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Home My WebLink About16458 (894)._,�--- �.u,.._ ., ------� . __ _ . . . . . .. , , CITY OF DIAMOND BAR - ' ' � COMMUNITY DEVELOPMENT DEPARTMENT //� ((�(, I �;,.w 21660 E.Copley Drive Suite 190 � � � �-� PRESS \,, �,,._ (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION FIF�M�V JOBSITE Gr C ' APPLICATION �j PERMIT P/C ✓ o ADDRESS Z 6 D �WA��/ G��G�)� � DATE • r �� NUMBER �# ' � ISSUE TYPE OCC APN LOT TRACT' DATE CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS - Z CITY ZIP TEL. FRONT RW ❑ o APPLICANT TEL. S DE/SIDE STREET RW ❑ z � CONTRACTOR L T 7��! � � SIDE ' p � ADDRESS PROPOSED USE �� Xj D o CITY ZIP TEL. � o � � ow ARCH/ENG/ �'J� �z DESIGNER NO.DWEL. . N0. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BCILDER DECLARATION . SFR/ADD/REM � - O p. I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTOfiS LJ- G8f89B/CBfpOfl W CENSELAWFOFTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n ' U CAUNTVWHICHREWIRESAPERMITTOCONSTRUCT,ALTERIMPROVE.DEA/OLISH,ORREPAIRANVSTAUC-' W w Il1RE,PRIOR TO ITF ISSUANCE,ALSO REOUIRES hIE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNED w P8I10/DOCK � ' STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS ll� � CENSE LAW(CHAPTER e(CAMMENCINO WITH SECTION�000)OF DIVISION 30F THE BUSINESSlWD PFO- � POOUSPB � FESSIONSCODE)OF7HATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (� � TION.ANV VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPIICANT T0 Z Re-Roof � ' A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(SSao).): ' � Z ❑I,ASONMEf10FTHEPROPERTV,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSATqN, � COff1RIBfC18I . , WILL Do THE WORK,AND THE STRUCTURE IS MOT INTENDED OR OFFERED FOR SALE(SEC,70u,BUSF J � NE55 AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � � � , PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES Sl1CM WORK HIMSELF OR HERSELF OR � TNROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEIAENTS ARE NOT INTENDED OR m � � . , . w OFFERE�FORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- � � TION,THE OYJNER-BUILDER WILL HAVE THE BUR�EN OF PROVINO THAT HE OR SHE DID�NOT Bl/1LD OR' Z IMPROVE FOR THE PURPOSE OF SALE). � _ ❑I,ASONRJEROFTHEPROPEFRV,AA/EXCLUSIVELVCONTRACTWOWITHUCENSEDCONTMCTORS W [[ TO CONSTHUCT THE PR0.IECT(SEC.7o4a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOqS LJ- VBIUe�lOf1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEFEON,AND � WFIOCANTRACTSFORSUCHPFOJECTSWITHACONTRACTOR(S)LICENSEDPURSUANiTOTHECOMRAC- QUANTITY DESCRIPTION FEE "- - � TORS LICENSE LAWJ. � O I AM EXEMPT UNDER SEC. 8.8 7.C.FOF 7HI5 REASON' Q � U u. ¢ DATE OWNEFi � Z w � LICENSED CONTFACTORS DECLARATION' . � w - � � � � I HEREBV AFFIFM UNDER PENA�TY OF PERJUi7V THAT 1 AM LICENSED UNDER PROVISKKJS OF CHAPTER � � o(COMMENCIN�WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND` Z MV LICENSE IS IN FULL FORCE AND EFFECT. �J/3 j m . � LICENSE CLASS�•Gl�`�LIC.NO. 7 � j ' V DATE�� CONTRACTOR � d W � . WORKERS'COMPENSATION DECLARATION ¢ - � 1 HEREBYAFFIiiM UNDER PENALTV OF PEfiJURY ONE OF THE FOLLOWINO DECLARATIONS: Z 0 _I HAVE AND WILL MNINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOFKERS' ¢ � ' � COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE.FOR THE PERFORMANCE U Q OF�TNE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REWIqED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHIp7 THIS PEfiMR IS ISSUED.MY WOFNERS'CAM,P(E�NSA�TION INSU��R///AN��.CE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � j CARRIER S��" / ?�f(�/Ie PLAN REVIEW � -r_ _�-� Z POUCVNUMBER ELECTRIC �- Q 0 (nussEcnor�r��r+oieE n+EaEaMrr�swaaNErx�nnr+Eooa.tnas�s�m�oa�ss�. PLUMBING. . w Z I CERTIFYTHqT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO 7HE (/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREEhIATIFISHOULDBECOME INSPECTIONFEE - � � SU&1ECT TO THE WORKERS'CAMPENSATION PROV�SIONS OF SECTION 3700 OF THE LABOR CADE,I SHALL FORTHWITH COMPLV WITH THO PROVISIONS. ISSUANCE p DATE:_��v!/APPLICANT:�'I/\� /.IA�.�� SMIP �" . W �� J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C J � SUBJECTANEMPLOVEFTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTFiWSAND ENERGYPERMIT DIX.lARS(f 100.oD0),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN J SECTION 3708 OF THE LPBOR CODE,INTEREST,AND ATTORNEV'S FEES. OC AETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � \ � I HEREBV AFFIqAI UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY � - FOR THE PERFORMfWCE OF 1HE WORK FOR WHICH THIS PERAl1T IS ISSUED(SEC.3oB7,CIV.C.). Z . W � IENDER'S NAME , • F— LENDER'SADDRESS � - ' W I CERTIFY THAT I HAVE flEAD THIS APPLICATqN AND STATE THAT THE ABOVE INFORMATpN IS CARFECT. TOTAL FE ES ��I/� ' ' ' � I AGREE TO CAMPLV WITM ALL CITY AND COUNTY OROINMlCES AND STATE UWS RELATING TO BUILDING `,1,G � CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CW NTV TO ENTER UPON THE t ' ' ' � � ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. � ' Z - �w • ! / COMMENTS • � � �/v! ��'V J � �/ m PERMITTE NAME RINn �/ - � � - �, �..�--- �4L✓ --o/� . � SIO E PERMITTEE / DATE�— � RECPT.N0. PAID BY VALIDATION ' - WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � � � � CiTY OF DIAMOND BAR ". . i . . .� INSPECTION RECORD • • � 1 • • - • � + • � - SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA RE�MTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLO�R CONDUiT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER. � FIREPLACE 80ND BEANI ' � - - WATER SERVFC�. MID HT BOND BEAM . � ROOF SHEATHING � � 8 FT. BOND BEAM FRAMINGNENTILIATION ' ` FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC � ROUGH GRADING ROUGH PLUN161NG FINISH GFIADING SHOWEFi/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILtNG INSULATION OFF SITE IMPS. DRYWALL NAILING � � DEDICATIONS SEWER -��z: ; � 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 _ � . � � , COMMENTS _ , �, ' �.� � � . ,,� . . , , . SEPTiC TANK SIZE SEEP PIT/U SIZE . ; ; , ,