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Home My WebLink AboutPR16-091F o= CL CD 0 0 LU J cc CD r d O 0 ro CD 0 CITY OF DIA" `)ND BAR DEFARTMEI )F COMMUNITX & DEVELOPMENT SERVIL 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fag: (909) 861-3117 Building Inspection Hotline (909) 839-7027 Fi R M LY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS Y a44ll- Zil- Vie\ APN LOT TRACT OWNER 'E/A/ / - ADDRESS - "/t i llli> CITY/ i�r �` ZJ _. ZIP TEL �) "4A-2- APPLICANT rp TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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 reasons) Indicated below by the checkmark(s), I have placed next to the applicable Item(s) [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 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] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($506). U 1, as owner oflhe property, or my employees with wages as their sole compensation, will do U 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 License Law does not apply to an owner of property who, through employees' or personal eff(rt, 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 of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale), (-) 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who holds or Improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State License Law.). j O I am exe t m Ii nsure under the Contractor's State License law jn�tbe full By my signature below I acknowledge that, except for my personal residence in which I mut have resided for at least one year prior to completion of the Improvements covered by this permit,) 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 Cade is available upon request when this application Is submitted or at the following Web site: httplwww.leginto.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby aft€rm 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 Name is In full force and effect. LICENSE CLASS: LIC. NO.: DATE: 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, tar the performance of the work for which this 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 work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEB] NOT BE COMPLETED IETHE PERMIT IS FOR ONE HUNDRED BOLWiS ($106) OR LESS). I certhythat in the performance of the work for which this permit is issued, I shall not employ any person in any mannerso as to become subject to the Workers Compensation Laws of California. And a ret if I should become subject to the Worker's Compensation provislgns of Sechon 3706 of the La�6F de, forth th wi h those provisions. DATFII I r' d APPHCANTX �-' � WARNING: Failure to secure Worker's Compensation coverage i 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 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 cf the work for which this permit Is Issued (Sec. 301 Civ. C), _ TENDER'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 ofthis county to enter upon the above-mentioned property for inspection purposes. Pk�fmffi (PHINI SISNA*'OF PERM1TfEE DATE APPLICATION DATE: 6, h -S k I 'a I ISSUE DATE: V% I PERMIT#: ._OIia C:";1 Ii TYPE CONST. OCC GROUP: Scope of Work X TlZyeAmliE:.)t' et ! 7M t4 # DWLL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR I ADJ. AREA/VALUATION SFR/ DD/REM Garage arport �, w Patio/Deck ut LL PODVSpa ZRe -Roof I Commercial 5 m ValuatlorP4 L AcIj. Area: QUANTITY DESCRIPTION FEE y y yz- w CA �! -r"i/ CONSTRUCTION: c CV `ti'T a cr y PLAN REVIEW: _f6 ELECTRIC: V:;�x \-" \'fir -a 1 PLUMBING: -c* ri C— --� `( MECHANICAL: V="A ! �A- INSPECTION FEE: ISSUANCE: SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE:y� PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES ' COMMENTS: P/C: PAID BY: I �, y, VALIDATION: RECEIPT p _ A'��I-"1 PAID Ell v `T� VALIDATION: WHITE— Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy SETBACK/ LETTER TRACT AND LEDGER FOOTINGS FORMSSWITCH GEAR SLAB_ 77 COMMERCIAL HOOD UG. PLUMBING T-BAR UG. ELECTRICALINTERCEPTER LIFER GROUND ... HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMINGNENTmo ROUGH ELECTRICAL' ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C () GAS TEST ROUGH PLUMRJNG PRE GUNITE INSULATION WALT INSULATION { kILINC POOL PRE DECK BONDING P-TRAP DRYWAI..L LATH (PHC) k.AFFI EXIERIOI. I ATH INI FRIOR GAS IT'S k SCRATCH COAD H k'CTRIC MFIE.R RELEASE PIAS M1.1I:R IIFLEASE FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 157( )2ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL SPLCIAL INSI'L_CTION ISO. FRAMING PLANNING APPROVAL FINAL BUILDING R®UGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT. FINAL PLANNING FINAL ENGINEERING/ PW., FINAL ELECTRICAL. FINAL PLUMBING T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. _...__, COMMENTS: 11 d FINAL INDUSTRIAL WASTE � ,o �`��J;' � �' � �� 4,ak_.. ' -1Cxl>-70 ®� gip` � Trite Is AWL(