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Home My WebLink AboutPR17-8866D1r1tl10�D`Bt1I�► r n'rn CITY OF 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 BUILDING PERMIT APPLICATION wivmcityofdiamondbai:cotn building@diamondbarea.gov ,TOB SITE ADDRESS �33 APN LOT TRACT OWNER ADDRESS >0 CITY'7 ZIP TEL. /Z° APPLICANT TEL, CONTRACTOR A�DDR ES8''~ ZIP TEL. ARCH/ENG/ DESIGNER ADD S ,C ZIP TEL• OWNER -BUILDER DECLARATION i hereby affirm under penally of perjury that I am exempt from the Contractor's State License Law for the reason(s) Indicated below by the chockmark(s), I have placed next to the applicable gem(s) ESectlon 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, atter. Improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to Nle 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 Code] orthat he or she Is exempt from licensure and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars t$500). U I, as owner of the property, or my employees withwages as theirsote compensation, will do () all at aro 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, hullds 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 11 was net bulli 7or 1 ved for the purpose of sale.). E I, as owner of the property, am exclusively contracting with licensed Contractors to construetthe project (Section 7944, Business and Professions Code: The Contractors' Slate License Law does not appy to an owner of properly who builds or improves thereon, and who contracts for the projects wtlh a licensed Contractor pursuant to the Contraetors' State License law.). U I am exempt rom Ila nsum under the Contfactor' late u€ nse owit 409 wing reason(s). Dale: Sign: By my signature below I acknowledge that, except for my personal residence In whlchl must have resided for at least one year prior to completion of the Improvements covered bythls permif,l cannot legally sell a structure that I have hu€ft as an owner -builder If It has not been constructed In its entirety by licensed contractors. I understand tbat a copy of the I applicable law, Section 7044 of the Business and Professions Code is available upon request when this application Is r submitted or at the following Web site: bttphvvnv.leginfo.ca.gov/calavr.html. a LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sect on 7000) Of Division 3 of the Business and Nofesslons Code, and my license Is In full force and effect. LICENSECLASS: LIC -NO.: EAP. DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION ? I REREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: s I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of Use Labor Code, for the performance of the work for which this permit Is Issued. a t have and will maintain Worker's Compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the wmkfor which this permit Is Issued. My Worker's Compensation Insurance Garner and Policy Number are: � CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMITIS FOR ONE HUNDRED DOLLARS $100 OR LESS). I eertlfythat In the performance of the work forwhich this permit Is issued, I shalt riot employ any person in any mannerso roto become subject to the Worker's Compensatlon Laws of Uliom1a. And agree that tl 1 should became subject to the Worker's JCompensation provisions of Sectlon 3700of tho Labor Cade, I shaft forthwith complyWth those provls€ons. C DATE: APPLICANT: a WARNING: Fallum to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal u penalties and civil fines up to one hundred thousand dollars ($100,000), in addlhon to the cost of the compensatl0a, L damages as provided for in sactlon 3708 of the labor code, Interest, and attorney's fees. D CONSTRUCTION LENDING AGENCY El I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which thls permit Is Issued (Sec. 3097, Civ, Q, LENDER'S NAME: r LENDER'S ADDRESS: Ll L certify that I bava read this application and state thatthe above Information is correct. I agree to comply with ail city and aunty ordinances and state laws relating to building construction, and hereby authorize representatives of this county to Jenterkeabova-mentioned prope�rInspection purposes. 5 FERINT) z SIGNATURE OF PERMITTEE GATE PRESS FIRMLY APPLICATION DATE: P/C# ISSUE DATE: i 8 ! PERMIT# :17g - i>RTYPE CONST. OCC GROUP: TYPE Scope of Work. �) # DWEL. UNITS If STORIES # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM GaragelCarpoH Patio/Deck LL Pool/Spa ZRe -Roof Commercial a a0 1/a1uat ton: QUANTITY DESCRIPTION FEE chi J w to a. w CONSTRUCTION: 'G2 ' 57 PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: 22' ENERGY P/C: ENERGY PERMIT: RETENTION FEE:_ 2 PRE -ALT FEE: BASF: a. PLOT PLAN: ZONING CLEARANCE: TOTAL FEES �' f COMMENTS: PJC: PAID BY: VALIDATION: RECEIPT tk / PAID BY: 5 VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy ® m MM SETBACK/ LEVER 1 RACT AND LEDGER FOOTINGS FORMS _ SWITCH GEAR ..—_ �. SLAB _ �.... �_.. —.. COMMERCIAL HOOD PLUMBING T -BAR _ INTERCEPTER ELECTRICAL UFFA ROUND HOT MOP/SHOWFRPAN SEWER TERM- SEPTIC/CFSSPOOI.. - HE RS REPORT RECEIVED MAIN WATER LINE I. SEWER CLEANOUT _ _ DEMOLITION EATHING ROOF DRAINS FLOOR SHEATHING _ ROUGH CONDUIT SHEAR WALLS EXTERIOR - _ PCOLISPA SHEAR WAl LS INTERIOR _- ROUGH PLUMBING FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL _ ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( GAS TEST ROUGH PLUMBING _ _. PRE GUNITE T SULATIDN WALI. POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE / GATE/ALARM LATH (PRE).. _._. FINAL POOL LATH EXTEHlOR WALLS: LATH INTERIOR _� FOOTING/STEEL. -WALL GAS TEST WALL STEEL I"( ) 2N0( } LIFT --- WALL BOND BEAM - -- WALL DRAIN/ SEAL SCRATCH COAT ELECTlfIC METER RELEASE- GAS METER RELEASE _. WALL FINAL �_. RO. FRAMING PLANNING APPROVAL SPECIAL INSPECTION _ FINAL BUILDING _. m .... ROUGH FIRE APPROVAL FINAL MECHANICAL...... FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING m T FINAL PLUMBING FINAL ENGINEERING/ PW T.G. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: - - _.-