HomeMy WebLinkAboutPR17-14772"' � CITY OF DIAMOND BAR.
DEPARTMENT OF COMMUNITY & D WELOPMENT SERVICES
a 21810 Copley Drive, Diamond Bar, CA 91765 PRIESS
(909) 839-70.20 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
•n BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov
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JOB SITE ADDRESS P
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APN LOT TRACT
OWNER il
ADDRESS 60 J + "'
CIN Q010- ZIP '10'x, `TEL. ler t -- 6di— T2761
APPLICANT TEL.
CONTRACTOR �' S h✓� 1'yt�°�L'4`r
ADDRESS 4 -*'t N. ikl,,a
CITY Vzc t eer4iij ZIP 2it:1. - TELL -(_40,1-7Z,-11
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm antler penalty of perjury that I am exempt from the Contractor's Stale License Law for the reason(s)
indicated below by the chnkmark(s), I I 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 applicantfor the permit to fife a signed statement that be or she
is licensed pursuant to the provisions of the Contractor's State License Law (Chapter9) Commencing with Section
7000 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 Seclion 7931.5 by any appllcant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
(_) I, as owner ofthe property, or my emptoyees with wages as their sale compensation, will do (-) all of or (-} portions
of the work, and the structure is not Intended or oflered for sale (Section 7044, Business and Professlons Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
of Improves the property, provided that the Improvements are not Intended or offered for sale. It however, the building or
Improvement is said within one year of compeller, the Owner-Bullder will have the burden of proving that it was not built
or Improved for the purpose 4f 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 scersed Contractor pursuant to the Contractors' Stats
License Law),
(_} I am exemptfrom licensure under the Contractor's State License law for the following reason(s):
Date: Sigm
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 permit,) cannot legally sell a structure that I have built as an
own er-but€der If it has not hear constructed in its entirety by licensed contractors I understand that a copy of the
applicable law, Section 7044 of the Business and Pfofesslors Cade Is available upon request when this application is
submitted or at the following Web site: hilp/www.leglnfo,ca.govloalawMrid.
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 Code, and my license Is In full force and effect.
LICENSE CLASS: C 3k LIC. NO.: q.5
EXP. DATE: " � CDNTRACTOR; d' d (G 4
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certlliicate of Consent to Self -Insure for Worker's Compensation, as provided by
Section 3700 of the Labor Code, for the performance ofthe work for which this permlt Is Issued.
i have and will maintain Worker's Compensation Insurance, as required by Saciion 3700 of the Labor Code; for
the performance ofthe work tor which this permit Is issued My Worker's Compensation Insurance Carrier and
Policy Number are: �-j--
t'r"�1 ta5�m` 'tC Ca
CARRIER _
POLICY NUMBER
(PHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS).
I certify that In the performance ofthe werkforwhich this permit is issued, I shall not employ any person in any manner so as to
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 Section 3700 of the Labor Code, l shall forthwith comply with those provisions.
DATE: APPI
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal
I and civil fines up to one hundred thousand dollars (S100,000), In addition to the cost of the compensation,
damages as provided for in section 3708 of the labor code, interest, and attomey's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of psrjury that there Is a Construction Lending Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. C.).
LENDER'S NAME:
LENDER'S ADDRESS:
I earthly that I have read this application and state thatthe above Information 1s 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
entoW4on the above-mentioned property for inspection purposes.
0
PERivi NAME (PR€
SIGNATURE OF PE IITTEE DATE
APPLICATION DATE:
ISSUE DATE. ate`
TYPE CONST.
PJC# t�
PERMIT# : "°�' 4�
OCC GROUP:
Scope of Work
# DWEL. UNITS
` 1q, -
# STORIES # BEDROOMS
DESCRIPTION 50. FT.
FACTOR PSF Al AREA/VALUATION
SFFVADD/REM
Garage/Carport
LO
Pal
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L)-
Pool
ZRe
-Roof
J
Commercial
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ValuaIIIII
Adj. Area:
QUANTITY
DESCRIPTION FEE
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W
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CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
_7-45
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY: gg VALIDATION:}
RECEIPT# PAD BY: f VALIDATION: 4✓'
WHITE --- Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
CITE OF DIAMOHD
INSPECTIC,N RECO-RD
SEIBACKILETTER
FOOTINGS FORMS
SLAB
_ -- ........ - .......
UG. PLUMBING
UG. ELECTRICAL
UFER GROUND
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
RCOF SHEATHING
FLOOR SHEATHING
SHEAR MALLS EXTERIOR
SHEAR WALLS INTERIOR
FRAMING/VENTING
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ( )'
ROUGH PLUMBING
INSULATION WALL ?
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR _m
LATH iNTE_RIOR
GAS TEST
............__-
SCRATCH COAL
ELECTRIC: Mf ILH RELEASE
GAS MI CLIi Iid±ASI-
...........................................
_
SPFC;IAL INSPLCI ION
FINAL BUILDING
........ _
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING r '
T.0 of OCCUPANCY
CERT of OCCUPANCY
COMMENTS:
TRACT AND LLDGER
SWITCH GIAR _
COMMERCIAL I100D
T -BAR
INTERCEP IC:Ii
HOT M0P/SH(.)WERPAN
SEPTIC/CESSPOOL
HERS REPORT RFCEIVFD
DEMOLITION
ROOF DRAINS
ROUGH CONI)IJIT
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE .
POOL PRE DECK RONDING
P -TRAP
FENCE / GATE/ Al -ARM
FINAL POOL
WALLS:
WALL FOOTING/STCFI
WALL STEEL 1IT( ) 7N°( ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL -
WALL FINAL
RO. FRAMING PLANNfNG APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW --
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT,
FINIAL INDUSTRIAL WASTE _.._....