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Home My WebLink AboutPR17-8435- CITY OF DIAMOND BAR i I I i 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 %ssw BUILDING PERMIT APPLICATION R,%vw.cityofdiamondbar,com building@diamondbarca.gov JOB SITE ADDRESS !� APN LOT TRACT OWNER ADDRESS 6%a ---V a CITY n F3 ZIP q J S EL. APPLICANT D ekc �✓ffi.c.�3 TEL. q 517y^ 8 e 11!!t CONTRACTOR C/ ADDRESS CIN J,, ZIP TEL. ARCH/ENG/ 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 reasons) indicated below by the checkmark(s), I have placed next to the applicable Items) )Section 7039.5, 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 Bj Commencing with Section 7000 of Divlslon 3 of the Business and Professions Code] or that he or she is exempt from licensure and to basls for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (3500). U €, as owner of the properly, or my employees with wages as their sole compensation, will de U all all j 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 omployees' or personal effort, bullds or improves the property, provided that the Improvements are not intended or offered for sale, If however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not hunt or improved for the purpose of sale.). Ca I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who builds or improves lhareon, and who contracts torthe projects with a licensed Contractor pursuantto the Contractors' State License Law.). (-) I am exemptfrom licensure under the Contractor's State License law 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 prior to completion of the improvements covered by this ii cannot legally sell a structure that I have built as an owner-bullder it 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: hftplwww.leg€nio.ca,govicalaw.html. 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 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: isLIC, NO.: Tic FXP.DATE: 12� 75 e 11 CONTRACTOR: rA. - WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent 10 Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, far 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 issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER 2 -GI lr ► �IJ� POLICY NUMBER JAI" If g� (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 09 LESS}. I certify that in the performance of the work for whlchthis permit is Issued, I shall not employany person in any mannerso as to 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. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation covefage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($1UO,OUD), in addition to the cost of the compensation, damages as provided for in section 3708 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, Clv. C.). LENDER'S NAME: LENDER'S ADDRESS: I cart tthat 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. PERMITTEAw RIN - -- --------- SIGNATURE DF PERMITTEE DATE APPLICATION DATE: ISSUE DATE: Z5 PERMIT# : TYPE CONST. P/C# _.?_ - PR + R V .S OCC GROUP: %� dR,� Scope of Work �3 IL # DWEL. UNITS # STORIES pp # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LOU Patlo/Deck Lu LL Pool/Spa ZRe-Rcof d Commercial o] Vaivatfan: Adj. Area: QUANTITY DESCRIPTION FEE J U r U w w m m rZ U Z Q z U CONSTRUCTION: PLAN REVIEW:r5'e 5� f LLLCTRIC: S PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 77 SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: Z BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: . ` PIC: &"a-°,'""� PAID BY: " - � ' .w `'v `"� VALIDATION: t�.- RFCFIPT # X58,3 PAID FRY _+A03(04 VALIDATION: WHITE —Department Copy, YELLOW — Finance Copy, PINK Assessor Copy 7§EIBACK/ LETTER "GEAR GS FORMS SLAB COMMERCIAL HOOD UG PLUMBING T-BAR UG ELECTRICAL INTERCEPTER LJFFR GROUND HOT MOP/SHOWERPAN SFWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA - SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C () GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P-TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE)FINAL -- ._ - POOL ........ . ....... LATH EXTERIOR WALLS: LATH INTERIOR WAL.I_ FOOTING/STEEL GAS TEST WAI I S"LEFL 1 S7( ) 2NO( ) LIFT SCRATCH COAT WAIL. BOND BEAM ELECTRIC METER RELEASE WAL L DRAIN/ SIAL GAS METER RELEASE WALL_ FINAL. SPECIAL INSPECTION RO, FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL ARE DEPARTMENT FINAL ELECTRICAL A 711 FINAL PLANNING FINAL PLUMBING ---- ---- ------- FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL. COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: *-.Ioq t