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Home My WebLink About10-1183 (5) CTTY OF DIAMOND BAR ' I ^---" �� 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 �'°""~ BUILDING PERMIT APPLICATION FIRMLY � JOBSITE y `�� APPLICATION / � PERMIT � p/C o ADDRESS__��O YGtIr�� Yi,Sra� efY .J�'✓3. � DATE_ /I.�A�/o NUMB O� # � APN LOT TRACT DA EE / /�,�_TMPE �� OCC p OWNER Lf�GG � �� CONST. GROUP p ADDRESS � � � Y� ' %S e�Y ZONING SETBACKS z CITY ZIP TEL.9o9 �6/-,�'�$ FRONT qyy p � APPLICAN TEL. � REAR � �� SIDE/SIDE STREET RW ❑ CONTRACTOR G�G e c � b0, SIDE p ADDRESS �2 ,� st� �� CITY /�.o��,- ZIP��7� TEL. � — 2f PROPOSED USE "I-" � o ARCWENG/ ._ � �z DESIGNER NO.DWEL. NO. Np, N ADDRESS UNITS � STORIES oZ BEDROOMS ^��/� � CITY ZIP TEL. � � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM � 1 HEREBY AFFIRM UNDER PENALTY OF PEiLIURV THAT I MI E%EMPT FROM THE CON7RACTORS LI- G8l9gB/C0lPOR W CENSE UW FOR THE FOLLOWIN�flEA50N(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITV OR (n U �JrJTyWF{ICHREWIRESAPERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOUSH,ORREPAIRANYSTRUC- W peNo/Deck � TURE,PRqR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w � STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- � Pool/Spa , � FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOED E%EMP- C7 TION.ANVVqLAT10NOFSECTION7071.6BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(i500).): 0 ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, � COffITBfCIBI Z WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Wa,BUSI- J N NESS AND PROFESSIONS CODE THE CONTfUC70R5 UCENSE LAW DOES NOi APP�V 70 AN OWNER OF � PROPER7V WFIO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR WTHROUGH HIS OR HER OWN EMPLOVEES.PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m Q OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWfTHINONEVEAROFCAMPLE� i Z TION.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OH SHE DID NOT BUILD OR � IMPqOVEFORTHEPURPOSEOFSALE). w ❑I,AS ONRlER OF THE PHOPEHTV,AM E%CLUSIVELV CONTRACTINO WITH UCENSED CONTRACTORS i � TO CONSTRUCT THE PqQIECT(SEC.7WI,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOR9 LI- VBIllfltlOfl A0.1.AREA W CENSELAWOOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBU4DSORIMPROVESTHEREON.AND � WFIOCONTMCTSFORSUCH7RQIECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION roas ucENSE uw.�. FEE � ❑I AM E7(EMPT UNDEfi SEC. B.8 P.C.FOR THIS REASON � � U LL' OATE OWNER � Z U �Q LICENSED CONTRACTORS DECLARATION w 2 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � �(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CADE,AND Z LLJ ��CENSE IS W FULL FORCE AND EFFECT. m � LICENSE CLAS �!� � LIC.NO. Do7- �"O � V DATE I � CONTRACTOR Q'v` d W � WORKERS'COMPENSATION DECLARATION � � . , � U � I HEREBY AFFIRM UNDER VENALTV OF PERJURY ONE OF TME FOLLOWING DECIARATIONS: Z ' � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a 2 Q COMPENSATION,AS PROVIDED BV SECTION 3700 0F THE LABOR CODE.FOR THE PERFORMMICE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � � w I HAVE AND WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q J700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � /�f/� � ISSUED.MV WORKERS'CyMP�Q SATION INSUAAIJCE CARRIER AtJD POLICV NUMBER ARE: NSTRUCTIO 7�� /_.� /�...,r�/ � CARRIER \%7«�! Y-�'r�"'� PLAN REVIEW Z POLICV NUMBER � ?9� ELECTRIC � ¢ � (1}OSSECfqNNE�N0TBE00AGlE7EDOFTVgPERMfTISFpqONEFIA�DREDD01.LPfLS(5100)ORLE55} PLUMBING W Z I CEHTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE (/) WORNERS'COMPENSATION IAWS OF CALIFORNIA,AND AGHEE THAT IF I SHIXILD BECOME INSPECTION FEE SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFS TION37ooOFTHELABOR S CODE.I SHALL ORTHWITH COMPLV WITH THOSE PRO � � p DATE: �� /V APPLICANT. IP w ENERGY P/C � 'J WARNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE J � SU&IECTAN EMPLOVEF TO CRIMINAL PENALTIESlWD CIVIL FINES UP TOONE HUNDRED TMOUSMID ENERGY PERMIT DOLURS(5100,000),IN�DDITION TO THE COST OF COMPENSATbN,OAMAGES AS PROVIDED FOR IN � ¢ SECTION 3708 OF THE LABOR CODE.INTEREST,ANO ATTORNEVS FEES. �E ION F ��, OCONSTRUCTION LENDING AGENCY P ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINO A6ENCV �� d FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV,CJ. Z W � LENDER'S NAME F— LENDER'S AODHESS w ICERTIFVTMATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATqNISCARRECT. TOTALFEES r3O�'� � I AGREE TO COMPLV WITH ALL CRV AND COUNTV OqDINANCES AND STATE UWS REUTINO TO BUILDINO � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ' Z ABOVE-MEMpNED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � �0��x ��i ` �� J � � QPERMITTEE NNAE(PRI � � �� /��0 � � SIONATUREOFPERMITTEE DA E � 2 RECPT.NO. � PAID BY VALIDATION �— WHITE—Department Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy , C@YY OF DIAii�Oft�D �,4R � II�S��CTIOi� 9�(�CORD .� oa�p�c�ooa , o��, v,, ;, -�� :;. a��c�ooa 3�A o�'�_�#'�� . s � � a � 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 MID H'L BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTIIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�fUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCIIVG 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 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' o COIViMEPVTS �Z SEPTIC TANK SIZE SEEP PIT1U SIZE U�J � G .t � �4 -