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Home My WebLink AboutPR17-13052UU10310 BAR CI'T'Y OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21.810 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@diamondbarea.gov JOB SITE ADDRESS irk `d " f l �` l � fC W /w,-- APN LOT TRACT OWNER a r ADDRESS 7913'1 CIN ;,t§Z a.$„A„r-r.:t--_zip To 7L15 TEL APPLICANT Ay4ig4P; TEL. €'° n r 2,9-, CONTRACTOR gc 'arw,r m c,, ' .. ADDRESS 30 ',0 , Z' D. -4 CITY ZIP � %'; TEL, v,<- ?a,p ? ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to REe a signed statement that he or she is licensed pursuarri the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 at Division 3 of the Business and Professions Code] or that he or she is exempt from licensura and the basis for the alleged exemption. Any violation of Secilon 7031.5 by any appllcantfor a permitsupects the applicant to a civil penalty at not more than five hundred dollars ($500). U I, as owner of the property, or my empfoyeas with wages as their sale compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply ID an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale If however, the building or Improvement Is sold within one year Df completion, the Owner -Builder will have the burden of proving that €t was not built or improved for the purpose of sale,), U i, as owner of the property, am exclusively contracting win licensed Contractors to construct the project (Scctlon 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to thin, Contractors' Slate License Law.). (,J I am exempt from ficensure under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permlt,l cannot legally sell a structure that I have built 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 application Is submitted or at the following Web site: httplwww.lag€nfo.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that f am licensed under provisEons of Chapter 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. LICENSE CLASS: 'L€C. NO.: EXP DATE: 'ir _70 CONTRACTOR: ”°r"sem-: `. WORKER'S COMPENSATION DECLARATION 1 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 ofthe work for which this permit Is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, for ' the performance of the workfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are CARRIER e-",im .,.,.-_. , , POLICY NUMBER ?":�" e:- .Z.a x . (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the performance of the workforwhich this permit is issued, I shat€ not employ any person in any manner so as to become subleet to the Warker's Compensation taws of California And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I scull iod ith 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 Df the compensation, damages as provided for in section 3706 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby afflrm 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 rasa' g to building construction, and hereby authorize representatives of this county to enter upon the ab nt€o ed o rty foT €nspaction purposes PERMITTEE NAME (PRINT SIGNATURE OF PERMITTEE DAA APPLICATION DATE: 4 /, P/yC# g i 1 � I 05 ISSUE DATE: PERMIT# : 1 1 `3 TYPE CONST. OCC GROUP: Scope of Work _ k a D= # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. ARFA/VALUATION SFR/ADD/REM Garage/Carport Patin,/Deck LL k Pool/Spa zRe -Roof � Commercial m valuation: Adj. Area: QUANTITY DESCRIPTION FEE U r U W J W co z m J a J 4 U U FEE CONSTRUCTION: PLAN REVIEW: bib 9-36 ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:y SMTP:, ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: 6C) BASF: j . cc - PLOT PLAN: ZONING CLEARANCE: TOTAL FEES,; COMMENTS: P/C: 3i, i Li 2-, PAID BY: G. �g' g;y VALIDATION: Rt=CEIPT# PAID BY: '� '1P�i.m VALIDATION:, ,1 WHITE Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy SETBACK/ LETTER FOaTINGS FORMS _ -_ . SLAB UG. PLUMBING ............. ...... . _.............. _ UG. ELECTRICAL UFEH GROUND SEWF-R LATERAL MAIN WATER LINE SF:WE:R CLEANOUT ROOF SHEATHING F�I OOR SHEATHING SHEAR WALLS EXTERIOR _ _...._ .._ _ SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL. ROUGH ELECTRICAL W( ) C ( ) ROUGH PLUMBING ...... INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC MEIEli RELEASE GAS METER HEL}_ASE SPECIAL INSPFC1ION FINAL BUILDING Z — FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING ......... — _ _. . T.C, of OCCUPANCY CERT.9 ®C PANCY COMMENTS: 7TRACTANDOW77AR COMMER[ IA,L 11001) T -BAR INTERCE.P IIli .. ............. HOT MOP/SHOWFRPAN SEP I'K,/I F.(SPOOL HERS REPORT RECEIVED DF.MOI (TION ... ...... _._ IiOOI DRAINS ROUCI I CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL. GAS I'ESi . ............. PRE GUNITE POOL PRE DECK BONDING P TRAP_ FENCE / GATE/ ALARM FINAL POOL MALLS: WALL FOOTING/STEL WALL STEEL 1 ST( ) 2NO( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL -- FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE