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Home My WebLink AboutPR17-13834CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 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 Z/ APN LOT TRACT OWNER r ADDRESS C L - 0 r CITY 0 �-) ' . y ; ' ZIP TEL. APPLICANT TEL. CONTRACTOR ADORES` CITY Thi '-n ZIP TEL. T 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 items) [Section 7031,5, Business and Professions Gode; Arty 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 be 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 anyapplicantiora permlt subjects the applicant to a civil penalty of not more than five hundred dollars (5500). LJ i, as owner of the property, or my employees with wages as their sole compensation, will do ( j 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 to 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, Ii 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.). C-) I, 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.). U I am exempt from bcensure under the Contractor's State License law for the following reason(s): Date: Slgn: By my signature below I acknowledge that, except for my personal residence in which I must have reelded 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-bullder If It has not boon constructed in its entirety by licensed contractors. I understand that a copy of the applicable law,Sectlon 7044 of the Business and Professions Code is available upon request when thls application is submitted or at the following Web site: http/www.l eginfo.ca.gov/cafaw,html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7009) of Division 3 of the Business and Profess€ons Code, and my license is in full force and effect, LICENSE CLAS&_y NO [LIG. EXP. DATE: " CTOR� CONTRA " 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 permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 370C of the Labor Cade, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Nu In CARRIER POLICY NUMBER 1,-,l m FHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FUR ONE HUNDRED DOLLARS $1CC OR LESS). I cerlify that in the performance of the work forwhlchthis permit is issued, I shall not employany person in any manner so aslo become subject to the Worker's Compensation Laws of Califomia. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 ofthechar C I shall forthwith comply with those provisions. Ila DATE:12APPLICANT: I' ? lr21iL�x 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 (S100,000), in addition to the cast 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, ON C.). LENDER'S NAME: LENDER'S ADDRFW I certify that I have read this application and state thatthe above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representallues of this county to enter upon the above -m at' ned property for Inspection purposes. FERMI -E£�I EjPRINT} - S]GF f li CF EP% �_E �f � DATE APPLICATION DATE: C P/C# ISSUE DATE: PERMIT# : /e6 7 TYPE CONST. OCC GROUP: 9 Scope of Works I i' {' - # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADWREM Garage/Carport LUPatio/Deck Lu U- Pool/5pa ZRe -Roof OJ Commercial Z) M lialuation: Adj. Area: QUANTITY DESCRIPTION FEE c3 U w c7 z m a q Auk aa ty CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL' , 7 INSPECTION FEE: ISSUANCE:a 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: Cd WHITE: — Department Copy, YELLOW— Finance Copy, PINK —Assessor Copy CITY F DIAMOND INSPECTION C SETBACK/ LETTER TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMBING T-BAR UG, ELECTRICAL INTERCEPTER UFER GROUND HOT MOP/SHIOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT" DEMOLITION RO.O.r. SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOUSPA SHEAR WALLS'INTERfOR ROUGH PLUMBING FRAMINGNENTING `: ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C () GAS TEST HOUGH PLUMBING PRE GUNITE INSULATION VVALI POOL PRE DECK BONDING INSULATION CFII.ING P-TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOL I A,FH EXTERIOR WALLS: LATH INTERIORWALL _ FOOTING/STEEL GAS TEST WALL STEEI. 7N°( } LIFT _... _ SCRATCH COAI WALL BOND [TAM ELECTRIC MFIER RELEASE WALL DRAIN. SLAL GAS METER "ILL.EASE WALL FINAL. SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING / ROUGH FIRE APPROVAL FINAL MECHANICAL - % FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CECT. 4f OCCUPAHCY FINAL. HEALTH DEPT. FINAL INDUSTRIAL WASTE CC_iMMENTS:_