Loading...
HomeMy WebLinkAboutPR17-0305_ .......... _ y..r.- CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES y" 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building a diamondbarca.gov JOB SITE ADDRESS` APN A_OT TRACT OWNER.."a� ADDRESS CITY ZIP 2z 17.. TFL.` APPL EAT TEL. CONTRACTOR �1. ..l ADDRESS...._ .'ZIP EL.>.. ARCH/E P.i G/ 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) indicated below by the checkmark(s), I have placed next to the applicable €tenni [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 statement that 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 Codel or that he or she is exempt from licensure and the basis for fire alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). (-)1, as owner of the property, or my employees with wages as their sole compensation, will do i all of or U portions of the work, and the structure is not intended or offered for safe (Section 7044, Business and Professions Code: 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 the improvements are not intended or offered for sale. If however, the building or improvement is sold within ane year of completion, the Owner Builder will have the burden of proving that it was not built or improved for the purpose of sake.). ( )1, as owner ofthe property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Coder The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). (� I am exempt from licensure underlhe Contractor's State License €aw for the following reason(s}: Date: Sign: By my signature below i acknowledge that, exceptfor my personal residence in which I must have resided for at least one year priortc completion otths 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 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 application is submitted or at the following Web site: http/www.lCglnfo.ca.pov/calaw,htrnl. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Code, and my license is In full forcpnd effect. LICENSE CLASS:!'"` -»"� LIC. NO.: EXP. )ATE',..': .*�..:✓�r-U`ONTRACTOR: WORKER'S COMPEN ATl N DECLARATION HEREB,TAWIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and wit maintain a Certificate of Consent 10 Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performanceAthkfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number a CARRIER POLICY NUMBER (CHIS SECRCN NEED NOT BE COMPLETED IF THE PERMITS FOR ONE HUi DOL $100 On LESS). I certifythat in the performance of the workfor which this permit is issued, I shall not employ any person in anymannerso as to become subject to the Worker's Compensation Laws of Calfo a,,Afid agree That It I should become subject to the Worker's Compensation Qrovisio s p Son 3700 of e a or to thwi h comply vrJ>b those proufsions ✓'y DATE: AfaFtiRPLICANT; ' r- r; WARNING: Failure to secure Worker's Campers ation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (S100,000), in additlrn to the cost of the compensation, damages as provided for in section 37DR 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 permit is issued (Sec. 3097, Civ. Q. LENDER'S NAME: LENDER'S AUDRFSS: 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 relaiing to building construction, and -hereby authorize representatives of this county to enteripon the ave 9fitioned property for inspecj on purposes ViiAME (PRI SCNATUR UE PEH ITTEE • DATE PRESS FIRMLY APPLICATION DATE: P/C# PIZ) _' ISSUE DATE: PERMIT# : -? ®`1 — TYPE CONST. OCC GROUP: Scope of Work'' # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport ua Patio/Deck u- Pool/Spa Re -Roof © Commercial Z) 00 Valuation: Adj. Area: QUANTITY DESCRIPTION FEE 3"` 9 ` 1 9 0+ ��M� � u� err''•: �, �. ' ,� v z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: .rc 2 ✓ C PLUMBING: MECHANICAL „ 71 - q 9 ::,it INSPECTION FEE: ISSUANCE: - Aik SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL. FEES COMMENTS: R _ P/C:? ; f 6 PAID BY: �, B p Jq�" VALIDATION: L(„ _ RECEIPT# PAIDBY: 'QyVALIDATION: WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy COMMENTS: Horizontal Application Unit installed on Platform Line contact is permissible but not preferred N see tiie unit nameplate for clearances. ' SAS ENW 3ERVIC . PLATFORM 055 VENT PIPE K RZAMV, IV 1z146� k � � _ .� � �, ,, f ,� ,� r