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Home My WebLink AboutPR17-7172DlVIOND BARI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES tt 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS API LOT TRACT OWNER i- v; ADDRESS CITY o r1 r ra ti 7 fi `q,e ZIP qe T Ee APPLICANT TEL. CONTRACTOR ADDRESS .l ] Tl 7 1. CITY °� la �� - ,,, -�y'j ZIP ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under peraliy of perjury that i am exempt from the Contractor's State License Law for the reasor(s) indicated below by the checkmark(s}, I have placed next To the appilcable item(,) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] orthat he or she Is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any appllcartfor a permit subjects the app€icantto a civil penalty of not more than five hundred dollars (S500). U I, as owner of the property, or my employees with wages as their sole compensation, will de F) all of or O portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State ILaw does not apply to an owner of property who, through employees' or personal effort, lr Improves the property, provided ihatthe improvements are not intended or offered for sale If however, the bullding or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or Improved for the purpose of sale,). O I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who holies or improves thereon, and who contracts far the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(,]: Date: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have reelded for at least one year prior to completion ofthe improvements covered by this parmit,l cannot legally sell a structure that I have hunt as an owner -builder If It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this appllcatlon Is submitted or stirs following Web site. httplwww.Ieginfo.ca.govlcalaw.html, LICENSED CONTRAGTOR'S DECLARATION I hereby afflrm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Cods, and my license is in full force and effect LICENSE CL455: ? LJC NO.: rW FXP. DATE: a CONTRACTOR: WORKER'S 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 Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which thls permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: - CARRIER 5 1 A P q w POLICY NUMBER cji c' T 3_12 c / (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certlfythat In the performance of the workfor which this perrel is issued, I shall not employ any person In any manner so as to hewme subject to the Worker's Compensation Laws of California, And agree that if I should become subject to the Worker's Compensation provislons of Section 3700 of the Labor Code, I shall forthwith comply with those provisions DATE: APPLICANT'. WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for In section 37DB 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 appllcatlon 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 aq ue-gtentlaned prop erty`for inspection purposes. 3�r tit PERMITTEE NAME (PRINT) f- SIGNATURE OF PERMITTEE DATE r Lam` APPLICATION DATE: / 1 -4 P/C# PKI- - J7 1 -+2- ISSUE DATE: PERMIT#: + T TYPE CONST. OCC GROUP: Scope of Work /i: " �i ,:� '.7� y / .S � r- g ry # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport E2 Patio/Deck - Lu LL Pool/Spa Z Fie -Hoof Commercial CC Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J4 V 2 ca u.a w co z m J a V Z Q x c� CONSTRUCTION: PLAN REVIEW: Z Zqq O qa 9 ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 42,2q Si Z. t I ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: ` 2.co BASF: e PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: 500-' P/C: PAID BY: VALIDATION: RECEIPT # 3 , -p ' f PAID BY: i - VALIDATION: - WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy SETBACK/ LETTFR FOOTINGS FORMS ............. . SLAB UG. PLUMBAG UG. ELECTRICAL UFER GROUND SEWER LATFRAI. MAIN WAll Fl. I IN[ SEWERCI.FANCUT ROOF ",HFATIIING FLOOR SHI ATHING ................... SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ROUGH PLUMBING INSULATION WALL CITY OF DIAMOND BAR INSPECTION RECORD I RAGF AND LEDGER SWITCH GEAR COMMERCIAL HOOD I -RA4 IN I1.1WI':PTER HOT MOP/SHOWERPAN SEPTICICESSPOOL HERS REPORT RECEIVED DEMOLITION _ ROOF DRAINS ROUGH CONDUIT PODLISPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING INSU! ATION CEILING P -TRAP DRYWALL .............. FENCE / GATE/ ALARM LATH (PRE) FINAL POOL I_A1H EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1s ( ) 2N°( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER HELLASE WALL DRAIN/ SLA/ GAS METER RFI E=ASE WALL FINAL. SPECIAL INSPF C [ION RO. FRAMING PI.ANNINCi APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING _ FINAL ENGINEEIRINGI PW - .. . .......... T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH [SEPT. FINAL INd 6iTRlAL WASTE COM E€VTS: