The URL can be used to link to this page

Home My WebLink AboutPR17-7047DI�L�IdI1) BAR CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 961-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS 99011.45 Z' APN LOT TRACT OWNER k"OH" F11444— g t i�leL �� /IAM ADDRESS ��IU..-.�� CITYDI q,A bat d® ZIP1i7r2J-T L. APPLICAN TEL. CONTRACTOR ADDRESS CITY ZIP TEL, 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 reasons) €ndlcated below by the checkmark(s), I have placed next to the applicable 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 issunnce, also requires the applicant for the permit to file a signed statement that he or she Is licensed pursuantto the provisions of the Contractor's Stale License Law (Chapter9) Commencing with Scotian 7000 of Division 3 of the Business and Professions Code] or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 byany applicant for a permitsubjeclsthe applicant to a civil penalty of not more than rive hundred dotlam ($500). C 11, as owner -of the property, or my employees with wages as their sole compensation, will do (-)all of or I-) 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, builds or Improves the property, provided that theImprovements are not Intended or offered for sale. if however, the building or Improvement Is sold vtlthin one year of completion, the Owner -Builder will have the burden of proving that it was not built or Improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cada: The Contractors' State License taw does not apply to an owner of property who builds or Improves thereon, and who contracts fol the projects with a licensed Contractor pursuant to the Contractors' State License Law.), O I am exempt from licensure under the Contractor's State License law for the following reasants): Date: Sign: By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at leastone year priorto oomplegon of the Improvements covered by this permlt,l cannot legally sell a structure that I have built as an owner -builder it it has not been constructed In Its entirely by licensed contractors. I understand that a copy of the j applicable lawn, SoOon 7044 of the Business and Professions Code is available upon request when this application Is submitted or at the following Web site: hilphwA v.leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION i I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. LICENSE CLASS:ILIC.NO.: �+ EXP. DATE: CONTRACTOR: WORi(ER'S COMPENSATION DECLOATION I HEREBYAFFiRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I and Wil maintain a Certificate of Consent to Solf-Insure for Worker's Compensation, as provided by [ ectIon 3700 of the Labor Code, for the performance of the wortciorwhich this permit is issued. € have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, fur the performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: ��! CARRIER —. /�I ✓}r� GC9D�--jr.=� g lYS 3 POLICY NUMBER (THIS SECTION NEED NOT BECOMPLETED IF TREPERMIT IS FOR ONE HUNDRED DOLENS $100 OR LESS). I certify that In the performance of the work for which this permit Is issued, I shall not employ any person in any manner sox to a become subject to the Workers Compensation Laws of Cailiomla. And agree that I I should become subject to the Worker's JCompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply,with those provisions. 7. DATE: APPLICANT: 5 WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal C penalties and civil fines up to one hundred thousand dollars ($tOD,000), In addition to the cost of the compensation, j damages as provided for In section 370a of the labor code, Interest, and attorney's fees. . L CONSTRUCTION LENDING AGENCY L FjI 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, Civ. C.). y LENDER'S NAME: LENDER'S ADDRESS: U L 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 cunstruction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Oft n E RE M DATE Pk. FIR1vr" r P/C# APPLICATION DATE: _41 -F - ISSUE DATE: 5 1 PERMIT# : T R k'+ r �b TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFRIADD/REM Garage/Carport Patio/Deck LLL PooVSpa Re -Roof O Commercla4 co Valuation: Ad]. Area: QUANTITY DESCRIPTION FEE 1 U w m - dCME a UAS METER R SPECIAL WSP FINAL BUILD, L) L) FINAL MECHA FINAL E LEcr(lr CONSTRUCTION: AL PLUI?BI PLAN REVIEW: Of DCCUPA ELECTRIC: of occU PLUMBING: MECHANICAL: INSPECTION FEE: M ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: � RETENTION FEE: ' PRE -ALT FEE: ' BASF: ' PLOT PLAN: ' ZONING CLEARANCE TOTAL. FEES COMMENTS: plC: V� PAID BY: RECEIPT # 60 — PAID BY: 4`Oty. WHITE --- Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy SETBACK/ LETTER FOOTINGS PORMS SLAB _ UG. PLUMBING��-_�- UG. ELECTRICAL LIFER GROUND [FLOOR EWER LATERAL AIN WATER LINE EWER CLEANOUT OOF SHEATHING SHEATHING _ SHEAR WALLS EXTERIOR�� SHEAR WALLS INTERIOR FRAMINGNENTING�� ROUGH MECHANICAL ROUGH ELECTRICAL W( C O� ROUGH PLUMBING INSULATION WALL - -....- INSULATION CEILING �. DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR _ - GAS TEST SCRATCH COAT ELE('T' TER RELEASE ELEASE iCTiON TICAL rNTS: CITY OF DIAVOND INSPECTION RECORD TRACT AND LEDGER SWITCH GEAR COMMERCfAL HOOD T -BAIT INTERCEPTER HOT MOP/SHOWERPAN SFPTfC/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 / GATE/ ALARM FINAL POOL WALLS: - WALL FOOTING/STEEL WALL STEEL 1ST( ) 2N°( ) LIFT WALL BOND BEAM WALL DHAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW _ FINAL COMMUNITY SERVICES FINAL HEALTH DEPT _. FINAL INDUSTRIAL WASTE