HomeMy WebLinkAboutPR17-4813_ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
fPRESS 21810 Copley Drive, Diamond Bar, CA 91765
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(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
`laa9. BUILDING PERMIT APPLICATION wwwrw.cityofdiamondbar.com building@diamondbarca.gov
P.
y _ APPLICATION DATE: 6 { P/C# Pfd
JOB SITE ADDRESS t9�
ISSUE DATE: PERMIT# : I 13
PISo
APIA LOT TRACT -TYPE CONST. OCC GROUP:
N OWNER - - -L--0,00k 0And'-'
Z] ADDRESS _.-1�aqCVtJ
CITY - ZIP I {� EL. i 1 6 ✓�
CD APPLICANT - TEL. -n L� " �>7 7✓
rn
o CONTRACTOR
C2 ADDRESS
C= CITY ZIP TEL.
LLo ARCH/ENG!
M DESIGNER
CD ADDRESS
m CITY ZIP TEL.
OWNER -BUILDER DECLARATION
2
CD I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the reason(s)
M indicated below by the checkmark(s), I have placed next to the applicable item(s) (Section 7031,5, Business and
M
Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any
a structure, prior to Its issuance, also requires the applicant for the permit to file a signed statementthat he or she
1-0 is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section
L+ 7000 of Division 3 of the Business and Professions Code] orthat he or she is exemptirom licensure and the basis for
rn the alleged exemption. Any violation of Section 7031,5 by any applicailtlicra POTMIt subjects the applIcaritto a civil penalty
= of
not more than five hundred dollars ($500).
q 1, as owner of the property, or my employees with wages as their sole compensation, will do (U all of or U portions
t the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Cade: Th
s
ED Contractors` State License Law does not apply to an owner of property who, through employees` or personale effort, builds
or improves the property, provided that the Improvements are not Mended ar offered for sale. It however, the building or
C; improvement Is sold within one year of completlan, the Owner -Builder will have the burden of proving that it was not built
`-c or Improved forthe purpose of sale.).
z(_) 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
M 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who
� builds orlmprovesthereon, and whocontracts fur tire projectswithaliicensedContractorpursuanttotheContractors'State
Z License Law.).
CD
?- U I am exempt from licensure under the Contractor's State License law for the following reason(s):
u_ %Z Sign:
Z Date
CD By my signature below I acknowledge that, except for my personal resident hich k must have resided for at least one
year prior to completion of the lmprovements covered by this permit,] cannot legally sell a structure that I have built as an
owner -builder if tt has not been constructed in its entirety by licensed contractors, k 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: httpAww.loglnfo.ca.gov/calaw.htmi.
}- LICENSED CONTRACTOR'S DECLARATION
U
W I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000}
0° of Division 3 of the Business and Professions Code, and my license Is in full force and effect.
N
j_ICENSE CLASS: LIC. NO,:
EXP. DATE'.
CONTRACTOR:
o WORKER'S COMPENSATION DECLARATION
H I HEREBY AFFIRM 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 Cade, far the performance of the work for which this permit is issued.
7 I have and will maintain Worker's Compensation Insurance, as required by Section 3730 of the Labor Code, for
the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
zCARRIER
POLICY NUMBER
CJ
�
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE RDNDRED DOLLARS 100 OR L
p I certify that in the performance of the workforwhich this permit is issued, I shall not employ any person In any manner so ae to
cm 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 provisions.
J
E: DATE: APPLICANT;
�5 WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
w penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the Wmpensatlon,
o damages as prDLldcd for In section 3706 of the labor code, interest, and attorney's fees,
CONSTRUCTION LENDING AGENCY
L5 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.).
F- LENDER'S NAME:
LENDER'S ADDRESS:
w
[L !certify that l have read this application and state that the above information is correct. I agree to complywl4h a€i city an
z county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to
o enter upon the above-�m�entioned property for
}inspection purposes.
[G
PER ITTEE NAME (PRINT)
2 S A E OF PER EE
DATE
H
Scope of Work
lL� it �f►1w"_ I`1. 6i.s Iii II.L.�� �.i xf
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ, AREA/VALUATION
SFR/ADD, E 2.
Garage/Carport
Patlo/Deck
Pool/Spa
Re -Roof
Commercial
Valuartia"Ar - 7 • O Adj. Area:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF: C
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: .. ',"" : PAID BY:I (i s ,� T _ VALIDATION: f® +
RECEIPT # -3 � PAID BY: I VALIDATION:
WHITE Department Copy, YELLOW —Finance Copy, PINK-- Assessor Copy
QUANTITY DESCRIPTION �tE
CONSTRUCTON:
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MECHANICAL:
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INSPECTION FEE:
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ISSUANCE:
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ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF: C
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: .. ',"" : PAID BY:I (i s ,� T _ VALIDATION: f® +
RECEIPT # -3 � PAID BY: I VALIDATION:
WHITE Department Copy, YELLOW —Finance Copy, PINK-- Assessor Copy
CONSTRUCTON:
PLAN REVIEW: I 1A,—
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF: C
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: .. ',"" : PAID BY:I (i s ,� T _ VALIDATION: f® +
RECEIPT # -3 � PAID BY: I VALIDATION:
WHITE Department Copy, YELLOW —Finance Copy, PINK-- Assessor Copy
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BACK/ LETTER
_RAC
I AND LEDGIrR
FINGS FORMS
—.
5WlTC',I-I GEAR
FFOO
E3
t:OMMERGlAL HOOD
PLUMBING
!-BAR
.ELECTRICAL
INTERCEPTER
.. -... �.
€JFER GROUND
—. —
HOT MOP/SHOWERPAN
SF-PTIC/CESSPO01_
.
SEWER LATFI3AL
—. —
MAIN WATER LINE—
— — — — —
— � — —
ITERS RE"PDRT RECEIVED
SEWER CLEANOUT
-
------.--.—
-
DfM01.ITI0N
ROOF SHEATHING
— — — — —
.
— — — ——
ROOF DRAINS
—
1:1 OOR SHEATHING
ROUGH CONDUIT
— — —
PODUSPA
— —
SHEAR WALLS EXl"ERIOR
�.. _. — _.
..
HEAR WALLS INTERIOR
ROUGH PLUMBING
— —
-- —.-- —
— ——_—...—
FRAMINGNENTING
ROUGH MECHANICAL
c
— — —
ROUGH ELECTRICAL
—....—..
—
ROUGH MECHANICAL
—
^—
.
ROUGH ELECTRICAL W( ) C {)
—
GAS TEST
—
- —.
ROUGH PLUMBING
__..
PRQm GUNlTE
—�
IN5ULA11(7N WALL
POOL PIKE DECK BONDING
INSULATION CHUNG
— — .—
DRYWALI
P-7 RAP
_.
—
—
FENCE / GATE/ ALARM
LATH (PRI) — .—.. — .—
— —
— — — —.—
FINAL POOLEXTf
RIOR
WALLS:
—.—
LATH INTEMOR
FOOTING/STEEL
GAS TEST
,L
— — — — —
..,—.
WX I_ STFil 1"( ) 211( ) LIFT
SCRA I CH COAT
WALL BOND EIEA
ELECTRIC METER REI_EA�;E:
_ —_ —__
—_ —. —
WALL DRAIN/ SEAL.
GAS METER RF LEASE
.�
WALL FINAL
SPECIAL INSPECTION-
.
RO. FRAMING PLANNING APPROVAL
—�_.--_
FINAL BUILDING _ _
—... ROUGH FIRE APPROVAL _
FINAL MECHANICAL- —_
FINAL FIRE DEPARTMENT — --
FINAL ELECTRICAL
FINAL PLANNING — ~ -
FINALPLUMBING — -
—.. - _ .. — —. FINAL ENGINEERING/ Pw
T.C. of OOCUPANCY
— -- — FINAL COMMUNITY SERVICES
CER , �€ UCCUPACY —. — .—. _ .—. —.... _ .
— — — — FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
COMMENTS:
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