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Home My WebLink AboutPR17-0984Q Q C M LLJ C7 U 0 C!] X ¢ O u.. z 0 N s u� CD U w m u7 L!J 0 zd a LU Q D Q a Ce z a X01. Sr�R CITY OF DIAMOND BAIL DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES r21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-311.7 Building Inspection Hotline (909) 839-7027 FIRMLY BUMDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS APN LOT TRACT OWNER Of1 ADDRESS Z55W> , f_/ CITY�/� ZIP TEL. APPLICANT 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(s1, I have placed next to the applicable Items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit in 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 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 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). O I, as owner of the property, or my employees with wages as their sole compensation, will do ( j all of or O portions of the work, and the structure Is not intended or offered for eels (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who, ttrough employees' or personal effort, builds or improves the property, provided that the Improvements are not Intended or offered for sale. If however, the bui€ding 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 licensure under the Contractor's State License law for the following reason(s): Date: Sign, By my signature below] acknowledge that, exceptfor my personal residence in which I must have resided for at least one year pnorto completion of the Improvements covered by this permit,I cannot Iegafly sell a structure that I have built as an owner -builder if It has not been constructed In its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Buslneas and Professions Code is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.govlcalaw.htmf 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 Division 3 at 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 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 Cade, for the performance of the work for which this pormlt Is Issued. I have and will malntaln 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 NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the work forwhich this permitis issued, I shall mat employ any person in any manner so as to become subject to the Worker's Compensatlan Laws of California. And agree that if I sheuld become subject to the Workar's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING Fallm 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 ofthe labor code, interest, and attorney`s fees. CONSTRUCTION LENDING AGENCY I hereby alflrm under penally of perjury that there is a Construction Lending Agency for the performance of the work for which this permit Is Issued (Sec. 3097, Clv. 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 holding construction, and hereby authorize representatives of this county to enter upon the above-mentlaned property for inspection purposes. PERMITTEE NAME (PRINT) SIGNATURE OF PERMIT -FEE DATE APPLICATION DATE: 1J 1P/C# ISSUE DATE: -i 0 PERMIT# : '0!�.Sq TYPE CONST. OCC GROUP: Scope of Work A Sh, r' f r i✓ CA( # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck W LL Pool/spa ZRe -Roof Commercial 7 CO Valuation: Adj. Area: QUANTITY DESCRIPTION FEE c�3 U w co z m J a J Q a a U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: BASF; PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: PIC: PAID BY: VALIDATION: RECEIPT # PAID BY: VALIDATION: WHITE —Department Copy, YELLOW -- Finance Copy, PINK ---Assessor Copy 7BALETTER TRACT AND LEDGER FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG, PLUMBING T -BAR UG. ELECTRICAL INTERCEPTER UFFR GROUND HOT MOP/SHOWERPAN SFWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOUSPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMINGNENTING I°'j ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTMCAL W( ) G ( GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOT]NGI` GAS TEST WALL STEEL I ST( )2N-["(. ) LIFT SCRATCH COAT WALL BOND REAM ELECTRIC METLII RLLEASE WALL DRAIN/ SEAL GAS METER RL.1 FASE WALL FINAL SPECIAL INSET(; HON _ _ R0. FRAMING PLANNING APPROVAL _.. FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANKING FINAL PLUMBINGFINAL _...... . ENGINEERINGPW _. T.C. of OCCUPANCY _._....._ . FINAL COMMUNITY SERVICES ......... _ CERT. Rf OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE