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CITY OF DIAMOND BAR �
—�--��` --- DEPAR'TMENT OF COMMUNITY&DEVELOPIvIENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRES$
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} JOBSITE � , APPLICATION /� / PERMIT f P/C
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� ISSUE � � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIGNED w Patio/Deck
S7ATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooVSpa �
� FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
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A CIVIL PENALTV OF NOT MOFiE 7HAN FIVE HUNDRED DOLURS(5500�.):
� OI,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N, � COmfil0fCl21 -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7oI4,BUSI- J
N NESS AND PROFESSIONS CODE:7HE CANTRAC70R5 LICENSE LAW DOES NO7 APPLY TO AN OWNER OF � , �! J
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DATE b J OWNER �
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� LICENSED CONTRACTORS DECLARATIO w
� I HEREBY AFFIRM UNDER PENPL7Y OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� p(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MV LICENSE IS IN FULL FORCE AND EFFEC7. m
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� WORKERS'COMPENSATION DECLARATION Q �S._/�� • �
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NIHEREBVAFFIRMUNDERPENALTVOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: Z
0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE fOR WORKERS' a
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Q CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CADE,FOR THE PERFORMANCE W
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SEC710N
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT 15
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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Z POLICV NUMBER ELECTRIC v
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Z I CERTIFV THAT IN THE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I!J/�� i
(.'} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECAME SUBJECT TO THE I
� WORKERS'COMPENSATIONUWSOFCALIFORNIA,ANDAGHEE7HATIFISHOULDBECOME INS?ECTIONFEE �
� SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 37000F THE U80R •i1 J I
� CODE,I SHALL FORTHWITH COMPLV WITM THOSE PROVISIONS. ISSUANCE �c� ��
p DATE: APPLICANT. SMIP -/r �
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHAIL BE ENERGY P/C
� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINE5l1PTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(5700.000),IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
¢ SEC710N 3708 OF THE 1A80R CODE,IN7EREST,AND A7TORNEY'S FEES. FETENTION FEE:
a CONSTRUCTION LENDING AC,ENCY PRE-ALT FEE: 7
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV _ _ ��
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.J097,CIV.C.�.
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� LENDER'S NAME
� LENDER'SADDRESS ,
� TOTAL FEES ��• ��
� 1 CEfiTIFY THAT I HAVE READ THIS APPLICA710N AND STATE TFIAT THE ABOVE INFORMA710N IS CORRECT.
w I AGREE 70 COMPLY WITH ALL CITY AND CAUNTV ORDINANCES AND STATE UWS RELATING 70 BUILDING S D.
� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESEN7A71VESOFTHISCOUNTVTOENTERUPONTHE
� ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES.
Z COMMENTS I 3/ �
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� PERMITTEE NAME(PRINT) � �� Q
� SIGNATU. OF RM DATE
= RECPT.N0. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, OL ENRO�File Copy,GREEN—ApplicanTs Copy
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SET BACK � FLOOR JOIST � '
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FTGS/FORMS/STEEL '; FHA RECIMTS �
ELECTRIC GROUND '; UNQER FLOOR DUCT � j
-- ---- _ _---- -�--- -- --...�----...__ __...-----
GROUND PLUMBING UNDER FLOOR CU�IDUIT ___
SLAB GRADE ._ _ _ FIREPLACE FOUNDATION __ !_ �___��_�
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TEMP POWER � FIREPLACE BOND BEAM � _
W,4TER SERVICE � • i N11D HT. BOND BEAPu1 ,
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ROOF SHEATHihlG 8 Ff. BOND BEAM � _
FRAMINGNENTILIATION FINAL BC3ND BEAM ;
- ---- _ ---- _ .. ___._........---
ROOF COVER PRE-GRADING � '
ROUGH HEATING BENCHlNG �
ROUGH ELECTRIC I ROUGH GRADING _
ROUGH PLUMBING I FlNISH GRADi�1G
— --- -----___
SHOWERlTUB TEST � POOL ELECTRIC
EXT. IJaTH/SIDIfVG POOL FENCING f
WALL Ii�SUlATlO(V POOL FINAL
CEILING IN�ULATION OFF S11'E IMPS. ; �
DRYWALL NAILIfVG DEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/Ll.. ON SITE IMPS. ---- -`---v_^---
GAS AIR TEST FINAL ZOiVING
FINAL CONST. FIRE DEPT. FINAL �
FINAL HEATIt�G � HEALTH DEPT. FINAL !
FINA�ELECTRIC � DEV. FEES PAID
FINAL PLUMBING ENERGY
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„ �� SENT BY:Xerox Telecopier 7021 ; 1-24-01 ; 2�12PM ; LACSD-FIN PLAN/PROP� ;� 2
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RECLAMATION
AOLIDWAJTEM�NAOEMENT COUNTY SANITATION DISTRICTa
OF L�S ANGELES COUNTY
1955 Workmon MII1 Road,Whinier,CA 90601-1400
Mailing Addreaa:P.O.Box 4998,Whittiar,CA 90607.d998 1AME5 F. STAHL
Telephone:{562)699•7411,FAX: (562)6995422 Chief Engineer ond Generol Monoger
Coun�FHbi�'�� 7:00 fl.m.- 4:00 p.m.Mou.-Thurs.
7:00 a.m.• 3:00 p.m.Fti. ��
-Aeco�i�tl�tS:� ��Q'L!.�� ;
:t�71s�t�tSC>Ata.k :21� ; :
SEWERAGE SYSTEM CONNECTION FEE �
Dare: January?A,2001
Froperty Owner; WILLIAM JUN ..
Address of Prop�rty: 2534 WAGON TRAIN LANE
DIAMOND BAR, CA 91765
Thomae Guide Page:
Contact: VIC HIZON
Phone; 909-429-8028 ,
Mailing Address: SAME ''
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County Asaessor Map Book,Page, and Parcel Aiumber: 8'713-026-014
I Struccure ia Proposod, I
User Cat�gory and Unirs oP Ueage:
cac�gory: O1 A
� Number of Uni�s: I
ISquare Footage:
� CO CTION E CALC ATION �
�
; 1.00 X $1,290.00 = ��•�
I Number of Unics of Usage Connectlon Pee Per Unit of Usage Connocdon Peo
1
CO�E�
� +'NO FEE-TENANT IMPROVEMENT ONLY(AriDING 3 BBDROOMS TO AND $0.00
EXTSTING SINdLE FAMILY HOM�) Connecdon Fee Due
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� ` SANITATION DI3TRICT8
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� ' �� Y � APPROUED
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l Raoyeied P�p�r . BUILDIIvG DEPT COPY
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WALNUT VALLEY UMF'IED SCHOOL DISTRICT
� � � ' 880 SOUTH LEMOIY AVENCTE WALNUT CA 9U89
CERTIFICATE OF COMPLIANCE �
With Fee Provisions of
Government Code Section 65996
DEVELOPER/OWNER /�'��• �/���- /�l —�u�✓ �t/- �
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ADDRESS 2,,�3� G��C�o T�AZN �...a.ne Signanue of Applicant
CIT'Y/ZIP fl iGt.�t o�r a� .13a�. G�1. 9/�7�-s` 'The person signing represents that he/she is su�horized
TELEPHONE 90�_6�2—�6�/. �i c�—�1.r—zoB�C te(/� to sign on behalf of the owner/developer and that che
. information provided is true and accurate ro the he�t ot
his/her lmowledge. �
NEW LOT ADDRESS USE OF BUILDING TOTAL SQ. FT.
Residential/Commercial/Industrial
Ciry " " � .
HOME IMPROVEMENT OR REMODELING PROJECT
I '�►a�3 L 1 � /Q O'1'1�����'1�, DESCRI ID OM TO��� f-`�I�'.
VI/ d.
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� Diamond Bar ut (Bedroom, Family Rm., Kitchen, etc.)
Signature of Superintendent of Buil'dings W����- p �N�'��'�'�--�Ll/)� Date / �`7 �
1
TO BE COMPLETED BY SCHOOL DISTRICT
FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL F ES DUE
School District under provision of Government Code §65995 $ � �j
are: (EFF. 8/17/98) Residential Developmeat $1.93/sq. ft. Receipt
Commercial/Industrial $0.31/sq. ft. Date / / p
Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling constru tio projects OVER 500 sq. feet
(eliminating gazage or uncovered patio).
l/ `� ' .This is to certify that all fees due to the Walnut Valley Unified School pistrict under provision of Government Code Section
65995 have been received and a building permit may be issued.
This is to certify that the above described development has been determined to be EXEMPT from the development fees of
Government Code Section 65995 and a building permit may be issued.
Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET
OTHER
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S -/.�%d±��Ci• �Dc�c('S m i f�
Assistant Superintendent
Fiscal aad Facilities Management
1/87 Rev. 2/88; 6/88; 8/89; 1/90; 8/90; 10/90: 8/92; 6/93; 11/93; 8/94; 6/96; 1/97: 8/98
PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES ON REVERSE SIDE
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