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Home My WebLink About13682 (859) ��6�� - • 1� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES S E P 10 2002 21660 E.Copley Drive Suite 190 (909)86Q3195 Faz(909)861-3117 PRES$ �� BUILDING PERMIT APPLICATION �IRMLY o DDRESS �7 f•�/ � DATEICATION`� Z,� G� NUMBER �� v #/C -1 1- �� ISSUE TYPE OCC � AP OT � TRACT DATE CONST. GROUP p OWNER �., � " ADDR�F.$S Q.t.+ ZONING SETBACKS � CITY��T� ZIP�(� TEL.j� FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR Ci SIDE ❑ Q ADDRESS PROPOSED USE '�P�..�21�.� YA<<•e�'�F-'l� � CIN ZIPq TEL.� '� o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFlRAI UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE COHTMCTORS LI- GefdJB/CBfPOfI � W CENSELAWfORTHEfOLLOWINGHEASON(SEC.7N7.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR (n CJ COUHfYMMICHREWIRESAPERMITTOCONSTRUCT,/LLTER.IMPROVE,DEMOLISH,ORREPAIRANVS7AUC- W patio/Deck w 7URE,VRIOR TO ITS ISSUANCE,ALSO REOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CANTRACTORS LI- � CENSE LAW(CHAPTER Y(COMMENCINa WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- V" POOVSpB FESSIDNS OODE)OR THAT HE OR SHE IS EXEMPT TNEREFROM M1D TME BASIS FOR THE ALlEOED EXEMP- TqN.ANYVI0UT10NOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Raot � A CML PENAL7V OF NO7 MORE THAN FNE HUNDRED DOLURS(i5ao).): � ❑I,ASOWNEROFTHEPROPERTY.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, 0 COrt1filBfClel � WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFiEO FOR SALE(SEC.70a�,BUSI- J NESS AND PROFESSIONS CODE:hIE CANTMCTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPEHTVNhqBUILDSORIMPROVESTHEREOH,ANDNh1000ESSUCHWORKHIMSELFORHEPSELFOR m CC THROUI3H HIS OR HEH OWN EAIPLOVEES,VROVIDED THA7 SUCH IMPROVEMEMS ARE NOT INTENDED OR � OOFFEREDFORSALEIF,FiOWEVERTMEBUILDINOORIMPROVEMENTIS50LOWITHINONEVEAROFCOMPLE� Z �'TqN,THE OWNERAUILDER VALL HAVE TME BURDEN OF 7ROVINO THAT HE OR SHE DID NOT BUItD OR � IMPROVE FOR THE PURPOSE OF SALE). ❑I,AS OWNER OF T1E PROPEHTV,AM E%0.USIVELY CONTMCTINO WfTM LICENSED CONTMCTOHS � TO CONSTRUCT THE PROJECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- �Valuation ADJ.AREA W CENSE LAW DOES HOTAPPLY TOAN OWNER OFA PROPERTV WHO BUILDS OH IMPROVES THEREON,AND � W/iOCOHTMCTSFOR5UCH7RO.lECTSNATHACONTMCTOR(S)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE � loas uceHSE uw.�. ❑I AM EXEAIPT UNDER SEC. B.8 P.C.FOR THIS REASON Q 3 � � � DATE ONMER V W � LICENSED CONTRACTORS DECLARATION w � 1 MEREBY AFFIHI/UNDER PENALTY OF PERIURV TNAT I AM IICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCWO N7TH SECTION 7000)OF DIVISION 9 OF THE BUSINESS AND PROFESSIONS CADE.AND Z .LI X MY LICENSE IS IN FULL FORCE AND EFFECT. m LLI � UCENSE CU S � LIC.N0. �� /� � V DATE_��...�L� CONTRACTOR � a W � WORKERS'COMPENSATION DECLARATION Q � U N I HEREBY AFFIRM UNDER PENALTY OF PEfiIURV ONE OF THE FOLLOWING DECLARATIONS: C� Q 0 I NAVE AND WILL MAINT/JN A CEiiTIFICATE OF CONSEN770 SELF-INSURE FOR WOHNERS' 2 � COMPENSATION,AS PROVIDED BV SECTION 370o OF THE UBOR CADE,FOR THE PERFORMANCE W OF THE WORK FOR VMICH THIS PERMIT IS ISSUED. � � W I HAVE AND WILL MAINTNN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION I !� '1 Q 970o OF THE UBOR OODE,FOR THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS {��) � � /� ISSUED.MY WORKERS'COMPEHSATION I SURANCE CAHRIER AND POLICY NUMBER AfiE: CONSTRUCTION �'7�j�'�� P �J✓ v jCARRIER � ��y PLAN REVIEW L—I ✓.l_.V.� � � Z POI.ICY NUMBER�� 9� ELECTRIC Q . � (f}C65E(.'fqNNE�NOTBE00APlEfIDOFiYfrPERMTISFORONEHIN�DFimWLLl�iLS(S10D)OR�ESS} PLUMBING — Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMI715 ISSUED,I MECHANICAL �� (3 S1WLL NOT EMVLOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE � WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGFEE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORNERS'COMPENSATION GROVISIONS OF SEC7�O�N 7o00F THE U R ,�� rj COOE SH ORTHWITHCAMPLYWI7H � EPpO 10 IJ'SUANCE 111�! r-v nnnn o �uiv j u t�;s� p DATE:� APPLICANT: � SMIP �'�� ENERGY P/C �j�1��?:C�+j ?,� "��:Ts�'Y`[},�� J WARNINO:FAILURE70SECUREWORKERS'CAMPENSATIONCOVERAGEISUNUWFUL.ANDSHALLBE J_:._,. � SU&IECT AN EMPLOVER TO CRIMINQ PENALTIES AND CIVIL FMES UP TOONE HUNDRED THOUSAN� ENERGY PERMIT --:� � % ' � � " ' �/ DOI.LARS(i100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 970E OF 7HE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � 2 a CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTHUCTION LENDING AGENCY �Y�I� FOR THE PERFORMANCE OF THE WOPK FOR WHICH 7HI5 VERMIT IS ISSUED(SEC.3087,CIV.C.). W � LENDER'S NAME �� 1— LENDER'S ADDRESS � � I CERTIFY THAT I HAVE READ THIS APPLICA710N AND STATE THAT 7HE ABOVE INFORMATION IS CARRECT. TOTAL FE ES / I�,1 /1�' � I AGREE TO fAMPLV WITH PLL CI7Y AND COUNTV ORDINANCES AND STA7E UWS REUTING TO BUILDING r �if �� \J/ � CONSTRUCTION.ANO HEREBV AUT}iORRE REPRESEN7ATIVES OF THIS COUN7Y TO ENTER U70N THE '(_�-��,j��/� Z ABOVE-MENTIONED PROPE FOR INSPECTION PURPOSES. COMMtIYI S � � P_g � « QPERMI AME(PRINT) � � � � �� N TUREO PERMI DATE = RECPT.NO. PAID BY VALIDATION ~ W ITE-0eparlment Copy,YELLOW--Finance Capy,PINK—Assessor Copy,GO ENROD--File Copy,GR N—Applicant's Copy - , � .. .. �. , . 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FRAMINGNENTILIATION FiNAL BOND BEAPvI � ` � '� � , ROOF COVER PRE-GRADING � ROUGN HEATING BENCHING ROUGH ELECTRIC ROUGN GRADING ~ ROUGH PLUIUIBING i FlNISH uRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING T-- WALL IiVSULATION POOL FiNAL CEILIiVG INSULATION OFF SITE IMPS. QRYINAL.L NAIUNG DEDICATIONS ; ____-- -----._.._ _— SEWEt� FiNAL ENG. ' — -- • , SEPTIC TANK LANDSCAPE/IRRIG. j , SEEf' PIT/LL ' ;`_. � �N SITE IMPS. —.� -----._.__.--.-.- iaAS AIR TEST FINAL Z�NING- FIfVAL COiVST. F{RE DEPT. FINAL - V � � FIN�L HEATING HEALTH DEPT. FINAI. I FIP�/�L ELECTRIC DEV. FEES PAID � �� =1N/�L PLUMF3ING � ENERGY -� . — -----__�---------- , ,,. -- � � �i '� ��"`"��. ��;r �:: :_ ...�,�. . :�:. �---- - � �. .;.. ---- �C��NiEf�'TS • .� • . � ... . si:,�a• �S_.� �i`\,��:,� : .-- -- ;,L�`r� �?.._T__�h:` _ . � , � '� � . .. , -,,.� —�C-`:,_� y �' , - .. , . SEPTIC TAPVK SIZE ----- — -----._.._..-- SE�P PI�'/U SIZE _._ -------�_�_ _____------ a � ` �' � - eP�h � , _ _ • -- . _ . � . c3 A v v 1� �.. , � ' .tf:� . , i _ ._ �� ________.._.. . . 1 .�4 t. � )�--'\`�' '�:�:\)`.� ' . ... . ' . . •� Y ,'\ \ ' �� . - .. i .. \` �`i :�'' ' �J� v��Y.`� •�`'r��V �� .__� � � ��.. � .� � .( �!��—�..�� V. \`•--.._,._._.�..�� C _.�.�,w �\.__.�_ I