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� CITY OF DIAMOND BAR I
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I • • "':.9�� BUILDING PERMIT APPLICATION r` i-- - ' ' FI MLY
oJOBSITE 2g00 WATER COURSE DRIVE � �
� APPUCATION .�l �,j\'1 PERMIT' � O� P/C �
ADDRESS DATE � � d�MUMBER #
� ISSUE )�� NPE OCC
APN LOT 1 TRACT 1j,]$5O DATE � 1!� � CONST. GROUP
p OWNER 1)i amond R W G , T,T,C
o ADDRESS 3480 Torrance BZVCl. Ste. 3�� ZONING SETBACKS
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o APPUCANT Ri Ch3Td goLtl d TEL. S3m0 REAR ❑
zd SIDE/SIDE STREET RW ❑
� CONTFIACTOR .TCC C�nGYrii�tinn SIDE ❑
o ADDRESS same 1S owner PROPOSED USE New Gi n 1 e fami 1 � res�dence
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z DESIGNER R. O 1 d & A OClat2S
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� DESCRIPTION SQ.FT. FACTOR PSF AD .AREANALUATION
O OWNEii•BUILDER DECLARATION SFR/ADD/REM 6 386
p I HEREBV AFFIRM UNDER 7EN/�17Y OF PERRIFV THAT I AM EXEMPT FROM THE COMRACTORS LI- G8f89B/CBfPOfi 7 6 g �
W CENSEUWFORTHEFOILOWINOREASON(SEC.7031.58USINESSANDPROFESSqNSCODE:ANVCITVOR (n
C-� COUNTVNRiICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w 17O
w TURE,PRIOR TO ITS ISSUANCE.AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck
' � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �
CENSE UW(CNAPTER e(COMMENCINQ WITH SECTION 7000)OF DNISqN 3 OF THE BUSINESS AND PR0. PaoUSpe
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMAND7HEBASISFOR7HEALLEOEDE%EMP� (�
TION.ANVVpLAT1ONOF5ECT10N7031.6BVANVAPPLICANTFORAPEFMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f500).J:
� ❑I,ASOWNEROFTHEPROPERT/,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 COrt1rt10fCifll -
Z WILI DO TFIE WOHIC,AND THE S7RUC7URE IS NO7 IN7ENDED OR OFFERED FOR SALE(SEC.7oa4,BU51- J
� �NESS AND PROFESSlONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO M!OWNER OF �
PROPEHTY WHO BUILOS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR �
Q THRWGH HIS OR HER OWN EMPLOVEES,VROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDE�OR m
0 OFFEREDFORSALEIF,HOWEVERNEBUILDINOORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE�. •
w OI,ASOWNEROFTHEPROPERTV,AME%CIUSIVELVCANTRACTINOWfTHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.70I6,BUSINE55 AND PROFESSIQVS CADE THE CONTMCTORS LI- V8Il1dIIOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVE57HEREON,AND
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Q ❑I AM EXEMPT UNDER SEC. B.8 G.C.FOR THIS REASON Q �
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� LICENSED CONTRACTORS DECLARATION W �
� I HEREBV AFFIRM UNDER PEfULTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � , bC ,
� e(COMMENCWOWRHSECTqN7000)OFDIVISION70FTHEBUSINESSANDPROFESSKKJSCODE,AND Z 0 '
LLI ��ICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS R uc.r,o. F,71 9 R� �
U DATE corirrucroa JCC ConStructio a
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� t` ' WORKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFIRAI UNDER PENALTY OF PERIURV ONE OF THE FOLLOWINQ DECLARATqNS: Z
�Z _IHAVEMlDWILLMAINTAINACERTIFICATEOFCqNSENTTOSELF-INSUREFORWORNERS' a
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COMPENSATION,AS PROVIDED BV SECTION 9700 OF TME IABOR CODE.FOR THE PERFOiiMANCE U
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. w
W X �HAVE AND WILL MNNTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION �
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS � ' �
J ISSUED.MY WORKERS'COMPENSATION INSURANCE CAHRIER AND POLICV NUMBERARE: CONSTRUCTION
j CARRIER ll PLAN REVIEW i
Z POLICVNUMBER 160449 00 ELECTRIC
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� (iHLSSECTIONNE�NO78EOp.1PLEfE�OFT1-EPEPMITISFOF70NEFAA�DREDD0UA0.S(5100)ORLESS} PLUMBING
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Z I CERTIFV THAT IN THE PERFORMAIJCE OF THE WOFN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.r} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE "�
(/� WORKERS'COMPENSATIONlAW50FCALIFOFNI0.�NDAGREETHATIFISHWLDBECOME INSPECTIONFEE ��
j SU&IECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION3]OOOFTHELABOR .��
CO�E,I SHNl FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANT: SMIP �
w ENERGY P/C �
J WAANINO:FA1LURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE
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� SU&IECTANEMPLOVERTOCRIMWALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLAAS(f1oo.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION37080FiHELABORCODE.INTEREST,ANDATTORNEV'SFEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,CIV.CJ. �
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� LENDER'S NAME
H LENDER'SADORE55 /�
w I CERTIFY TI1AT I HAVE READ THIS APPLICATqN AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES 5 I L� �GI
� I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBV AUh10RIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z �ABOVE-MENTIONED PROPERTY WR INSPECTION PURPOSES. COMM�TS
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� RECPT.NO. � � PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finence Copy.PINK—Assessor Copy,GOLDENRO�File Copy,GFEEN—Applicant's Copy
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SLAB GRADE � ` FIREPtACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
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ROOF SHEATHING �l ,;�j�j 8 FT. BOND BEAM
FRAMIRIGNEN�ILIATIOM FINA�BOND BEAM
ROOF COVER PRE-GRADWG
R�UGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
R�UGH PLUNIBING �INISH uRADING
SHdWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL IIVSULATION POOL FINAL
CEILING INSULATIOIV QFF SITE IMPS.
DRYWALL NAILIfdG �_�' � DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/tRRIG.
SEEP PIT/�.L. ON SITE IMPS.
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FIiVAL HEATING ���•�-� ' •���� " HEALTH DEPT. FiNAL
FINAL ELECTRIC - _.� :� DEV. FEES PAID
FINALPLUMBING / '����-' �'`.;�C , ENERGY
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