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Home My WebLink AboutPR17-11092L010AI BAR: CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 1010, 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839.7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS t "6✓A APN SOT TRACT OWNER ADDRESS,. CITY 1J1t3 frM C L TEL. APPLICANT TEL. CONTRACTOR JIB z ADDRESS L(? B CITY 1,• ZIPTEL. �]g4 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. GWNER-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), 1 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 permitto 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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). L) I, as owner of the property, or my employeeswith wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Sector 7044, Business and Professions Cotle, The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are net 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.). U 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 builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law}, (_) i am exemptfrom IICenaafe 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 permits cannot legally sell a structure that I have built as an owner -builder If It has not been consiructed in its entirety by licensed contractors. I undersiand that a copy of the applicable law, Section 7U44 of the Business and Professions Code is available upon request when this application is submitted or at the fallowing Web site: h p ivwvadeginfe,ca.govlcaEawthml. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Dlvlslen 3 of the Business and Professions Code, g and my licensee is in full force and effect, 10 LICENSE CLAS S: LIC. NO.: E1 $ y ggpp EXP. DATE: CONTRACTOR:I�dr�—.-n� WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJllRY 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 tabor Code, for the performance of the work for which this permit Is Issued $/ I have and will masntain 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 Nombar are: i CARRIER�°!C-E� POLICY NUMBER _ CeA72lll - T'S (PHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOB ONE HUNDRED DOLLARS $100 OR LESS). I cartlfythat In the performance of the workfor which this permstis 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 Compensation provisions of Section 3709 ofthe 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 clvll fines up to one hundred thousand dollars (S100,000), in addition to the cost of the compensation, damages as provided for In section 3708 of the labor code, interest, and atlorney'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, ON, C.). LENDER'S NAME: LENDFR'S ADDRESS' I certify that I have read this application and state that the above information is correct. I agree to comply wbh all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes, PERME N IN SIGNATURE OF PER ITTE DATE PRESS FIRMLY APPLICATION DATE: ISSUE DATE I PERMIT#: �JI IllOq"L TYPE CONST. OCC GROUP: Scope of Work " # DWEL. UNITS # STORIES # BEDROOMS_ DESCRIPTION SO. FT. FACTOR PSE ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LO Patio/Deck LL [i Pool/Spa - Re -Roof Commercial CO Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J U V W w co z m J a J Q U 4 x V uJ CONSTRUCTION: PLAN REVIEW: ELECTRIC: & PLUMBING: MECHANICAL.: INSPECTION FEE: ISSUANCE: -7-Lr 7_Bd� SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: g BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: r CJv° TL P/C: PAID BY:ECEIPT# VALIDATION: d VALIDATION: O RPAID BY'. d®®® ®�J0� Y WHITE — Department Copy, YELLOW —Finance Copy, PINK— Assessor Copy CITE OF DIAMOND INSPECTION SETBACK/ LEI IER IMCI AND LEDGER FOOTINGS FORMS SWI IGII GEAR SLAB COMMEACIA€. HOOD UG. PLUMBING I IiAR UG. ELECTRICAL INII RGLP'lEll - - - LIFER GROUND H{1T IVIONSHDWERPAN SEWER LATFRALSFPTI{,/C1 SSPOOL -- .... ..... ... .... . MAIN WAfFTi LINE kII RS f1FPORT RECEIVED SEWER {;I LANOUT OFMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SI IEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( CAS TEST ROUGH PLUMBING PRE GUNITE INS[)[ ANION WALL POOL PRE DECK BONDING INSUI ATION CEILING P=f RAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOL 1.01 EXTERIOR MALLS: I AlIf INTERIOR WALL FOOTING/STEEL GAS l EST _ WALL STEEL 1 sr� ) 2No( ) LIFT _ -- — - S{;BATCH COAT WALL BOND BEAM METER RELEASE WALL DRAIN/ SEAL I.ELECTRIC GAS METER RELEASE WALL FINAL SPECIAL INSPECTIONR0. FRAMING PLANNING APPROVAL ...... . _ _... FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.G. of OCCUPANCY FINAL COMMUNITY SERVICES CE Ta of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE