORMlWCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICA� CJ SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE (n WORKERS'COMPENSATqN UWS OF CALIFORNIA,ANO AQREE THAT IF I SHOULD BECAME INSP�CTION FEE SU&IECT TO THE WOHICERS'COMPENSATqN PROVISKKJS OF SECTION 3700 OF THE UBOR �j CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE / � � p DATE: APPLICANT: SMIP W J WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION COVERADE IS UNUWFIIL,AND SHALL BE ENERGY P/C LL SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCMIFMESUPTOONEHUNDFEDTHWSAND ENERGYPERMIT OOLURS(f 1 ao,o00),IN ADDITION TO THE COST OF CAMPENSATpN,DAA/AOES AS PROVIDED FOR IN ¢ SECTION 3�OB OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNOEH PENALTV OF PERIURV THAT THERE IS A CqNSTRUCTION LENDING AGENCV FOR 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. Z W �Z LENDER'S NAME i � LENDER'SADDFESS w I CERTIFY TNAT I HAVE READ THIS APPLICATION AND STATE TFUT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES � - ( ) � 1 AGREE TO CAMPLV WfTH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING � ��/ � CONSTRUCTION,AND HEREBV AUTHORIZ EPRESENTATIVES OF 7HI5 CWN7Y TO ENTER UPON THE Z ABOVE�MENTqNED PROPERTV FOR INSP TION PURPOSES. COMMENTS � J � m PERMI7TEE NAME(PRINT) � /` � �/% ¢ � � / � / � � SI E F PERMI DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy (��T �� fm�Q(��1� f�/�f�ii � p��L�[�C��'0�f� �L��i� - . D�G� DD/�� o �� r� ' 5ET BACK FLOQR J�IST FTGS/FORP/ISlSTEEL � FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GRt�UND PLUMBING UNDER FLOOR CU�IDUIT SLAB GRADE FIREPLACE FOU(VDATION � TEP/IP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 F7. BOND BEAM � FRAMI(VGNENTILiATiON FtNAL BOND BEAM ROOF COVER PRE-GRAD►NG ROUGH HEATlNG BENCNiNG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNIBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. L4TH/SIdING POOL FENCING WALL IIVSULATIOfV POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIOiVS SEWER 1 Z'3-�\ � FINAL ENG. �� SEPTIC TAfVK LANDSCAPE/IRR�G. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL Z�NING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEAL7H DEPT. FINAL FINAL ELECTRIC • DEV. FEES PAID FINAL PLUM8ING �( b2 � ENERGY � � C�G�OG� Q < o COMiViENTS SEPTIC TANK SIZE SEEP PIT/U SIZE � � . .� �