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Home My WebLink AboutPR17-16858n VION BA 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 building@diamoudbarea.gov JOB SITE ADDRESS ! § APN LOT TRACT OWNER � . 4a ( ADDRESS '' �-�" �' %' - CITY' APPLICANT r� aha"� : @r� k '� e TEL. n CONTRACTOR "C-2 WC.: Ull�Lk ADDRESS '2°,P$'s``" �._. CITY s3 Z}P 4' " TEL. .`a° ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATIDN 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, ! have placed next 10 the applicable items) [Section 70315, 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 statementthat 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 Ilcensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit su4jects the appllcantio a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do C-} all of or i portions of the work, and the structure is not intended or offered for sale (Section 7944, 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 arc not intended or offered for sale. If however, the building or improvement is said within one year of completion, the Owner -Rudder will have the burden of proving that It was not built or improved for the purpose of sale.). (-) €, 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 ei property who builds or improves thereon, and who coniracisforthe projects with a licensed Contractor pursuant to the Contractors' State License law.). (-) I am exempt from licensors under the Contractor's State License law for the following reascn(s): Date: Sign: By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year char to completion of the Improvements covered by this permlt,I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by 11censed contractors, I understand that a copy of the applicable law, Section 7044 of the Rusiness and Professions Code is available upon request when this application is submitted or atthe following Web site: htlp/www.leglnfo.ca.gav/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 717170) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS:. ' LIC. NO,, EXP. DATE: I- "-,`4:� CONTRACTDR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FGLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by 1 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 €nsurince, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. My Worker's Compensation Insurance Carrier and Polley Number are: CARRIER }....�„R.,'' �.==-;,.:';?'•�. POLICY NUMBER � y " i FHIS SECTION NEED NOT BE COMPL IF THE PERMIT 15 FOR ONE HUNDRED DOLLARS 5100 OR LESS), Icerlitythat inthe performance oftheworkfarwhlc this permll €s issued, shallr�ot mployanyperson inany manner so�to r become sub' di to the Worker's Compensation Law of Call am€af And ag e�! should become subjectto the Worker's i Comp ti a rovlslons of Section 3700 of the Lebo Code, shall fodhwr c ly+mhh'tf provisions. DATE:x APPLICANT: <"�`"'� i WARNING: Failure to secure Worker's Compe5sati8n coverage Is unlawful, "and shall subject an employer to criminal i penalties and civil fines up to one hundred fhousal3d dollars ($100,000), in aceiilon to the cost of the compensation, damages as provided for fn section 3706 of the Iabof�oode, Interest, and attorney's tees. CONSTRUCTION LENDING AGENCY j I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work #or which this permit Is issued (Sec. 3097, Civ. C.). LENDER'S NAME: = LENDER'S ADDRESS: i - 1 certify that i have re d this application and state That the above Information is correct I agree to comply with all city and county ordinances a state laws relating to building constructlen, and hereby authorize representatives of this county to 5 enter upon the above mentioned propeor inpRectioh purposes. r FERMI EE NAME (P INT) g a fir. SIGNATURE OF PERM DATE APPLICATION DATE: SSUEDATE: a. TYPE CONST. ( P/C# PERMIT#: /7 OCC GROUP: r Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO, FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck W Ll. Pooll Z Re -Roof Commercial M 0] A Valuation: Adj. Area: QIJAINTlTYT DESCRIPTION FEE J U W W ca z m J 0. c� z c_7 CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: _ SMTP: - ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: cr'yp PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: „P RECEIPT# ✓e AID PAIDRY'._,_, VALIDATIION. WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy NMOND BAR ON RECORD TRACT AND I_LUf4FR SWITCH GEAIi COMMERCIAL_ HOOD T -BAR - INTERCEPTE:l3 HOT MOP/SHOWF.RPAN SEPTIC/CESSPOO1. HERS REPORT RFCE IVED DEMOLITION _ ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL. ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ Al ARM FINAL POOL WALLS: WALL FOOTING/STFFI. WALL STEEL 117( ) 2NP( LIFT WALL BOND BEAM WALL DRAIN/ SEAL WAI.,L FINAL 110. FRAMING PLANNING APPROVAL L8nimp riRF Appp lim - - FINIAL, ENGINEERING PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE ,90BACK/ LET 1 FR FOOI INGS FORMS SLAB UG. PLUMBING UG ELECTRICAL UFFR GROUND SFWFR LATERAI MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATWNG SHEAR WALLS EXTERIOR SHEAR WALLS IN I ERI OR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ROUGH PLUMBING INSULATION WALL - INSULATION CEILING DRYWALL LATH CPRE) ......... LATH I(TERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL_ MECHANICAL FINAL ELECTRICAL FINAL. PLUMBING - T,,C, of OCCUPANCY ERT of l)GCUPA CY NMOND BAR ON RECORD TRACT AND I_LUf4FR SWITCH GEAIi COMMERCIAL_ HOOD T -BAR - INTERCEPTE:l3 HOT MOP/SHOWF.RPAN SEPTIC/CESSPOO1. HERS REPORT RFCE IVED DEMOLITION _ ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL. ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ Al ARM FINAL POOL WALLS: WALL FOOTING/STFFI. WALL STEEL 117( ) 2NP( LIFT WALL BOND BEAM WALL DRAIN/ SEAL WAI.,L FINAL 110. FRAMING PLANNING APPROVAL L8nimp riRF Appp lim - - FINIAL, ENGINEERING PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE