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Home My WebLink About16713 r� � '"� -- CITY OF DIAMOND BAI� �� - DBPARTMENT OF COMMUNITY Bc L7EVELOPMENT SERVICES W 2166Q E.Copley Brivo Suite t 90 �Y (909)860-3195 Fa�e(909)861-3]17 PRESS ` '""� BUILDII�(G PERMIT APPLICATION _ FIRMLY � JOBSITE DATE CATION ' � p'1� PERMIT � p/C/�P ,,,i""� � ADpRESS 286$ WATr,R COi1R"� DRTtrF ___��'� 1.� tirt � � NUNlBER��-q � ISSUE { T�NPE OCC pAPN (�{}T_ i 1 TRAGT_(t�g�j�-. DATE_ 1_� �CONST. GROUP OWNER Diamond Bar WeG._�_,_._.L�,�_`i � ADDRESS_��+$O TOY'Y81ICE BLVCI St@ ��__ ZONING SETBACKS � CITY Torraitcfl Z!P_„�„5�� TEL3�,0-51�0-`�99 FRQNT RW p APPLICANT_8�1�},�rd �nu�,d TEL.�mo t,,,� REAR n � SfpF1SIDE STREET RW ❑ a� GONTRACTdR JCC Construction SIDE _ � pG ADDRESS GamP a� nkmar - '� �y}y 2yp TEL. PROPOSEDUSE ngw 5in�'�p farnilv rQGi�Pnr� w ARCWENG/ �� pESIGNER R_ Crn i i r� �c gn.�, NO,DWEL. NO. ADDRESS S71I1C 11�ov UNIiS 1 STORIES 2 g pRppp�g �3 � C�T1` ZIP TEL._,, � [}ESCRIPTION SQ.FF. FACTC}R PSF ADJ.AiiEANALUATiC3N q� QWNER-BUILDER DECLARATION gfR/RDDlREM � l SJ ("'a I NEREBY AFFlRM UNpER PFNP.LTV OF pERJURY THqT I AM EXEMp7 FROM THE CON7RACTORS LI- (`�a�a 8/C8 OR -7 1C3,J,1 GEMSECAWFOpT}�pFpLLpWlNGREASON(SEC709758USINESSANDPROFESS�ONSCODE�ANYC17Y4R (� g � 1 51 � 'R1�RE PRIOR TOR7&USS ANCE�q SO�11SRE5C HEtAPPLICANT�FOR 9UGOH P�qM1T 70 p E q 5 GN D � -Q��neCl( 'Z�'S _ � STATEM�N7 THAT HE aR SHE tS UGEN3E0 PURSUANT 70 TtiE P!{4YISIONS bt TN[CONTAACTOR5 L4 W � � CENS�{AW(q{pP7ER 9(C9MMENCMQ WITH SECTION 7W0}OF OIVISION 3 0F FHE OUSINESS AND PR0- i'�' PooUSpa � FESSIONSCp6E�ORTHATNEORSHEISE%EMPT7HEREFRpMANDTHEBA515FpRTM�qLIECaEDEXEMP- (� V TION.ANYYpGATiONOfSECTtbN7o3S88YANYAPPi,iCANTF44APEftMI75UBJEC7STHEAPPUCANTTO � Re-Raof r A CI�ryL PEN/�,'ry OF NOT MORE THAN FIVE HUNDRED pOLURS(f600)) � OI,ASOWNEROFTH6PROPERN.OFMVEMPIOYEESWITHWAGESAS7HElqSOLECAMPENSATION, G7 CORIfflBfCi&I WILL 00 TH�WOfl}(.q[�'�'{{E&'fFiUCTURE IS NOT MTENpED OR OFFERED FdR SALG{SEC 7oai,HUSh J � NES&pND PRQFESSbNS CODE THE CONTflACTORS LICENSE LAW DOE9 NOT APpLY TO AN OWNEN DF PROPERTY 1N108UlLDS OR IA#PROVES Tl+ER�L7N,AND WHO OOES SUCH WORK WMSEI.f Oft NERSELF Oq � P Q r c h L�O � StfRq70MHISORHEROWNEMPI.pyEES,PAOViDEDi}1AT$UCHIMPflOVEMENTSAREN6TINTEN�E06A C� � OFFEqEDFOflSALEIF,HOWEVER,THEBNLDMGORIMPROV�MENTI5501DWITHINONEVEAFOFCOM7lE- TIOPi,THE QWNEA.9UILt7ER Wk1..HAYE Ttt1E RUFiOEN Ut HI{qY1N(i(HAT HE 4ft SNE DID NOT 8Ui4fl Ofl � IMPROYE FOR THE PURPdSE OF SpLE). �I,AS ON?lEp OF TI IE PROPEFTY,AM EXCLUSNELV CONTRAC7ING WITH LICENSEO CANTRACTOqS pC ro coNs'rrnecr'rNE vRo,�sc�r{sEc 1aa,eusiwEss nHo w�essior�s caoE rrt�ccr�iwnc-roas u- Va�uatian ' ADJ.AREA � CENSELAWCNJESNOTAPYLYTOANONMEflOFAPROPERTYWHOBUILpSORIlAPflOVESTHEREON,AND r WHOCONTMCT9FqA5UCNPRI7JECTSWITHACONTRACTpR(S)UCENSEDPURSVANTTOTNECON7RAC- �roRsuc�s�uw} QUANTIN DESCR1Pi4dN FEE � C!tAM EXEMpT UNpER SEO p&P C fpR THIS R�ASON � � � G!' DATE OWNER ......._,_�- M --.V � _..____.._.., C3 s( t�iCEN3ED C6N7RACTORS OEGLdFtATt4N W �� CC IHEHEBYAFFIRMUNDEflPENALTYOFPERWFIYTHATIAMLICENSEDUNDEFRqO��ISIpNS01'CHAPTER � � 9{CQMMENGMlB'RITH SECTKKi 70oa}OF DiV7S14N 3 OF THE BUSIN£SS AND FROFESStONS COOE,A46 � �S`� MY LICENSE IS IN FULI FORCE ANO EFFECT m � LICENSE CLASS � uc ruo .,, ci 7 3�R� ,,, � � DATE CpNTRACT4R.+�Q'1 C'�".�l� i a � WQRKERS'C4MPENSATIQN 6EGLARATI4N � N IHEREBYAFFIpMUNDERPENNL7YOFpERJURYONE�FTHEFOLLOWINGDECLARATIONS U i!3 Q Q ,_�.IHAVEANDWILIMAINYAINAC6pT�FICATEOFCONSENTTUSE6F�IN5UREFORWOHNERS' � COMPEN9ATI6N,ASPFXSVlDEDBYSEG7tIX�737aopFTHE�ABORCCIAE,F4RFNEPERFaaMANCE U OF 7HE WC7RK FOR WHICH THI&PERMIT IS ISSUED � w � �2 d ..�IHAVEPN�WiLLMAIMA1NWOtiKERS'WMPENSA170NINSURANCe,ASREOUiREDPY5EC7lON —� � 37o00FTHELABpRCOUE,FORfHEpERWRMANCEOFTHEWQRKfORWHICHTHISPERMITIS �� ISSUE4.MYWQPoCERS'CAMPENSATIONhNSUFNX`.EGAflRtEftAN4P0(.IGYNUMBERAHE C4NSTRUCTION 1��_.__� J _..._ � CARRIER - 'y"9ril�� Fyi PLANREVIEW ' + E .. .� � POUCYNUMBER 1�i�1tLt 7f}� ELECTRIC t�,�Q�.�� _�..,��} (�S[CiK7NNEWN078EWR5'LEiEQOFi}�FPFPo4qit5WRavEHU�,YJfimC�UAAS(Si�70Ri.C-95} PLUMBiNG e � � ��.._ _.__�. � I CENT(FY T'ktAT iN Tt�PERFOMiANC:E OF THE WORK EQR WHiCH 7HiS PEftMiT tS iSSUED,i MECNANICAL t (,� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS 70 BECOMe"SUBJEC.T TO THE � uj WORKEF76'COMPENSATIONLA.WSOFCALIFOfINIq,ANOAGREETHATIFISHOULDAECOME INSWECTIONFEE _ � S SUBJECFi4TNEYX]FMCERS'GQMPENSATbMPR4YlStONS4fSECTi�hl3To0QFTHEIABOR �� _ �� CODE,I SHALL FORTf1WITH CpMPLY WITH Th10SE PROVISIONS ISSUANCE _ _\ � ,/,A lJ p RATE. APPLICANT _ SM4P � l.' � WARNISK�FA�URET45ECAAiEWOfli(ER5'IXJMPEPISATIQNGOVERAGEIStJNVtWFUI.At+�SHAILBE ENERGYP/C � "`I�� ,,, � ' �y, SUBJECTANEMPLOYERTOCRIMINALPENAL7IESANOpViLFINESUPTbONEHtINDRE�THpVSAryU ENERGYPERMI OOLIAHS(l100,000),IN AQDITION TO THE COS7 OF COMPENSATION,DPMHGE5 AS PRbVI�ED FOR IN ' � SEGTbN3T086FTHEi�180FiCX70E7NTEREST,ANQATTOHNfVSFEEs � . y I - • t • RETENTI6N FEE.( �� ,+� OGONSTRUCtiON LENDING AGENCY PRE-A�T F£E { � � , y � lHEAEOYAFFIflMUNDERPENALiYOFPERJURVTHATTHE%EISACONSTPUC710NLENDINGAGENCY t� a- FORTHEPERFFDiiMANCEOF7N£WOHKF4RWFFtGHTHiSPERMiT!SiSSUEO{5EG 3097,G1V C} '��`? __..'� �_f ""'—'- W —�,.r 3"^.-..._�» . .... � tENDEft'SNAME ,�„ 1-- IENDEq'SADDAE5S q �y w ICERTIFVTHATIHAVEREA�TNISAPGIICATIONANpSTATETHATTiEAOWEWFORMATIONISCORREC7 TOTALFEE� �� l � +"�d /!V� 4 A4fiEET4 fAMPtY WITH Att GIY At;O COUdlTY CkRDiNANCES pt�STATF LAWS FE(.kTiN(3 TO bNLDiNG `,�J V � CON5TPUCTION,AND HEREBVAUTHOFIZE R6PRESENTAI'IVES OFTHIS COUN7Y TO ENTER UPON THE Z A60VE-MENTIONEOVFiOFERTYFORIN5PEC710NpURPOuES COMM6NTS � L G� h{ `��L—�r �s t„I (,, � _. _ m TTEE AME(PRINT7 a � Cl? "Z- � e� � � NAT(/ OF PEPM DATE ' y REQPT.N0. PAID BY YALIDATION ~ WHITE--Pepartmsnt Coqy,YELLOW—Financa Copy,PINK—Assesspr Capy,GOI..DENROp--File Copy,GREEN—Applicant's Copy CITI� �� 1 t� � A 1 ��'E�T1C? 1RE� F�� a,�i�ir'' "#'� � ,�a i:Vs,�•� `,"�'•�:t V'a��r..�;fiy,-�;��'F-�"t;Y.S��jv:;:.i'M1•e�a x� " +^t=+1YL��-��!i�d ��'M�,°� .��7M"1'?4�l.. 'r� ��. ,�� •:]. ., �L�r •' "':"+'%Y.''ir•.. ��'_�„ �:dL•. �+i$;�A.a#'�i � iJ., s �•i' ' y � - .'�"�� ,;i-;.:w�r:�' a ��`.Fi,x.:.�r�,!y'^h:.'".i:.e��.o.�.'t- Y•+�+��"£�'i�+L'e.��'.dr.'.e.sC3f:��''.� .... ABY�rr."d'� x.. �Y � b� � . . .. ..,.. � �, i.....�__. . . A.i�'.'. �.�: ''�r'v.x'�s*:.��7Fi nil��d"."��+.. �>i�i t3AC44 i:- . . 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BC}NCt BEAM -- - �C>4��F+�=�THINC� �-��(! ! 8 FT.BC�ND B�At� ---- �RA�NIl�!(�;'VEN�'iLsJ�71bN�j��Z-G/ �=iNRL BQNd BEA� RC��CU�`�l��d ( PRE-GFt�#C?tiV� S�C51!f':�-!�-i�A`i"i�IC, �T (� -- - _ � EiENCHiNG _. . : • .. . • : ,: , ,� � , : , .,:", ,.;lC�IG _ � __ , 4�i�ttiC�1i F'�.UM�ii�4s; __� � FI�lI sN GRRi31NCa -- ---_ __,=---...--- ._..______ � _ ��i�W�`�?li"U�T'�S�' � PC7bL ELECTRlC ___� .__ �___._..-_____._�__---- - -- ---._.__ --...___ F?C�". i.1�T={J`��"I�I�!� i/��-G/ I Pt�O�.rENCINC; _� UV��.:V.�N�tJl��i�:'�� w,_...v� --- ---�.. _- ; PC){?L�ItVAL. � � -- ��3t_i�1� SC�,'S�lLAT3C1i�l�-��F�� `� C}F�SIT�(P�FgS. - � €��'Y�Pr��t.t��1I�.INt� ___�1;:��1 ' ".�---"-' DEDI��TIUNS � -- �r`��,-..___._. _Y_� FIhIt�L EtVG. ---__ _ �ca��ft�T,�P-;FS_�_._i. �� -._._ Lr�h9D5C.�aPE16RRIG. S��P;'ETt'�..t._ry _ , C�N S(T�1MPS. __3____ c`'aA�AIF�T��"i" ..._..�__.._.._,_. �It��4L 7_C}NIl�iG _ _'_� 1�____ ____ .___—._.._--- -._ �.____ _�_.__ ___��__.�_. _ FltvA.!_�:Q��i�. i , ! �iRF?�EPT. 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(�� NUMBER� # � � � ISSUE TYPE OCC APN -� LOT IL___ TRACT �� C.i DATE CONST. GROUP p OWNER yL�(��l11" l.A�� .�— p ADDRES :�'-t �C ��C7��i� ZONING SETBACKS z CITY ��/�P�IQ..E ZIP �� TEL.�1�"�YO�?�I� FRONT RW ❑ � APPLICANT TEL. REAR ❑ Z 51DE/SIDE STREET RW I-1 Q CONTRACT�R � L�C.�LC; SIDE ❑ � ADDRESS �f��3 ��`✓� � CITY Sr u^N�u WA/.�7 ZIP T 7;w TEL.'�i�3 r7��!a�1 PROPOSED USE W ARCH/ENG/ �I Z DESIGNER =`L� IQ , �SS�_ W ��',�/ NO.DWEL. NO. NO. a ADDRESS � � L71.L/s� �v�+� UNITS STORIES BEDROOMS � CITY��1W�--L� ZIP /�`J�' TEL..��'�� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLAFiATION SFR/A��/REM O I HEFEBY AFFIRM UNDER PENALTV OF PERJUFY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8QB/CflfPOR � W CENSELAWFORTHEFOILOWMGREA50N(SEC703158USINESSANDPROFES510NSCODE.ANYCINOR (n U COUNTYWHICHREOUIFESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRl1G W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPUCANT FOR SUCH PERMIT TO Fl�E A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- LL � CENSE LAW(CNAPTER 9(CAMMENCINO WITH SECTION 7000)OF DIVISpN 3 OF THE B1151NESS AND PRO� POOI/SP3 FESSIONSCODEJORTHATHEORSHEISEXEMPTTHEFEFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� � TION,ANYVIOLqTIONOFSECTION703158VANYAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Raof ACIVILPENALTV OF NOT MORE THAN FIVE HUNDRED DOLLAFS(f500)) ❑I,AS OWNER OF THE PROPERTV,OR MV EMPLOV EES W ITH WAGES AS THEIR SOLE COMPENSATION, O � Commeraal Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BUSI� J � NESS AN�PROFESSIONS CO�E THE CON7RACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF j PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGM MIS OR HER OWN EMPLOVEES,PROVI�ED THAT SUGM IMPROVEMENTS ARE NOT INTENDED OF m OOFFERE�FORSALE.IF,HOWEVER,THEBUILOINGORIMPROVEMENTISSOLOWITHINONEYEAROFCOMPLE- Z TION,hIE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPUflPO5EOF5ALE) w ❑I,ASOWNEHOFTHEPqOPERTV,AMEXCIUSIVELVCONTRACTINGWITHIICENSEDCONTRACTORS � TO CANSTRUCT THE PR0.IECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- VdIUdlI0f1 ADJ AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROYESTHEREON,AND � WHOCON7RACTSFOfiSUCHPfiOJECTSWITHACONTRACTOH(S)LICENSEOPURSUANTT07HECONTRAG QUANTIN DESCRIPTION FEE � TORS LICENSE I.AW) ,q/'� � ❑IAMEXEMPTl1NDERSEC. B&PC FOFTHISFEASON � �IiCJ' �'� ��4�YC..� o a � a � 5 �c�� c� � �ATE OWNER � h , . �-y Z w � �� 'L+�I�M1 � 'al � LICENSED CONTRACTORS DECLARATION W '��, ��n� � I HEREBY AFFIRM UNDER PENALN OF PERJURY THAT I AM UCENSEO LINDER PPOVISIONS OF CHAPTER � !' � 9(COMMENCINGWITHSECTION7000)OFDIVISION30FTHEBUSINESSPNDPROFESSIONSCODE.AND Z � � t `X MV UCENSE IS IN FULL FORCE AND EFFECT m Q LICENSE CLA33 C._'•� LIC NO � � � V DATE �'�� CONTRACTOR M1�' �Z ,� � W � WORKERS'COMPENSATION DECLARATION a = U � IHER YAFFIRMUNDERPENALTVOFPERJURYONEOFTMEFOLLOWINGDECLARATIONS (� Z 0 _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN7TOSELFINSUREFORWORKERS' _ COMPENSATION,AS PROVIDED BY SEC710N 97oa OF 7HE LABOR GODE.FOR THE PERFORMANCE U a OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED � w `'�I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSUFANCE,AS