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Home My WebLink AboutPR17-17501CITY�b ZIP TEL. ..' a ARCH/ENG/ z DESIGNER C) ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION [cc a 1 hereby affirm under -penalty of perjury that I am exempt from the Contractor's State License Law for the reason{s) oIndicated below by the checkmark(s), I have placed next to the applicable Item(s) [section 7031.5, Business and z Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any E `ru structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she J °i is licensed pursuantta the provisions of the Contractor's State License Law {Chapter 9) Commencing with Section cc M 7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from licensure and the basis for Sn the alleged exemption. Any viclaticn of Section 7031.5 by any applicant for a permit subjects the aPPIIcRntt0 a civil Penalty 2 of not more than five hundred dollars ($500}. 0 e U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (r} portions z of the work, and the structure is not intended or offered for sale {Section 7044, Business and Professions Code: The LU Contractors' State License Law does not apply to an owner at 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 cD O improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that It was not built or Improved for the purpose of sale,}. C, (_] 1, 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 Y builds or improves thereon, and who corttracts forti projects with a licensed Cointractor pursuantto the Contractors' State ce License Law.). 0 U I am exemptfrom licensure under the Contractor's State License law for the following reasons 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 prlorto completion of the Improvements covered by this permli,i cannot legally sell a structure that I have hull as an Q owner -builder it It has not been constructed in its entirety, by licensed contractors. 1 understand that a copy of the 'S applicable law, Section 7044 of the Business and Professions Cade is available upon request when this application Is co submitted or at the following Web site: httpMww.loglnio,ca.gov/calaw,htrnl H v LICENSED 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 ai fEsslons Code; and my license is in full force and effect. U) LICENSE CLASS,' LJC. NO.: - o t, EYP. DATE: CONTRACTOR: i V. e , % ' �, o WORKER'S COMPENSATION DECLARATION w [— I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: o I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Q !Section 3700 of the labor Code, for the performance of the work for which this permit is issued r I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for 0 the performance of the work for whi5lFthls permit Is Issued My Worker's Campensatlan Insurance Carrier and Policy Number LL; CARRIER 'He. cR 5L, z POLICY NUMBER 5 (PHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS SS 00 OR LESS). cD I certify that in the performance blithe work for which this permitis issued, I shall net employany person in any manner so as to cm become subject to the Worker's Compensation Laws of California. And agree that if I should become subject 10 the Worker's LU Compensation provisions of Secllon 3700 of the Labor Code, I shall forthwith complywiih those provlslons: DATE: APPLICANT! WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal Lu penalties and civil tines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, 4 damages as provided for in section 3708 at the labor code, interest, and attorney's fees. 0. CONSTRUCTION LENDING AGENCY w 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: w � I certify that [have read this application and state that the above Information is correct ! agree to comply with all city and z cdsounty ordinances anfe laws relating to building construction, and hereby authorize representatives of this county to p enter upan the above- ntioned properryfor inspeatlon purposes. co lie PERMITTEE NAME (PRINT),, T_ I SIGNATURE OFTEWItTEE DATE l— DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFWADD/REM Garage/Carporl. Patio/Deck Pool/Spa Re -Root Commercial Valuation: Adj. Area: «'�_ ... ......... . CITY OF DIAMOND BAR ELECTRIC: .... DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES J J TOTAL. FEES COMMENTS: - 21810 Copley Drive, Diamond Sar, CA 91765yL PRESS - a (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7:027 FIRMLY V z BUILDING PERMITAPPLICATION