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Home My WebLink About17747� �� _ CITY OF DIAMOND BAR DEPARTMENT OF C01�RvILJNITY&DEVELOPMENT SERVICES �� . 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 � PRESS "'-9�� BUILDING PERMIT APPLICATION FIRMLY i } JOBSITE �,�� '��Q�,� � APPLICATION /L, � n�7 PERMIT I�� /C o ADDRESS DATE � V L' NUMBER � APN LOT TRACT �SSUE TYPE pCC -�- DATE � CONST. GROUP p OWNER ��LJ�- p ADD ESS `�}-3.�i' `�`e-��"' --t� ZONING SETBACKS z CITY ZIP �lt'1bS TEL.��C7- I�IO FRONT Ryy ❑ � APPLICANT��.c �Cr�� TE . REAR ❑ �� SIDE/SIDE STREET RW ❑ CONTRACTOR r SIDE p ADDR SS � CITY ZIP TEL. ��3 PROPOSED USE o --� �� S'�—r--� ,�,�-•- w ARCH/ENG/ ' z DESIGNER �'�"LS�-�-�� ST. ' w NO.DWEL. NO. NO. � ADDRESS 2 � CITY R�� TEL. UNITS � STORIES � BEDROOMS �J � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTY OF PERNRV THAT I AM E%EMPT FROM THE CONTRACTORS LI� GefegB/COfPOR � W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (�j U �OUNTyWl{ICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPHOVE,DEMOfJSH,ORREPAIRANYSTRUC- W NRE,PRIOR TO ITS ISSUANCE.ALSO REW IRES 7HE APPLICANT FOR SUpi PEFMIT TO FILE A SIONED w Patio/Deck � STATEMEM 7HAT HE OR SHE IS LICENSED PURSUANT TO h1E PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPO � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE AlLEOED EXEMP� C7 TqN.M/YVIOLATI0NOF5ECTION7031.6BYANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof O A CML PENALTV OF NOT AbRE THAN FIVE HUNDRED OOLLARS(f5oo�.): � ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOVEESWITFIWAGESASTHEIRSOLECOMPENSATION, � CORIrt10fC101 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.7014,BUSI- J J � NE55 AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERfV Vh10 BUILDS OR IMPROVES iHEREON,AND WHO DOES SUCH WORK HIMSEIF OR HERSELF OR wTHROUGH HIS OR HEF OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVERNEBUILDINOORIMPROVEMENTISSOLDWI7HINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PUFPOSE OF SALE). w OI,ASOWNEROFTHEPROPEHTY,AAIEXClUSNELVCANTMCTINOWfTHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRq1ECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U8�IOf1 ADJ.AREA W CENSE LAW DOES NOTAPPLV TO AN ON?JEF OF A PROPERTV WF10 BUILDS OR IMPROVES THEREON,AND � WFpCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S�UCENSEDPURSUANTTOTHECONTMC- QUANTITY DESCRIPTION FEE Y 70RS UCENSE LAW.). � ❑1 AM EXEMPT UNDER SEC. B.A P.G FOR THIS REqSON Q ?� U LL DATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRM UNDER PENALTV OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � �(COMMENCINO WITH SECTION 7000)OF DIVI510N 3 0F THE BUSINE55 AND PROFE5510N5 CODE,AND Z � LLI ��ENSE IS IN FULL FORCE/WD EFFECL m � LICENSE CLAS,pS� LIC.NO. ��.�,,��. �O � U DATE ✓ 2-- CONTRACTOR ��a�� a W � WORKERS'COMPENSATION DECLARATION a � U � I HERE AFFIRM UNDER PENALTV OF PEFJURV ONE OF THE FOLLOWINQ DECLARATIONS: Z - � _I HAVE M!D WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORI(ERS' a � COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE IABOR CODE,FOR THE PERf-0RMANCE U Q OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED. � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION /� ///�� 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF iHE WORK FOq WHICH THIS PERMIT IS •l� � ISSUED.AIV WORKERS'COMPENg{A�TIO�N/y�SURANCE CARqIER AND POIICV NUMBER ARE: CONSTRUCTION X j CARFIER 1v/ . PLAN REVIEW � � POLICYNUMBER�I a ELECTRIC ¢ � (rwssEcrqr�nFIDraieEao'.s�ErIDOFn-EVE or�E�p �tiro�oa�ss� PLUMBING � w Z I CERTIFY THqT IN THE PERFORMANC HE RK FOR ICH THIS P I IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN Y M N 50 A TO C EC TO THE (n WORKERS'COMPENSATIONLAWSOF ALIF RNIA, IFI BECOME INSPECTIONFEE S SU ECT O 7HE WORNEFS'COMPE ROVI ION� O THE LABOF , E,I ALL FORTHWITH COMPLV T O ISSUANCE � �+- p DATE: �� APPLICANT: SMIP � l W J WARNINO:FAILURE TO SECURE WORKERS'CAMPE SATION COVERAOE IS U ALL BE ENERGY P/C J , � SU&IECTANEMPLOVEHTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOl15AfJD ENERGYPERMIT DOLLAAS(5100,Oa0),IN ADDITION TO THE COST OF CAMPENSATION,DNAAGES AS PROVIDED FOR IN J SECTION 37oe OF 7HE IABOR CODE,INTEREST,AND ATTORNEV'S FEES. - �� w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PEfiJURV THAT THERE IS A CONSTRUCTION LENDINQ AOENCY � FOR THE PERFOflMANCE OF THE WORK F WHICH THIS PERMIT IS ISSUED(SEC.JOB7,CIV.C.). Z W � LENDER'S NAME � LENDER5ADDRESS w I CERTIFV THAT I HAVE FEAD 7HIS AP7LICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES � I AGREE TO COMPLV WITH AlL CITV AND COUNiY ORDIN 5 AtJD STATE LAWS RELATING TO BUILDINO �� CANSTRUCT40N,AND HEREBV AUTHORIZE REPRESE IVE F THIS CW NTV TO ENTER UPON THE Z V IONED PPOPE OR INSPEC7ION P PoSES. COMMENTS � �� SC�'"-�-- m PE TTEE E(PRIM � Q O�� SI URE DATE � RECPT.NO. PqID BY VALIDATION T — e m nt Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIDENRO�File Copy,GREEN—Applicant's Copy (G��1'� �6� (�9l�1f�(CDG�l� �ll(� �fi��(�'[��'�S�f�9 (��C�� C� Do G'a1�J� ��° o� l��C�`�`�Lf�C�tf`�.l , D .� � a�?� p �' , � SET BACK FLOOR J�IST FT'GS/FORMS;STEEL FHA REC2hAT5 EI.ECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING � UNQER FLOOR CU�IDUIT SLAB GRADE FIREPLACE�FOUNDATION � TEPIIP POWER ' FIREPLACE BOND BEAM WATER SERVICE �_ � MID HT. BOND BEAM ' ROOF SHEATHING ' _� dl ` �___ -r�-�{pr' F � __ FRAMINGNENTILIATtO�+ � FINAL BOND BEAM ROOF COVER "_`$�dL �P E-GRAQING � �� ROUGH HEATING BENCI-iING ROUGH ELECTRIC ROUGH GRAD'NG ROUGH PLUIUIB►NG FIIJISH GRA�ING � SHOWER/TUB TEST POOL ELECTRIC EXT. 1�1T4-1/SIDING POOI FENCING WALL INSULATION POOL FINAL j �EILING INBULATION QFF SITE IMPS. DRYWALL NA{LING DEDICATIONS SEWER FWAL ENG. � SEPTIC TANK LANDSCAPE/iRRfG. SEEP PIT/L.L. ON SITE IMPS. � GAS A!R TEST FINAL ZONING FIN,4L CO(VST. __� �_c��f�� , FIRE DEPT. FINF�L FINAL I-IEATINC, � HEALTH DEPT. FINRL FINAI.ELECTRIC / �- DEV. FEES PAID FINAL PLUfv1BlNG ENERGY �.____��. � p l( O(�C�a CC7�/if�EfVTS SEPTIC TANK SIZE ! ^ SEEP PIT/U SIZE . � � , � � � � �