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HomeMy WebLinkAboutPR17-11970t CD a m CITY OF DIAMOND BAR � i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 09-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION iv%vw. JOB SITE ADDRESS v1' IS77 C--t`1' APN LOT T CT OWNER ADDRESS _ CITY `C `c lP / CJTEL. �%f✓`� APPL€CANT ' CONTRACTOR r-7 01'r ADDR SS C1 G CIN l ZIP q Hca'kL, r0_d: ARCH/ENG/ DESIGNER ADDRESS CIT`( ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Lacy for the reason(sj Indicated below by the eheckmark(s), I have placed next to the appticable item(s) (Section 7031.5, Business and Pmtessluns 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 life a signed statement that he or she Is licensed pursuant to the provisions of the Contractor's State License law (Chapter 0) Commencing with Section 7000 of Division 3 of the Business and Professions Codej or that he or she Is exemptfrom Ilcensure and the basis for the alleged exemption. My violation of Section 7031.5 byany appllcantfor a permitsubjectsthe applicant to a civil penalty of not more than tive hundred dollars ($500). () I, asowner of the properly, or my employees with wages as their sole compensation, will do (-) all of of U 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 not applyto 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 said within 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.}. Q I, 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, andwho contractsforthe projects with a licensed Contractor pursuant tothe Contractors' State License Law.). U I am exempt from Ilcensure under the Contractor's State License law for the following reason(s): Gate: Sign: By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one year poor to completion of the Improvements covered by this permit,I cannot legally sell a structure that I have built as an owner -Wilder If It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 71)44 of the Business and Professions Code Is available upon lequest when this application Is submitted or at the following Web site: http/vnvw.leglnlo.co.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wlth Section 7000) of Dlvislon 3 of the Business and Professions Code, and Lm%y license is in full force and effect. LICENSE CLASS: LIC. NO.: r Lt �0 / EXP, DATE: LIC. !'T-4Z WORKER'S COMPS SATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have d will maintain a CerUOcate of Consent to Self -insure for Worker's Compensation, as provided by on 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 Labor Code, for the performance of the work for which this permit Is I ued. My Worker's Compensation Insurance Carder and Policy Hum bera�r ./ CARRIER IV V POLICY NUMBER (THISSECTION NEED NOT BE GGMPLEfED IFTHE PFSiMff IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certilythatin the performance of tha wool for which this permh4s Issued, I shall not employ any person in any mannerso asto become subject to the Worker's Compensation Laws of Califomfa. And agree tbat If I should become subject to the Workoes Compensation provisions of SecEon 3700 of the Labor Cade, I shall forthwith complywith those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shalt subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of She compensation, damages as provided for In section 3708 of the labor code, interest, and allomay'sfees. 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 (Sec. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read We appUcation and state thatthe above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby Ruthoriz representatives of this county to enteruponih bove-mentionedpropertyfor#nspectlonpurposes. PER ITTFENAME(PRINT) SIGNATURE OFPERMITTE DATE O PRESS PiRlllll V cityoldiamondbar. com MCI! - -- ---t 91--- APPLICATION DATE: P/C# • ` Iyy31 ISSUE DATE PERMIT# : Ml— TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES M #BEDROOMS ADJ. AREAAIALUATION WHITE: — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U_ (r w c7 z co J CL U U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: 01 Z • «. INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: __ cn- BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: . PlC: PAID BY: VALIDATION: RECEIPT # PAID BY/ VALIDATION: sw WHITE: — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy III il 1, MCI 1: a-, - mam3ammmimlimmmsEm SETBACK/ LETTER FOOTINGS FORMS . .... - 0 0� TRACT AND LEDGER . 0. . SWITCH, GEAR . . ..... .. SLAB UG. PLUMBING COMMERCIAL HOOD T -BAR UG. ELECTRICAL INTERCEPTER UFER GROUNDHOT MOP/SHOWERPAN SEWER LATERAL . SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITfON ROOF SHEATHING ROOF DRAINS FLOOR SHEATq!jNQ._ ROUGH CONDUIT SHEAR WALL �,EX'TEq`100 v 0 POOL/SPA SHEAR WALL8'IN_TqfQF[ 44 FRAMINGNE ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHAN16AC, -ROUGH MECHANICAL ROUGH ELECTRICAL W( C GAS TEST ROUGH PLUMBING INSULATION WALL PRE GUNITE POOL PRE DECK BONDING INSULATION CEILING P-TnAP DRYWALL FENCE/GATE/ALARM LATH (PRE) FINAL POOL I. ATH EXTERIOR WALLS: WALL FOOTING/STEEL WALL STEEL 1sT( ) 2mb( LIFT WALL BOND BEAM LATH INTERIOR ... . ....... SCRATCH COAT ELECI . RIC, METER RELEASE GAS METER RELEASE WALL DRAIN/ SEAL WALL FINAL SPECIAL INSPECTION .. ........ RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT _FlINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS:__- . . FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. -FINAL INDUSTRIAL WASTE . ...... . . . . ...........