HomeMy WebLinkAboutPR17-0116CITY OF DIAMOND BAR €
1 I I DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
` 21810 Copley Drive, Diamond Bar, CA 91765
. ,.� (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909)
B€JILDING PERMIT APPLICATION wwwcityofdiamondbar.co€n
004
JOB SITE ADDRESS ^ +�
APN LOT TRACT
OWNER UO
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION
ADDRESS
CITY UUMOU96 TEL.
APPLICANT TEL.
CONTRACTOR
ADDRESS3 fz
Poovspa
CITY1 ZtP EL.
ARCH/ENG/
DESIGNER
Commercial
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from tie Contractor's State License Law for the reason(s)
Indicated below by the checkmark(s). I have placed next to the applicable itemjs) [Sectian 7031.5, 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 We applicant for the permit to file a signed statement that he or she
is licensed pursuant to the provisionsof the Contractor's State License Law (Chapter8) Commencing withsection
7000 of Division 3 of the Business and Professions Code] or that he orshe is exempt from licensure and the basis for
the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
O1, as owner of the property, or my employeeswith wagesas thefrsole compensa€€on,will do U all of or (J portions
of the work, and the structure Is not Intended or offered for sale (Section 7044, Bus€aess and Professions Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
ortmproves the property, provided that the improvements are not Intended or offered for sale. If however, the building or
improvement is sold widhln one year of complotion, the Owner -Builder will have the burden of proving that itwas not built
orimproved for the purpose of sale.).
U f, 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 of property wha
builds or improves thereon, and Who contracts forthe projects with a licensed Contractor piesuantiotha Coalfactors' State
License Law.),
(_J I am exempt from licensure under the Contractor's State License law forthe following reason(s):
Date:__ Slgn:
By my signature below I acknowledge that, except for my personal residence in which 1 musthave resided for at least one
year prior to completion of the improvements covered by this perm€t,l cannot legally sell a structure that I have bail as an
owner-bullder it R has not been constructed In Its entirety by licensed contractors. I understand that a copy of Uhe
applicable law, Section 7044 of the Business and Professions Cada Is available upon request when this application Is
submitted or at the following Web site: httplwww.leginfo.ca.gov/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 7000)
of Division 3 of the Business Professions Cafe, and my license is Inj full force and effect.
}and
LICENSE CLASS: "�' LIC. NO.: qq enT �
FXP,DATE� CONTRACTOR: ' /
WORKERS COMPENS TIONDE LARATf
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWINC DECLARATIONS:
I have and will maintain a Certificate of Consent to Self -insure for Worker's Compensation, as provided by
/ Section 3700 of the Labor Cale, forthe performance of the work for which this permit is issued.
Y I have and will maintain Workers CornpensaUon Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work forwhich this permit Is Issued, My Workers Compensation Insurance Carrier and
.
CARRINRetherare:C
��q( aA J
MECHANICAL: ?-3, C
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THEPERMIFIS FOR ONE HUNDRED DOLLARS $100 On LESS).
I certify that in the performance of the work for wh€di this permit is issued, l shall not employ any person in any mannan soar to
become subject to the Workers Compensation Laws of California. And agree that it I should become subject to the Worker's
Compeasation provisions of Section 3700 ofthe Labor Code, I shall fathwith comply with those provisions.
DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
penalties and chill Ones up to one hundred thousand dollars ($100,000), In adi itiom to the cost of the compensation,
damages as provided for In section 3700 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. 3087, Civ. Q.
LENDER'S NAME:
LENDER'S ADDRESS:
I cerBfy that I have read this appllcalian and state that the above Information Is carect. I agree to comply wish all city and
tate laws relating to building construction, and hereby authorize representatives of Oils county to
es limed property for inspection purposes.
c*ITTF
r
T) _ r
SIN DATE
-�r U
PRESS
FIRMLY
APPLICATION DATE: N-1-201 I _P/C#
ISSUE DATE: y�,,99 ppgg 1�,4F i ( PERMIT# : M i q
TYPE CONST. kt .Ac OCC GROUP:
Scope of Work
41 DWEL UNITS # STORIES # BEDROOMS -
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
Garage/Carport
Patio/Deck
IL
Poovspa
zRe
-Roof
A
Commercial
valuation: Adj. Area:
QUANTITY DESCRIPTION FEE
v
EE
w
co
z
w
J
a
� i
{
x
CONSTRUCTION:
PLAN REVIEW:
ELFCTRIC:
PLUMBING:
MECHANICAL: ?-3, C
INSPECTION FEE:
ISSUANCE: aft _4
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE: C3 C
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL. FEES
COMMENTS:
P/C: PAIDBY: VALIDATION:
RECEIPT u ;�213 PAID BY: V i VALIDATION. Aid
WHITE— Department Copy, YELLOW — Finance Copy, PINK --Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
COMMENTS:
963 Fairway Dr Wainut'CA 91789
800-847.0877
License# 994100
To City of Diamond Bar Building and Safety,
We at Air Caresaver, as the HVAC contractor pulled the permit PR170116, wo�id like to
request the permit be reinstated. The homeowners have been honest and informed us
they have forgotten to complete the permit process within 180 days. Please advise if
you can help us reinstate the permit. Thank you.
Ralph Ayers
Air Caresaver
9
LA
W
�
I
�
rt n
�
w
n
C'1
N
pl ry C
of
(a
!D
3
fD
m
ID
O
H
O
3 3
O O
3
C
r
O
a
0.
n m d
a-
m
3 °.
m
3
3
fD
h
O
�
r
O
7 c
cn
0
7
O. 'a*
N
VF
0
S
m
m
3
�G C n
rt
H
co
rt
m s m
w
a)
O
n
rt
O
W
7
O
C
A
O
Z. n
h
m
m ` m
O
j
�
m g m
O
r
m
n
�+
v
n
� C 9
3 N
N
La
(
7
Ul
Z
0
UR
G)
ro
L
N
7
(D
O H
N �
n
0
rt
1!)
a
ro
0.
n
t
rmrt O 7
m
o
.+ d
rY 3 CK
•V
a
o
a
o
C a
�
O0
M
—
G
V3� •C _..
c
�Q,3
0
m
n
m
n
m
y F
5V
va
7
•V G
a 3 a
m mo
m
R
t
3q
C9 M
tl r3+ 7
3
:+
-0CQ
m
¢
Z
0)
m
RL
0
�. m
fi RL
ND
�
�
�
m
C
rt
3
m
N
=r
a
CL
n O014
m
7 r+
m
� ro �
C
�
i•a
CL
3
O
O
N
5
r -r
LA
W
�
I
C'1
N
'O
fD
fD
ID
O O
C
r
O
m
0.
n m d
m
3 °.
m
3
3
fD
h
7 c
O ro
m O
0
S
m m
VO
cr)
W
Ln
O
C
O
Z. n
h
CL
O
j
w
O
r
m
n
�+
v
a
LU
(
3
7
Z
0
G)
ro
L
N
(D
n
0
rt
1!)
a
ro
0.
_3
3
of
N
3
E+
a
o
a
o
M
—
G
c
�Q,3
0
m
n
m
n
m
y F
5V
va
a 3 a
m mo
oq
R
t
3q
C9 M
3
N .:+
3
:+
-0CQ
m
¢
0)
�. m
S
a
�
�
�
�
m
C
rt
3
m
N
m
Q
CL
ro
3
m
N
m
m
Q
o
m
n
G
m
M
M
c�.
c
m
O
7
m
0
n
ro
0
m
w D
-y
°
6-
N°
—
m
;p
m
C Q tl
rn
w a
bn
y
�o
S
In(j?p
Ln
A
m
—
flm
a
m �`
n
A 7
N
°•
vii
O `_°
Iii !�
n
3
P
C�
n..
�
�2io@9d9
M
..
z
0
cs 0
. '
m
s
n
m
T.ro
e 3 ro o
Z
n
3
r+
(D
o a ID
m
>
=r
m
a
N H 7
.`
S
N
paq m rt 7
OM
7
V
ATE
urs
n
N
m v
w
N
!D
a m
(nD
4
3
O
a"—
n
� N:
=I
(A
0w a 2
ra ° 'a s v
N
N
t+
C7
m
w
F S
as
OW-
OQ H Fj CL
7
w a
ro'
rr
N' ON gar
f0 3
m_
u p0
ro
Q a �" ° m
o R, aM:
n
m
b
- K. o °
ED
.v
O �' P eo s
Q.
O
m
3
a
a in
..
N
ID =b0
m 3 o.. m a 0
3
m
P N n7 m m �1
pay
C.
O m N a �'
Q
3 3 c:3 n 3
7
v_ a w m
nd,. ".
EX
m v
t1
y ''a Q 3 N
M
@
V c
6 a 1 a
''D a
n c
3
m w
(n C.
o
x
m o
!t
Ncn
v
m'm:3
brtt
in
is
-1
IDCID
i�
CL
0
�
a
rn
CL
rn
3
rt.
Cb
a
0 19
ep
c
£4 m
CL
-P P
�.
�i
1 °
�+cu
(b
c ry 0
40
ro_ a
P v
Fd
a co C Srt
0 3 o T
rn �
C - C1 7
a ID P N
a � R
m a
a` O 2 ti
n 3
a a
a �
�
@ g
o-
� s
m