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HomeMy WebLinkAboutPR17-12792Iw c C LL LL y LE LE cccc a x LL z LL LL `Dli1��IghTD BAS 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*diamondbarca.gov JOS SITE ADDRESS , S ?s%Ar$ Kr �1tt^� (Ac"� APIN LOT TRACT OWNER c'L f kms., +per ADDRESS ' Lis �i'k- llj o' CITY Vil J &-re, ZIP q`_? --S TEL. 909 V7 "-l" APPLICANT TEL. ��®'t l 001 CONTRACTOR T t�yy Tis � 1 a -+ r - ADDRESS 50 2'sd'�S s ti drII CITY 00+ca.Ir' ZIP TEL- ARCH/ENG/ DESIGNER ADDRESS CITY 71P TEL, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's Slate License Law for the reasor(s) Indicated below by the checkmark(s), I have placed next to the applicable Items} [Section 7031.5, 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 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 Gods] or that he or she Is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any appllcantfor a permit subjects the applicantto a civil penalty of not more than five hundred dollars ($500). (_,] i, as owner of the property, or my employees with wages as their safe compensation, will do L j all of or LJ portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State L€cease Law does not apply to an owner of property who, through employees' or personal effort, truilds 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 hays 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 Code; The Contractors' Stale 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.) U I am exempt from licensure under the Contractor's State License law for the following reasonl 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 permit,l cannot legally sell a structure that I have buht as an owner-bullder if 11 has not been constructed In its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business Rid Professions Cade Is avallahle upon request when this application is submitted or atthe following Web site: httplwww leginfc.ca.govlcalaw,himf. 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 Prafesslons Code, and t. ymy license Is In full force and affect LICENSE CLASS: C''3''� LIC. NO.: / 013 - EXP. DATE: ill' I AZY t CONTRACTOR: _ • 12 e lA A WORKER'S COMPENSATION DECLARATION NJ I HFRFBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DFCLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 all Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation insurance Carrier and Policy Number are: {{ CARRIER 6MDI0A�rGet, r'a POLICY NUMBER f9"i_7 Cr� y '74 (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS S100 OR LESS. I certifythat in the performance of the work for which this permit is issued, I shall flat employ any person In any manner so as to became subject to the Worker's Compensatlon Laws of California. And agree that If I should become sudlect to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT, WARNING Failure to secure Worker's Compensatlon coverage Is unlawful, and shall subject an employer to crlminal penalties and civil fines up to one hundred thousand dollars (5100,000), 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, Civ. G.). LENDER'S NAME: LENDER'SADDRFSS: I comity that I have read this appllcatloi and stale that the above Informaticn 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 properly for inspection purposes ,- i J rgfi �zl PERMi EE NA E (P TJ 13 NATnE 31PIStEMITTEE DATE APPLICATION DATE: 0 19 P/C# ISSUE DATE: PEI TYPE CONST. OCC GROUP: Scope of Work so no,t�cs 1 Liahe „"—e C) xi # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ- FT. FACTOR PSF ADJ. AREANALUATION SFR7ADD/RENT Garage/Carport W Patio/Deck ILL IL Poo€/Spa ZRe -Roof © Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a u LJu c� z m a J 4 ¢ U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY; VALIDATION: RECEIPT# / r V! t� PAID BY: 171 VALIDATION:�� WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy _ f / SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER GROUND SEWER LATERAL. MAIN WATER I INE _ SEVVFR CLEANOUT ROOF SHFATI IING FLOOR 5HFATMNG SHEAR WALLS LXI EHIOR SHEAR WALLS INTERIOR - FRAMINGNENTINta ROUGH MECHANICAL ROUGH ELECTRICAL W( ) (, ROUGH PLUMHING 1NSUL AT10N WAl I ...... .. fNSULATTON CEI/ IN(; DRYWALL. LAI LI (PRl") IATH FXTFR10R I Ail l INTIRIOR GAS IF:SI" I RAC I AND LL -D G[ 11 SWI I LI I I EAtl COMMS RCIAL 11000 I LiAH lid I EHCLP I LR ..... HOT M0P/SHOWFIiPAN S!"PT1GI(FSS1'00I HERS Rt:PORT RF(;FIVFI) ._.... DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING HOUGH ELLCiRICAL ROUGH MECHANICAL W_ _..._ __... GAS TEST PRE GUNITE POOL PRE ITFCK HONDING P -TRAP FFNCF 1 GATFI At _ ___._,., ....... ---- _ ._... _..... -- ..__.._.. - --. ... ... .... _ _ FINAL. POOL. MALLS: WALL FOOTING/STEEL WALL STEEL IST( ) 21�c( ) LIFT SC, RAI (l I COAL WALL BOND BEAM - E:LEC i RIC ML I ER RELEASE WALL DRAIN/ SEAL (GA`) fVIE;FFII RELEASE WALL FINAL SPECIAL. INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FiNAL PLANNING FINAL PLUMBING T,C. of OCCUPANCY FINAL ENGINEERING/ PW FILIAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WAST