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Home My WebLink AboutPR17-7163LU Q a 5 0 z a 0 LU cn H C3 0 0 H DIAiiI011TD'SAR 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.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS ✓� z '6 APN LOT TRACT OWNER ADDRESS .2 °0-0 .r00y---,' a` LVe-44 CITY m fi.;,,y ZIP ` tv s TEL. ` �a lx ¢ - g 2 APPLICANT C -e - r i a hw TEL. L m` - S i . CONTRACTOR i4t3 t- ADDRESS / ®iC�i4Ili e-�,$t,- LBc - CITY aa:w.� he_�oZIPw TEL. 9'% C; ai ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL, OWNER -BUILDER DECLARATION I hereby affirm under penalty of pal that I am exempt from the Coniractar's State License Law for the reasons} indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 71131.5, 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 far 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 Code] Drthaf he or she Is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 ey any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500) U I, as owner of the property, or my employees with wages as their sale compensation, will do U all of or U 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 the improvements are not Intended or offered for sale, It however, the building or improvement is sold within one year of completion, the Owner-Bulider will have the burden of proving that It was not built or improved for the purpose of sale.). 11, as owner of the property, am exclusivefy 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 belles 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 under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one year prior 10 completion of the improvements covered by this 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 application is submitted or at the following Web site httplwww.leg€nfc.ca.gov/calaw.html LICENSED CDNTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Df Division 3 of the Buslness and Professions Code, and my license is in full force and effect. LICENSE CLADS: &� LIC. NO.: C' EXP. DATE: ag ' CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS, siF have and will maintain a Certificate of Consent to 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. I 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 Issued My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER {THIS SECTION NEED NOT BE COMPLETED IF THE P BRED COLLARS $100 OR LESS). I certify that In the performance of the work for which this per ' s Is Is line ploy any person in any mannerso as io become subject to the Worker's Compensation ws Df Cal dne that if hould become suhfect to the Worker's Compensation provisions of Section 3700 of abor is 11 f rth Rh oratty w f those provisions. DATE:') ' r I 1-7 APPLICANT WARNING: Failure to secure Worker' Compensa n cov age is shall subject an employer to criminal penalties and civil floes up to one hundred thousand delta 00,000), In addition to the cost of the compensation, damages as provided for In section 3706 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, C,). LENDER'S NAME: LENDER'S ADDRESS: I cartify 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. RFRMITT (PRIIT1 AT PERMITTEE ,,-. DATE APPLICATION DATE:2 - C, - € -� PIC# hgm2nm ISSUE DATE: i 4 PLRMIT# : P K I+ " TYPE CONST. OCC GROUP: Scope of Work 0 r -'mss w .^ LV # DWLL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFPJADD/REM Garage/Carport LO Patio/Deck LL Pool/Spa zRe -Roof j Commercial CD Valuation: g Adj. Area: QUANTITY DESCRIPTION FEE J a v U w z z m rl U_ U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: = [ SMTP: -- ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: t° BASF: PLOT PLAN: ZONING CLEARANCE: 1, 33J TOTAL FEES COMMENTS: P/C: PAID f3Y: VALIDATION: s p RECEIPT L. '_-) PAID BY: e "tit VALIDATION: WHITE — Department Copy, YFLLO W — Finance Copy, PINK —Assessor Copy CITY OF DIAMOND INSPECTION RECO SETBACK/ LETTER ITRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMBING T -BAR UG. ELECTRICAL INTERCEPTER HOT MOP/SHOWERPAN UFER GROUND __ RO FRAMING PLANNING APPROVAL ROUGH PLUMBING SEWER LATERAL PRE GUNITE SEPTIC/GESSPOOL MAIN WATER LINE HERS REPORT RECEIVED INSULATION CEILING DRYWALL SEXIER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMINGNENT#NG ROUGH ELECTRICAL ROUGH MECHANICAL ELELI"RIC Mf.I LI; RLLEASE GAS MEI Eii 4L EASE SPECIAL INSPECTION ROUGH MECHANICAL ROUGH ELECTRICAL W C () () GAS TEST RO FRAMING PLANNING APPROVAL ROUGH PLUMBING ROUGH FIRE APPROVAL FIRE DEPARTMENT FINAL PLANNING FINAL, IrNGINEERINGI PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL MDUSTRIAL WASTE PRE GUNITE INSMATON WALL POOL PRE DECK BONDING FINAL PLUMBING INSULATION CEILING DRYWALL P -T -RAP FENCE I GATE/ ALARM CERTa of OCCUPANCY I ATH (PREF) LATI I F XTCRIOR LATI I INTERIOR GAS I LST FINAL POOL WALLS: WAI 1. FOOTING/STEEL WAI I. STEEL 1sT ) 2'1°{ ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL SCRAICII COAT ELELI"RIC Mf.I LI; RLLEASE GAS MEI Eii 4L EASE SPECIAL INSPECTION - ZZFINAL RO FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FIRE DEPARTMENT FINAL PLANNING FINAL, IrNGINEERINGI PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL MDUSTRIAL WASTE FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERTa of OCCUPANCY