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Home My WebLink AboutPR17-13847C LLa } z 0 LU z co CITY OF DIAMOND BAR ry DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES _ 21810 Copley Drive, Diamond Bar, CA )1765PRESS (909) 839-7020 Fax: {909} 861-3117 Bottling Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS_- APN LOT TRACT OWNER f +" ADDRESS CITY .a y, 0,4101121 fa y' ZIP t✓ i e ]; TEL. APPLICANT '-t TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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 reasons) 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, afler, improve, demolish, or repair, any structure, prior 10 its issuance, also requires the applicant for the permit to file a signed statementthaf he or she Is licensed pursuant to the provisions of the Contractor's State license Law (Chapter 91 Commencing with Section 7000 of Division 3 of the Business and Professions Cade] or that he or she is exempt from licensure and the basis for the alleged exemption. Any vlolatlon of Section 7031.5 by any applicantfor a permit subjects the appiicantto a civil penalty of not more than five hundred dollars ($500). CU I, as owner of the property, or my employees with wages as their sole compensation, wilt do U all of or () portions of the work, and the structure is not intended or offered for sale (Section 7044, Buslness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through empiayees' ar 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 -Builder wlll have the burden of proving that It was not built or �improved for the purpose of sale.]. %3' as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Slate 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 exempli licensure under the Contractor's State Licens law for the following reason(s): Date'. d ,;` `... °.. I � Slgn� ••"5, �-W By my signature below I acknowledge that, exceptfor my personal reside ern which I must have resided for at hast one year prior to completion of the improvements covered by this permit mot legally sell a structure that 1 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 following Web aII http/www.loglnlo.ca.gov/calaw,Mml. 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 Professlons Code, and my license Is in full farce and effect. LICENSE CLASS: LIC. ND.: EXP. DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOI-LOWING DFCtARATION& I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 37OU of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Cade, for the performance of the worktor which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (PHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). 1 certify that in the performance of the wall which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Worker's Compansatlon taws of California. And agree that If I should became subject to the Worker's Compensation p ovlsions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions. DATWO a APPLICANT WARNING: F !lure t s cure Worker's Compensati rage Is unlawful, and shall subject an cmployer to criminal penalties and civil fines up to ore hundred t a chars ($100,000), In addltlon to the cost of the compensation, damages as provided for in section 3708 of th or code, interest, and attorney's fees CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Construction Lend[ng Agency for the performance of the work for which this permit Is Issued (Sec. 3097, Clv. C.). LENDER'S NAME: LENDER'S ADDRESS, I certify that I have read this application and state that the above Informatlon 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-mentioned property for inspection purposes. '15IRMITTEE NAME (PAT) IGNATUJtE-Or I ff DATE APPLICATION DATE: S1 A -7 P/C# - ISSUE DATE: $� i -S 'b PERMIT# : \Pi o TYPE CONST. OCC GROUP: Scope of Work :` t srt �_ : i t . #,.r t':efo ii, � # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFUADD/REM Garage/Carport LL Pat€c/Deck LL u. PDcli ZRe -Raaf n Commercial �l Valuation: Adj. Area: QUANTITY DESCRIPTION FEF .files '� meg° c� ii U 4 x V CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MFCHAN[CAL: INSPECTION FEE: ISSUANCE: SNIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE:_..:....r PRE-ALT FEE: r�— BASF: PLOT PLAN: ZONING CLEARANCE; TOTAL FEES COMMENTS: P/C: PAID BY: RECEIPT# RilgpAIDBY: �� VALIDATION: VALIDATION:_,,,_ WH ITE — Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy CITY OF E D BA?' INSPECTION RECORD SETBAW LETTER TRACT AND tll,)GLIi FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL 11000 UG, PLUMBING T -BAR UG. ELECTRICAL INTERCEPTER UFFI3 GROUND HOT MOPISHOWFRPAN 5FWF}i IATFRAI SEPTIC/CESSPOOI MAIN WATT"H I INE. HERS REPORT RECLIVI'D SEWER CI LANOUT DEMOLITION ROOF SI IFATI IING ROOF DRAINS FLUOR SHFAIHING ROUGH CONDUIT SHLAH WALLS EXI LRIOR PDOUSPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C { GAS TEST ROUGH PLUMBING - - PRE GUNITE €NSULATION WALL �� - - POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALLS FENCE IGATE/ ALARM LATH (PRE)OL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTINGISTEEL GAS TEST WALL STEEL IST( ) 2N°( )LFT 5CRA1 Gii COAT WALL BOND BEAM FLL(I HI( NIH] I H Ti LFASF WALL DRAIN/ SEAL EI GAS Eli Iil LEA.�L f -- _. _ - WALL FINAL SI'F.CIAL INSPEM ION RO. FRAMING PLANNING APPROVAL -FINAL BUILCIING ! ROUGH FIRE APPITOVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL. ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL. ENGINEERING- PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT, of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: � �� --