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Home My WebLink About18351 .� CITY OF DIAMOND BAR � --- �� --� DEPARTME?�r1'OF COIvIIv1UM71'&�DEVELOPMENT SERVICES I � 21825 E.Copley Drive �' (909)860-3195 Fax(909)861-3117 � � ) PRESS �`'�� BUILDING PERMIT APPLiCATION FIRMLY QJOBSITE 0 DATECATION NUMBER ��J � #/C ¢ ADDRESS_�.l 31�l TGt.vn I� �la c� 2 2 p °r APN LOT TRACT �SSUE TYPE OCC p OWNER I.�J l L.�-( DATE Z � CONST. GROUP � ADDRE S P L ZONING SETBACKS Z CITY � ZIP c�l7�TEL� - 75 FRONT F{Vy ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z ¢ CONTRACTOR SIDE ❑ ADDRESS � CITY ZIP TEL. PROPOSED USE tS W ��kl l J Z«`�J oARCH/ENG/ �ti � �� z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/AEM O I HEREBV AFFIRM UNDER PENALTV OF PERIUHV 7HA7 I AM F.XEMPT FROM THE CONTRACTORS LI- GBfeJe/CBfpOft W CENSEUWFORTHEFOLLOWINGREASON(SEC.7037.58USINE55ANDPROFESSIONSCODE:ANVCITVOR (n U CAUNTVNRiICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMoqOVE,DEMOLISM,ORREPAIRANYSTRUG W PdliO/D6Ck TURE,PRIOR TO I7S ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PURSUAIJT TO THE PROVISIONS OF THE CONTMCTORS ll- . w � CENSE LAW(CHAPTER e(COMMENCING WITM SECTION 7000)OF DIVISION 3 C1F THE BUSINE55 AND PRO- � PooUSpa fESSIONSCADE)ORTHATHEORSHEISE7(EMPTTH�REFROMANDTHEBASISFORTHEALIEGEDE%EMV� (� � TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICAN�FORAPERMITSUBJECfS'fHEAPPLICANTTO Z Re-Roof � � A CNIL NALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): � Z � OWNEROFTHEPROPERIY,ORMVEMPLOYEESWiTHWAGE5ASIHEIR50LECAMPENSATiON, � COffllflCfCi81 WILL THE WORK,AND THE STRUCTURE IS NOT INiENDED OR OFFERED fOR SALE(SEC.70�a,BU51- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DO'e5 NO'APPLV TO AN OWNER OF � 7ROPERTV WHO BUILDS OR IMPROVES THEREON,AND MMO�OES SUCH WORN MIMSELF OR HERSELF Oq Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m w OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- 0 TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING:HAT HE OR SHE DID NOT BUIID OR Z IMPROVE FOR THE PURPOSE OF SALE). _ ❑I,AS ONrtJER OF THE PROPEHTV,AM EXCLUSIVELV CONTqACTING WITH LICENSED CONT(iAC70RS W � TO CANSTFUCT THE PRQIECT(SEC.701�,6USINESS AN�PROFESSIONS CODE:THF CONTRACTORS LI- V8IU2l10l1 � ADJ.AREA � W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOZUII,DSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- OUANTITY DESCRIPTION FEE Y TORS LICENSE IAW.). �/� � O I AM EXEMPT UNDER SEC. B.6 P.C.FOP THIS REASON Q G� � OKTI-�/� � U � ¢ 'C �p`�-C - Z DATE " OWNER � / W Cy Vb/'�' �U � � LICENSED CONTRACTOFiS DECLARATION w � Q l7(c '1� s Q I HEREBYAFFIRM UNDER PENALTV OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAP7ER � d 9(COMMENCINGWITHSECTION7o00�OFDIVISION30F7HE8USINESSANDPP.OfESSIONSCODE,AND Z � �(S, QSIP' �X MV LICENSE IS IN FULI FORCE AND EFFEC7. m � � �S � � LICENSE CLASS LIC.NO. � S l A.� G � J U DATE GONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I MEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECURATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT i O SE�F�INSURE FOR WORKERS' _ CAMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOR CODE,FOR THE PE{ifORMANCE `U OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BY SECTION Q 37oa OF 7HE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �DO� ISSUED.MV WORKERS'COMPENSATION INSUFANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION J j CARRIER PLAN REVIEW � ZPOLICY NUMBER ELECTRIC O "� � (iHISSECTONNE�NOTBE�MPLETEDOFTHEPERMfTiSFORONEHUI�DRED00LLARS(f100)OqLE55). PLUMBING �� Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (,'} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE �/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE = SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE LABOR CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE ��'�O � SMIP . �JL� p DATE: APPLICANT: J WARNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHAIL BE ENERGY P/C � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 37080F THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: 4.D� � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � FOR THE PEHFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.�. Z W � LENDER'S NAME F— LENDER'SADDRESS � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES 2 � I • � w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS HELATING TO BUILOING - d � CONST{iUCTION,AND HEREBV AUTHOR2E REPRESENTATIVES OF THIS COUNTY TO ENTER UPUN THE Z ABOVE-MENTIONEO FROPERTV FOR INSPECTION PURPOSES. COMMENTS � �llr/�u�n? GU, 7�U7'�>nl J � m P�ITT NAM (PRINT) � � � ¢ / � � 2Z� � ' � s[� � G A • OF PERMITTEEr� � DA7E = RECPT.�0. PAID BY VALIDATION . ~ WHITE—Department Copy.YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy �0�'�! �� De��l11��3 [E��4F$ � � 9i�",��'��'d'E�t�& �&��3�3D � � `> �0 `�,+: ° 0 � a�`g � �� d � r� • ° p ;� p ' ,^a� �; ,� ��e �'� ,. „�. � _., , SET BACK I_ � F� _�OOR JQIST — --I --- -- -- ._... _ _..._ --- .... -- -_. _..--- FTGS/F�RMS/STEEL � � FN/� RE�MTS ' -- - --- ---- -- _._ . , ____ � - ELEGTRIC GROUND � __ _L�_ _.___._------- 4JNDER FLOOR_DUCl" --• ! � - ---- -- __— _ ____�_.._ _._.-— GRC�UND PLUNiBING ' ---Yl---- .—.- --._. ------- - UNDE R FLC70R CUt�iL�U17 ; _ — .__._ -----�— ------- ._.. -- SLAB GRADE ' � ___ ; FIREPLACE FOUNDATION___i____ I ' - --- - _ TEMP POWER __^ � __ � _ _.___ `I�EPLACE BONQ BEAM - � --------f-- ---- WATER SERViCE __ ___ ; ' , M!D HT. F30Ni� E3EAM � --- _..... . _ � _--------- : , ___�_.._. --- -- -._. ..--------- ; ROOF SHEATHING ' � � 8 t-�i`. BOND_BEAM ________ _ ___ - - - --:-- --_.� _.--- - - --- FRAMINGNENTILIATION I � : FIt�A�BOND BEAM - — -- ._ � _.. --- _-- -- ----- ` --.. _.. ROOF COVER ! _- ---._ __ .._ ._PRE�GRAi�ING_` ___ .'._---____ � , __ ----_ ----._ . ROUGH HEATING BENGHING __ ! __ ROUGH ELECTRIC ; � RQUGH GRAD(NG • t----- --- -- � --_..__- ------ --- — ROUGH PLUMBING 'i. ; FWfSH iaRADINU ---_..__,_��__ ._T�__ _-----�_._. _ ��.�-—-- ......---- -----`— . POOL ELEC i`RIC _. SHOWER�1'UB TEST ---- !-�...............--- ------- �--- EXT. IATHlSIDING I ; POO�FENCING i -- ----- -- --- — --... _ ___._- WALL INSULATION � j Pt�OL FINAL � _ _ _..__ _ _... - --- .___- --------- -- -.------ CEfLING IN�ULATION �; � i U�F SiTE IMPS. � - --- -- - ._...---------__ _-- ---. .-------- ----� DRYWALL NAILING ' C�EDIC�TI�NS � -- --- ---- — — - SEWER � FINAL ENG. I � ---- --- -- — -_... -1------ SEPTICTANK ' I LAN�SGAPE,If�RfG. j -- -...._---------- � _____--- -._....---- -- -.._.-- SEEP PIT/L.L. CN S{TE IMPS. � I-------- --- — GAS AIR TEST T-" , FINAL ZONING __ __ --, -------- ----- FINAL CONST. � I , ��RE DF!'T. FINAL — -----+-------_....__.. _�_.. ..___.__��,�_..._._...----- —`---------- FINAL HEATING � __ � ; I ��ALTH �E�"i. FWAL __ FiNAL ELECTRIC ! � � DEV. FEES PAlD ------ --�---------- ------ � ------ FINAL PLUMBING j i ' ENERGY ' - - ----•-- ---...._...._._�_ �.__----.._....__ _-------. ._....._._._..---.._..___.�� i _.._.............. --- � : .....__--- 0 0 � ;� a' '� CUMNiENTS :�`-23.�z� �`' �rs.u� u� ,�,��s��C��J � a��J � �cti'do.�g��ra� — �----- _C,'�;a!�.�i c�s_��i�F�`�2_a _. _ ------ SEPTIC TANK SIZE SEEP PIT/U SIZE --___-- _--_--------- ------..___ _--.__------- --._..._.._.---- a -- �--- - . ----- � . � .� --------- - -------- . � �� __. _