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Home My WebLink About16642 (22) � ' `---_��` — CTI'Y OF DIAMOND BAR _ DEPARTMENT OF CONIIvIUNTI'1'&DEVELOPIvfENT SERVICES ..�--- � - 21825 E.Copley Drive �// (909)860.3195 Fax(909)861-3117 RESS `�'�»�� BUILDING PERMiT APPLICATION ' FIRMLY '' ¢ ADDRIESS_�O�' CS, '�� L�/V � >- J APPLICATION " (� PERMIT �f . �P/C o DATE �+V NUMBER �+' # � APN LOT SRACT ISSUE TYPE OCC ` DATE CONST. GROUP p OWNER ' l" A.� L� o ADDRESS P/ ZONING SETBACKS - gCI � ZI ��f�TEL. � REART RW ❑ APPLICANT TELr ❑ zd SIDE/SIDE STREET RW ❑ a� CONTRACTOR L -�' � 'fJ- ( �G(l f� SIDE p ADDRESS �i �� % � CITY . . ZI '�, ' PROPOSED USE L� R�,(I Ft oARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. i � DESCRIPTION Q.FT. CTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLAAATION SFR/ADD/REM O I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM E%EMPT FROM THE CONTRACTORS LI� G8f8(JB/COfPOfI W CENSELAWFORTHEFOLLOWINOREASON(SEC.70.A1.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n U COUNTYNMICHREOUIRESAPERMITTOCON57AUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTAUC- P8�10/DBCK Z NRE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W w STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U� W �� CENSE LAW(CHAPTER B(CqMMENCINO WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB FESSIONSCODE)OR7TiA7HEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (� V TION.ANV VqLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTV OF NOT MOFE THAN FIVE HUNDRED OOLLARS(f5oo)J: � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � �pmm0fCi8I Z WILL DO THE WORK�ND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I4,BUSI� J � NESS AND PROFESSIONS CODE:TNE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPEH7Y NRiO BUILDS OR IMPROVES THEREON.M!D WHO DOES SUCH WORN HIMSELFOR HERSELF OR Q THRWGH HIS OR HER OWN EM7LOVEES,PqOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREOFORSALEIF,HOWEVER7HEBUILDINGORIMPROVEMENTISSOLDWRHINONEYEAROFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE Oq SHE DID NOT BUILD OR � IMPROVEFOqTHEPURPOSEOFSALE). w OI,ASOWNEHOFTHEPROPERTY,AME%CLUSIVELVCONTRACTINOWfTHLICENSEDCONTMCTORS � TO CONSTRUCT THE PR0.IECT(SEC.7014,BUSINE55 AND PROFESSIONS CODE:THE COMRACTORS U� V81U8f1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,MID � NTIOCONTMCTSf-0qSUCHPRQIECTSWI7HACOMRACTOR(S)UCENSEDPURSUANTTOTHECON7RAG pUANTITY � DESCRIPTION FEE Y TORS LICENSE UW.). � ❑I AM D(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � DATE OWNER ¢ Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBYAFFIRM UNDER PENALTV OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER d D(COMMENCWO WITH SECTION 7000)OF DIVISION�OF 7HE BUSINESS AND PROFESSIONS CODE,AND Z N X MY LICENSE IS IN FULI FORCE AND EFFECT. m (� . e � L�I }� � � � � � LICENSE CLASS /% LIC.NO. � - U DATE CONTRACTOR � ��f�� d � , �� LL1 ^M . - .�, ..' .>. . � WORKERS'COMPENSATION DECLARATION —+� � � � Q �VI'/,"!�j"�`, �� . � I HEREBV AFFIRM UNDER PENiV.7Y OF PERIURV ONE OF THE FOLLOWINQ DECLAMTqNS: Z � �� ,{� � Q `, '1 � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ " , ,`� '7d- COMGENSATION,AS PROVIDED BV SECTION 37ao OF 7HE LABOR CODE.FOR THE PERFORMANCE U - u OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED. ' W 0 � W _I MAVE AND WILL MAINTAIN WORKERS'COMPENSATqN INSURANCE.AS REOUIRED BV SECTION � Q 3�00 OF THE LABOR CODE,FOR THE PER WRMANCE OF THE WORK FOR WHlpi 7HI5 PERMIT IS '�. ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE: CONSTR TION J j CARRIER PLAN REVIEW Z PoLICV NUMBER ELECTRIC Q � (iHLSSECTqNNE�NOTBE00MPLEfmOFTHEPERMfTISFORONEHIAi%iEDDOIl/f5(5700)OFiLESS} P�UMBING � W Z I CERTIFV THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AfJD AOREE THAT IF I SFIOULD BECAME INSPECTION FEE � . SU&IECT TO THE WORKERS'COMPENSATION PqOVIS10NS OF SECTION 3�00 OF THE LABOR s COOE.I SNALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE . . � / p DATE: APPLICANT: SMIP '�' L. W J WAANING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J �y SU&IECTMIEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLAAS(f700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAQES AS PROVIDED FOR IN J SECTION 37oB OF THE LABOR CODE,MTEREST,AND ATTOFNEV'S FEES. OC RETENTION FEE ---�- '—'—'�— OCONSTRl1CTION IENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED(SEC.30Y7,CIV.C.). Z W � LENDER'S NAME I-- LENDER'SADDRESS q w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES ��, V � I AGREE TO COMPLV WITH PLL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDINO � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNTV TO ENTER UPON THE Z ABOVE-MENTIONED PPOPERTV FOR INSPECTION PURPOSES. COMMENTS � � %/`✓ J � � m PERMITT NT) . ¢ .6 3 � � � SIGNATU OF � ATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy t��"6"�( �� fID�G�6!��4�[� [�G�16� � • . �it�� [�� OG�� t o � DQ� �C� a � p, ,C� r o DGJ4C� , 0(��G�G3 SET BACK . , FLOOR JOIST FTGS/FORMS/STEEL �g�l', FHA RECIMTS i --�Ji ELECTRIC G�OUtJD !�'�'( UNDER FLOOR DUCT GROUND PLUMBING ��_ , UNDER FLOOR CU�IDUIT SLAB GRADE FIREPLACE F�UNDATION 7EMP F�OWER FIREPLACE BUND BEAM WATER SERVICE �-/ ~d� MID HT. BOND BEAM ROOF SNEATHING -j J�-✓ 8 F�'. BONQ BEAM FRAMIIJGNENTILIATION FINAL BOND BEA(�1 � ROOF COVER PRE-GRADING i � � ROUGH HEATING BENGHING ROUGH ELECTRIC ROUGH GRADING ROUGN PLUMBING FfNISH GRADING � ^ SHOWER/TU8 TEST POUL ELECTRIC EXT. L4THlSIDIM1JG POOL FENCENG �JVALL INSULATION ,jl�,°�-`t'� POOL FINAI. _ CEILING INBULATlON r�C �, . CJFF SITE IMPS. DRYWALL NAILING DEDICATIONS ` SEWER � �� FINAL ENG. ' SEPT{C TANK LANDSCAPE/IRRiG. ` SEEP PI�/L.L. ON SITE iMPS. GAS AIR TEST �� _� _� FlNAL Z�NING FINAL COt�ST. GIRE DEPT. FINA� FIh1AL t-IFATING ��_?`QZ �( HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING �L�d ENERGY _ __ '_ _ ��''/yk��l�a /'�� .�G�'/ r. � ... . ��ar — ' � � �ti v� � �b� _ _-.—sp--,. . �_� _ �'>-��, �.�. _ _---- _ — - - - ---- — •v -, y .,. a ---- - ----- - � �or�,��T�� ; _��y�� , � _. ,,,�� ;��;� � y ---- i R..�� _ ( �--- — f___ __�---- �_._�._ � ��C�"�!��s��}� J��Z� � + ��"`��IT1U SIZE � �`��, — �� ;��, [Y��/(;;��I,�. � ;'�""�..L ' . . � �'�� o u k �`�,, � � ��F � � � �� .. > � ;sw� ��;�_ 4 �� . �