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Home My WebLink About11408 --�— CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E.Copley Drive Suite 190 PRESS � (909)860-3195 Fax(909)861-3117 �'""' BUILDING PERMIT APPLICATION FI R M LY JOBSITE n (�/ APPLICATION ' PEFIMIT L� P/C /� o ADDRESS �� I'S�D� �q"V• DATE � �� NUMBER 1� # ��lD" � ISSUE TYPE OCC � APN LOT TRACT DATE � CONST. GROUP p OWNER � ADDRESS D6 � 10- � ZONING SETBACKS Z CITY �IA'r''ti�*+h I��_ ZIP 6 TEL - bo�� FRONT RW ❑ � APPLICANT � TEL. REAR ❑ � � SIDE/SIDE STREET RW ❑ a CONTRACTOR �'l76 �b�S(�nhl � C.uIvS�I1�IGTio/�Lb. SIDE ❑ o ADDRESS ' PROPOSED USE ��'� S�F �M /�'��I�O,hI CITY �,A-/_/�L(� ZIP�� TEL. - -O --r- w ARCH/ENG/ I, -'D C D z DESIGNER ��K NO.DWEL. NO. � NO. � ADDRESS /1'7iU C. S�I�N �j ��ti UNITS STORIES BEDROOMS � CITY ��G�'1S'�� ZIP��j TEL. � ��i� � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BI;ILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTY OF PERJURY THA7 I AM EXEMPT FROM THE CONTRACTORS LI� � Garage/Carport W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCADE:ANYCITYOR U COUNTVWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIFANVSTRUC- W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMEN7 THAY HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI� � CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSP2 � FESSIONS CODE)OR THAT HE OR SHE IS EXEMP77HEREFFOM AND THE BASIS FOR THE ALLEGED EXEMP� V TION.ANV VIOIATION OF SECTION 7091.5 BY ANY APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof A CIVIL PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f5oo).): ❑I,ASOWNEROFTl1EPROPERTV,ORMYEMPIOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 O Commercial Z WILL�O THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7046,BU51� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � � PROPERTYWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR m CC THROUGHHISORHEROWNEMPLOVEES,PROVIDED7HATSUCHIMPROVEMENTSARENOTINTENDEDOR w OFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SAIE). � �_ ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCANTRACTINGWITHLICENSEDCANTMCTOflS TO CONSTRUCT THE PFOJECT(SEC.701t,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI� V8IU8�1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSOHIMPFOVESTHEREON,AND . � WHOCONTRACTSFORSUCHPp0.1ECTSWITHACONTRACTOR(S)LICENSEDPURSUANT70THECONTRAC- QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). .) I_ � ❑I AM E%EMPT UNDER SEC. 8.d P.C.FOR THIS REASON Q � �v �( V�� II�� U � � DATE OWNER U Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSE�UNDER P(70VISIONS OF CHAPTER � I �p,� � 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND � v• X MV LICENSE IS IN FULL FORCE AND EFFECT. (� d � LICENSE CL4SS � LIC.NO. (�� Q � I m Z L S � V DATE�= ' CONTRACTOR �� U�I y1y ��A a �� w -r O q�� T�� ,/I��n� H�3"W�RKEFIS'COMPENSATION DECLARATION U �Y � � Q � I EREBVAFFIRM UNDER PENALN OF PERIURV ONE OFTHE FOILOWING DECURATIONS: Z � I HAVE AND WILL MAWTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WOFKERS' _ �CAMPENSATION,AS PROVIDED BY SECTION 370oOF THE LABOR CADE.FOR THE PERFORMANCE U ¢ OF THE WOFK FOF WHICH THIS PEiiM1T IS ISSUED. � 0 w _I HAVE AND WILL MAINTAIN WOFiKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION Q 37oa OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �� 'S ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION .� iI . /S) � � CARRIER ST��'i �GN�� PLAN REVIEW ` Z POLICVNUMBER ELECTRIC •�� Q Q � (iHISSECI%JNNE�NOTBECOMREfEDOFTHEPEMUrISFaRONEHUI�DREDDOLLARS(f100)ORLESS). PLUMBING �2.. �/0 Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMI7IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECTTOTHEWORKERS'COFIPENSATIONPROVISIONSOFSECTION37000FT 'CABOR � CODE,I SHALL FOiTH�H COMPLV WITH THOSE PROVISIONS. �SSUANCE ��.D�L� � SMIP I T�� p DATE:�� APPLICANT: 1 � J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL.AND SHALL BE ENERGY P/C 1 '�� J � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT • � �,� DOLURS(5100.000),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SEC710N 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: .• u O Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THEilE IS A CONSTRUCTION LENDING AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERMIT IS ISSUED fSEC.3097,CIV.C.). Z W � LENDER'S NAME � LENDER'SADDRESS /� � I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORHECT. TOTAL FE ES ' f 2 Lb�'R / �� "Z w I AGREE TO COMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS REIATWG TO BUILDING � CONSTRUCTION,AN�HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ZABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � W �I7��N Gb� ��31 � � � QPERMITTEE NAME(PRINT) ' ��_ (/J Uj SIGNA7UREOFPEHMITTEE / DATE � = RECPT.N0. PAID BY VAIIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy . ��V O� D1A��i� ��9� . B�9S(�f��O�Df� ff�[�'��f�� ' �� --oyyy—��, �� `�; �; tr'LS��J`�u�W '°��•' �,�lt''t��—�� T. � '�"� ' � � � � � a � , D�l:� a ' ;°_ � �e� � � , � . '. , t. ...� SET BACK F�OOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLQOR DUCT � GROUND PLUMBING UNDER FLOOR CUPIDUIT . SLAB GRADE FIREPLACE FOUNQATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE • MID HT. BOND BEAM ROOF SHEATHING ' 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM � ROOF COVER PRE-GRADJNG ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST �"'•'� POOL ELECTRIC EXT. LATH/SIDING PODL FENCING WALL INSULATION �'�'� POOL FINAL CEILING IfVSULATION 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. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY o �� =�� 5._w ; _ � . COiVliViENTS � �r' �1 t'��y 3 _,�� i..J - � _., .. . SEPTICTANKSIZE ��' �`. •; .`ii.'' SEEP PIT/U SIZE � � 4 .' d � � . 4 5��. ' ' +�4 �� }�S��^��. ��, � �� ' �'� � ; a � ��t�r � ��,z "�� :�'. �� A�� . ;: