The URL can be used to link to this page

Home My WebLink AboutPR17-3707a CITY OF DIAMOND BAR "'' 1 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 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov APPLICATION DATE: — 1 ISSUE DATE: PERMIT# : TYPE CONST. WHITE — o L JOB SITE ADDRESS " wl o Al !?,_114 LOT 02,"S TRACT 00 OWNER L ADDRESS 0 rv. 9 s9c.t� CITY '�> ZIP (7 TEL (,2 1 PC.3 a '70 APPLICANT � CSCA- TEL. G- I CONTRACTOR ADDRESS CITY vY ZiP40{ TEL. C� a 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 reason{s) indicated below by the checkmark(s), I have placed next to the applicable Items) [section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, 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 10 the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from Ilcensure and the basis far the alleged exemption. Any violation of Section 7631.5 by any applicant for a permit subjects the app€Item to a civil penalty of not more than five hundred dollars ($500). U €, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or O portions of the work, and the structure Is not Intended or offered for sale (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 balding or Improvement Is sold within one year of completlen, the Owner -Builder will have the burden of proving that it was not bulli of Improved for the purpose of sale.). 11, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply tD an owner of property who builds or improves thereon, and who contracts for the projects with R licensed Contractor pursuanttotho Contractors' State License Law.). U 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 priorm completion of the improvements covered by this perrah,l cannot legally sell a structure that I have bullt 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 submhted or at the following Web site: http/www.leginfo.ca.govlcalaw.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 Coda, and my license is in 110 force and effect. 4Y ? LICENSE CLASS: LIC. NO.: EXP. DATE:& CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will malntalr a Cedif€cats 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, I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is issu2dMWorker's Compensation Insurance Carrier and Policy Number are: _ CARRIER �� c e.- L�§ • " "" POLICY NUMBER 0 k7l Licl Lab 42— (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}. certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to became 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 Cade, I shall forthwith corn ith those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (51 00,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, Interest, and attorney's tees. 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 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 relating to building canstru d hereby authorize reprosentah'ves of this county to enter upon the above- 'Dned property for inspection pu oses. PERMITTEE N E {PRI g S SIGNATURE OF PER TTEE DATE APPLICATION DATE: — 1 ISSUE DATE: PERMIT# : TYPE CONST. WHITE — P/C# eQ %-I P R I I — T `±" OCC GROUP: Scope of Work _ meq+ 2,?, ew� # DWEL UNITS # STORIES, # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL u. Pool/Spa ZRe -Roof C2 Commercial CQ Valuation: t1 Acfj, Area: QUANTITY DESCRIPTION FEE a U U w w z z m a 1 c�5 z z v CONSTRUCTION: PLAN REVIEW: ELECTRIC' Tel , PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: o . ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: -152— Go BASF: PLOT PLAN: mm ZONING CLEARANCE: TOTAL FEES d9%. %4R COMMENTS: 4 , P/C:7S1 S� PAID BY: 1N 4,��NIgLf��r0� VALIDATION: RECEIPT # .� ",;,e PAID BY:l "�@ $Tw- VALIDATION:-4-4— ALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK Assessor Copy CITY OF DIA MCMD BA INSPECTION RECORI SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG ELECTRICAL UFER GROUND.' SFWffl LATERAL 1 HAC1 AND LEDGER SWITCH GEAR COMMERCIAL HOOD i -BRUT INIERCEPTER HOT MOP/SHOWERPAN SEPTIC/GESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SOWER CLEANOUT DEMOLITION ROOD SHEATHING ROCF DRAINS FI OOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) GAS TEST ROEJGH PLUMBING PRE GUNITE INSULATION WALL ... ...............- POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL I ATH (PRE) LATH EXTERIORWALLS: LATH INTERICR GAS TEST SCRATCH COAT FENCE / GATE/ ALARM FINAL POOL -.. __. WALL FOOTING/STEEL WALL STEEL 1 ST( )2 ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL ELECTRIC METER RELEASE GAS METER RELEASES SPECIAL INSPECI ION WALL FINAL RO:FRAMING PLANNING APPROVAL FINAL BUILDING rvi ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLUMBING FINAL PLANNING FINAL ENGINEERING/ PW T,C. of OCCUPANCY FINAL CGMMUNITY SERVICES CERT. of OCCUPANCY. FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE _..