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Home My WebLink About10-1162� _ �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building lnspection Hotline(909)839-7027 PRESS �4''�"'� BUILDING PERMIT APPLICATION FIRMLY Q JOBSITE ��v S��e c G�s� L N DATE NUMBE APPLICATION PERMIT !� �jp(C ¢ ADDRESS �l O'�� APN LOT TRACT D TEE I/�!S /� TMPE OCC p OWNE��_ ',EJ C� CONST.��//GROUP p ADDRE�SS�Z9�G �:�/p � C '� L�"v'C � ZONING SETBACKS z CIT`LL�� t�._./'U ZIP��'"'TEL FRONT qyy � � APPLICANT ��T��Y��:-t..�.n �TEL. S DE/SIDE STREET pyy ❑ � CONTRACTOR �-� ��`� � G�C �-/V� SIDE � ADD SS �J o CITY�Da-c<�N-..- GS,/ ZIP�(�, TEL a G� PROPOSED USE o ARCH/ENG/ ��; s "'- � .DESIGNER NO.DWEL. NO. NO. ADDRESS cn UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � p SFR/ADD/REM i � I HEREBY AFFlRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI- G8fe9B/CBfPOff W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.68U5WE5SANDCROFESSIONSCODE:ANYCITVOR (n C� COUNTYNM1iICHREOUIRESAPEFMITTOCANSTRUCT,ALTER,IMPROVE.DEA/OLISH,ORREPAIRANVSTRUG P8�10/DBCI( w NRE,PRpR TO ITS ISSUANCE,ALSO REQUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIONED w � STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO TiE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CHMTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' POOUSPB FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THEALLEQED EXEMP- � TKKJ.ANY VIOLATqN OF SECTION 7071.6 BV ANY APPLICANT FOR A PERMIT SU&IECTS 7HE APPLICANT T0 Z Re-Roof � A qVIL VENALTV OF NOT MORE TMAN FIVE HUNDRED DOLURS(f500).): � O4�SOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOIECOMPENSATION, COrtIrtIBfC19I . WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a/,BUSI� � � NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF PROPERTY VAiO BUILDS OR IMPROVES THEREON,AND NM1iO DOES SUCH WORN HIMSELF OR HERSELF OR � WGC Q THROUGFI HIS OR HER ONM EMPLOVEES,PROVIDE�THAT SUC}i WPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORS�LEIF,FIOWEVER7}1EBUILDINOORIA/PROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNEREUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OH � UAPROVE FOR 7NE PURPOSE OF SALE). W ❑I,AS OWNER OF THE PROPERTV,AM EXQUSNELV COMRACTING WITH LICENSED CONTRACTORS � � TO CONSTRUCT THE PR0.IECT(SEC.70/1,BUSINE55 M!D PROFESSIONS CODE:THE CONTRACTORS LI� V01 � ADJ.AREA W CENSE LAW DOES NOTMPLV TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND � NMOCONTRACTSf-0RSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTNECONTRAG QUANTITY DESCRIPTION Y TORSLICENSELAWJ. FEE � ❑I AM EXEMPT UNDER SEC, B.8 P.C.FOR THIS REASON Q �� Ly, m U � DA7E OWNER F- Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRAI UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEfl � � D(COMA/ENCING WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �� MY UCENSE IS IN FULL FORCE AND EFFECT. m o �' L ' �� -- C r � � LICENSE LASS � LIC.NO. � V DATE _ p +- CONT TOR d . W � WORKERS'COMPENSA DECLARA N �� U � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLAflATIONS: Z � � _I HAVE MID WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIF�INSURE FOR WORKERS' a • 2 Q COMPEN3ATION,AS PROVIDED BY SECTION 3700 OF THE IABOR CODE.FOR THE PERFORMANCE U OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. W 0 � I HAVE AND VJILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION , Q 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS JJ_/� �O' ISSUED.MV WO�qKE�RS'COMPENSATION INSURANCE CARRIER M!D POLICV NUMBER AAE: N O'�•�� jCAARIER o d C-L�� J� N EVI �7 I Z POLICV NUMBER �" - ELECTRIC Q � (fFBSSECTqNNE�NOTBE00MR.EfIDOFTFEPER1.i�ISFOqpNEFAlH7FimD0UARS(f100)ORLESS} PLUMBING W Z �CERTIFV THAT IN THE PERFOFMANCE OF THE WORK FOR WHICH UED,I MECHANICAL CS SHALL NOT EMPLOY ANV 7ERSON W ANV MANNER 50 AS-TO BECOME SU&IECT TO TH (/J WORKERS'COMPENSATION LAWS OF CA , EE'TM�YT-1� ULD y INSPECTION FEE SU&IECT TO THE WORKERS'COM ION P OVISIONS OF SECTION 3 E B ��`�^ � CODE,I SHALL FORTHWITH C lV WITH THO PROVISIONS. U � � �� '– v AP C MI ��p O p DATE W J WARNINO:FAILURE TO SECURE WOHKERS' CAV AGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f10D.000).IN ADOITION TO TNE COST OF COMPENSA ION,DAMAOES AS PqOVIDED FOR IN � SECTION 37ae OF 7HE LABOR CODE,MTEREST,AND ATTORNEVS FEES. E TION ��D W � CONSTRUCTION LENDING AGENCY PR LT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HATTHERE IS ACONSTRUCTION LENDINO AOENCV ��I�� / � � FOR TNE PERFORMANCE OF THE WOi7K FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). / Z W � LENDER'S NAME F- LENDER'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES /��/ � I AGREE TO COMPLV WITH A�L CITY AND COUNTV ORDINANCES AND STATE LAWS PEUTING TO BUILDING � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTY TO ENTER UPON THE � Z ABOVE-MEMIONED PqOPERTV FOR INSPECTqN PURPOSES. p /� COMMENTS ' i J �� `C- � � m EEN Q j��j � � �/V r SIG DATE - � � - / _ A n � RECPT.NO. _ _ PAID B _ _ vei inennu _ _ _ _ E—Depanment Copy,YELLOW--Finance Copy,PINK—Assessar Copy,GOLDENROD—Flle Copy,GREEN—Applicanl's Copy CITV OF DI,��fiO�D ��,R IPlSPECT901� 6�ECORD 'oa�p c�ooa oa4� .. oa��a. : oa�a�c��aoa �� r�a��-�� =k� �i��c�c��< �.- SET BACK FLOQR JOIST FTGS/FORMS/STEEL � FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBWG UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT.BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM RO�F COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�T'UB TEST POOL ELECTRIC EXT. LATH/SIDING PQOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST - - FINAL ZONING FINAL CONST. —?ric� __�' FIRE DEPT. FINAL . FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ��o � COIVIMENTS ` —� � �� - - SEPTIC TANK SIZE SEEP PIT/U SIZE a � �� Q� . .��