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Home My WebLink AboutPR17-5472DIVIOND BAR CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityvildiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS ?} S 4P I C I A - be- 11 F,m rt APIA LOT TRACT OWNER Wa 4- 2 Y C h 0 0 - ADDRESS L 1't CITY ZIPI I -1 Le TEL ) 09 Le 10 - 3 APPLICANT hT Lt I CONTRACTOR &EFo d a L le- N o t e ,- ADDRESS 11 3 a V Co 11 -ej A 4"I oy-) CITY 1A fie n pGf a, ZIP R 3 S STll. RISS) ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL, OWNER-BLIRDER BECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason{s) Indicated Wow by the checkmafk(sf. I have placed next to the applicable items) [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 statementthat 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 Cade] or that he or she is exempt from llcensura and the basis for the alleged exemption. Anyviolagon of Section 7031.5 by any appllcantfora permit subjects the applicant toa civil penalty of not more than five hundred dollars ($500). { j I, as owner of the property, or myemptoyees with wages as their sole compensation, will do L} all of or [j portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does net apply In 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. If however, the building or Improvement Is sold within one year of compfebon, the Owner -Builder will have the burden of proving that It vias 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 Professlons Code: The Contractors' State License Law does not apply to an owner of property who buildsof improves thereon, and who contractsforthe projectswith a licensed Contractor pursuanttothe Contractors' State License Law.). (-) I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: S€gn: By my signature below I acknowledge that, except for my personal residence In whtch I must have resided for at least one year prior to completion of the Improvements covered by nils permit,) cannot legally sell a structure that I have built as an owner -builder 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 Code is available upon request when this appitcatien Is submitted or at the fallowing Web site: httpAvvw.leginto.ca.gov/ca3avl.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm ander penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Divlslon 3 of the Business and Professions Code, and my Ilcense is In full force and effect. LICENSE CLASS:, 2� LP Ll."'. - EXP. DATE: '=i . biD , f CONTRA _ . fc 6, a - WORKER'S COMPENSA N OEGLARATION I HEREBY AFF€RM UNDER PENALTY Of PERJURY ONE OF THE FOLLOWING 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 Code, forihe 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 Labor Code, for the performance of the work far which this permit Is Issued, My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER I ns U Y [rte__ - e- C . 12 1-1a 2 U/ f u�' POLICY NUMBER (THiSSECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED UOLLARS $1D0 ORLESS). I certhyibat in the performance of the work for which this permit Is issued, i shall not employ any person In any manner so as to become subject to the Worker's Compensation Lavas of California. And agree that it I should became subject to the Worker's Compensation provisions of Section 3700 of the Labor Cade, I shall forihvrilh complywRh those provisions. DATE APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensatton, damages as provOed for In section 370a 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 permlt Is issued (Sec. 3097, Clv. 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 upon the above-mentioned property for Inspection purposes. PERMITTEE NAM (PRINT) L SIGNATURE OF PERMITTEE DATE APPLICATION DATE: ISSUE DATE; TYPE CONST. P!C# ��L�q�� PERMIT# OCC GROUP: Scope of Work R e � Ct I1PP9:,AA:::csr # DWEL. UNITS C ? Q a k -G1 0i # STORIES 2, a 1 Yti LU CL ±± r- - 2 1OCak-iov.=- CAa-r- aU # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFPJADD/REM Garage/Carport CO W Patio/Deck W LL PooVSpa K Re -Roof � Commercial M M Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J c� W W w c� z m J a c� zd x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: ��• ��^ SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: 2 �' BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: �' 71/ P/C: ,J PAID [3i---' iD ^ RE P VALIDPy�\\ N: of VALIDATI@(1�. WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy - ��®- SETBACK/ LETTER _. TRACT AND LEDGER FOOTINGS FORMS _777 SWITCH GEAR SLAB COMMERCIAL 11000 T-BALE INTERCEPTER UG. PLUMBING UG. ELECTRICAL UFER GROUND HOT MOP/SHOWERPAN SEPTIC/CESSPOOI. SEWER LATERAL MAIN WATER LINE HERS REPORT RECEIVED DEMOLITION SEWER CLEANOUT ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR - POOL/SPA _ SHEAR WALLS INTERIOR ROUGH PLUMBING - FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL HOUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( GAS TEST ROUGH PLUMBING — PRE GUNITE POOL PRE DECK BONDING INSULATION WALL INSULATION CEILING P-TRAP FENCE / GATE/ ALARM DRYWALL .... LATH (PRE) ------ - ___.... FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL. WALL STEEL 15T( )2"'( ) LIFT GAS TEST SCRATCH COAT WALL. BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO, FRAMING PLANNING APPROVAL ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECI ION 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 CERT. of OCCUPANCY _.....___, FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE .._m _.---....... COMMENTS;