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Home My WebLink About17746 (1325) CTTY OF DIAMOND BAR ' � ! �---��---- DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��"�9�" BUILDING PERMIT APPLICATION FIRMLY , JOBSITE � APPLICATION PERMIT � P/C o ADDRESS �� S, v/�LL(L�T �S�/� DATE ��O� NUMBER � # O� r � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER S o ADDRESS�ZD MAIIU cS' 1 . �� ZONING SETBACKS gCITY ��\,J1 til�- ZIP�� TEL. 4Q-GZZ-3�IC FRONT qyy ❑ APPLICANT TEL.--v REAR p I � SIDE/SIDE STREEf RW ❑ � CONTRACTOR SW A1 1\.J �I C�N r �N � ' SIDE ❑, Q ADDRESS I'?s Li r. , �'S 5 1 i` � � CITY C')�iTA 2�(�L_ ZIP �7 TEL. �ZT,j� PROPOSED USE�� STyT� v� �1 ��N-I 1.��,(m �y • o ARCH/ENG/ L-P-l7 5=PS ��1 f��1�' iz DESIGNER NO.DWEL. NO. Np, a ADDRESS � CI7Y ZIP TEL. UNITS STORIES BEDROOMS cr� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBV AFFlRM UNDER PENALTY OF PERNRV THAT I AM E%EMPT FROM THE CONTRACTORS LI� GBfO B/C8 Ofl W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCOOE:ANVCITYOR (n 9 � U �p�rJJyWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH.ORFEPAIRAtJYSTRUC� w w TURE,PRIOR TO ITS ISSUMICE,AL50 REWIRES THE APPLICANT FOR SUCH VERMIT TO FILE A SIGNED w Patio/Deck � � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF T1E CONTRACTOflS LI- � � CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO� POOUSpe ^ FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP� (� V TION.MIVVIOUTIONOFSECTION7031.6BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Foof A CML PENALTY OF NOT MORE THAN FfVE HUNDRED DOLURS(f500).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfflrtlBfClel Z WILL DO 7HE WORK,AND 7HE STRUC7UFE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7aa,BUSI� J � � NESS AND PROFESSIONS CODE:THE CAMRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEHTY NM1iO BUILDS OR IMPROVES THERE-0N,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR w7HROUGHNISORHEROWNEMPLOVEES,PROVIDEDTHATSUCNIMPROVEMEMSARENOTINTENDEDOR m � OFFEREDFORSALEIF,HOWEVE{i,THEBUILDIN00RIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� , Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OH SHE DID NOT BUILD OR � IMVROVE FOR THE PURPOSE OF SAL�. w ❑I,ASOWNEROFTHEPROPEHTV,AME%CLUSIVELYCANTRACiINOWfTHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7oN,BUSINESS AND PqOFESSIONS CODE:THE CONTRACTORS ll- V81U8�i0f1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANON7JEROFAPHOPERTYWHOBUILDSORIMPROVESTHEREON,AND � WFiOCONTMCTSFORSUq1PHOJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECANT{UC� OUANTITY DESCRIPTION FEE Y TORS UCENSELAW.). � ❑I AA/EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q �2 U � DATE OWNER F— Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENA�TY OF PERJURY THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCINO WITH SECTION 7oa0)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AN� Z X MY LICENSE IS W FULL FOHCE AND EFFEC7. � m LLI �A 2 lj (,.� � UCENSE CLASS�l/�v O O"'1 LIC.NO. G 1 S � � J U DATE�'��O� CONTRACTOR� a W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBY AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWINO DECLARATIONS: Z �Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUFE FOR WORKERS' a Q CAMPENSATION,AS PROVIDED BY SECTION 3�00 OF THE LABOR CODE,FOR THE PERFORMANCE U Q OF T E WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE AtJD WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REWIRED BY SECTlON �� 37aa OF THE LABOR CODE,FOR 7HE PER WRMANCE OF THE WORK FOfl WHICH THIS PERMIT IS , ��, ISSUED.MV WORKERS'COMPENSATION I �CE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � j CARRIER 5�� PLAN REVIEW �J J , Z POLICV NUMBER I �� Cy�1 ELECTRIC ¢ p (IHISSECTqNNE�NOTBE00A¢LFfEDOFT}�PE{��$Fpqp�¢{{�J�.pqEppqy��y�pp�pq��r} PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C} SHALL NOT EMPLOY ANV PERSON IN ANV MlWNER 50 AS TO BECAME SUBJECT TO THE N WORNERS'COMPENSATION LqW50F CALIFORNIA,AND AGREE THAT IF I SHOUTA BECOME INSPECTION FEE = SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR /� CODEISHALLFORTHWIhiCOMPLVWITHTHO5EPRl0 5. ISSUANCE UV p DATE:v �_OZ APPLICANT� J"�� SMIP '� (� W "'� WARNIN�:FAILURE TO SECUFE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C J � SU&IECT�V!EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE MUNDRED THWSAND ENERGY PERMIT DOLLAAS(f1o0.o00�,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION�]oe OF THE LABOR fADE,INTEREST,AND ATTORNEY'S FEES. w RETENTION FEE: � O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.Joe�,CIV.C.�. ' Z W � LENDER'S NAA/E � LENDERS,O�DRE55 � � (� w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES � � �� `J� ��' � 1 AOREE TO COMPLV WITH ALL CITV AND COUN7V ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO ENTER UPON THE ? �NTqNED PROPER f^R S�N PURPOSES. � � � �� COMMENTS J n�� P� E�(PRI� �� A Fr,_(� � SIONANREOFPERMITfEE DATE , ` = RECPT.NO. PAID BV v VALIDATION ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy c�B��Y �I� [�U�l[�1�[�¢� [��l(f� ��l�L��{��D�I� IF��L�?� �� „ OG��DC� D� �� {�°��'" o R � � U o "� a�� o�m � SET BfiC6C FLOOR J�IST FTGS/FbRMS/STEEL � FHA REC�MTS ELECTRIC GROUND _ __ i_� UNDER FLO�R DUCT _ GROUND PWMBING ' UNDER FLOOR CU�IL?tJiT SLAB GRADE FIREPLAGE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. B�ND BEAM ROOF SHEATHING $ FT. BOfvD BEAM FRAMfNG/VENTILIATtON FINAL BOND BEAM ` '^ ROOF COVER PRE-GRADING ROUGH HEATING BENCNING ROUGN ELECTRIC ROUGH GRADING � ROUGFi PLUNIBING �INISH GRADING � SHOWER/TUB TEST POO�ELECTRIG EXT. LATH/SIDING POOL FENCING WALL INSUTATION POOL FINAL CEILING INSULATlON OFF SITE IMPS. DRYWALL.IVAlLING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK . LANDSGAPE/IRRIG. SEEP PfT/L.L. ON SITE IMPS. GAS AIR TEST FlNAL ZONING FlNAL COhlST. 3�g.pZ,�� FlRE DEPT. FINA! FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID _, FINAL PLUMBIMG ENERGY C�G�OO(� o � o COMii�Ef�TS SEPTIC TAiVK SIZE SEEP PIT/U SIZE - � � � � ' °�;, - -- � �. � � � . .