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Home My WebLink About16545 + � CITY OF DIAMOND BAR � ` ��l^�-� ` --��` — DEPARTMENT OF COIvIIvfUN1TY 8c DEVELOPIviENT SERVICES 21825 E.Copley Drive �- (909)860-3195 Fax(909)861-3117 PRE$$ I ��%9��w � BUILDING PERMIT APPLICATION "�� FIRMLY ¢ DDRESS � p� +�[7►��Y �p�JYa'y� APPLICATION 1.�� °�� 1 PERMIT �� (l)'C #/C p {, DATE J� /� 1 NUMBER IIDJ I�� ISSUE TYPE OCC APN LOT�� TRACT Q � DATE CONST. GROUP p OWNER ��A�1MtL..c� 4']C.t�V V..�aG: �Z L o ADDRES �y�7'a-✓�re�,�ca �(.:�c� ZONING SETBACKS z CITY� � ZI� TEL3b4�5�� FRONT qyy ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW O � CONTRACTOR �l�T?i �Citi.• ( ` SIDE ❑ ADDRESS1r27-3 f14cr� � CITYC�tvl�i1ML�. ZIPq�]'�� TEL.�-L��1C�3�{ PROPOSED USE w ARCH/ENG/ z DESIGNER � l�t�V��I � �SSE�'• w � NO.DWEL. NO. NO. � ADDRESS '�' g'�D 'Ttrrr_ t� lu � CITY � ZIP TEL. UNITS STORIES BEDROOMS � • � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER•BUILDER DECLARATION SFR/ADD/REM '"i a � I HEREBV AFFIRM UNDER PENALT/OF PERNFV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8fflg0/COfPOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n C-) COUNTVWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUG W Patlo/Deck I w TURE,PRIOR TO ITS ISSUPNCE,ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED w � STATEMENT THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF hIE COMMCTORS LI� � � CENSE LAW(CHAPTER e(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPB ^ FESSqNS CODE)OR THAT HE OH SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED ExEMP- (� U TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CML PENALTV OF NOT A/ORE TlW�FIVE HUNDRED DOLLARS(S600).): � ❑I,ASONTJEROFTHEPROPERTV.ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIRIBfC18I Z WILL DO THE WORKµD THE STRUCNHE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.70a�,BUSI� J � NESS AND PROFESSIONS CODE:TNE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUpi WORK HIMSELF OR HERSELF Oq Q TMROUGH HIS OR HER OVM EMPLOVEES.PROVIDED THAT SUCH IMPROVEMENTS AqE NOT INTENDED OR m � OFFEREDFORSALEIF,HOWEVERTMEBURDINGORIMPROVEMENTISSOLDWITHINONEVEqqOFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILO OR � IMPROVE FOq THE PURPOSE OF SALE). �y,� ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTIN6WITHLICENSEDCONTqACTORS ¢ TO CANSTRUCT THE PRQIECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U� VeI118fIOf1 ADJ.AREA W CENSE UW DOES NOTAPPLY TO AN OVMER OF A PROPERTV WMO BUILDS OR IMPROVES THEREON,AND � WFIOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE Y TOqS t10ENSE LAWJ. � O 1 AM EXEMPT UNDER SEC. B.8 7.C.FOR THIS REASON � / �QO �Mi S�XV� U� t b � LL DATE ON?JER � Ue ^ � L � � LICENSED CONTRACTORS DECLARATION W G i ��N - � I HEREBV AFFIRM UNDEfl PENA�TY OF PERJURV hIAT I AM LICENSED UNDER VROVISIONS OF CHAPTER � � Y(OOMMENCINOWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE.AND Z �� MY LlCENSE IS IN FULL FORCE M!D EFFECT. m � UCENSE CLAS,,,S��---��,`'''^''' ��,'��av LIC.NO. [ /_I ZZ� � , L ~ DATE_ ��I� CONTRACTOH�TL`� a " w � � � WORKERS'COMPENSATION DECLARATION