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Home My WebLink About11-1090 � �� CITY OF DIAMOND BAR ,. �„� , r . � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVI ES � ' ° � . ,� 21825 Copley Drive,Diamond Bar,CA 91765 •,�� . �; (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(9 -702 `' ' r��E:7��'1�,: �'°�'� BUILDING PERMIT APPLICATION � o� JOBSITE � I APPLICATION PERMIT p/C ADDRESS DATE _ NUMBER " D p � ISSUE O/J�- O� / TYPE pCC APN LOT TRACT DATE 77 CONST. GROUP p OWNER o ADDRESS ZONING SETBACKS z CITY ZIP TEL PRONT Ryy � g APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTO SIDE p ADD SS " � CITY ZIP TEL. PROPOSED USE o ARCH/ENG/ z� DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEFEBV AFFIRM UNDER PENALTY OF PERRIRV THAT I MI E%EMPT FROM THE CONTRACTORS ll• Gef9(J9/C9fpOR W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSKKJSCADE:ANVCITYOR (n C-� COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPPJRANVSTRUC• W w 7URE,PRIOR TO ITS ISSUANCE,ALSO FEOUIRES iHE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W Patio/Deck � STATEMENT 7HAT HE OR SHE IS LICENSED PUFlSUANT TO THE PqOVI510N5 OF THE CONTRACTORS ll� � CENSE LAW(CHAPTER Y(COMMENqNG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPe FESSIONS CODE)OR THAT HE OR SHE IS E%EAIPT THEREFROM AND 7HE BASIS FOR THE ALLEGED E%EMP- TqN.ANV VIOLATqN OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof II � A CML PEN�LTV OF NOT A/ORE 7HAN FIVE HUNDRED DOLLARS(f500).): � �I,ASOWNEROF7HEPFOPERTV,ORMVEMPLOVEESWI7HWAOESASTHEIFSOIECAMPEN5A710N, � CommBfCi81 WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7w�,BU51� J � NESS AND PROFESSIONS CODE THE CONTMCTORS LICENSE LAW DOES NOT APPLV TO/W OWNER Of � PROPEHTV WHO BUtLDS OR IMPROVES THEAEON,AND NM110 DOES SUCH WORK HIMSELF OR HERSELF OR . w TMROUGH HIS OR NER OWN EMPLOVEES,PROVIDED THAT SUqI IMPROVEMEMS ARE NOT WTENDED OR m Q OFFEREDFORSALEIF,HOWEVER7}1EBUILDWOORIMPROVEMENTISSOLDWRHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUIIAER WILL HAVE TME BURDEN OF PROVIN6 THAT HE OR SHE DID NOT BUIID OR � � W PROVE FOR THE PURP0.SE OF SALE). w ❑I,AS ONRJER OF THE PROPEHTV,AM E%CWSNELV CAMRACTINO WITH UCENSED COFlTRACTORS [L TO CONSTRUCT THE PRQIECT(SEC.70t�,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTOqS LI- V8IU01IOf1 ADJ.AREA W CENSELAWDOESNOTMPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWITHACONTMCTOR(S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y roas ucENSE uw.>. FEE � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON � ?� U � DATE OWNER � Z U �¢ LICENSED CONTRACTORS DECLARATION W 2 I HEREBV AFFIRAI UNDER PENALTV OF PERJURV THAT I AM UCENSE�UNDER PROVISKKJS OF CHAPTER � � G(COMMENCW�WRH SECTqN 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,M1D Z LLI ��ICENSE IS IN FULL C D FECT. /� m � LICENSE CLAS LIC.NO. /�� Z Z � V DATE � CON7RACTOR d W ' � WOFKERS'COMPENSATION DECLAR T O � � I HE BV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOILOWING DECLARATqNS: V � � Z � I HAVE MID WILL MAINTAIN A CERTIFICATE OF CqNSENT TO SELF-INSURE FOR WORKERS' ¢ 2 � Q COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � w _I HAVE AND WILL AIAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS , � ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION > CARRIER PLAN REVIEW QPOLICV NUMBER ELECTRIC � (RiI5SEC110NNE�NO7BEOJAWI.EfEflOFT1iEPEPA4T�SFORONEFIIA.flFiEDOp1ARS�t100)ORLESS). PLUMBING W � Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED,I MECHANICAL �} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&1ECT THE (n WORKEFS'COMPENSATIONUWSOFCALIFORNIA,ANDAGREET IF BECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION VROVI510 F THE IABOR �/•/� O coq5, sH FORT1iY/ITHCAMPIVWITH sio ISSUANCE _ p DATE: �j � /( APPLICANT: SMIP W ENEAGY P/C J WARNINO:FAILURE TO SECURE WORKERS'COMPE ON CAVERAGE IS UNLAWFUL,AND SHAlLBE J � SUBJECT AN EMPLOVER TO CRIMWAL PENALTIES AND CIVIL FINES UP TOONE HUNDRE�THOUSAND ENERGY PERMIT DOlLARS(S 700,000).IN AD�ITION TO TFIE COST OF COMPENSATION,DAMNGES AS PROVIDED FOR IN J SECTION 37oE OF THE LABOR CODE,MTEREST,AND ATTORNEV'9 FEES. �� w RETENTION FEE: _ O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDEF PENALTY OF PERJURV THAT THEFE IS A CONSTRUCTION LENOING AOENCV � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ. Z W � LENDER'S NAME ' F— LENDERSADDRESS w I CERTIFV TNAT 1 HAVE READ THIS APPLICATION AND STATE TMAT THE ABOVE IN �ATbN�5�RAE�T. TOTAL F E E$ ��i 7� � 1 AGREE TO CAMPLV WITH ALL CT'AND COUNTV ORDINANCES AND STAT 5 REIATIN(3 TO BUIIDINO � CONSTRUCTIO ,AND HEREBV AUTHORIZE RE ESENTATIVES OF THIS TO ENTER UPON THE Z ABOVE- NED PROPERTV FOR IN auacosEs. COMMENTS � � J / � m PE AME Q � � 510 AT E � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Appliranfs Copy �r;�t'r��;� �, , 1,. �� r J �.0�� Is��.�� r�`` . �`� t� `^ �� , �� ,��.t�1�,�� 1,� �' �� ., ,'�.�'`��_;-;�_R-"17�7, �`,�!;��,��-�r� INS��C�'BC�f� ��CORD �_ , . ,, . ,. < ' � o a�� oa�p�c�4oa �� a�c��ooa :- . o �,. � :4 4�� o � �4� SET BACK ',� FLO�R 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 MID H'L 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 ELECTRIC EXT. LATH/SIDING POOL FENCIfVG WALL INSULATION POOL FINAL CEILING INSULATION QFF 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. FIRE DEPT. FINAL FINAL HEATING � 1 � HEALTH DEPT. FINAL FINALELECTRIC O �� _'� DEV. FEES PAID FINAL PLUMBING ENERGY C�0[�o � COMMEfVTS ��(:/_9�0��'�� SEPTIC TANK SIZE SEEP P�T/U SIZE a � Q �. . ��- �,��