RE�UIRED BV SECTION Q 97000FTHELABORCODE,FOflTHEPERFORMANCEOFTHEWORKFORWHICHTMISPERMITIS � 0 ISSUED MYWORKERS'CO PENSAT�gDL�INSUR.4N ECARRIERANDPOLICYNUMBERARE CONSTRUCTION � � � �/1 j CAFiAIER �� rti� PLAN REVIEW � aoucvNUMeEa :��'CJ� C7C71��!f� ELECTRIC + ¢ � (iHIS5EC710NNEmNOTBE00MPLEfEDOFTHEPERMRISWRONEHUrAREDOCLLSAS(5700)ORLESS) PLUMBING Z I CERTIFV THAT INTHE PEFFOFMANCE OFTHE WORK FOq WHICHTHIS PERMIT IS I55UE�,l MECHANICAL (} SHALLNOTEMPLOYANVPEflSONINANVMANNER50ASTOBECOMESUeJECTTOTHE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECT TO THE WORKERS'CAMPENSATION VROVISIONS OF SECTION 3]oa OF THE LABOR j CODE,I SHALL FORTMWITH COMPLY WITH THOSE PROVISIONS ISSUANCE ,_yy_�_,t •' 0 � 0 pq7E. APPLICANT SMIP A � ENERGY P/C /" WARNINO FAILUPETO SECURE WORKERS'COMPENSATION COVEFAGE IS UNUWFUL,AN9 SHAIL BE � SU&IECTRNEMPLOYERTOCRIMINALPENFLTIESANDGIVILFMESUPTOONEHUNDREDTHW3AND ENERGYPERMIT � DOLLARS(floo.oaO�,INAD�ITIONTOTHEC0.STOFCOMPENSATION.DAMAGE5A5PROVIDEOFOFIN � ,. J SECTION3]OBOFTHELABORCODE,INTEFEST,ANDATTORNEV'SFEES RETENTIONFEE: � a CONSTRUCTION LENDINGAGENCY PRE-ALT FEE � IHERE6VAFFlFlMUNDERPENALTVOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCV d FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITI5155UED(SEC�o9],CIVC� Z W j LENDEP'S NAME tl _ � F— LENDEfl'SADDRESS � I CERTIFV TNAT I HAVE READ THIS APPLICATION ANO STATE THAT THEABOVE INFORMATION IS CORRECT TOTAL FEES w 1 AGREE TO COMPLV WITH ALL CITY AND COUNTV OR�INANCES AND STATE LAWS RELATING TO BUILDING � � CONSTRUCTION.ANDHEREBYAUTHORIZEREPPESENTATIVESOFTHISCOUNTYTOENTERUPONTHE ZABOVE�MENTIONED GROPEFTV FOR INSPECTION PURPOSES COMMENTS � � �iV1C�!� � r�e>('i�� s m PERMITTEE N E�PR�NT) a �.-C� /Z Q J � f � SIGNA PERMITTEE DAT � /� PAID BY l �• � VALIDATION = RECPT.NO ~' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREBN—ApplicanTs Copy ---------�--- -- - -- - -- - - _ _- �/-�:�-D��.:" L ,� -�'�, � . - � �-��"� �=-._ -- . -- : � �� - - � � �',� � CITY OF DIAMOND BAR � f$' �P ��B �! E `�--�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 � � '� " ' (909)860-3195 Fax(909)861-3117 �` � PRE$$ \ '�' BUII�DING PERI�IIT APPLICATION � � FIRMLY y JOBSITE 7�(7 APPLICATION C "'� o ADDRESS-a�C/—�-.G�LJ��'�� ,��^ DATE �� l�J� NUMBER '' 1 �/C $ ISSUE TYPE OCC APN LOT.� TRACT��_ DATE CONST. GROUP p OWNER ' C� o AD�D�RESS �� OIIA7�.r/Cl" lv� ZONING SETBACKS z CITY JB[2� ZIP� TEL�/J.S�y� 3S�7D FRONT RW ❑ g APPLICANT TEL. RE� a SIDE/SIQE STREET RW p CONTRACTOR � rYJ�i�- f�`�u I4•. /n., SIDE ❑ ADDRE S �_�U s',�rJtia s�J��rr � CITY� �>rts'da ZIP'�7f71�d TEL�t9� G 2,�% PROPOSED USE oARCWENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS cn UNITS STORIES BEDROOMS � CfTY ZIP TEL. � DESCRIPTION SQ.FT. 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GROUP p OWNER �t.. � �1,.E� p ADDRESS ' �• � , y ' -�/T ZONING SETBACKS Z CITY��.�3C'��i ZIP�V`�-'i�jTEL''. ` � ' FRONT RW ❑ � APPLICANT " TE�. REAR ❑ z SIDE/SIDE STREET RW ❑ a CONTRACTOR �i'�T C%Z1?.�C.GD� h�(: - SIDE ❑ p� ADDRESS ��i�s�Cj �i4'�7fi� L�_ �. ,G��.�� CITY��'�U;a��,.i;�r: ZIPL`'Ztl.` TEL. � '� ��, �– PROPOSED USE ` E��'� C=c%'�o�T I rr�c�'� �-{'�"� w ARCH/ENG/ n z DESIGNER I'� �'��'�''� � +�'S'�� - a ADDRESS �Z ,rJ�•' NO.DWEL. NO. NO. m T,�.�� UNITS STORIES BEDROOMS � CI ! - ZIP�(c�L"s��TEL. ` Z'-- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECIARATION p SFR/ADD/REM I HEREBY AFFIRM UN�ER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GflfflgB/CBfpOfl �W CENSEL4WFORTHEFOLLOWINGREASON�SEC70375BUSINESSANDPROFESSIONSCO�EANYCITVOR (n � COUNTVWHICHREOUIRESAPERMITTOCONSTRUC7,ALTER,IMPflOVE,DEMOLISM,ORREPAIRANVSTRUF W Paf10/DBCk w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSE�Pl1RSUANT TO THE PROVISIONS OF THE CONTqACTORS LI- � CENSE LAW(qiAPTER 9(COMMENCINO WITH SECTION]000}OF OIVISiON 3 OF THE BUSINE55 AND PRO- � POOVSpa � FESSIONSCODE)ORTHATMEORSHEISEXEMPTTHEREFROMAN�THEBASISFORTHEALLEGEDE%EMP- (� V TION.ANVVIOLATIONOFSECTION7o315BYANVAPPLICAN7FORAPERMITSUBJEC7STHEAPPLICANTTO Z Re-Roat F, A qVIL PENALiV OF NOT MORE TNAN FNE HUNORED DOLLARS(E500)j Q ❑I,ASOWNERDFTHEPflOPEF7Y,ORMYEMPLOYEESWITHWAGESASTHEIR50LECAMPENSATION, O COrtIlIIBfCIdI Z WILL DD THE WORK,AND THE STRUCTUR6 IS NOT MTENDED Oq OFFERED FOR SALE�SEC 7a44,BU51� J � NESS AND PHOFESSIONS CADE THE CONTfiACTORB LICENSE LAW DOES NOT APPLV TO AN OWNER OF {j,,�y PROPERTYWHOBUILOSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � �✓�L !.)'�1�� THROUGH HIS OR HER OWN EMPLOVEES,PROVI�ED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVER,THEBUIL�MGORIMPROVEMENTISSOLOWITHINONEYEAROFGOMPLE- Z TION,TME OWNER-BUILDER WILL FIAVE THE BUR�EN OF PROVING THAT HE Ofi SHE DID NDT 0111LD OR = IMGPOVE FOR THE PURPOSE OF SALE) W ❑I,ASOIYNEROFTHEPROPEpTV,AMEXCLU5IVELYCONiRACTINGWITFILICENSEDCAMRACiORS � TO CONSTRVCT THE PqOJEC7(SEC 7044,BUSINE55 AND PROFESSIONS CODE THE CONTRqCTORS LI- V8I118110f1 ADJ AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPFOVESTHEREON,AND � � WHOCONTRACTSFORSUCHPROJECTSWITHACONTflACTOfl(5)LICENSEDPURSUANTTOTHECONTRqC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW� � ❑I AM EXEMPT UNDER SEC B 8 P C FOR THIS REASON Q � U � DA7E pWNER � Z U � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBV AFFIRM UNDEfl PENALTY OF PERJUFV THAT 1 AAA LICENSE�UNDEft PROVISIONS OF CHAP7ER � d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS O� z 'X MY LICENSE IS IN FULL FORCE ND EFFECT .1 m � LICENSE CLASS I..IC NO � L�7►� � �/� � U DATE " " �.�+ CONTRACTOR��'tr�`»�•-� �S a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM I1NOEfl 7ENALTV OF PERIURY ONEOFTHE GO�LOWING DECIARATIONS Z Z IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�WSUREFORWORKERS' a 2 Q CAMPENSATION,ASPROVIDEDBVSECTION3]OOOFTHEUBOFiCODE.FORTHEPERFORMANCE U O �OFTHE WOflN WR WHICH THIS PERMIT IS ISSUED � w _I HAVE AND WIIL MAINTAIN WORKERS'COMPENSRTION INSURANCE,AS REOUIRE�BY SECTION ��1��/^ Q 3]OOOF THE L4BOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 0 � � ISSUED.MYWORKERS'COMPENSATIONINSURRNCECqRRIERANDPOLICYNUMBERARE CONSTRUCTION /'�____ �� j CARRIEH �j_��'�'� PLAN REVIEW � � POLICY NUMBEfl i��LL'sC.�i�i ¢ ELECTRIC Q,�� a � (�TiISSE(:t10NNEmNOTBE00MPLETEDOFiHEPERMfTISFORONEHUWRED 55) PLUMBING Z I CERTIFV THAT IN TiE PERFORMANCE OF THE WORK FO IS P RMIT IS ISSUED,I MECHANICAL (.'3 SHALLNOTEMPLOYANYPERSONINr�NYMANNERSO COMESU JECT707HE (n WORNERS'COMPENSATION LAWS OF CALIFORNIA D A EE THAT IF I OULD BECOME INSPECTION FEE � SUBJECTTOTHEWORNEFIS'COMPENSATIONP VISIO OFSECTIO ]OOOFTHELAB , ';"� � COOE.ISH LLFORTHWITHCOMPIVWITHT EPROVI 5 ISSUANCE L �..��., o I�r� P �� DATE. APPLICANT SMIP J WAFNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS IJNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT DOLLARS(Sf oo.0ao),IN RDDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN � SECTION37080FTHELABORCODE,INTEREST,ANDATTOflNEY'SFEES RETENTIONFEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IMEREBVAFFIqMUNDERPENALTYOFPEFJURYTHATTHEREISPCONSTRUGT10NlENDINGAGENCY � �� FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097.CIV C) W � � LENDER'SNAME - � F- LENDER'SADDRESS W ICERTIFV7HA71HAVEREADTHISAPPLICA710NANDS7ATE7HA77HEABOVEINFORMATIONiSCORRECT TOTAL FEES.� �p�, ��/)�� I ACaREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING ^ �� CONSTRUCTION,ANDHEREBYAUTHO DRESENTATNESOFTHISCOUNTVTOENTERUPONTHE /y� 3 ��FJI ZABOVE-MENTIONED PROPERTY NSPECT N PURPOSES �'� �G ^0 o � COMMENTS aPEFMITTEENA (PRIN7) �� r �'Y� � i�i�v(v�. � SIGNATUREOFPERMITfE DATE J �� = RECPT NO. PAID BY VALIDATION ~ _WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Pde Copy,GR N—ApplicanYs Copy _ � � - Sc_�" �'�C:-�iaf�iii �4�Z�'� _ - - - Z" 7S--O`L �T[�S � S�'CtE A+� I,�C-ST Ol-c � ' CITY OF DIAMOND BAR � � __--�?`.�.-- DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS �"""' BUILDING PERMIT APPLICATION FIR LY � JOBSITE �,r /�� APPLICATION PERMIT P/C o ADDRESS��C� �PY'Wl.t(�,S �, DATE � I � NUMBER � � o�� ISSUE �JI TYPE OCC `r APN LOT TRACT DATE � CONST. GROUP p OWNER Y o ADDRESS�SY � r e ZONING SETBACKS Z CITY� L �aY' ZIP 9/7dSTEL. FRONT RW ❑ p APPLICANT � TEL,�� S DE/SIDE STREET RW ❑ z ¢ CONTRACTOR � ✓e�h S�u � SIDE ❑ ADDRESS P p �/ PROPOSED USE j o CITY �� ZIP TEL S 0 � o ARCHlENG/ iz DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STaRIES BEDROOMS � C1TY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDlREM O I HEREBV AFFIRM UNDEfi PENALT'OF PEFiIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G9f09B/Cef()01f W CENSELAWFORTHEFOLLOWINGqF�SON(SEC7031.58USINESSAN�PROFESSIONSCWE:ANVCITYOR (n U ��'WFiICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,OflFEPAIRANYSTFUG W Pg�lO/DBCK � TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE AFPLICANT FOR SUCH PEHMIT TO FILE A SIGNED � � STpTEMENf TH/T HE OR SI1E IS LICENSED PURSUANT TO THE PflOVISIONS OF THE CONTflAGTORS ll- CENSE UW(CHAPTER B(COMMENCINa WI7H SECTION'lD00)OF DIVISION 3 OF THE BUSINESSAND PRO- �' Pool/5pa FESSIONSCODE)ORTHATHEOR3HEISEXEMPTTHEflEFFiOMAND7HEBASISFORTHEALLEGEDEXEMP- (� � TION.ANYVIOLATIONOFSECTION7U31.5BYANYAPPIICANTFOR�PERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oa)�: � ❑I,ASOWNEROFTHEPROPERT'.ORMYEMPLOYEESWITHYJAGESASTHEIRSOLECAMPENSATION, 0 COII1R1BfC18I Z WILL DO THE WORK,AND THE STqUCTURE IS HO7 INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J N NESSAND PROFESSIONS CODE hIE CONTRACTORS LICENSE UW DOES NOT ACGLY TO AN OWNEN OF � PROPER'fY WFIO BUI�DS OR IMVROVES THEREON,ANO WHO DOES SUCM WOHK HIM9ELF OR HERSEIF OR � THFOUGHHISORHERONMEMPLOVEES7ROVIDEDTHATSUCHIMPpOVEMENTSARENOTINTENDEDOp CO w OFFEREDWRSALEIFHOWEVER,7HEBUILDINGORWIPROVEMENTISSOLDWITHINONEYEAROFCAMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PROVING THAT HE OR 6NE DID NOT BUILD OR � IMPROVEFOHTHEPURPOSEOFSRLE). = OI,ASOYMEROFTNEPROPEFifY.NdEXCLUSIVELYCONTMCTIN6WITHLICENSEDCONTMCTORS W � TO CONSTRUGT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE�THE CANTRACTOAS ll. VBIUaI1011 ADJ.AREA W CENSEIAWDOESNOTAPPLYTOANON/NEROFAPROPERTVWF708UILOSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(SjLICENSEOPURSUANTTOTHECONTRAC QUANTITY DESCRIPTION FEE Y TOHSLICENSELAW.) � ❑I AM EXEMPT UNDER SEC. B S P.C.FORTHIS REASON � � U � � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION �j � I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PflOVI510N5 OF CHAPTEfl � d B(COMMENCIN(3 WITH SECTION 7000j OF DIVISION 30F THE BUSINES6AND PROFE&SIONS CODE,ANO Z X AIV UCENSE IS IN FULL FORCE AND EFFECT. m � IICENSECL45S '��2 / LIC NO �-�.��/ L � V DATE ��IZ ��, CONTRACTOR�e lT11A7 a W � WORKERS'COMPENSATION DECLARATION Q � U � 1 HEREBVAFFIRM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWMG DECLqRATIONS � Z Q � ,INAVEANDWILLMAINTAINACERTIFICATEOFCONSFNTTOSELF-INSUREFORWORKERS' _ COMPENSATION,AS PROVI�ED BV SECTION 3]OOOFTHE LA90N CODE.FOR TME PERFORMANCE U QOFTHE WORK FOR WNICM THIS PERMIT IS ISSUED. � W ^I NAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS flEOUIRED BV SECTION Q37000FTNELABORCO�E,FOATHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS + � � ISSUED.MY WORKERS'COr.��yPEN�SATIOrN INSURANC�E,lC ARRIER AND POLICY NUMBER ARE' CONSTRUCTION j cnaRiER��Q�IJ�c t�1�k�1 PLANREVIEW Z POLICY NUMBER I LL(7�OF�.� ELECTRIC Q � (fHISSCLR1oNNE�NOTeEOpMPLETmOF7NEPER�MISWHONEHUPDRED00LLARS(f10�MLESS} PLUMBING w MECHANICAL Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHIGH THIS PERMIT IS ISSUED,I (} SHALLNOTEMPL�VANYPEflSONINANYMANNERSOA5TO8ECAMESUBJECTTOTHE - N WORNEFS'COMPENSATION UM�S OF CALIFOHNIA,ANU AGREE THAT IF I SHOULD BECOME INSPECTION FEE +' r SU&IECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37000FTHE LA60F1 1SSUANCE � CODE,I SHALL FORTHWITN COMPLV WITH THOSE PROVISIONS. "' p DATE: APPLIGANT SMIP � W ENERGY P/C "� WAflNINO;FAILURETOSECUREWORKERS'COMPENSATIONCOYERAGEISl1NU1WFUL,AN�SFIALLBE LL SU&IECTANEMPLOYEflTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(i100.000).IN ADDITION TO 7HE COSTOF COMPENSATION,DAMAGES AS PROVIOED FOR IN J SECTION 3�OB OF THE LAP�R CODE,INTEHEST,ANDATfORNEV'S FEES RETENTION FEE: � � � CONSTRUCTION LENDING AGENCY PRE-AL7 FEE: � I NEREBV AFFIHM 11NDER PENALTV OF PERJLIRY THAT iHERE IS A CONSTRUCTION LENOING AGENCV d FOR THE PERFORMANCE OF THE WOAK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV C) Z W � LENOER'S NAME F- LENDER'SAODRESS M/y � ICEHTIFVTMATINAVEREADTHISAPPLICATIONANDSTATETHAT7HEABOVEINFOfiMATIONISCARRECT TOTAL FEES ' �T, w I AGREETO CAMPLY WITH ALL CITYAND COUNTY OHDINANCESPND STATE UWS REUTING TO BUILDING �� CANSTRUCTI�N,ANOHERE9YAUrHORIZE0.EPRE5ENTAT1YE50FTHISCOUNNT�ENTERUPONTME Z AeOVEMENTIONED PROPEFiTY FOR INSPECTION PUflPO5E3 CO ENTS Q ^ � r_ � G � QPERMITTEE NAME w JI�_� � ✓ Uj SIGNATU �RTE RECPT.NO. 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Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION APPLICATION DATE OI PERMIT 1,,,,apicoi.,....1,0 ' ..... NUMBER i II # Z�) ISSUE DATE A TYPE OCC tr, •SCONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 0 N0. PROPOSED UNITS USE DWEL, new single family residence N0. N0. 1 STORIES 2 BEDROOMS 6 DESCRIPTION SQ. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM 7,199 In ten. Garage/Carport 751 , , • " CD 0-91--/ , 0 ILI -RatiolDeck 272 1 ,-1 LL1 I-1- PooVSpa ., CD Re-Roof Z 0 Commercial 5 Porch 160 11 TO CI:1 )s-72,,.V ADJ.AREA Valuation ' 15 1, QUANTITY DESCRIPTION FEE 8 EE F- -J LLI CD Z 03 -J CI- t-ti, 2 a x �••) cli d CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERM RETENTION FEE, PRE-ALT FEE: 45.W 10:01111 --ivar----411SIC0 NMINIIIIIIWASIS iliffe• P1 i -,S ss)C)iffil 0,.. 'g-If j' .ioli'fa'KS111111IIIIIIIIMIEZGIIM 97 t-0 1 1 ' t ' .).--, :3 6 41 TOTAL FEEa 41(O1 , i i 441130,N COMMENTS RECPT, N0. PAID BY VALIDATION C3 JOBSITE ADDRESS_2868 U.M_Q(111gU_DJ/LIT.E APN LOT 1] TRACT_4_7_854) OWNER Diamond Bar West, LLC ADDRESS 3480 Torrance Blvd. Ste. 300 a-1-y Torrance zw 90503 TEL310-540-399( APPLICANT Thirhard Gould TEL - same ab-a-ve CONTRACTOR JC C Construction ADDRESS SPMP as owner CITY ZIP TEL ARCH/ENG/ DESIGNER R.Gould& Assoc ADDRESS same above CITY ZIP TEL I CERTIFY THAT I HAVE READ 11-lIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES WHITE--Depadment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy PRESS FIRMLY OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE'ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUCTURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION,ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FO1 A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) DI,AS OWNER Of THE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS UCENSE LAW) LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS DATE LIC NO 671987 CONTRAGTOR JCC Constructio WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE II 'I . CARRIER POLICY NUMBER 1 6044 700 S• 9 -... (THIS SECTICN NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED COUAFLS($103)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE, APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS 0 I AM EXEMPT UNDER SEC B&P C FOR THIS REASON DATE OWNER CITY OF DIAMOND BAR INSPECTION RECCRD .r. •2 4410- " . .. . .. .��. �� i • q .• S_ •• . i _ � �• � �.. . . .. � �� .. ... ,. .,.. . .. ... � � . .• , .. ' -ilt,4,?'r!.-:T; ', .;t.. ::11T4-WIIMW 4, ';,i„-.',".: 1.1.'Wf- frfit, „ 1 ' : .. :-. :' : ,'. ' —.. :..'.:,,,,:.. „ n, ,,, , .....'447.- ' '.: "4'f' ...1.1 .1^,: .... ...t 1-' '1 :41;0•461iegth-,iif 0*. . ' .14 1 'll i.l}C:KkinfrgitttiiV#1::Wiriallit SEI BACK FLOOR JOIST , 42,4 i,l !1, .f, _?:_i, ' 11'1' 15 ' i FHA REQMTS FTGS,FORMS/STEEi _,:J, I UNDER FLOOR DUCT ELECTRIC GROUND GROUND PLUMBING ..a&W - I UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION I FIREPLACE BOND BEAM TEMP POWER MID HT. BOND BEAM WATER SEAN/ICE I ROOF SHEATHING 1 ', V W:0!!"."' 8 FT. BOND BEAM /HZ-0/ FRAMINGNENTIUATION _..e,,,,,:,.... I FINAL BOND BEAM ROOF OF COVER I PRE-GRADING ,F-I HFATIW; _ ' .. _ . , .# • .. . • , . , . . BENCHING - . ... . 0.; VF f . .T.,..." 1.";ING ROUGH PLUMBING FINISH GRADING . H WER/TUBITTEST POOL ELECTRIC EXT. LATH/SID'ING I/N4-0/ ...,,er POOL FENCING . POOL FINAL A-1.:.. INSULATION - ' DUNG INSULATION - OFF SITE IMPS. DRYWALL NAILING 1 il",.;1,9,6-V' . _ DEDICATIONS / S t--- -WE R FINAL ENG. -4 SEPTIC TAI�TiK- LANDSCAPE/IRRIG. SEEP PIT/L.L, ON SITE IMPS. GAS AIR TEST I A FINAL ZONING FIRE DEPT. FINAL FINAL CONST. "Ii^-lii HEA-I ING tif 1 1 HEALTH DEPT. FINAL FINAL ELECTRIC-- ! lir DEV. FEES PA-ID llIl�l-1. PLUMBING 1 ENERGY ---1 . � . 0, .. COMMENTS ERTIC TANK SIZE EER RIT/LI SIZE DIAMOND BAR i \\L PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ,,,,, .. ADDRESS 2-6 to 2 itilk..+E AI APN LOT II TRACT Li 7 8,s---0 OWNER D ittliottAirl 13CIr (.4.0112.St- i L e.- ADDRES,S A-t iik, -1-mgisio,e,l a:- CITY'76 gir/1466 ZIP 917 50 a TEL510 0_VIC APPLICANT TEL. CONTRACTOR -11_7, LE-e-Tg LC- ADDRESS -"IP1 '1 ik�.5.- ir. 3/- . CITY k 4tk\Ijii MLA- .3 ZIP Cii 113 TEL. 'Z.10 4t ef.r,Vl ARCH/ENG/ , 67%e". 1":)11 5:...1-,C— DESIGNER ael- e ADD RESS 7i)R.p(Le-.14. .i.7iSt, CITY "' lii/I ZIP 7475 C�i, 'TEL. MO-31W OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,SUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC. B&P C FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS —1 0 LIC NO Li q Z-z-z— DATE 1 y clo/ CONTRACTOR L. WORKERS'COMPENSATION DECLARATION I HER y AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED LI' - I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COFPENSATLQ.N4NSURANcIE CARRIER AND POLICY NUMBER ARE CARRIER *Iet-I-e.._. trOvt,cl POLICY NUMBER 2-25'j -01 el 0 1 3,4,1 (MS SECTION NEED NOT BE COMPLETEDOF THE PERNITT IS FOR ONE HUNDRED OCLLAFLS($100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE. APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES I CONSTRUCTION LENDING AGENCY i - I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY - FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) i . LENDER'S NAME LENDER'S ADDRESS i I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT _ I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ' ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES 5 J ,..)-- cktme L, , bki 5 5 1 PERMITTEE N E(PRINT) C i 4 IZ06 3 4 i 44 &AI -4""' .4 -.LaL ) SIGNA • PERMITTEE DAT APPLICATION DATE PERMIT . P/C i Lpey O1 # ISSUE DATE TYPE PE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW CI EI SIDE/SIDE STREET RW EI . p N0. PROPOSED UNITS USE D W EL. N0. N0. STORIES BEDROOMS (.1) W w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION 0- 0 Z SFR/ADD/REM al iq 9 Garage/Carport 5.50 Patio/Deck PooVSpa Re-Roof E ) Commercial 5 on Valuation ADJ AREA QUANTITY DESCRIPTION FEE < 0 E 8 w 1 i i eV a iv .e."VI C.--t-' 50: )0 1 Z00 5 d .6 Pei n-c..../ as-. ct o 4 A c LAwc-fh; '7 ,(VD —ig-4:71—0 v e- i 2 135 2 ..V.AR IIIIMIIM i D J a •A b. L \-...... (....... -J < 0 2 < I 0 w 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING M ECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE G, 5-). (tdC +.1"?7&0 I' A rami. # TOTAL FEES COMMENTS -I--.9440 0 RECPT. NO 49 PAID BY "Zi I VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Copy,L,HIthN— 1 PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 6'g,,,,,,,-/A-/e 0,214190,,,r,69,2„ ......�-�,g� APN LOT// TRACT d';i2g...ca OWNER C e- ADDRE ..:"40 0 / , CI it9R.4.41,e1e go" ZI KO CO 3 TRW, .5-90 3sco APPLICANT TEL. c n . CONTRACTOR(.4,/2. a en A: P 41,4-0. I".., ADDREV/_co 4/S'A.-,-,4 /4 frt., i"'it s CITY e yeL,,,s7 y. ZIPV7/e,TEL*?tiC2T-G272, ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRESAPERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION,ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CR% PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(MO)). 0 I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE.IHE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING INITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW.) 0 I AM EXEMPT UNDER SEC. B&P.0 FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7(300)OF DIVISIONS OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT 1.97 1., ... 7 LICENSE CLASS J.6 LIC. NO a I R .,,i DATE CONTRACTOR4-"por 400/"R6i WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSAT/ON,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOR/SERJS'COMPENSATION INSURANCE CARRIER D POLICY NUMBER ARE CARRIER ...Y.-At 74 4.- 17-' ,ver POLICY NUMBER/z v4."4•:, 7-7 (THIS SECTION NEED NOT BE COMPLETEDOF THE PERMIT e RORONE HUNDRED COLLARS($150)OR LESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE APPLICANT. WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($1 03.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY /HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV CI LENDER'S NAME LENDER'S ADDRESS , I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT ' I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES ,•C/,",ARV,6'7 Pe9 .,V' PE ITTEE N INT) - / ca- I NATURE OF PERM SE DATE APPLICATION DATE c x i(e1jP/C — 1 -LiI PERMIT I NUMBER # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW p 0 PROPOSED N0. UNITS USE D W EL. N0. N0. STORIES BEDROOMS u) 1-1-1 w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION U. 0 Z SFR/ADD/REM Garage/Carport Patio/Deck PooVSPa Re-Roof -6 I Commercial 5 CD Valuation ADJ AREA QUANTITY DESCRIPTION FEE -.1 <Co EE I- 0 1.11 UJ /0//4(e745 .., e 0 A•09' 1„A1 "X O,g ..'S" e. , • C.,, , of / ',/- -ii-. 0,Co (..D z Ed m D 0- AeL, A 0.50 r:•12-- 4,0 -I < 0 2 a .. 69e..94, -7-5 x c> U) m IiMPNIMIIIIM, PrZMItriMINVMMEN MEMa,O ,MaIIE 7/. i a /A.ro 44 t' ) CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: LAOc I . IL) •/� JUL 0 0 ,-,' I (C rm, 7, — TOTAL FEES Li Ct') .61 0 COMMENTS ( elt ilv I, ,V j RECPT. N0, 1 91 i IN PAID BY Li/ '1 K.1 "-" VALIDATIONCLe-- WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy 4qGj.P • '4 H.V Ot-is3 At ia A WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ' DATE APPLICATION 0-z_ PERMIT y -72::;,c.,.....----" DATE NUMBER ISSUE 0 OT_COPNE OCC 1 19 ST GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW EI 0 N0. PROPOSED UNITS USE D W EL. AA / N0. N0. STORIES 7.--- BEDROOMS e, a) W w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION 1-1- 0 z SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Roof 5 —I Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE .. i < C) I- I- O UJ -J UJ 0 Z Ei3 2 D —J a. —) < o AllirerMielliMMWO ...... 2 alffir:We - a a O,v 0 elliMIIIIIMMLIIIP CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: gm?. ...-- 1 - TOTAL FEES G7 at" COMMENTS ,dria RECPT. N0.ArSak PAID BY VALIDATION 74110._ JOBSITE ADDRESS U3 >——J U.3 APN OWNER ADDRESS CITY 011 lr)fte ZIP APPLICANT I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUCTURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 70001 OF DIVISION SOP THE BUSINESS AND PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)). I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE,IF, HOWEVER:REBUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS UCENSE LAW) DATE I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL F. -CE AND EFFECT LICENSE CLAS ,...1 ,-me LIC NO --rw-77',"7 DATE CONTRACTo, WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT 0 THE WORKERS'COMPENSATIO PROVISIONS OF SECTION 3700 OF THE LABOR CO DATE: APPLICANT 10/1,4-OJ ,ALL RTHWITH COMPLY WITH T E PROVI WARNING. FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY MID COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTR TION, MID HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MElITIONED PROPERTY FOR INSPECTION PURPOSES 0 I AM EXEMPT UNDER SEC. B PC FOR THIS REASON I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS'COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF TFjWORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' EbI,SATION TANCE CA RAND POLICY NUMBER ARE CARRIER POLICY NUMBER ertJ °I) (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT LS FOR ONE HUNDRED DOLLARS(81C0)OR LESS) PERMITT LICENSED CONTRACTORS DECLARATION OWNER-BUILDER DECLARATION CONSTRUCTION LENDING AGENCY 4/All?-1/ OWNER TEL. TEL. 417 -ec)t4 PRESS FIRMLY CONTRACTOR .14 ADDRESS CITY Ii..ZIPaaIIW TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. CITY OF DIAMOND BAR INSPECTION RECORD ;.).10643.14...4'. . -. .. -,:. .,. . , . , . 11 . • il',..:jaaleleLr'b!"': 1 r 5 • .0.,. • ..• I 1.' i .. !..' „ .. '7.1...1 ' +A'.•.X.4:� ��:.:::: .. ..�� 7.1 . ; ��:1 �� , ....-rti WM' it-1. �„�� Z SET BACK 1 FLOOR JOIST - FTGS!FORMS/STEE I FHA REQMTS -ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT,BOND BEAM ROOF SHEATHING 8 Ff. BOND BEAM FRAMINGIVENTILIAI ION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOW-ER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING _ WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS EWER .-- FINAL ENG. PT1C TANI< . LANDSCAPE/IRRIG. SEEP P1T/L.L. ON SITE IMPS, -lAS AiR TEST J FINAL ZONING FINAL CONSI. TF FIRE DEPT, HNAL -TINA! .C: r!---- rcl:-.,1 .__ I 1 4-1FAITI-4 r^FPT PIM1141 HFATINC; FINAL PLUMBING CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION / PRESS FIRMLY JOBSITE 9 ADDRESS 1. �10 °41'41 CIL ' "'g r---- APN LOT I TRACT 4-Te2i9c.) OWNER 9 Au..,,,i 7) it-- l�ir 4A--e- ADDRESS....> , Vi I., ....., CITY icii1.03"-V.,4--- ZIPqO-)t.1;17TEIL 'AMIN/ APPLICANT TEL. CONTRACTOR i-VOio--co' _ ....., "..d.... ADDRESS* ..aftWallir" AWEISMIIM .. CITY Z11'4424111 TEL. 5 J :53 ARCH/ENG/ DESIGNER (1.- C., i-Ic5r.:4, ADDRESS 'I) 21iex., TL)11.0".4(>11- 177e-4) CITYr-4 fLr"-.2,--- ZIP9c...,-3t.3 TEL.-hr:: 511)7111�; OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)) DI,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC B 8 PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS ODE.AND MY LICENSE IS IN FULL FORCE ND EFFECT LICENSE CLASS LIC NO -1L1-1(„' 1. DATE (I I..._-,1 0 2— CONTRACTOR C74."1--e�C.:�'41:--P 1:5. WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE Iiki........OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER 17r4TS° RAI'? POLICY NUMBER i II'1.14=c)(6.:1 (THIS SECTICN NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE I-IUNORED SS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FO IS P RMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO COME SU JECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA D A EE THAT IF I OULD BECOME SUBJECT TO THE WORKERS'COMPENSATION P VISIO OF SECTIO 700 OF THE LAB CODE.I SHILL FORTHWITH COMPLY WITH T SE PROVI •S „-��..---IOW�� DATE I I k)CA.' APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097.CIV C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREBY AUTHO PRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY PN PURPOSES PERMITTEE NA .. - (c.:32- SIGNATURE OF PERMITTE DATE APPLICATIO DATE 0 0 2.— PERMIT ",\<\'P/C NUMBER -Pi ISSUE DATE ' TYPE OCC ONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW EI 0 SIDE/SIDE STREET RW 0 0 3PROPOSED N0. UNITS USE DWEL. 1 Et4ru 154:-.04-,A. r Fee•r-la-'V 4-14-44T, N0. N0. STORIES BEDROOMS CO W w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION u- 0 Z SFR/ADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Root EI Commercial 5 — co Valuation -I 1 tx.i..), ADJ AREA QUANTITY DESCRIPTION FEE i <C 0 CC I- 0 LLI -J LU a Z Ea 2 M a_ -J < c.) 2 < c.) to 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: eV.' ICA,tio V" 9 0,-"c 0, i.) ,I5 0 U\, It IP I Miiireli TOTAL , COMMENTS FEES,Tv. ? a0',1). (0 0 x co- 141 I 64mii AVilA/0 RECPT N0. /2. i PAID BY 1 cr' I VALIDATION , WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy pekeiHlit7i3 2 zs-o rcoTpcs5 OE,5cura iekkA eyr OK CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION >-JOBSITE RIM ADDRESS —Ogre)"COW:Se 1>-; 11=. CO —APN LOT TRACT 0 OWNER A-Cr. 56 c c, cr u ca ADDRESS z CITYI2;CIM6)t. Eat Y"ZIP 9/76S TEL. ILI OCIZvrC CD CONTRACTOR •Ct CC ADDRESS 0 CITY I MI ZIP TEL.94.5_915_65s GI Lo ARCH/ENG/ ct z DESIGNER LU o_ADDRESS C/3 CITY ZIP CO CO CC 0 0 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U- LU CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.6 BUSINESS AND PROFESSIONS CODE:ANY CITY OR C..) COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED 111 M STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- M CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-°FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-(.3 TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO 1-- A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(8500)): 0 o LAS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH_WAG ES AS THEIR SOLE COMPENSATION, m WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,SUSI- CO NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR WOFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- Gt TON,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE). 1.1.1 DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS CC TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE;THE CONTRACTORS U-LU CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND 2 WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- 1-TORS LICENSE LAW.) Li-DATE OWNER 0 LICENSED CONTRACTORS DECLARATION C2 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER CI_B (COMMENCING WITH SECTION 7000 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND n MY LICENSE IS IN FULL FORCE AND EFFECT, 0 LICENSE CLASS tg Act-7 LIC NO 5z//581 DATE 03 CONTRACTOR L/I 2 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS C/3 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE.rc OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. LU a- < CI O1 FkA CI POLICY NUMBER /4 Cr7f24ve LU I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE C/3 WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. c) DATE: APPLICANT Li! WARNING, FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ISSUED. MY WORKERS'COL&ISATION INSURANCE ARRIER AND POLICY NUMBER ARE. CARRIER /CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES DATE APPLICANT 24"j4 .W5/ 115:43 TELg TEL. OWNER-BUILDER DECLARATION CC 0 I AM EXEMPT UNDER SEC. B 8 P.C. FOR THIS REASON (THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE HUNDRED CCUARS 03)OR LESS). DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN --1 SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES CC LU CL CONSTRUCTION LENDING AGENCY CC I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY ••••-• FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C) 1.1.1 LENDER'S NAME I-LENDER'S ADDRESS ct LLJ CD PERMITTEE NAME Cf)C/3 1- SIGNAT APPLICATION 1 12463 PERMIT NUMBER 11%6 P/C DATE # 0' .I W ISSUE i 1 I CO TYPE GROUP DATE CONST. OCC I FRONT SEfBACKS RW ZONING REAR SIDE/SIDE SIDE 0 P STREET RW 0 0 N0. PROPOSED UNITS USE DWEL '*00(s q ;le a-I' N0. STORIES N0. BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport LIJ al Patio/Deck I-1- PooVSpa 0 Re-Roof Z 5 -) Commercial 5 CO C1 00 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE —.I < 0 ff I-- 0 w I L11 0 Z Fri m D 1 a 1 75 2' < x (...) to M CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: • .1 • I'D . Iclo a TOTAL FEES I I I• n:7 (%J5 6 CO ENTS COZEMIkilli WO i smor lin ---.2.11) RECPT. N0, PAID BY !DATION ,—......- PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy vb. /HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS VAL Fla DIAN1:40 i - 11-7:NIP ;A FICK.):4-7: ',.31^LiF.P, BOND BEAM FFAMiNa " Hui FIC):.;(N,c!!J7,t- f EXL WALL SEIF SEEP GAS FI NAL FINAL Ft: AI 1•\,;:_i FI NAt FiNA,! dENCKNG �: fIADi\ CiP,ADINC7 1'001. ELEC, POOL FENCING FINAL OFF DEl)1C,RTIONS FINAL[-N0. LANDSCAPD-RHIG. ON i-:-IMPS. -r-r- FI NAL I-111F DEPT'. rliV-AA. 1--1E-:Allri DLr F!\1,41. DEV. FEES r:Xl'.! ; ENERGY