a N U � I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF 7HE FOLLOWINO DECLARATIONS: Z �Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WOqKERS' a Q = COMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOq CODE,FOF THE PER W RMMICE U OF 7HE WORK FOR WHICH THIS PERAl1T IS ISSUED. � . � �// Qw — I HAVE AND WILL 1.1A1NTAIN WORICERS'COMPENSATqN INSURANCE.AS FEWIRED BY SECTION 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK F-0R WHICH 7HIS PERMIT IS ¢ ISSUED.MY WO�R�P�NSATION�^S+U�R��ARRIER AND POLICV NUMBER AAE: CONSTRUCTION J � CARRIER K PLAN REVIEW Z PoLICV NUMBER Z Z Q �m I n�3�b-7 ELECTRIC � Q 1 p (nassE�tp�r��t�oiBE�TmoFn-�vEwnr�sr�aor��oouus(E�rolaa�ssl PLUMBING w Z �CERTIFV THAT IN h1E PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �} SHALL NOT EMPLOV PNV PERSON IN ANV MANNER SOAS TO BECOME SU&IECTTO THE (/J WORI(ERS'COMPENSATION LAWS OF CALIFORNI/�AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE � SU&IECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTqN3�000FTHELABOR — �i � CODE,I SHALL FORTHWITH COMPLV WITH TFqSE PROVISIONS. ISSUANCE ��''�� I � . l. . ..�� . p DATE: APPLICANT: SMIP � - w ENEfiGY P/C � J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE J � SU6IECT/WEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT DOLLAAS(5100.000).IN ADDITION TO THE CQST OF COMPENSATIDN,DAMAGES AS PROVIDED FOR IN � J SECTION37oeOFTHELABORCODE.WTEREST,ANDATTORNEY'SFEES. [t RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: � � 1 HEHEBV AFFlRM UNDER PENALTV OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AOENCV � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. Z W � LENDER'S NNdE . !— LENDER'SADDRESS w ICERTIFYTHATIHAVEqEADTHISAPPLICATIONANDSTATETHAT7HEA80VEINFORAIATIONISCORRECT. TOTAL FEES �yS . � I AGREE TO CqMPLV WITH ALL CITV M1D COUNTY ORDINANCES AND STATE UWS REUTINO TO BUILDINO — � CANSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCWNTVTOENTERUPONTHE Z ABOVE�MENTIONED PqOPERTV FOR INSPECTION PURPOSES. COMMENTS � � WtR. L- �e�kc � m PERMfTT NAME(PR11fT) '. /� ¢ � L✓r � O C!J � SI 7U OF PERMITTEE D E � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy cco-�� o��c�� • � o��a�� c�� °� �QGJ��' �C�t�J �� dCaSr� ° �� OG�� o � t� Of�J�C�3 SET BACK FLOOR JDIST FT'GS/FORMS/STEEL �' � FHA RE�MTS ELECTRIC GROUND UNQER FLOOR DUCT- - GROUND PLUMBING UPVDER FLOOR CU�IDUIT_ • SLAB GRADE FIREPLACE FOUIVDAI'ION • • TEMP POWER ' FIREPLACF BOND BEAM � WATER SERVICE MID HT. BOND BEAM � ROOF SHEATHING 8 FT. B�NQ BEP,M � FRAMffVGNENTILIATION FIPVAL BOND BEAM ROOF COVER PRE-GRADING ^ ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUP/IBING � ' FINISH GRADING SHOWER�TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL Ii�ISULATION POOL FINAI CEILING WSULATION OFF SITE IMPS. DRYWALL NAIUNG DEDICATIONS � SEWER FIfVAL ENG. SEPTIC T�4NK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FlNAL ZONING FINAL COfVST. ' FlRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FitJAL ELECTRiC �f��'�� . DEV. FEES PAID FItJAL PLUMBING FNERGY �)U U'`�JV VJ�J6 � COItlI�`1 V�v SEPTIG TAfVK SIZE � SEEP PIT/U SIZE � � � � � .