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Home My WebLink About11-107 I �,! CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 . (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS i �'�"��W BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ,�J/_' ?I �i/�j �` � /� / o ADDRESS �r��J rir i i i f/ DATE CATIO� �� NUMBER� �/C � �g- DATE O/ NPE OCC APN LOT TR�UU� Q CONST. L� � GROUP p OWNER /Y . . Y!7 p ADDRE S _ ZONING S ACKS w - FRONT z CITY P L. � REAR RW � g APPLICANT TEL. ❑ � SIDE/SIDE STREET p�ry ❑ I � CONTRACTOR � � SIDE 0 ADDRES `„ / � CITY ZIP . �!%��' � PROPOSED USE i i �/l� o ARCH/ENG/ Q�O � � z� DESIGNER NO.DWEL. NO. NO. n, ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERHIRV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GBfe(J6/CBfPOff W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSKKJSCODE:ANVCITYOR (f� V CWNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTqUG W P8fI0/DBCI( w NRE,PRIOR TO fTS ISSUANCE.AL50 REQUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIONED W � STA7EMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PqOVISIONS OF THE CONTRACTORS L6 � CENSE LAW(pUPTEF e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSpO FESSIONSCODE)ORiHATHEORSHEISE%EMPTTHEHEFROMAN�THEBASISFORTHEALLEOEDE%EMP- � TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Re-Roof � A CML PENALTY OF NOT MOFE THAN FIVE HUNDRED DOLURS(5500).): Z I � ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � COlf1RIBfCIeI . I WILL DO THE WORI(,AND THE STRUCTURE IS NOT INTENDED OF OFFERED FOR SALE(SEC.70�1,BU51� J � NE53 AND PROFESSIONS CODE:THE CONTRACTOPS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? ' PROPERTY NTiO BUILDS OR UdPROVES THEREON,AND NM110 DOES SUCH WORN HIMSELF OR HERSELF OR � THROU(LI HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREOFORSALEIF,FIOWEVERTMEBUIIDINGORIMPROVEMENiISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DIO NOT BUILD OR = IMPROVE FOR THE PURPOSE OF SAL�. w ❑I.ASONMEROFTHEPROPEHTV,AMEXCLUSIVELVCONTRACTINOWITHLICENSEDCONTqACTORS � TO CONSTRUCT h1E PROJECT(SEC,JON,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V8IU8IIOf1 ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN ONTJER OF A PROPERTV NM1iO BUILDS OR IMPROVES TMEREON,AND � WFIOCONTFiACT5FOR5UCHPRQlECTSWITHACONTRACTOR(S�LICENSEDPl1RSUMfTTOTHECONiRAP QUANTITY DESCRIPTION Y TORS IJCENSE LAW.). FEE � � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON � ?� U � DATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION w � 1 HEREBYAFFIRN UNDER PEN�LTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � 9(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MV�ICENSE IS W NLL FORCE AND EFFECT. m � LICENSE CLASS li� � LIC.NO. � � V DATE � CONTRACTOR d W � WORKERS'COMPENSATION DECLARATIO � � U � I HEREBV AFFIRM UNDER GENALTV OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z . 0 _IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSEMTOSELF-INSUREFORWORKERS' _ � � COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE VERFORMANCE U O WORK FOP WHICH THIS PERMIT IS ISSUED. W � � � H�NE AND WIIL MAINTAIN WORKERS'COA/PENSATION INSUHANCE,AS REOUIRED 8V SECTION Q 3700 OF THE UBOR COOE,FOR 7HE PER�;JRMANCE OF THE WORN FOR WHICH THIS PERMR IS ISSUED.MV�S'CqMPENSATIO IINSURANCE CAARI AND POLICY NUMBER AAE: CONSTRUCTION jCARRIER 7/� PLAN REVIEW ¢ POLICY NUMBEF ��7 7 ELECTRIC p (iH6SECTqNN�NDTBE00MR.EfIDOFhEPER1.nI5FpqpNEFA.POREDDOLLARSK100)ORLFSS) PLUMBING Tj �j� W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED.I MECHANICAL C,�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE (/j WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORNERS'COMPENSATpN PROVISIONS OF SECTKKJ 370o OF THE LABOR �� O CODE/7SHALLFORT ITHCOMPIVWITHTHOSEP O �61]idS.�-� ISSUANCE p DATE:�/�.-✓�/APPLICANT: i/i��E�� - 1 SMIP � WAHNI 6:FAILURE TO SECURE WORKERS'COMPENSATION.GOVERAGE IS 11NLAWFUL,ANO SHALL BE ENERGY P/C - � SU&IECTANEMPLOYERTOCFIMIN�I.PENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOlLARS(f 700.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMA�ES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATTORNEV'S FEES. v w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AOENCV � FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.909],CIV.C.). Z W � LENDER'S NAME F— LENDER'SADDRESS w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES /� D � I AGREE TO COM7LV WITH ALL CITY AND COUNTV ORDINAIJCES AND STATE UWS REUTINO TO BUIL�INO � CONSTRUCTION,AND HEREBV AUTHORRE REPFESENTATIVES OFTHIS CWNTV TO ENTER UPON THE Z ABOVE-MENTqNED PROPERTY FOF INSPECTION WRPOSES. COMMENTS ' � ��/>%�G�' �G1�'d�O��. m PERMITTEE NAME(PRl ' � � SIONANRE ERMfT7EE s�TE / � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,OOLDENROD--File Copy,GREEN—ApplkanYs Copy CITY O� DIAMON� �AR IMSPECT'IOft! RECORD � d,. . �..:�a�p�c��ooa b� �� . �r�c�p :� oa� c�ao �a�c�� p .� �?@ G:� o o ��3� SET BACK ^ FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE M(D HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�UB TEST POOL ELECTRIG EXT. LATH/SIDING POOL 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 1MPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL PLUMBING ENERGY �� COMME�lTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � a :=�; ��