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Home My WebLink AboutPR17-9766CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES ( ✓`" l 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Pax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbancom building(i�diamon"d[ierca.vov SOS SITE ADDRESS APN L T TRACT OWNER C� ADDR SS CITY Y" EL: APPLICANT i TEL. CONTRACTOR t it i 14 ADDRESS 0 ` het CITY J ZIP TEL ARCH/EN DESIGNERT ADDRESS — CITY ZIP TEL. OWNER -BUILDER DECLARATION I herehy affirm Eder penalty of perjury that I am exempt from the CoaRactor's State Liceuse. Law for the reasoa(s) Indicated belovrlby the checkmad (s), I have placed next to the applicable ltern(s) [Section 7031.5, Ruslaess and Professions Cdife: Arty city or county that requires a permit to cunstmct, alter, Improve, demo)€sh, or repair, any structure, prleika Els issuance, also raquires the applicantfor the permit to file a signed statement that hnor she is licensed pursuant to the provisions of the Contractor's Slate L€censu taw (Chapteril) CornmeneingwithSection 7oDD of Divisio>r3 of tire Business and Professions Cade] or that he or she Is exemptfrom licensure and the basis for the alleged exemption. Any vioWun of Section 7031.5 by any applicant for a ponndtsubjecis the applicant to a civil penalty of not more thau:five hundred tial€ars ($500). (�1.asowner u}the property, or my employees with wages as their sole compensation, will do( )alt ofor(}pssttisns of the Work, and the slruclure is not Intended or offered for We (Section 7044, Business and Professions Cod& Tho Contractors' Stale License Law does not applyto art owner of property who, through emAuyeea' or personal effort, builds or Improves the property, provided that the Improvements are not Intended or offered torsade. If however, the building of improvement Is sold wMIn one year of completion, the Owner -Builder Will have the burden of proving that Rwas not built or Improved foribe purpose of sale.). L) I, as owner of the property, am exclusively contracting with licensed Contractors to censtruotthe project (Section 7044, Business; and Professions Code: The Coniracforsr State license Law does not apply to an owner of property who builds w Improves thereon, and who cantracts torthe projects with a licensed Contractorpursoantlo the Contractors' State Lcense Law.). U I am exempt from ilconsure under the Contractor's State License law for the following reason(s): Data: Sign: Bymysignature belosv I ackovAedgo that, exceptfor my personal residence is wh€ct I must have residedfor at leastane year prior to coo�plelfon of the improvements covered bythis pormit,l cannot legally sell a structure that € have bulltas an owner-bulider lilt 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 Professlons Code Is available upon request when this application is submitted or at The folfovAng Web site: futtpAwvw.legfnfa.ca.govlcafaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurythat I am licensed under provisions of Chapterg (cummendng wkh Section 70013) of Division 3 of fha gustiness and Professlons Cade, and my license is in full fore and effect. LICENSE CLASS: r LIC, NO, EXP. DATE, 'f CONTRACTOR: '-' WORKFR'SCOMPENSATIONDECLARATIOt I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and wi0 maMaln a Certificate of Consent to Solf-fnsure for Worker's Compensation, as provided by SeclIon 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I has and vAll maintain Worker's Compensation insurance, as requked by Section 3700 of the labor Code, for the performance of the work for which this permit is Issued- My Worker's Compensation Insurance Carder and Paftcp Num4r are: /� CARRIE ! V 1A 4 POLICY NUMBER (THIS, SECTION NEO NOT BECOMPLEIEDIFTHERFRMfTISFOR ARS HUNDREDDULL$icoOnEr ], Icertifythat In0ie,pedommance(if the work for which this permit isIssued, €8101 not emp mun)nanymannersoasto become subject io the Workers Compensation Laws o€ California. And agr aH s arlrjk come stat ecu to the Worker's Compensat on prnvyslo f 5° of the Labor Coda, I shall qt 3 oro yavl dos ons- DATE:J'� `APPkICItNT: � „_ WARNING: Failure to secure 4yorkar's Compensagnn coverage is unto I, and shall subject ad employ r to criminal Pa nalties and civil Ones up to ane hundred thousand dollars (y10O,13DD), In addition to the cost of the compensation, de as prbvldsd for In section 3708 of tiro lahw code, Interest, and at[omey's fees. CONSTRUCTION LENDING AGENCY I bereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which ihls permit is issued (See, 3607, Civ, C.). LENDER`S NAME: LENDER'S ADO( ESS: I certify that I have read this application and state that the above information is correct i apte a to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize reprosentatives of this county to enter upon the �I uve mentioned property for inspection purposes. PERMITTEE WOE 010� ! `y I, c SIGNATURE OPP€RMITTEE DATE PRESS FIRMLY . APPLIGAT)ON DATE: %� P/C# Pr1s ISSUE DATE: Z PERMIT# : ¢ 1 TYPE CONST. OCC GROUP: Scope of Work If DWELL UNITS #STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFPJADD/REM Garage/Carport w Pat€o/Deck w ZRe Pool/Spa -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE v , v � 1 ur cn a m 3 d CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: �Z, vs - _ MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: 7,60 BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES,` COMMENTS: - P/C: PAII713Y- VALIDATION: RECEIPT # ;J 2908 'PA1_DE3y;V3311QVALIDATION: WHITE---€)ennrtrnentr:nnv_YFltf1W—F1nanr_nr'.r,rnr cwK—e..o...,rfl—, CITY OF DIAMOND BAR INSPECTION REiORD DATE: INSPECTOR SETBACK/ LETTER 7TRAD LEDGER FOOTINGS FORMS EAR 77 SLAB GIAHOQC7 .. UG. PLUMBING T -BAR UG. ELECTRICAL _ - INTERCEPTER LIFER G ROUN D -� _. _. _.. HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL __.-- MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION k ROOF SHEATHING ROOF DRAINS FLOOR SHEA' HING ROUGH CONDUIT SHEAR WALLS EXTERIOR, POOLLSPA SHEAR WALKS INTERIOR ROUGH PLUMBING FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL _. ROUGH MECHANICAL ROUGH ELECTRICAL_ W( ) C (} _ GAS TEST ROUGH PLUMBING - PRE GUNITE INSULATION. WALL _ POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL _ _ __ _ FENCE/ GATE/ -ALARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL IST( ) 2N°( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION FINAL BUILDING RD: FRAMING PLANNING APPROVAL ROUGH FIRE,APPROVAL. —. FINAL MECHANICAL FINAL ELECTRICALFINAL FINAL FIRE DEPARTMENT ---- PLANNING FINAL PLUMBING 9,4,' k7. FINAL ENGINEERING/ PW T.G. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: