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Home My WebLink AboutPR17-10939CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 PRESS '•s" BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov FIRMLY JOB SITE ADDRESS 1520 brio o!Dr, JOB APPLICATION DATE: 8 1 111 P/C# JPR 1--- I0 I,3q APN LOT TRACT ISSUE DATE; !!� i -7 PERI R17— OWNER ADDRESS �a' TYPE CONST. OCC GROUP: �'� ; �,. ,� CITY ; uYve ; C.,�; ZI TEL. _ APPLICANT TEL. Scope of Work CONTRACTOR CITYM4 01112"V_LZIP - e' TEL. ADDRESS CIN ZIP OWNER -BUILDER DECLARATION f hereby affirm under penalty of perjury that 1 am exempt fromthe Contractor's State License Law for the reason{s) indicated below by the checkmark(s), I have placed next to the applicable lien{s) ]Section 7D31,5, Business and Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he er she Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter D) 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. Ary violation of Section 7031,5 by any appllcantfor a permit subjects the applicant to a 0101 penalty of not more than five hundred dollars ($500). (_)1, as owner of the property, or my employees with wages as theksole compensation, will do U all of or (� portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: 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 -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). () I, as owner of the property, am exclusively contracfng with Ilcensed 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 licensed Contractor pursuant to the Contractors' State License Law.). LJ I am exempt from licensure under the Contractor's State License law for the following reasons By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year prior to cOn ietion of the improvements covered by this permlt,l cannot legally sell a structure that I have built as EP 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 site: http/wmJeginfo.ca,gov/calaw.html. w LICENSED CONTRACTOR'S OEGCARAiION M hereby affirm under penaNy of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) = of Divislon 3 of the Business and Professions Cede, and my license Is in full force and effect. LIC, NO.:LICENSE CLASS: l EXP, DATE: CCNTRACTOR: .>4�_ O WORKER'S COMPENSATION DECLARATION LL I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 ofthe Labor Code, for the partormaocc of the work for which this permit Is issued. p 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, for ZE the performance cfthe work for which this permit Is issued. My Worker's Compensation Insurance Carrier and d Policy Number are. ; ,� LU CARRIER �A6k_,Ni6Y CD POLICY NUMBER55 F" (THIS SECTION NEED N07 BE COMPLETED IF THE PERMIT 1S FOR ONE HONORED DOLL4RS .$f C5 DR LE55), CD I certify that In the performance of the work for which this permit Is issued, l shall not employ any person In anymanner so as to LL o became subject to the Workers Compensatlon Laws of California. And agree that if I should become subject to the Workers � Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. CZ: DATE: APPLICANT: cc WARNING Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal Eli penalties and civil fines up to one hundred thousand dollars ($Icc.000), in addition to the cast of the compensation, p damages as provided for In section 3708 of the labor code, interest, and attorney's fees CC :` CONSTRUCTION LENDING AGENCY ;� rI hereby afflrm 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, Civ. C.}. H LENDER'S NAME: LENDER'S ADDRESS: LU zI certify that I have read this application and state that the above information is correct 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to o enter above-mentioned propertyfpx inspection purposes. co PERMITTEE NAME (PRINT) d SIGNATI p� p (j=�EE DATE # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREANALUATION SFR/ADD/HEM GaragelCarport EL, PatiolDeck LL Pool/Spa ZRe Roof � Commercial m Adj. Area: QUANTITY DESCRIPTION FEE U U w z m 5 a 8 U CONSTRUCTION: r PLAN REVIEW: Z a ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES Z00.0 COMMENTS: P/C: PAIL] BY: VALIDATION: RECEIPT #_315B3_�L PAID BY7 ZI—IL— VALIDATION: LC_ WHITE — Department Copy, YELLOW — Firanae Copy, PINK—Assessor Copy CITYOF Ij �:, - - - I CTI ECORD SACK/ LETTER TRACT AND LEDGER TINGS FORMS "WITCH GEAR 3 COMMERCIAL HOOD 'LUMBING T -BAR ELECTRICAL INTERCEPTER I GROUND HOT MOP/SHOWERPAN ER LATERAL SE.P-FIC/CESSPOOL I WATER LINE HERS REPORT RECEIVCO ER CLEANOUT DFMOLITION F SHEATHING ROOF DRAINS )R SHEATHING HOUGH CONDUIT �R WALLS EXTERIOR POOL/SPA kR WALLS INTERIORROUGH . ..... - PLUMBING AING/UENTING �'�. ROUGH ELECTRICAL aH MECHANICAL _ ROUGH MECHANICAL 3H ELECTRICAL W( ) C-( GAS TEST 3H PLUMBING PRI- GUNITE LATION WALL Y001- PRE DECK BONDING LATION CEILING P TRAP VALL l FF NCE /GATE/ALARM _ (PRE) FINAL POOL _. EXTERIOR WALLS: INTERIOR WAIT FOOTING/STEEL - TEST WAIL STEEL 15r( ) 2N°( ) I IFT ITCH COAT WALL BOND BEAM TRIC METER RELEASE WALL DRAIN/ SEAL METER RELEASE WAl L. FINAL IAL INSPECTION R0. FRAMING PLANNING APPROVAL L BUILDING ROUGH FIRE APPROVAL MECHANICAL. FINAL FIRE DEPARTMENT �._. _ ELECTRICAL — FWAL PLANNING I _ PLUMBING FINAL. ENGINEERING/ PSI )f OCCUPANCY . FINAL COMMUNITY SERVICES °. alOCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: