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Home My WebLink AboutPR17-8190CITY OF DIAMOND BAR DEPARTMENT OF COM1NIUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Sar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION �vivw,cltyofdiamondbar.co i building@diamondbarea.gov SOB SITE ADDRE=SS � ` 1 � 10 00 l W!t t� � APN LOT TRACT OWNER i f` ' ADDRESS 2- 9tD ^' CITY EL. O� rL APPLICANT TEL. CONTRACTOR •— 't l� ADDR OO �v IvLot ,,�� CITY ar 6P 'y�r f_TEL. 402—k, ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that i am exempt from the Contractor's State License Law for the reason(s) Indicated below by the checkmark(s), I have placed next to the applicable Iterate) [Section 7033.5, 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 she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7G00 of Division 3 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 applicant for apermit subjects the applicant to aclvll penalty of not more than five hundred dollars ($500). U €, as owner of the property, or my employees with wages as theirsole compensation, will de U all of or{) portions of the work, and the structure Is not Intended or offered for safe (Section 7U44, Business and Professions Code: The Contractors' State License Law does not applyte an owner of property who, through employees' or personal effort, builds or improves the pmporty, 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-Sullderwlil have the burden of proving that it was not built or Improved for the purpose of sale.). (-)1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Pmfessdons Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who coptracts lorthe 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 reason(s): Date: Sign: By mysignature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year prior to completlon of the Improvements covered by this permit,1 cannel legally sell a structure that I have built as an owner -builder If It has not been constructed In Its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this application Is submitted or at the following Web site: httpfwww.leg[nia.ca.gov/calaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penaltyof perjurythat i am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my licensee Is In full force and effect LICENSE CLASS: L ^ LIC. NO.: - EXP. DATE: P CONTRACTOR: WORKER'S COMPENSATION DECLAflATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have a B maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Se 3700 of the Labor Code, for the performance of the work for which this permit Is issued. have and will maintain Worker's Compensation Insurance, as required bySectlon 3700 of the Labor Code, for the porformance of the work (or which this permit Is Issued. My Worker's Compensatlon Insurance Carrier and Policy Number are:�J CARRIER �t_rt L1 i�� zi zl ga POLICY NUMBERCT�a (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 DR LESS). I cerlfiy that in the performance of the work for which thlla permit Is Issued, Isbell not employ any parson In any manner so as to become subject to the Worker's Compensation Laws of California. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provlslons. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subjeet an employer to crlminai penalties and civil fines up to one hundred thousand dollars (5100,000), in addiben to the cast of the compensatfon, 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 {Sac. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this applicaUen and state That the above information Is corroct. I agree 1e comply with all city and county ordinan s and state laws relating to building construction, and hereby authorize representatives of this county 10 enter upon a vemenlionedproperty forinspcUonpurpows. /l01 r,-� t��Zw PERMITTEE NAME (PRINT) SIGNATURE OF DATE APPLICATION DATE: ISSUE DATE:I L s�-- TYPE CONST. - I - P/C# �® Irl PERMIT# : OCC GROUP: Scope of 0- Work - # DWEL. UNITS r � `i _ # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFFVADO/REM Garage/Carport w Patio/Deck w LL. Pool/spa ZRe -Roof Commercial 00 Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U W w w co m J a z a x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL; INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: a QQ BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FETES COMMENTS: P/C: /PAID BY: VALIDATION: RECEIPT# 8S6S ✓ PAID BY: ''lam a VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy INSPECTION RECORD LETTER TRACT AND LEDGER 7SETBACK1 INGS FORMS SWITCH GEAR - COMMERCIAL HOOD UG. PLUMBINGT-BAR UG. ELECTRICAL INTERCEPTER LIFER GROUND _..... HOT MOP/SHOWERPAN SEWER LATERAL SEPTIG/CESSPOOL MAIN WATER LINE SEWER CLEANOUT HERS REPORT RECEIVED DEMOLITION ROOF SHEATHING FLOOR SHEATHING ROOF DRAINS ROUGk-( CONDUIT SHEAR WALLS EXTERIOR __._.__......._..--- POOL/SPA SHEAR WALLS INTERIOR �— ROUGH PLUMBING FRAMINGAIENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C (�) ROUGH PLUMBING INSUI ATI ON WALL INSULATION CEILING _ / GAS TEST: PRE GUNIT- -- POOL PRE DECK BONDING P -TRAP FENCE / GA1 E/ ALARM - POOL DRYWALL _ LATH (PRE)FINAL LATH EXTERIOR WALLS: WALL FOOTING/STFEL. ..._ STEEL ) 2ND( ) LIFT WALL. BOND BEAM WALL DRAIN/ SEAL _.... WALL FINAL __._... _.. R0. FRAMING PLANNING APPROVAL - __ ...... ... .. .... ... ......_ ...... ... - _ ._.._.. -...... ... _... LATH INTERIOR - GAS TESTWALL SCRATCH COAT ELECTRIC METERRELEASE ........ GAS METER RELEASE - _._ _..._..... SPECIAL INSPECTION _...... FINAL BUILDINGROUGH FIRE APPROVAL. _..._ _..— --------- .._ ..................._-- FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICALFINAL PLANNING - ,.._.,_... — ........ _........ ... _.� —.. - ......._..- - FINAL PLUMBING FINAL ENGINEERING/ PW T.G. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: