The URL can be used to link to this page

Home My WebLink AboutPR16-1453W CITY OF DIAMOND BAR' DEPARTMENT OF COMMUNITY & DEV>E+ LOPMENT-SERVWES 21810 Corley Driv`ic, Diamond Bat; CA 91765 \ PRESS (909) 839-7020 Fax: (909) 861.3117 Building Inspection Hotline (909) 8397027 " FIRMLY BUILDING PERMIT APPLICATION www.cityofdiatnondbar.com building(a-Miamondbarca.gov JOB SITE ADDRESS 73 € C-A�n" RA ' ,?-d APN ES 7f3 1>'0 17 " LOT 'L TRACT ' —ti6 �a OWNER ir71�C7�t` DIaR-.��= ADDR SS APPLICANT �O'•u-!a(L�� L,C4iZ TEL. CONTRACTOR«lam` f".d ADDR SS (Y% ! 1 . l'' L.4- ST # 9-Jr:)I CITY �13�Y�dnS zip qV,,2> 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) Indicaled1below by the checkmark(s), I have placed next to the applicable ftem(s) [Scotian 7031.5, Business and Protest ' r Code: Any city or county that requires a permit to nonstrunk alter, improve, demolish, or repair, any struct lar to its Issuance, also requires the applicant for the permit to file a signed statement that he or she isfice.'" .�ursuaat to [be provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of cion 3 of the Business and Professions Cade) or that he or she is exempt from licensure and the basis for Hie alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more than rive hundred dollars ($500). f-) 1, as owner of the property, or my employees with wages astheir sole compensation, will do O all of orO portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License taw does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. It however, the building or improvement is sold within one year of completion, the Owner-Buildar will have the burden of proving that it was not built or Improved forthe purpose of sale.). V 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 who builds or Improves thereon, and who cantracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). (} I am exemptfrem Bcensure under the Contractor's State License law for Hie fallowing reason(s): 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 -builder If It has not been constructed in its entirely by licensed contractors. 1 understand that a copy of the applleabfe law, Section 7044 of the Business and Professlons Code is available upon request when this application is submitted or at the following Web site: hOpAwAv.leginfo.cagoy/caiaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7600€ of Division 3 of the BBuns-iiness and Prnfeasions Code, and my license is in full force and effect. LICENSE CLASS: +-✓ LIC.NO.:��, DATE: O J� '�G CONTRACTOR: k �-, ;'S t , L6 ULE WORKER'S COMPENSATION DECLARATION I HEHEBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: f have and unit mainlafn a Certificate of Consent to Self Insure far Worker's Compensation, as provided by Section 3700 of the Labor Cade, for the performance of the work for wbleb this permit Is Issued. I have and wlTI maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit N issued. My Workers Compensation Insurance Carder and Policy Numbet are: CARRIER S� ul2d 01!*:Tia'`�1�+<- POLICY NUMBER 5 W Co. %011 81j40 (IRIS SECTION NEED NOT BE WMREU €F THE PERMIT IS FOR ONE HUNDRED DOLLARS ($400) OR LESS). I certify that in the pedormanceof the work forwh4ch this permit is issued, Ishall not employ any person in any manner so as to became subject to the Workers Compensation Laws of Caliiomia. And agree that B I should became subject to the Warkees Compensation provisions of Section 3700of Labor Cade, l shall forth% ' camp with €hose prpvisio �. DATE: APPLICANT: � C-LICILO-A (-� l ` WARNING: Failure to secure Workers Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil Ones up to one hundred thousand dollars ($100,000), 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 LENOING AGENCY I hereby affirm under penally of perjury that there is a Construction Lending Agency for the performance of the work far which this permit is issued (Sec. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter n the above-mentioned properly for inspection purposes. L e-? 'n'. cc.4c� PER E E (P (31-u—CL"V (S)6A L, SIGNATUREOFPERMDTEE DATE APDL€CATION�DATE: p� 0�I 4/ 20kLo P/CIE pP�R d:�/b�" ISSUE DATE: //Ad a/d`V16j mPERMIT# : I✓ a �f1 ` lil TYPE CONST. OCC GROUP: Scope of Work C u C � � iScwu:s (- ) Ltic r-arz-Lit V-Ut V!l,icA+ L.J,t+LL"`?s'V!r'fC��1�_ �wre-.fl Start.�[,.1 P�L�A�� S`C"..L.�.ls��yTi�t4• # DWEL. UNITS # STORIES it BEDROOMS TALE. C - Nits. PccyrL- DESCRIPTION SQ, FT, FACTOR PSF ADJ. AREA/VALUATION SFPJADD/REM Garage/Carport Patia/Deck w ri PooVSpa ZRe -Hoof I Commercial D Valuation:QC3 Adj. Area: QUANTITYT DESCRIPTION FEE cs U w �, U a �; + lks a UZ_ K x U CONSTRUCTION: T PLAN REVIEW: CIO • 4(0 ELECTRIC: �1 .t* tr_r PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: • ri' S€VtIP: t •s ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: % _o d PLOT PLAN: ZONING CLEARANCE: TOTAL. FEES 4=VQ COMMENTS: PIC: PAID BY:VALIDATION:___,_,_ RECEIPT# lkp IP PAID BY: At, '/R VALIDATION: WHITE --- Department Copy, YELLOW Finance Copy, PINK—Assessor Copy M CITY OF DIA ONS OAR snl PCTIOIA RECORD SETBACKI LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER GRO[IND , SEWER LATERAL _... MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING mm WALLS EXTERIOR SHEAR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ROUGH PLUMBING INSULATION WALL INSII(ATION CFIL.ING - .... ......_. DRYWALL LATH (PRE) LATH EXTERIOR _ –.... LATH INTERIOR GAS TESTlee - I _.L.....__ .. SCRATCH COAT _ ELECTRIC METER RELEASE GAS METER 13ELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T , of OCCUPANCY CE4iF. ®P OGCUPAHCY COMMENTS:_ Pp,o,-d 2 - �t TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD �— T-_BAR INTERCEPTER HOT MOPISHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION .......... ROOF DRAINS ........- - ROUGH CONDUIT POOL/SPA ROUGH PLUMBING _ ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE -----_.---- . _. � _ ______ _ POOL PRE DECK BONDING P -TRAP FENCE / GATU ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1sT( ) 2N°( ) LIFT WALL BOND BEAM _ WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANMNGAPPROVAL ROUGH FIRE APPROVAL FINAL .FIRE DEPARTMENT LA -M P[PiALW��1(NG�`RVIf .! FINAL .L COMMUNITY SERVICES _ _.......... FINAL HEALTH OEPT. FINALIND ST L WASTE d.