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Home My WebLink AboutPR17-12934'T CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES ... 21810 Copley Drive, Diamond Bag�'065 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buildi g@diamolndbarea.gov FIRMLY JOB SITE ADDRESS l APN LOT TRACT OWNER L ADDRESS CITY iEL. c a APPLICANT��+ dY �'' TEL. ✓ CONTRACTOR (` r ADDRFS CITY '� ! i TEL. + y 7,2--12 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 reasen(s) indicated below by the checkmark(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, alter, improve, demolish, or repair, any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statementthat he or she is licensed pursuantte the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 700D of Division 3 of the Business and Professions Cade] or that he or she Is exempt from Ilcensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant io a civil penalty of not more than Ove 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 for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' er 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 Owner-Bullder will have the burden of proving that it was nut built or improved for the purpose of sale.), U 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 bullds or improves thereon, and who contracts iorthe 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, exceptfer my personal residence In which I must have resided for of least one year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an owner-bullder 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.leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby afflrm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700(1) of Division 3 of the Business and Professions Code, and my license Is inn full fJor�ce and effect. LICENSE CLASS: L LIC. NO.: �-`' `t EXP. DATE: f J r CONTRACTOR: —r— WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will malntaln a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by ZSec 3700 of the Labor Cade, for the performance of the workfor which this permit is issued, have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued, My Worker' Compensation Insurance Carrier and PNicyNumbar areC L CARRIER POLICY NUMBER MiIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS). I certlfy that in the performance of the workfor 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 Ca1€tornia. And agree that d I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions DATE: APPLICANT: WARNING; Failure to secure Worker's Compensation coverage is unlawful, and shail subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000). in addition to the cast 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 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: i I certify that I have read this application and state that the above information Is correct. I agree to comply with ah city and county ordinance and stale laws relating to building construction, and hereby authorize representatives of this county to enter upon the , o�vtinned property tar inspection purpas. PERMITTEE NAME IN r SIGNA OF PE29E DATE APPLICATION DATE: i., iP!/C# ISSUE DATE: O 7 PERMIT# : ® 7��, TYPE CONST. OCC GROUP: c i Scope of Work ,1? It DWEL. UNITS # STORIES , y S # BEDROOMS DESCRIPTION SQ. FT. FACTOR I ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LO W Patio/Deck Lu Li Pcovspa ZRe -Roof =J Commercial m lfalfiation: Adj. Area: QUANTITY DESCRIPTION FEE a U s r v ui w CD a m J a c45 z x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: O MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: Plc: PAID BY: RECEIPT# d PAIDRY; I VALIDATION: VALII WHITE — Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy QTY OF DIAMOND I . iRECORD SL IIKK/ LETTER TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD LIG. PLUMBING T -BAR LIG. ELECTRICAL INTERCEPTER UFER GROUND . HOT MOP/SHOWERPAN SFWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINEHERS REPO RI- RECEIVED SEWER CLEANOUT ----------------------- -- — DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIOR ROUGH PLUMBING_ FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( j C ( ) GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WALL — . POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE / GATE/ AL..ARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTINWSTFEI, GAS TEST WALL STEEL. 'I r( j 1v°( ) LIFT SCRATCH COAD WAIL BOND BLAM ELECTRIC METER RELEASk WALL DRAIN/ SLAT GAS MFTf"R RI L EASE WAIL FINAL. SPECIAL INSI'EC I ION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL. PLUMBING � �' MNAL PLANNING FINIAL. ENGINEERING/ PW T.C. of OCCUPANCY FINAL. COMMUNITY SERVICES CENT. of OCCUPANCYFINAL HEALTH DEPT. _....__._ _._ .. _._.- -_ ... _ _..... FINAL INDUSTRIAL WASTE COMMENTS: OMppE T J e._._.�.,.�G-.fiv _. .��(L.avl• "" Y ............._