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Home My WebLink About11-1100 I . _��_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 �W� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 � PRESS �'m"� BUILDING PERMIT APPLICATION FIRMLY �� JOBSITE �,! , n _ ,, APPLICATION Q J PERMIT p/C � ADDRESS��Q IN/IVAIIA�C_� ��[C�-_�� DATE L/ /O I/ NUMBER �/ /l� # � ISSUE �� n // TYPE OCC APN LOT� TRACT DATE_ p OWNERX�T�M �'i LVU F C'.l-}��/EZ /`�----CONST. GROUP p ADDRE6S ZONING SETBACKS z CITY ZIP TEL. FRONT qyy � g APPLICANT TEL. REAR � � SIDE/SIDE STREET RW ❑ � CONTRACTOR �L+J t�1`- �jl� � c SIDE � ADDRESS � CITY ZIP TEL. PROPOSED USE oARCWENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFFVADD/REM O � I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM E%EMPT FAOM THE CONTMCTORS LI� GefBgB/CBfpOff W CENSEUWFORTHEFOLLOWINOREASON(SEC.7D31.6BUSINESSANDPROFESSION9COOE:ANYCITVOR (n U COUNTVWFIICHREOUIRESAPERMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISH,OHFEPAIRANVSTqUC� W P9�I0/DBCIC < NRE,PRqR TO ITS ISSUANCE,/�150 REOUIfiES THE APPUCANT FOH SUCH PERMIT TO FILE A SIQNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTMCTORS LI- � CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISlON 3 OF THE BUSINESS AND PRO� � POOUSPB � FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFROAIANOTHEBASISFORTHEALLEOEDEXEMP� � TqN.ANV VIOUTION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof A CIVIL PENALTV OF NOT MOi7E THAN FIVE HUNDRED DOLLARS(5500)J: � ❑I,ASOWNEROFTHEPROPER7Y,ORAIYEMPLOVEESWITHWAOESASTHEIRSO�ECOMPENSATION, � COR1rtIBfClel Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704I,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF j PROPERTV NM1iO BUILDS OR IMPROVES THEREON,AND YA10 DOES SUCH WORK HIMSELF OR HERSELF OR w THROUGH HIS OR MER OWN EMPLOYEES,PROVIDED THAT SUCH IMPqOVEMENTS ARE NOT IMENDED OR m 0 OFFEREDFORSALEIF,HOWEVERIMEBUUDINOORIMPqOVEMENTISSqDWRHINONEVEAROFCAMPLE- Z TqN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � IMVROVE FOR THE PURPOSE OF SALE). w ❑I,AS ONMER OF THE PROPERTV,AA1 E%CLUSIVELV CONTMCTINO WfTH LICENSED CONTMCTORS � TO CONSTRUCT THE PRQIECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� ValUOIiOf1 ADJ.AREA W CENSELAWDOESNOTAPPIVTOANOWNEROFAPROPERTVWHOBUILASOHIMPROVESTHEREON,AND � NRIOCONTRACTSFORSUCHPROJECTSWITHACONTMCIOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION Y TORS UCENSE LAW.). FEE ¢ ❑I AM EXEMPT UNDER SEC. B. C.FOR THIS REASON � � � �y U � DATE ✓ I OWNER � �/ ¢� LICENSED CONTRACTORS DECLARATION w L�� O 2 I HEREBY AFFIRM UNDER PEN�LTY OF PERJURV THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER � D(COMMENCINO WITH SECTION 7000)OF DIVISqN J OF THE BUSINESS AN�PROFESSIONS CODE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFECT, m � LICENSE CLASS LIC.NO. � U DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � U � 1 HEREBY AFFIRM UNDER PENAL7V OF PERIUFV ONE OF THE FOLLOWING DECLARATIONS: Z O _I HAVE AND WILI MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKEFS' ¢ . _ Q COMPENSATION,AS PROVI�ED BV SECTION 3700 OF TME LABOR CODE,FOR THE PERFORMANCE U - OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE L/�BOH CODE,FOR THE PER WRMANCE OF THE WORK FOR WHICH THIS PEqM1T IS � ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION ] CARRIER PLAN REVIEW 0 POLICV NUMBEp Zd ELECT � (RLLSSECTqNNE�NO7BE00AMLEfmOFhEPERMfTISFOqONEHUI�DF1ED00LlARS(5100)ORLESS) PLUMBING W Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHIp1 THIS PERMIT IS ISSUED,1 MECHANICAL C} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE (/� WORKERS'COMPENSATION LAWS OF CALIFORN10.NdD AGREE THAT IF I SHOULD BECAME INSPECTION FEE = SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000F �PL7� � CODE,1 F THWITH CAMPLV WITH TFIOSE PRO ISSUANC � p DATE:. � APPLICANT: �SMIP w ENERGY P/C � WAPNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVEfUGE IS UNLAWFUL,AN 8E � SU&IECTANEMPIOVERTOCRIMWALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHIXISAND ENERGYPERMIT • DOLLARS(f1ao,000),IN/�DDITION TO THE CQST OF CAMPENSATqN,DAMAGES AS PROVIDED FOR IN w SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. E7ENTION FE ,� O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIfiM UNDER PENALTY OF PERIURV THAT THERE IS ACONSTRUCTION LENDIN�AOENCY FOR THE PERFORMANCE OF THE WORK F-0R WHICH 7HIS PERMIT IS ISSUED(SEC.3ao7,CIV.C.�. Z W � LENDER'S NMIE � F— LENDERSADDRESS w I CERTIFY THAT 1 HAVE READ THIS APPLICATION/WD STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES 3f , � 1 AGREE TO COMPLV WITH ALL CI7Y AND COUNTY ORDINANCES AND STATE IAWS PELATINO TO BUILDINO � CONSTFUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNTV TO ENTER UPON THE ' Z ABOVE�MEMbNED PROPERTV FOR INSPECTKKJ PURPOSES. COMMENTS ' � �( 'TF�tvr-+/aS Gt-h�v�Z ¢ PERMITTEE NAME(PRI � cn 8 �V � � OF PERMITTEE DA7E � RECPT.NO. PAID BY' VALIDATION WHITE—Department Copy.YELLOW—Finence Copy,PINK—Aasessor Copy,(iOLDENRO�File Copy,aREEN—ApplicanPs Copy c��v o� �o,��o�� . - ��s��c-�-so� ��co�� QG]�pC C�400(�] i�Q4{� D�1�3�C�4�p . - O[��pCC�4001� , � �5.��` ..:�_� _ .e, �. . ,o s SET BACK FLOOR JOIST FTGS/FORMS/STEEL 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 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER 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 �� COMMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE a . � Q �-��_� � � _�, a