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HomeMy WebLinkAboutPR17-10816CITY OF DLkMOND BAR '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 JOB SITE ADDRESS Ci✓ ��E APN LOT TRACT OWNER ADDRESS - 'V l} CITY ZIP qrXill TEL. (o l c+ APPLICANT TEL. 5 IIiD 2_!JLA CONTRACTOR ADDRESS CITY I TEL. tCl 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 Cheokmark(s), I have placed next 10 the applicable items) [section 7031.5, Business antl 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 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] or that he or she is exempt from licensors and the bads for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ( j I, as owner of the property, or my employees with wages as their sole compensation, will do U) all of or (-) portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Cade: 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 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.). U €, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts forms 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 reasoni 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 permlt,I 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 fallowing Web site, http/www.leglnfo.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 jandP.rQfessions Cade, and my license Is In full force and affect. LICENSE CLASS: _ LIC, NO.: `_Kyb EXP, DATE:ONTRAI"WORKECRaS COMPENSATION ECLAEtATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: have and will maintain a Certificate of Consent 1D Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the workfur which this permit Is Issued. I have and will maintain Worker's Compensation Insurance, as required to, Section 3700 of the Labor Cade, for the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number are, CARRIER w i� PSE POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the work Far 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 the Worker's Compensation provisions otts_ction 3700 of the Labor Code, I shall forthwith comply with those provisions, DATE: L pS� 1Ar'PLICANT:�-"'-- WARNING: Failure to secure Worker's Compensation coverage [s unlawful, and shall sublect 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 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 (Seo. 3097, CIv. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read frits application and state that the above lnformatlon Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentionsd property -For Inspection purposes. l y - PERMITTEE NAME (PRINT) tj SIGNATURE OF PERMITTEE DATE APPLICATION DATE: —11 S I I to P�/C#9 PRIJ-10810 I SUE DATE: I � PIR R l7 ` lag 1(0 TYPE CONST- OCC GROUP: Scope of Work n� # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport LL PatWDeck LIJ LL Pool/Spa or Re -Roof 11 r 13 © CommercialLJ ' m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U it U u� c7 z m J a U 4 x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: •�% SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASE: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: VALIDATION: VALIDATION: RECEIPT # 50 PAID BY: i'® 50 ( VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK --- Assessor Copy CITY OF DIAMOND B INSPECTION RECORD COMMENTS: SETBACK/ LETTER w 7 TRACT AND LEDGER _ ..-....., FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMBING T BAR UG. ELECTRICAL IN FE:RCEPTER UFER GROUND 1101" MOP/SHOVIIERPAN SEWER I-AITHAL MAIN WATTfi I INF Sl WF:R CI FANOUT ROOF 31 IFATI IING f LOUR SI R ATI{ING_ SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR ...... ..._...._ FRAMINGNENTING ROUGH M ROUGH ELECTRICAL) C ( ROUGH PI_INRING INSULAPON WALL INSUI-ATION CEILING DRYWALL SFNI1C/CESSPOOL HERS /REPORT RECEIVED" DFMOI.ITION ROOF DRAINS IIOUGII CONDUIT POOLISPA ROUGIi PI_IJM$ING _-.......__ ROUGH ELECTRICAL _.. R{7l-19H.—MECHANICAL GAS TEST PRE GUNITE POOL PRT DECK BONDING p TRAP ........ - FFNCF / GATE/ ALARM FINAL. POOL. WALLS: WALL FOOTING/STEEL WALL STLEI_ 1:r[( ) pNo( ) LIFT 'NALL BOND BLAM WALL DRAIN/ SEAL. WALL FINAL R0. FRAMING PLANNINGAPPROV k ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT — LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL RUWDING SINAI. MECHANICAL FINAL ELECTRICAL FINAL. PLUMING T.C, of OCCUPANCY CENT, �f OC U���lC� FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINIAL INDUSTRIAL WASTE COMMENTS: Refgc o OBR-MCH-25-H (Page 4 of 4) Dacumc,r,:as Juan 1,?I!< ; u' , : iii 1cisener Regl tl a i -;.=RS Provider: CACERTS CA �'.Is k;.,., r'.: < ,.:� ���_; - r.'JAI_I.:, -c'. , _ c =';✓r I.`._i3: 707.7-08-16 21:24:17 y State OfC hk9nia DEPARTMENT OF COMMUN R Y SERVICES AND DEVELOPMENT CSD 610 (Rev. 10/14/11) Insulation Cert ate Vf ,j' Customer Name J Weatlter¢ation Agency Name Number and Street Carty Telephone Numbers) DESCRIPTION OF CSD WE.ATHERIZATION PROGRAM -INSTALLED INSULATION: CEILING Baft or Blanket Tyise Thickness (inches) Loose Fill Type ri ,) Contractor's minimum installed weightiff Brand Name Thermal Resistance (R -Value) Brand Name Minimum thickness Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) EXTERIOR.WALL•. Material Brand Name _ Thickness (inches) Thermal Resistance (R Value) -- RAISED FLOOR Material Brand Name _ Thickness (inches) Thermal Resistance (R Value) SLAB FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value) --- GROUND SOURCE VAPOR BARRIER INSTALLED? (Circle One) YES O DESCRIPTION OF COVERAGE AREA: L l DECLARATION I hereby certify that the above insulation was installed in the residence at the above location in conformance with the current Building Energy Efficiency Standards for residential buildings contained in Title 24 of the California Administrative Code and in FTC regulation 16 CFR 460.17. General Contractor (Agency Representative) Signature and Idle License Number r Date q;65 �ti1 License Number_ J -Date