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Home My WebLink AboutPR17-11913CITY OF DIAMOND BAR l 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 sm�0 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building*diamondbarea.gov S I I"'t C_ CA,e' d C. t JOB SITE ADDRESS APN -ra0c-v ' °' LOT TRACT OWNER &,`V jg %`I.f `a ADDRESS S JiCk C Ct,, YY'+ O� k C br, f e'er t° CITY °C+.avdp. his C ZIP 9-71-'" TEL.,�XL, a �` APPLICANT C t'Cl le: Vie; rn . e TEL ".a 3n „rvf l i CONTRACTOR't ADDRESS'_a $� CITY C7 L >, C€ ,j Ci „,E"ZIP a j C.3 TEL. E , 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 7031.5, Business and Professions Coda, Any city or county that requires a permit to consinict, 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 Cade] Dr that he or she is exempt from licensure and the basis for the alleged exemption. Anyviolation of Section 7031.5 by any appiicantfora permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500). CJ i, as owner of the property, or my employees with wages as their sole compensation, will do O all of or O portions of the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Cade: The Contractors' Stale Llcense 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 one year of cornpletlor, the Dwner-OUllder will have the burden of proving that it was not built or Improved for the purpose of sale.). U I, 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 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 licensors 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 to completion of the Improvements covered by this permit,I cannot legally sell a structure that I have built as an owner -builder if It has not been constructed In Its entirely by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professlons Code Is available upon request when this application is submitted or at the following Web site: http/wwwJeglnfo•ca•gevlcalaw.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 farce and effect. LICENSE CLASS C ®C` LIG. NO.: EXP. DATE: Ci CONTRACTOR: E Q s &cayk WORKER'S COMPENSATION DECLARATION I HERERYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's CDmpensation, as provided by Section 3700 of the Lader Code, for the performance of fhe workfor which this permit is issued• I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, for the performance ofthe workforwhich this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: p CARRIER POLICY NWRFR CP 01" -.Z. (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS &100 OR LESS). I certify that in the performance of She work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of Callfornla. And agree that if I should become subject to fhe Worker's Compensation provisions of Section 3700 ofthe Labor Cade, I shall forthwith comply with 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 ($100,000}, 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 1 hereby affirm under penalty of perjury that there is a Constructlon Landing 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 slate laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes PERMITTEE N E {PRINT} SII PERMITTEE DATE APPLICATION DATE: q) ' 1 ! PIC# rD ISSUE DATE:__ /ibJ9-1 PLRMIT#:SIR N-1 — TYPE CONST. OCC GROUP: Scope of Workq�)a gip. A, �' -y } C -._G -'€f.,..,,. re'7: # DWEL. UNITS # STORIES — # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADO/REM Garage/Carport w Patio/Deck Lu LL Pool ZRe -Roof Commercial m Adj. Area: QUANTITY DESCRIPTION FEE U_ U w w a m 2E J U C x U CONSTRUCTION: PIAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL• INSPECTION FEE: ISSUANCE: Si ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: ` T BASF: x PLOT PLAN: — ZONING CLEARANCE: TOTAL FEES COMMENTS: S� P/C: PAID BY: F VALIDATION: RECEIPT # C, PAID BY: VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SE: ["BACK/ LETTER FOOTINGS FORMS SLAB UG, PLUMBING UG. ELECTRICAL UFFR GROUND SEWER LATERAL MAIN WATER UNE ^SEWER CLEANOUT,.. _ ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ...... ...... ROUGH MECHANICAL ROUGH ELECTRICAL W( )-C ROUGH PLUMBING INSULATION WALI INSULATION (,F -.H ING DRYWALL _.._ LATH(PRE) LATH EXTI=.RIGH LATH INTERIOR GAS TESL. SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL G FINAL ELECTRICAL C FINAL PLUMBING T.C. of. OCCUPANCY CERT. of OCCUPANCY 0"ITY OF DIAMOND .A INSPECTION RECORD TRACT AND LEDGER .......... SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MCP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOLISPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL ` GAS TEST ................ PRE GUNITE POOL PRE DECK BONDING _.... _ P -TRAP FENCE 1 GATE/ ALARM 1 FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1sT( )2N°( ) LIFT WALL, BOND BEAM WALL DRAIN/ SLAL WAIL . _... . RO FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT _.... FINAL PLANNING -- FINAL ENG INEERIN GI PW FINAL COMMUNITY SERVICES FINAL, HEALTH DEPT. FINAL INDUSTffiAL WASTE