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HomeMy WebLinkAboutPR17-8860nU010AIn '��rllV..� ip CITY 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 bujtlding@diamondbarca.gov JOB SITE ADDRESS ® T APN LOT TRACT OWNER e— Al SS CITY e . _ ZIP APPLICANT a P - " TEL. (A, CONTRACTOR ADDRE5lI3 CITY ZIP 4 -TEL. A 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 reasen(s) Indicated below by the checkmark(s), I have placed next to the applicable Item(s) {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 permit to file a signed statement that he ur she Is licensed pursuant to the provisions of the Contractor's State License Law tChapter B) 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 vlalailon of Section 7031.5 by any applIcaric for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). �_) I, as owner of the property, or my employees with wages as their sole compensation, will de U all of or F) 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 DT 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 -Builder will 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 Cade: The Contractors' State License Law does net apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuanttothe Contractors' State License Law.). LI I am exempil licensure under the Contractor's State License law for the following reason(sp. 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 permlt,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code Is available upon request when this application is submitted or at the iollowing Web site: http/www-loglrfc,ca.gov/calavv,html. 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 of the Business and Professions Coda, and my license Is In full force and effect. LICENSE CLASS:, LIC. NO.r EXP. DATE: CONTRACTOR', `p. ,, C, WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PFNALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS' I have a il€ maintain a Certificate of Consent to Self -Insure for Worker's Compensalion, as provided by Se 3700 of the Labor Code, for the performance of the work for which this permit is issued, have and will maintain Worker's Compensation Insurance, as required by Section 3790 of the Labor Code, for the performance of the work for which this ermit is issued y Worker's Compiar.tio0 insurance Carrier and Policy Num her Se', J/ CARRIER f- _ POLICY NUMBER C LT (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS) I certify that in the performance of the work for whlch this permit Is Issued, I shall not employ any person In any manner so asto become subject to the Worker's Compensation Laws of California. And agree that If I should became subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forMwith 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 civil flnes up to one hundred thousand dollars ($100,000), In addition 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 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: Icertify that I have read this application and state that the above Information Is correct I agree to comply with all city and county ordi noes and state laws relating to building construction, and hereby authorize representatives of this county to enter upo above-mentioned prope,%for (reception dicposes. X t -e PERMITTEE NAME (PRI SIGNATI-II&CITIPERMIl DATE APPLICATION DATE: C F ! 3t PIC# i i ISSUE DATE: 6 f : PEI . "' 10 TYPE CONST. GROUP: Scope of Work f.p # DWEL. UNITS ryryOCC I' J Irk (I I # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport � PatIWDeok LU u- Pcoll ZRe -Roof i Commercial 5 03 valuation: Adj. Area: QUANTITY DESCRIPTION FEE U r U W w co a Era J a a cs z x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: �_JC'j MECHANICAL: INSPECTION FEE: ISSUANCE: _ `._ _, SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BAS F: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: s P/C: PAID BY: VALIDATION: RECEIPT ft -`'r ?AID $Y:�' t ,^.. ; VALIDATION: WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy SETBACK/ LETTER TRACTAND LEXIll SWITCH GEAR COMMERCIAL HOOF T -BAR INTERCEPTER HOT MOPISHOWE13PAN SEPTIC/CESSPOOf... HERS REPORT RECI RED DEMOLITION ROOF DRAINS CONDUIT - _ - POOLISPA ROUGH PLUMBING ROUGH ELECTRICAL FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFFR GROUND SEWER LATERAL ......... MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHINGROUGH SHEAR WALLS EXTEHIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL - ....... . ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING; ROUGH ELEC1131CAL W( ) C ( ) ROUGH PLUMBING .z(y INSULATION WAI.I _...... .......... ....... �? �7 _. ......_ W INSULATION CFII INGP-TRAP — DRYWALL ......... FENCE 1 GATT/ ALARM FINAL POOL WALL& WALL FOOTINGISTL FI. WALL STEF I IS1( )1wn( )LIFT WALL BOND BEAM WALL DRAIN/ SLAL WALL FINAL RO. FRAMING f'LANNING APPROVAL FIRE APPROVAL FINAL FIRE. DEPARTMENT FINAL, PLANNING. _ ...- FINAL ENGINEE NGI PW ...... _.__ _ LATH (PRE) LATH EXTFHIOF3 _ _ LATH INTFRIOH ...... _ GAS TEST SCRA i (;H GOA I ELECTRIC MEIER RELEASE GAS MF i Hi RELEASE SPECIAL INSPECTION FINAL. BUILDINGROUGH FINAL MECHANICAL -- FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCYFINAL _.. ........... _..... C[BMMUNIFY SERVICES _ FINAL HEALTH BELT. FINAL INDUSTRIAL WASTE CENt of OCCUPANCY COMMENTS:-....