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Home My WebLink AboutPR17-17496CITY OF DIAMOND BAIL DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bat, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION -tw-mcityofiliamondbancom building(&diamondbarca.t=_ov JOB SITE ADDRESS✓ (" a APN LOT TRACT � CITY IP TE 1 a � CONTRACTOR � °• °" - � : t '� i ADDRE CITY a ARCH/ENG/ DESIGNER a = ADDRESS CITY ZIP TFL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasonls) J indicated below by the checkmark(s), I have placed next to the appifcable Item(s) [Section 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 the applicant for the permit to file a signed statement that he or sha Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of 010810113 of the Business and Professions Cade] or that he or she Is exempt from licensure and the basis for '- the alleged exemption. Any violation of Section 7031.5 by any appllcantfora permit subjects the applicant toa civil penalty of not more than Ove hundred dollars ($500). j U1, as ownerof the property, of my employees with wages as theirsole compensation, will do Q oil of or L) portions t of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The I Contractors' State License Law does not apply to an ownerof property who, through employees' or personal effort, buOds E or Improves the property, provided that the Improvements are not Intended or offered for sate. If however, the build)ng or i improvement Is sold within one year of completion, the Owner-Bulldar will have She burden of proving that it was not built or improved for the purpose of sale.). O I, as owner of the property, am exclusively contracting with licensed Contractors to constract the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds of improves thereon, and who contracts for the projects with a Ifcensed Contractor pursuant to the Contractors' State Licenso Law.). L) I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknowledge that, exceptfor 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 built as an owner-bu0dar 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 Cade Is available upon request when this application Is submitted or at the following Web site: hltp/vnrnv.leglnto.ca.gov/caiaw.hlml- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing Mill Section 7000) of Division 3 of the Business and Pmfesslons Code, and my license Is In full force and effect. r LICENSE CLASS: LIC. NO,; " EXP, DATE:.. CONTRACTOR: a WORKER'S COMPENSATEf IDN I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLO IQGDECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Waiker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the tabor Code, for the performance of the work for which this permit Is Issued, My Worker's Compensation lnsumece Carrier and Policy Number re: CARRIER POLICY NUMBER (THIS SECTION NEED NOTRE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 ORLESS). I certitythat In the performance of the work for vrbich this permit is issued, I shall not employ any person In any manner so as to become subject to the Worker's Compensation Laws of California, And agree that If f should become suhject to the Worker's Componsaton provisions of Section 3700 of the Labor We. I shall forthwith complyvAth Nose provisions. DATE: APPLICANT: WARNING: raliure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up 10 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 parjuq that there Is a Conshuctlon Lending Agency for the performance of the work for which this permit Is Issued (Sec. 3097, Civ. CJ, LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this apphcallon and state that the above information Is correct, t agree to comply with all city and county ordinances and stale lays relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned proper€yfor Inspection purposes. /Z - RMITTEF NAME (PHIN Y^ SlONATUREOFFERMI f€ •', DATE t APPLICATION DATE: �Ii ! _ P/C# ISSUE DATE: i 1- PERMIT# : PR i T- IT4 1q TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFPJADD/REM Garage/Carport LoU Patio/Dock LL PooVSpa zRe -Roof Commercial M M Valuation: AdJ. Area: QUANTITY DESCRIPTION FEE rL J w z m7 4�� a. J Q U_ U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: =43. SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: 19 PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES 7 Q COMMENTS: P/C: PAID BY: j7 ��// VALIDATION: RECEIPT #3(0(a(,, (P PAIDBY:t! J3340 S VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy SETBACK/ LETTER TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR COMMERCIAL HOOD T HAR INTERCEPTER HOT MOP/SHOWERPAN SLAB UG. PLUMBING UG. ELECTRICAL UFFR GROUND ......... _....... _ SEWER LATERALSEPI-IC/CFSSPOOL MAIN WATER LINEHERS _ .. _ REPORT RECEIVED — _. _.. _..... SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS ROUGH CONDUIT FLOOR SHEATHING SHEAR WALLS EXTERIOR POOL/SPA _ SHEAR WALLS INTERIOR` ROUGH PLUMBING FRAMINGNENTING HOUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C O ROUGH PLUMBING GAS TEST PRE GUNITE INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P-TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) LATH EXTERIOR FINAL POOL WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEFT. 1ST( ) 2!D( ) LIFT WALL BOND BEAM SCRATCH COAT ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION R0. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES FINAL HEALTH DEPT, CERT. of OCCUPANCY FINAL INDUSTRIAL WASTE COMMENTS: