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Home My WebLink AboutPR17-0529CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICER 21810 Copley Drive, Diamond Bar, CA 91765 PRESS / (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 `yap BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov FIRMLY JOB SITE ADDRESS APN LOT TRACT OWNER L_ i". 1 ADDRESS _z ._...... ate:g ram, t k CITY ZIP TEL. _ APPLICANT 1"+AU5 il T i�e;*0, ,TEL. CONTRACTOR ADDRESS 13 i �;_ A), = . o►yp �' `_ CITY '�-k - ZIP �t � ti7k �TEL.$�j� � �0 7 : 1 C:� fa ARCH/ENG/ DESIGNER �5c, e. ADDRESS CfTY 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 tate 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 toils -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 7DDO of Division 3 of the Business and Professions Code] orthat 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 penahy of not more than five hundred dollars ($500). Q 1, as owner of the properly, or my employees with wages as their sole compensation, will do U all of or U portions of the war? and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Cade; The Cortracters' Stale License Law does rot 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 wlll have the burden of proving that it was not built or Improved for the purpose of sale,). U 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.). L) I am exempt from licensure under the Contractor's State License law for the faliowPng 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 ane year prior to completion of the improvements covered by this Perri cannot legally sell a structure that I have built as an owner -builder if it has not been constructed In Its entlrety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professlons Code Is available upon request when this application Is submitted or at the following Web site: httplwvvvv leglnfoca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am Ilcorsed under provisions of Chapter 9 (commencing with Section 7001 of Division 3 of the Business and Profasslons Code, and °-7may license is in full force and effect. LICENSE CLASS LID. NO.: 1r1 aP 40 CL EXP. CATE:� CONTAACiOR'.._.3[3 YTv"� F'�I7C"f•e'°_'� 1 WORKER'S COMPENSATION DEGLARATION y 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, for the performance of the work for which this permit a issued. I have and will maintain Worker's Compersatlon insurance, as required by Section 3700 of the Labor Code, for the performance ofthe work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number re: CARRIERT� A POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the workfor which this permit is Issued, I shall not employ any person In any manner so as to become subject to the Worker's Comporsa7elb. s of California,And agree that It I should become subject to the Worker's Compensaflon proA Ions of Section 3700 efr de, I shall forthwith comply with these provisions, DATE: ,,.-APPLICANT, '\_...,..d.— 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 ($100,000), In addltlan 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 Constructlon Lending Agency for the performance of the work for which this permit Is Issued (Sec. 3097, Civ. C.), LENDER'S NAME: LENCER'S ADDRESS: certify that I have read this application and state that the above Wormatlon Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-iramloned property for Inspection purposes. .lr® r-, if riuc `w :e. 3 PERMITTEE N (P T) _ "� SIGNATURE f E DATE APPLICATION DATE: I S P/C# ISSUE DATE: EV I PEI : W 11 TYPE CONST. OCC GROUP: S Scope of Work7 -4-1,06 C 1y 9�1yt, pY y y�_y",g # BEDROOMS g DESCRIPTION SQ. ET. FACTOR I ADJ. AREA/VALUATION SFR/ADD/REM 17 Garage/Carport LOU Patlo/Deck I rr- Pool/Spa ZRe -Roof Commercial Z) �.4 Soo Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U s Zoo prne'Ex w co z m a U � O1ia��5�i��C•. 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 (VO COMMENTS: 5 P/C: PAID BY: VALIDATION: RECEIPT # PAID EIY, VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy A TRACT AND LEDGER SNITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOPISHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOL€TION ROOF DRA[NS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTINGISTEEL WALL STEEL IST( )2 [qD( J LIFT WALL. BOND BEAM WALL DRAIN/ SEAL WALL FINAL .. ............. f30. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING _.� _... FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES _ ..... .. ........................... ... _ FINAL HEALTH KEPT, FINAL INDUSTRIAL WASTE