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Home My WebLink AboutPR17-0054r OWNER b _ - D ADDRESS w a f.a CITY a - u ' ZIP � TEL � �bo C) APPLICANT TEL. _ cn _ o CONTRACTOR co ADDRESS ILI3_r i,°-�1— - ) C) CITY b;', Ti 12v ° L ZIP $ -9 i TEL. IT -)L M ARCH/ENG/ z DESIGNER 0 M ADDRESS m CITY ZIP TEL. a OWNER -BUILDER DECLARATION CDa I hereby affirm under penalty of perjury that I am exempt from the Contractor's Stale License Law for the reason(s) d w indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 71131.5, Business and z Professivas 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 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 cn 7000 of Division 3 of the Business and Processions Code] or chat he or she is exempilrom licensure and the basis ler cn the al! ged exemption. Any violation of Section 70315 by any applicant for a pormitsubjects fdoapplicanitto a divil penalty CD of not more than five hundred dollars ($500). ®(-) I, as ownerof the property, or my employees with wages astheir sole compensation, will do (_) all at or i 3 portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code, The rzv Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds :E or Improves the property, provided that the improvements are not intended or offered for sale. If however, the building or pImprovement is sold within one year of completion, the OwnerBuilder will have the burden of proving that it was act bu!it or improved for the purpose of sale.). I, as owner of the property, am exclusively cmnimcting with licensed Contractors to construct the project (Section 7044, Rosiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who Y builds or irnprovesthmx, and who contractsforthe projects with a licensed Controdor pursuant tothel Contractors' State 0 License Law.). Ili I am exempt from licensure undorthe Contractor's State License law for the following reason(s): LL G Date: Sign: a By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year priorto completion of the improvements covered by this permitl cannot legally sell a structure that I have built as an ra: owner -builder it it has not been constructed 1n its entirety by €icensed contractors. I understand that a copy of the X applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is cD submitted or attire following Web site: httplwww.leginfo.ca.govlcalaw.html. F— LICENSE] CONTRACTOR'S DECLARATION mI 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 farce and effect. LICENSE CLASS: LIC. NO.: z EXP. DATE:T s � ---' CONTRACTOR: - i 4 2 c9 �WORKER'S COMPENSATION DECLARATIONC'S'Zjt '~� H I HEREBY AFFIRM FINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ 1 have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by J ,Section 3700 of the Labor Code, forthe 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 workfor which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER - - z CII POLICY NUMBER �o�> t- Ti T.Zl C/3(THIS SECTIpN NEED NOT RE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $too OR LESS). 0 1 eertifythat in the performance of the work for whichthis permilis issued, I shall not employ any person in any manner so as to o become subject to the Worker's Compensation Laws of California, And agree that if I should become subject to the Worker's LU Compensation provisions of Section 3700 of a Labor Code, I shall fnrihwith comply with these .:pravisions. ti DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shad subject an employer to criminal Lu penaties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, 0- damages as provided for in section 3708 cfthe labor code, Interest, and attorney's fees. CD CONSTRUCTION LENDING AGENCY Lu I hereby affirm under penalty of perjury that there is a Construction Lending Agency forthe performance of the work for � which this penult is issued (Sec. 3097, Civ. C.). F— LENDER'S NAME: LENDER'S ADDRESS: w LL E certify that E have read this application and state that the above Information is correct: k agree to comply with all city and z county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to E5 enter upon She above-mentioned property for inspection purposes. J M1y\�'y / co 5 '' L-, �. �' Y , V < =;(PR€NT) PERMITTEE NAMI -. ,z _ 1 E SIGNATURE PERMITTEE DATE Scope of Work # Di UNITS # STORIES # BEDROOMS— rn Lu Lu LL 0 z 0 o] DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD7RFM Garage7Carport PatiolDeck Pool/Spa Re -Roof Commercial Valuation: `� '^ - Adj. Area: CITY OF DIAMOND BAR tr fml ARTMFNT OF COMMUNITY & DEVELOPMENT SERVICES U J 21810 Copley Drive, Diamond Bar, CA 91765 PRESS =� (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY ENERGY P/C: BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov ENERGY PERMIT: APPLICATION DATE: P/C# a JOB SITE ADDRESS *X 2-1 z e, z ISSUEDATE: I tom+ PERMIT# - o APN LOT TRACT TYPE CONST. OCC GROUP: r OWNER b _ - D ADDRESS w a f.a CITY a - u ' ZIP � TEL � �bo C) APPLICANT TEL. _ cn _ o CONTRACTOR co ADDRESS ILI3_r i,°-�1— - ) C) CITY b;', Ti 12v ° L ZIP $ -9 i TEL. IT -)L M ARCH/ENG/ z DESIGNER 0 M ADDRESS m CITY ZIP TEL. a OWNER -BUILDER DECLARATION CDa I hereby affirm under penalty of perjury that I am exempt from the Contractor's Stale License Law for the reason(s) d w indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 71131.5, Business and z Professivas 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 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 cn 7000 of Division 3 of the Business and Processions Code] or chat he or she is exempilrom licensure and the basis ler cn the al! ged exemption. Any violation of Section 70315 by any applicant for a pormitsubjects fdoapplicanitto a divil penalty CD of not more than five hundred dollars ($500). ®(-) I, as ownerof the property, or my employees with wages astheir sole compensation, will do (_) all at or i 3 portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code, The rzv Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds :E or Improves the property, provided that the improvements are not intended or offered for sale. If however, the building or pImprovement is sold within one year of completion, the OwnerBuilder will have the burden of proving that it was act bu!it or improved for the purpose of sale.). I, as owner of the property, am exclusively cmnimcting with licensed Contractors to construct the project (Section 7044, Rosiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who Y builds or irnprovesthmx, and who contractsforthe projects with a licensed Controdor pursuant tothel Contractors' State 0 License Law.). Ili I am exempt from licensure undorthe Contractor's State License law for the following reason(s): LL G Date: Sign: a By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year priorto completion of the improvements covered by this permitl cannot legally sell a structure that I have built as an ra: owner -builder it it has not been constructed 1n its entirety by €icensed contractors. I understand that a copy of the X applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is cD submitted or attire following Web site: httplwww.leginfo.ca.govlcalaw.html. F— LICENSE] CONTRACTOR'S DECLARATION mI 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 farce and effect. LICENSE CLASS: LIC. NO.: z EXP. DATE:T s � ---' CONTRACTOR: - i 4 2 c9 �WORKER'S COMPENSATION DECLARATIONC'S'Zjt '~� H I HEREBY AFFIRM FINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ 1 have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by J ,Section 3700 of the Labor Code, forthe 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 workfor which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER - - z CII POLICY NUMBER �o�> t- Ti T.Zl C/3(THIS SECTIpN NEED NOT RE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $too OR LESS). 0 1 eertifythat in the performance of the work for whichthis permilis issued, I shall not employ any person in any manner so as to o become subject to the Worker's Compensation Laws of California, And agree that if I should become subject to the Worker's LU Compensation provisions of Section 3700 of a Labor Code, I shall fnrihwith comply with these .:pravisions. ti DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shad subject an employer to criminal Lu penaties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, 0- damages as provided for in section 3708 cfthe labor code, Interest, and attorney's fees. CD CONSTRUCTION LENDING AGENCY Lu I hereby affirm under penalty of perjury that there is a Construction Lending Agency forthe performance of the work for � which this penult is issued (Sec. 3097, Civ. C.). F— LENDER'S NAME: LENDER'S ADDRESS: w LL E certify that E have read this application and state that the above Information is correct: k agree to comply with all city and z county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to E5 enter upon She above-mentioned property for inspection purposes. J M1y\�'y / co 5 '' L-, �. �' Y , V < =;(PR€NT) PERMITTEE NAMI -. ,z _ 1 E SIGNATURE PERMITTEE DATE Scope of Work # Di UNITS # STORIES # BEDROOMS— rn Lu Lu LL 0 z 0 o] DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD7RFM Garage7Carport PatiolDeck Pool/Spa Re -Roof Commercial Valuation: `� '^ - Adj. Area: CONSTRUCTION: PLAN REVIEW: t• 3.19 QUANTITY DESCRIPTION FEE J4 U U J -- w =� m ENERGY P/C: ENERGY PERMIT: PIC: PAID BY: RECEIPT X PAID BY: VALIDATION: `c' ' VALIDATION: - U z U CONSTRUCTION: PLAN REVIEW: t• 3.19 t ELECTRIC: PLUMBING: MECHANICAL: -- INSPECTION FEE: ISSUANCE: =� SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: -- TOTAL FEES COMMENTS: PIC: PAID BY: RECEIPT X PAID BY: VALIDATION: `c' ' VALIDATION: - WHITE—Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy COMMENTS: Cabinet Installation Master 635 E. Whittier Blvd La Habra, CA 90631 Phone: (562) 691-9001/Fax: (562) 691-9088 License number: 989680 Wednesday, May 24, 2017 To City of Diamond bar: I would like to inform you that I would like to take my name off the following permits, or as your representative described it to me on the phone call today (cancel the permits) , the homeowner have denied us access work , we worry that she will be hiring another licensed or unlicensed person to preform work under my permit, I don't want take responsibility for someone else's work. This is the permits numbers: P R 16-1579 PR17-0054 For windows. House address is at : 2520 Crooked Creek Dr Diamond Bar Ca 91765 Sincerely Salam Mahmoud Contractor. a I T HE L Oji T -.; Mnl r .... ? Isam MaElytah 1.a liabm € Orange F. f135 [. %VNi Ge' f5€dti 24,2;a, a ;zt G2 F;3t3� �, is ^� `�rc:3` E r3r>sRge, rp RaaM t Aprd 12, 20'17 To wham it may concern, In reference to permit #PR16-1579 dated June 30, 2015 ior the, job site address of 25201 Cfooked geek Drive, Diamond Bar, CA 91765 We. are,, already done with this jot) however, we need to exte#id this permit because. it has expired and we need to schedule an appoinCrnent to have the final inspection done. Thank you, Isa)m tvlaaytah i'resiclerlt