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Home My WebLink AboutPR17-11370r` D�11011 Bim. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bari CA 91765, , PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@damondbarea.gov JOB SITE ADDRESS'` Advt4f°'®„ P € APN LOT TRACT OWNER &`e_,-, L- ADDRESSrvLl - CITY ea -2- e- t ZIP'{ d "� TEL. a- C .-. ji- 1 W.- . APPLICANT_ r c TEL. CONTRACTOR s C 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 reason(s) 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, atter, 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 pursuant to 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 Ncensure and the basis for the alleged exemption. Any vlolal of Section 7031.5 by any applicantfora permit subjects the applicant to a civil penalty of not more then five hundred dollars ($500). (-) f, as owner of the property, or my employees with wages as their sale compensation, will do U all of or U pardons 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' cr 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 of murplation, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). Iroject as owner of the property, am exclusively contracting with licensed Contractors to construct the p(Section 0 as and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State License Law.). [j I am exempt frum.licensure under Contractor's State Lice,. Wing reasoni {late: R' Sign: -,- By my signature b law I acknowledge that, except for my personal residence in which € must have resided for at least one ,year prior to completion of the Improvements covered by this permit,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 appi€cab€e law, Section 7044 of the Business and Professions Code is available upon request when this appilcatlon Is submitted or atthe following Web site: httplwww.leglnfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am Ilcensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. LICENSE CLASS: LIC. NO.: ExP.DATE: CONTRACTOR WORKER'S COMPENSATION DECLARATION I HERESY 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 this permit Is issued, I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Cade, for the performance of the workforwhich this permit is Issued. My Worker's Compensator Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (PHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS S100 OR LESS). I certify that in the performance of the work for which this permh is Issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Camper fie pmvisi s eckion 3700 of the Labor Code, sh tmwhh comply with those provisions DAT 7 APPLICANT: W •-- WARN€N : Failur 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 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 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 relating to bullding construction, and hereby authorize representatives of this county to enter upon the above-mentioned property tot inspection purposes. PERMITTEE NAM - ,q SIGNATURE OF PERMITTEE DAT APPLICATION DATE: ISSUE DATE: TYPE CONST. P/C# PERI `Pict OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSI' ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck Lu W_ Pool/Spa Re -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a g @Y U w J cu CDU uza J a J U Z Q x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: mm MECHANICAL: INSPECTION FEE. ISSUANCE: SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: �[ S PIC: PAID BY: VALIDATION: RECEIPT # PAII BY: ✓ s �11 ;?,IVAL€DATICN: 1/0_,.,-, WHITE -- Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG, ELEGIR1CAL UFFH GROUND 5f WFR LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERfOR ......... FRAMINGNENTING ROUGH MECHANICAL )TOUGH ELECTRICAL W{ }_ L ( ) ROUGH PLUMBING INSULATION WALL INSULATION CEILING, DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAl ELECTRIC ME L13 RELEASE ...... GAS METER RELEASE SPECIAL IN,WE-GIION FINAL SLIILDING FINAL MECHANICAL - FINAL ELECTRICAL 'rzr FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: TRACT AND LEDGPI SWITCH GEAR COMMERCIAL MOUE) T—BAR INTERCEPTER HOT MOP/SHOWFRPAN SEPTIC/CESSPOOL. HERS REPORT RF'(I IVFD DEMOLITION ROOF DRAINS &U6 .. C;UNOLIIT SPA RCUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE CUNITE _.. ___..,..............._..-- POOL PRE DECK BONDING P THAL' FENCE / GATE/ AI ARM FINAL_ POOL. WALLS: WAIL FOOTING/STEEL OVA{.IST€ F.I IST( ) 2rao( ) LIFT WALL 130ND BEAM WALL DRAIN/ SEAL WALT_ FINAL.. RU, FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING —_ —. _... FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES ..............._ _ FINAL HEALTH DEPT, — FINAL MDUSTRIAL WASTE