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HomeMy WebLinkAboutPR17-8025-- CITY OF DIAMOND BAR r 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 buildin2(7a,diamondbarca.Eov JOB SITE ADDRESS APNLOT TRACT OWNER qI+ ADDRESS e CITY ZIP 'f EL. APPLICANT CONTRACTOR ADDRESS CITY+s sd, W 0_'1A 86Z 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 Iter l [Section 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requites 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 700 of Division 3 of the Business and Professions Cade] 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 for a permit subjects the applicant 10 a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered tot 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, 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 Ownef-Builder will have the burden of proving that It was not tulh or Improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors bo 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.), U I am exempt from licensure 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 [east one year prior to completion of the improvements covered by this parr it,E 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 of the following Web sltei httphvww.leglnfc.ca.gov/calaw.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: C.' LIC. NO.: 6-2 EXP. DATE I CONTRACTOR: f WORKER'S COMPENSATION DECLARATION I HERESY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and wl[i 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 oftho Labor Code, for the performance ofihe work for which this permit is issued. My Worker's Compensation Insurance Garrlerand Policy Number are: CARRIER POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IF THE PE I71S FOR ONE HUNDRED DOLLARS $100 OR LESS), I certify that in the performance of the work for which this it is issued, I not employ any person In any manner so as to I subject to the Worker's Compensation Laws alifamia, And ree that if I should become subject to the Worker's Compensation provisions of Section 3700 Ythe Code, I shali!ol comply with those provisions. DATE: APPLICANT: �� WARNING: Failure to secure Worker's C er*tion coverage�is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hu a housand dollars ($100,900), in addition to the cost of the compensation, damages as provided for in secllon B`ef the labor code, interest, and attorney's fees. r 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 permft is issued (Sec. 3097, Div. C.). LENDFP'S NAME LENDER'S ADDRESS: I cedifythaf I have read this application and state that the above information is correct. I agree to comply wlth all city and county ordinances and staie laws relating to bull g construction, and hereby authorize representatives of this county to enter upon the mentioned property for paction purposes. PERMITTEE NAME (PRIN SIGNATURE OF PER .:::.: -:,.- : --�' - - DATE APPLICATION DATE: i P/G# ISSUE DATE: PERMIT# : -I — X09 -5 p095 TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LO uu Patio/Deck Lu LL Pool/Spa ZRe -Roof � Commercial Z) CO Valuation: Adj. Area: QUANTITY DESCRIPTION FEE d ca ti V w m J rL J Q U a x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: RECEIPT #! AryI BY: VALIDATION: PAID BY: VALIDATION: if WRITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy CITY OF DIAMOND ; INSPECTION RECORD Jig: 11111 1111 SETBACK/ LETTER ....... ..... . TRACT AND7d00D FOOTINGS FORMS SWITCH GE SLAB COMMERCI UG. PLUMBING T -BAR UG, ELECTRICAL INTERCEPTER LIFER GROUND HOT MOP/SHOWFRPAN - SEWFfI LATERAL SEPTIC/CESSPOOL MAIN WATER UNE HERS REPORT RFCLIVED SE WLR CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FI -GOR SHEATHING ROUGH CONDUIT S};EAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMINGIVENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) G ( } � r_� p GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WAI I POOL PRE DECK BONDING INSULATION CF.II LNG P -TRAP DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOI LATH EXTERIOR 7 /fes WALLS: _.. LATH INTERIOR WALL. FOOTING/STEL GAS TEST WALL STF.FI,1s!( )2N°( ) LIFT SCRATCH COAL WALLBONDBEAM ELECTRIC METER RELEASE WAIL DRAIN/ SEAL GAS METL.R RELEASEWALL FINAL ...- . SPECIAL.. INSPECTIONRO F= TAMING PLANNING APPROVAL FINAL BUILDING ..... ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT .FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL.. ENGINEERING1 PW T.Ca of OCCUPANCY FINAL, COMMUNITY SERVICES CERT d OCCUPANCY FINAL.. HEALTH DEPT. FINAL INDUSTRIAL. WASTE COMMENTS-...