HomeMy WebLinkAboutPR17-7475DMI14_ ►ID BA_R'
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.cityotdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS Y'_) .5 °" C ' D '
APN '671630 /9009 LOT TRACT
OWNER C=hluh IC t7
ADDRESS LC] . (V d Q._P'T >a /,, r F
CITY AL(l ! ¢ 600. ZIP qi TEL.
APPLICANT Fi{'S ,S6J1f.ner TEL. CT Z7'3- ellf IV
CONTRACTOR
ADDRESS /1 �J l �f1r� Pf 7L'CCF J
CITY- Co ro�����ZIP TEL. qS i ^ Z�]�- qq
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
{ hereby affirm under penalty of perjury that I am exempt from the Contractor's Slate Llcense Law for the reasons)
Irdlcated below by the checkma k(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, alley Improve, demolish, or repair, any
structure, prier to its Issuance, also requires the applicant for the permit to file a signed statement that he or she
is licensed pursuantto the provisions ofthe 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 licensure and the basis for
the alleged exemption Any violation of Section 7031.5 by any applicant fora permit suhjects the appiicantto a civil penalty
of not more than five hundred dollars (5500).
L) I, as owner ofthe property, or my employees with wages asthor sole compensation, will do (- all of or (j portions
of the work, and the structure Is not intended of 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 building or
Improvement is sold within ore year of completion, the Owner -Builder 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 w[th licensed Contractors to construct the project (Section
7044, Business and Pfefeselons 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 I[censed Contractor pursuant to the Contractors' State
License Law,),
L) I am exemptfrom licensure under the Contractor's State License law for the following reason(s):
Date: Signe
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one
year pr[orto 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 httpiwww.loginfo,ca.gov/ca[aw.htmi.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that i am Ilcensed under provisions of Chapter 9 (commencing with Section 7000}
of Division 3 of the Business and Professions Code. and my license is
iin full force and effect.
LICENSE CLASS: C_ `9 q 6 LIC NO.: Cl () (`! C/
EXP. DATE: CONTRACTOR: —SP n (, f �-- ffd) CC 9 =tl
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNCER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I 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 have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, for
the performance ofthe workfor which this permit Is Issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER toef)Kh k,
POLICY NUMBER k✓r_ yn i F 7 if/ ID 0 7 �i � 0
(THIS SEC -PON NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS).
I certitythat in the performance ofthe: workfer which this permit Is Issued, I shall Put employ any person in any manner so as to
become subject to the Worker's Compensation Laws of California. And agree that If I should become subjecf to the Worker's
Compensation provisions of Section 3700 of the Labor Code, €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 ($100,00{7), in addition to the cost of the compensation,
damages as provided for in section 3708 of the labor code, interest, slid attorney's fees.
CONSTRUCTION LENDING AGENCY
f hereby affirm under penalty of perjury that there Is a Construction Lending Agency for the performance of titre work for
which title permit Is Issued (Sec. 3097, Civ. C.).
LENDER'S NAME:
LENDER'S ADDRESS,
I certify that I have read this application and stale 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 authorfze representatives of this county to
enter upon the above-mentioned property for Inspection purposes.
PERMITTEE NAME (PRINT)
�1r�z
SIGNATURE OF PERMIl DATE
APPLICATION DATE: f P/C#
ISSUE DATE: _7/ 8°i PERMIT# : FV, 171
TYPE CONST. OCC GROUP:
Scope of Work LO //Cly% � L/ C [ P-) i,�}- O-) IL W
ba/ 7"1 �- CAO J F el L ] P..
# IUNITS # STORIES # BEDROOMS 1
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
GaragnICarport
TL
Parfo/Deck
LL
LL
Pool/Spa
ZRe
-Roof
Commercial
m
lfalluafi0n: 7 / Adj. Area:
QUANTITY DESCRIPTION FEE
U_
U
w
Ed
CD
z
m
J
a
J
d
U
Z
Q
x
U
CONSTRUCTION: m
PLAN REV[EW:
ELECTRIC: Gill
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY PIG:
ENERGY PERMIT:
RETENTION FEE:_
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLFARANCL:
TOTAL FEES a
COMMENTS:
ECE
EGIF PAID BY: 3 �Ii� 1VALD
RDATION:
WHITE— Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy
SETBACK/ LETTER
IRAQI AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
UG. PLUMBING
UG. ELECTRICAL
COMMERCIAL HOOD
T-BAR
INTERCEPTER
UFER GROUND
SEWER I ATERAL
MAIN WATER LINE
SEWE13 CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
SHEAR WALLS EXTERIOR
HOT MOP/SHOWERPAN
SFPTIC/CFSSPOOL
HERS REPORT RECEIVFD
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
PODUSPA
SHFAH WALLS INTERIOR
FRAMINGNENTING
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL VII( .) C ( )
ROUGH MECHANICAL
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSI ILATI0N WALL
POOL PRE DECK BONDING
P-TRAP
FENCE / GATE/ Al ARM
FINAL POOL
WALLS:
WALL FOOTING/STEEL
WALL STEEL I �''( ) 7M°( ) LIFT
WALL BOND BLAM
INSULATION CEILING.
DRYWALL
I Al H (PRE)
I ATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COA1'
ELECTRIC MEILII RELEASE
WALL DRAIN/ SL-AL
WALL FINAL
GAS METER 1`1 LEASE
SPECIAL 1NSPECI ION
FINAL BUILDING
FINAL MECHANICAL
R0. FRAMING PLANNING APPROVAL
®'
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICALd�
FINAL PLANNING^ .... _..... _._-
FINAL PLUMBING
_..._ .. _
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
HEALTH DEPT.
FINAL INDUSTRIAL WASTE _.. -
T.C. of OCCIJPANCY
CERT. of OCCUPANCYFINAL
COMMENTS: _ .
- _ .....