The URL can be used to link to this page

Home My WebLink AboutPR17-8865e c ao- CITY OF DIAMOND BAR II I I i DEPAR'T'MENT OF COMMUNITY & DEVELOPMENT SERVICES -Pr' 21810 Copley Drive, Diamond Bar, CA 91765 PRESS I (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS APN LOT TRACT OWNER 0 In ADDRESS O€ 1lA}riy hr� a ZIP`TEL APPLICANT 67 liel I C. 1 ejR? TEL, `1% CONTRACTOR 0 r A a2 Ct' .t rLP ADDRESSCO f' CITY Va I e nl a ziPg TEL. c' 3 o O(F 7 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(sJ, I have placed next to the applicable item(s) [Section 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, ahoy improve, demolish, or repair, any structure, prior to Its issuance, also requires the applicant for the permit to fife a signed statement that hear she is licensed pursuantto the provisions of the Contractor's State License Law (Chapter 9( Commencing with Section 700D of Division 3 of the Business and Professions Codel or that he or she is exempt from licensure and the basis for the alleged exemptlan. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant a nivil penalty of not more than five hundred dollars ($500), (} I, as owner of the property, or my employees wfth wages as their sale compensator, will do V all of or(-) 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. If however, the building or improvement is sold within one year of completion, the Owner-Bullder will have the burden of proving that it was not built or improved for the purpose of saie.j { 1 I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7944, Business and Professions Code The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who centractsforfhe projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reasorl Date: Sign: By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year prior to compietien ofthe improvements covered by this permlt,l cannot legally sell a structure that I have bind as an Omer -builder If It has not been constructed in Its entirety by licensed contractors. I understand that a copy of the I applicable law, Section 7044 of the Business and Professions Code Is available upon request when this application Is s submitted or atthe following Web $Its httplwww.Icginlo.nmgevlcalawhtml. LICENSED CONTRACTOR'S DECLARATION iI hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full farce and effect. LICENSE CLASS: G 3 Ld LIC, NO,, EXP. DATE: 4 i CDNTAACTOR: i WORKER'S COMP ION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: = I have and will maintain a Cert[flcate of Consent to Self -Insure for Worker's Compensatiun, as provided by /Section 3700 of the Labor Code, for the performance of the wo(kfor which this permit is issued. 1. I have and will maintain Worker's Compensation Insurance, as required by Secton 3700 of She Labor Code, for the performance ofthe work for which this permit is Issued My Worker's Compensation Insurance Carrier and Policy Number are; S a CARRIER n POLICY NUMBER C 3 7 7 G FH15 SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 DR LESSj, I certify that In the performance of the work for Mich this permhis issued, I shall not employ any person in any mannerso mto 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 SBctlon 3700 of the Labor Code, I shall forthwith comply with those provisions. J DATE: APPLICANT: WARNING, Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal u penalties and clvll fines up to one hundred thousand dollars (5100,000), in addition to the cost of the compensation, L damages as provided for in section 3708 of the labor code, interest, and attorney's fees. 7 L CONSTRUCTION LENDING AGENCY u I hereby al under penalty of perjury that there Is a Construction Lending Agency for the performance of the work for 5 which this permit Is issued (Sec. 3097, Civ. C.). LENDER'S NAME: E LENDER'S ADORFSS: u � 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 building construction, and hereby authorize representatives of this county to :1 enter upon the above-mentioned property for inspection purposes, -a n r RC1 L� F S PERMITTEE NAME (PRIN ,e n � � n = SIGNATURE OF PERMITTEE DATE APPLICATION DATE: X \.1 P/C# ISSUE DATE: l PERMIT# : Ve`� TYPE CONST, OCC GROUP: Scope of Work E5 i'T Y p # DWEL. UNITS # STORIES. # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport Patlo/Deck PooVSpa Re -Roof Commercial Vafuaafion: G Adj. Area: CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: p VALIDATION: RECEIPT# PAID BY:, _ VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy 0 QUANTITY DESCRIPTION FEE U v w w [o m } a z CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: p VALIDATION: RECEIPT# PAID BY:, _ VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy 0 CONTY OF DIAN OND BAR INSPECTION RECORD 1 SETBACKI LETTER _... TRACT AND LEDGER FOOTINGS FORMS _ SWII C! I GEAR _.. SLAB COMMERCIAL HOOD _ UG. PLUMBING T -BAIT UG. ELECTRICAL INT=IROEPTER LIFER GROUND HOT MOP/SHOWEHPAN SEWER LATEIIAL SFPTIG/CESSPOOI. MAIN WATER HNE HERS REPORT RECEIVED SEWE=R CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS 11 OOR SHEATHING ROUGI I CONDUIT SHEAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIOR ROUGI{ PLUMBING FHAMINGAIENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL_ W( ) C { j GAS TEST ROUGH PLUMBING_ PRE GIINITE INS(ILATION WAII POOL PILE DECK BONDING INSULATION CEI! INC, P—TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOL LATEI EXTERIOR WALLS! LATTI INTERIOR WALL FOOTINGISTFF.I. GAS TEST WALL `zfI:EL 1sT( ) 1N0( )LIFT SCHNICH COAT WALL BOND BEAM ELEG I HLC METER RELEASE WALL DRAIN! SEAL GAS METER RELEASE WALL FINAL. SPECIAi INSPECTION RD. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLUMBING i FINAL PLANNING .FINAL EN INEEMNGI P T.C. of OCCUPANCY FINAL COMMiINIiM SERVICES CERT, of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE _. ......_ _ _.