www.cityofdiamondbar.com buildi►rhg*a'tliamondharca.gov APPLICATION DATE: ENERGY PERMIT: e 17� P/C# W'� °� EL JOB SITE ADDRESS PERMIT# �O APN LOT ISSUE DATE: TRACT M TYPE CONST. OCC GROUP: UJ OWNER ADDRES Scope of Work CITYtri:a'' Xx.. ZIP--!Ja TEL. cE'i i1'& 0 A6 APPLICANT C' g `t c. d TEL. L " ui o CONTRACTOR oo ADDRESS tif . DWEL. UNITS #STORIES #BEDROOMS CITY�b ZIP TEL. ..' a ARCH/ENG/ z DESIGNER C) ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION [cc a 1 hereby affirm under -penalty of perjury that I am exempt from the Contractor's State License Law for the reason{s) oIndicated below by the checkmark(s), I have placed next to the applicable Item(s) [section 7031.5, Business and z Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any E `ru structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she J °i is licensed pursuantta the provisions of the Contractor's State License Law {Chapter 9) Commencing with Section cc M 7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from licensure and the basis for Sn the alleged exemption. Any viclaticn of Section 7031.5 by any applicant for a permit subjects the aPPIIcRntt0 a civil Penalty 2 of not more than five hundred dollars ($500}. 0 e U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (r} portions z of the work, and the structure is not intended or offered for sale {Section 7044, Business and Professions Code: The LU Contractors' State License Law does not apply to an owner at 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 cD O improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that It was not built or Improved for the purpose of sale,}. C, (_] 1, 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 Y builds or improves thereon, and who corttracts forti projects with a licensed Cointractor pursuantto the Contractors' State ce License Law.). 0 U I am exemptfrom licensure under the Contractor's State License law for the following reasons 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 prlorto completion of the Improvements covered by this permli,i cannot legally sell a structure that I have hull as an Q owner -builder it It has not been constructed in its entirety, by licensed contractors. 1 understand that a copy of the 'S applicable law, Section 7044 of the Business and Professions Cade is available upon request when this application Is co submitted or at the following Web site: httpMww.loglnio,ca.gov/calaw,htrnl H v LICENSED 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 ai fEsslons Code; and my license is in full force and effect. U) LICENSE CLASS,' LJC. NO.: - o t, EYP. DATE: CONTRACTOR: i V. e , % ' �, o WORKER'S COMPENSATION DECLARATION w [— I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: o I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Q !Section 3700 of the labor Code, for the performance of the work for which this permit is issued r I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for 0 the performance of the work for whi5lFthls permit Is Issued My Worker's Campensatlan Insurance Carrier and Policy Number LL; CARRIER 'He. cR 5L, z POLICY NUMBER 5 (PHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS SS 00 OR LESS). cD I certify that in the performance blithe work for which this permitis issued, I shall net employany person in any manner so as to cm become subject to the Worker's Compensation Laws of California. And agree that if I should become subject 10 the Worker's LU Compensation provisions of Secllon 3700 of the Labor Code, I shall forthwith complywiih those provlslons: DATE: APPLICANT! WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal Lu penalties and civil tines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, 4 damages as provided for in section 3708 at the labor code, interest, and attorney's fees. 0. CONSTRUCTION LENDING AGENCY w 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: w � I certify that [have read this application and state that the above Information is correct ! agree to comply with all city and z cdsounty ordinances anfe laws relating to building construction, and hereby authorize representatives of this county to p enter upan the above- ntioned properryfor inspeatlon purposes. co lie PERMITTEE NAME (PRINT),, T_ I SIGNATURE OFTEWItTEE DATE l— DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFWADD/REM Garage/Carporl. Patio/Deck Pool/Spa Re -Root Commercial Valuation: Adj. Area: CONSTRUCTION: QUANTITY DESCRIPTION FEE J ELECTRIC: u J J TOTAL. FEES COMMENTS: La a 5"-7 SMTP: V z x CONSTRUCTION: ®e. PLAN REVIEW: ELECTRIC: ZONING CLEARANCE: PLUMBING: TOTAL. FEES COMMENTS: MECHANICAL: INSPECTION FEE: ISSUANCE: 5"-7 SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL. FEES COMMENTS: PIC: RECEIPT# PAID BY: VALIDATION: PAID BY: '!fll - VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITE OF DIAMOND BAR INSPECTION RECORD i RACT AND LEDGIfl - SWITCH (U. AR COMMERCIAL HOOD I - BAR - IN"FERCEPI'ER HOT MOP/SHOWERPAN SF I'TIC/CFSSPOOI HEFTS REPORT RECEIVED — — DI:MOLITION — — ROOF DRAINS R01 ;GH GONDUIT _..— ... PCJQI fSPA . ..._ ROtJGH PLUMBING ROUGH ELECTRICAL ROFJGH MECHANICAL GAS TEST — —_ PRE GUNITE ,_.�._... POOL PRE DECK BONDING P -TRAP — FENCE / GATE/ ALARM FINAL. POOL WALLS: WAI1. FOOTING/STECI_ WAL.I STEEL 1 sT( ) ?ND( } LRF T WALL. BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW _. FINAL COMMUNITY SERIACES FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE — SETBACK/LETTER FOOTINGS FORMS SLAB _...� . _. UG. PLUMBING UG. ELECTRICAL LIFER G.HOUND SEWER LATERAL MAIN WATER LINE — — SEWER CLEANOWf — — ROOF SHEATHING FLOOR SlIEATHING SHEAR WALLS EXTERIOR SHEAR WALLS IN ^_... FRAMING/VENTING ROUGH MECHANICAL ROUGH ELECTRICAL W{ ) C ( } BOUGH PLUMBING INSULATION WALL INSULATIOCEILING' . — — -DRYWALL _ — I ATH (PRE) — LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELFGTRC METER RELEASE GAS METER IIELEASI- SPECIAL INSPECTION FINAL BUILDING Z.... L PJY/ 1'�— -.'. P-11 FINAL. MECHANICAL FINAL ELECTRICAL T 1 e-- C_ -PD�- FINAL PLUMBING T -C, of OCCUPANCY CERT. of OCCUPANCY i RACT AND LEDGIfl - SWITCH (U. AR COMMERCIAL HOOD I - BAR - IN"FERCEPI'ER HOT MOP/SHOWERPAN SF I'TIC/CFSSPOOI HEFTS REPORT RECEIVED — — DI:MOLITION — — ROOF DRAINS R01 ;GH GONDUIT _..— ... PCJQI fSPA . ..._ ROtJGH PLUMBING ROUGH ELECTRICAL ROFJGH MECHANICAL GAS TEST — —_ PRE GUNITE ,_.�._... POOL PRE DECK BONDING P -TRAP — FENCE / GATE/ ALARM FINAL. POOL WALLS: WAI1. FOOTING/STECI_ WAL.I STEEL 1 sT( ) ?ND( } LRF T WALL. BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW _. FINAL COMMUNITY SERIACES FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE — CITY r OF DIAMOND BAR I' I 1 I DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES PRESS 21810 Copley Drive, Diamond Bar, CA 91765 notlinc 909 839-7027 - 117 Building Inspection ( ) 13 20 Fax, 86 g p FIRMLY (909) 839 70 ( ) ,b 9e BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diam.Qwdbarca.gov ~ } APPLICATION DATE: P!C# CL JOB SITEADDRLSS €. `°arri�� F� ISSUE DATE: i Z T PERMIT# : _ PIR1 — APN LOT TRACT TYPE CONST. OCC GROUP: OWNER ADDRESS CG �&.% ZIP`' I' CITY � TEL. r✓� ' . Scope of Work APPLICANT 9 TEL• E4 a CONTRACTOR ^ r� & . t� 7-V ' . at ADDRESS i, � k" " . " J # DWEL. UNITS CITY_ ZIP i. "TEL. 3io pc� (— ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION u1 L-1 LL l hereby affirm under penalty of perjury that l am exempt from the Contractor's State License Law for the reasons) 0 i Indicated below by the checkmark(s), 1 have placed next to the applicable Item(s) (Section 71131.5, Business and Z Professions 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 for the permit to file a signed statemenithat he or she j Is licensed pursuantto the provisions of the Contractor's State License Law {Chapter 9} Commencing with Section m a 7900 of Division 3 of the Business and Professions Codej or that he or she is exempt from licensure and the basis for the alleged exemption Any violation of Section 7031.5 by any applicantfor a permitsubjects the applicant to a civil penalty a of not more than five hundred dollars {$500}. U I, as owner of the property, or my employees with wages as their sole compensation, wilt do U all of or L] portions ff r d for sale (Section 7044 Business and Professions Code: The It STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR IADJ. AREA/VALUA I IUN SFB/ADD/REM E Adj. Area: of the work, and the structure is not intended or E e u Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds st or Improves the property, provided that the Improvements are not Intended or offered for sale. If however, the building or QUANTITY DESCRIPTION Eimprovement is sold within one year of completer, the Owner-Bullder will have the burden of proving that it was not built -11�i aJ ;All LUT a or Improved for the purpose of sale.). DU I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section n 7044. Business and Professions Code The Comtractors' State License Law does not apply to an owner of property who builds or improvesthereon, and who contractsfortheprojectswiihalicensed Contractor pursuanttot oContractors'State w License Law.), (,1 am exernptfrom licensure under Me Contractor's State License law for the following reason{s}: J~ � 7 Data: Bigm•� m 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,) cannot legally sell a structure that I have built as an a pt7 owner -builder if It has not been constructed In its entirety by ilconsed contractors I understand that a copy of the applicable law, Section 7044 of the Business and Professions Cade is available upon request when this application Is a O submitted or aithe following Web site. httphvww.leginfo.ca.gov/calaw.hl H l•^ LICENSED CONTRACTOR'S DECLARATION U LuI hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000} and effect.of Division 3 of the Bus ass and P,rgtesslans Code, and my license in full force (pf r LICENSE CLA55' LfC. NO.: y En EXP. DATE `� CONTRACTOR: ... �°-i'.. °-l.'1.�"'d"_ °%f� , a w: �' ,•��.,_ WORKER'S COMPENSATION DECLARATION a QI HERESY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: A I have and will maintain a C5,Tflcafe of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued 7 I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Coda, for the performance of the work for which this permit is Issued. My Worker's Compensation Insurance Carrier and Policy Numbe ar ', jgg i pp y Lw CARRIER '''".%F�. de•" ,,:� - z oD_ POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FDR ONE HUNDRED DOLLARS &100 OR LE55}. F qI certitythat in the performance of the workior which this permit Is Issued, I shall not employ any person in any manner so as to in 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. J ri DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal Lu penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cast of the compensation, p damages as provided for in section 37DB of the labor code, interest, and attorney's fees. m CONSTRUCTION LENDING AGENCY Lu 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,}, 1_ LEN DER'S NAME: a LENDER'S ADDRESS: w a I certify that I have read this application and state Tel the above information is correct I agree to comply with all city an caz county ordinances and state laws relating to building comstructlon, and hereby authorize representatives ofthis county to p enter upon t above-mentioned property inspection purposes. i �� onm can PERMITTEE NAME IN ` � ATE = SIGNA PERMITTEE h FEE WHITE — Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy g CONSTRUCTION'. PLAN REVIEVyr:� ELECTRIC' �.. .. - PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RLTENTION FEE: FEE: PRE -ALT BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL. FEES COMMENTS: p/C; PAID BY: VALIDATION: RECEIPT # PAID BY: VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy CITE OF DIAMOND INSPECTION RE ® A a W SETBRCKI LETTER TRACT AND L:_DGER FOOTINGS FORMS ..—_ .— — — —_— SWITCHGEAR SLAB COMMERCIAL. HOOD UG. PLUMBING ... T- BAR UG. ELEGTRICAL - ... INIFRCE:PTER — LIFER GROUND .. HOT MOP/SHOWERPAN SEWER LATERAL. — _ SEPTIC/CESSPOOL MAIN WATER LINE - —. — — — — — — - HERS REPORT RECEIVED — — — — — — — SEWER Cl EANOUT —. — — — — DEMOLITION ROOF SHEATHING -..— — — — — — - ROOF DRAINS FLOOR SHL ATHING -_�_ — — — — - ROUGH CONDUIT SHEAR WALLS EXTERIOR - - ._ — — — POOL/SPA SHEAR WALLS INTERIOR — — — .--.. —"— — — ROUGH PLUMBING FRAMING/VENTING — — —..—. — — — — ROUGH ELECTRICAL ROUGH MECHANICAL —. ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C O .. -� GAS TEST —" ROUGH PLUMBMG PRE GUNITE INSU I"ATJON WALi.. —. POOL PRE DECK BONDING — INSUIATION CEILNG —. — —. — —P — TRAP DRYWALL —. FENCE/GATE/ALARM LATH {PRE} --... -'- — — — — — I"19NAL. POOL_ . IATH FXTERIOR —_ .— WALLS: LATH INTERIOR WALL FOOTING/STEER. — GAS TLS7 _— _— — SCf(ATCH COAL —. — WALL STEEL JIT{ } 2A41( } LIFT - - ELLCTRIC METER RELEASE - GA5 MEI FR RE! EASE: WALLE(OND REAM — — - WALL DRAIN/ SEAL.. WALL FINAL SPECIAL INSPEL' ETON— "— — RO, fRAMiNG PLANNINGAPPROVAL FINAL BUILDING — .... ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL ELECTRICAL _ FINAL FIRE DEPARTMENT — — FINAL PL,4NNWG FINAL PLUMBING - - FINAL ENGINEERING/ PW T.C, of OCCUPANCY - - FINAL COMMUNITY SERVICES CERT, Of G.CCUP ,NCS°— _ FINAL HEALTH DEPT. FINAL [NOUSTRIAL WASTE COMMENTS: