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HomeMy WebLinkAboutPR17-11897CITY OF DIAMOND BAR � I I i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �. 21$10 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839 Q27 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buildnag@diamondbarca.gov JOB SITE ADDRESS �f �f +� .Ga " S c- APN LOT TRACT OWNER s CITY ! . ° v`r'IP'TL x 1 C APPL CANT TEL. CONTRACTOR ADDRESS v �' CITYL4 J =,.. �., ZIP SEL. 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 Items} [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demoflsh, or repair, any structure, prior to its issuance, also requires the applicant for the permit to rile a signed statementthat he or she is licensed pursuant to the provisions ofthe Contractor's State License Law (Chapterg) Commending with Section 7000 of Division 3 of the Business and Professions Cade) or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031,6 by any applicant for a permit subjects the appllcant to a civil penally 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 {) 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 10 an owner Y property who, through employees' or persona€ effort, builds or improves the property, provided that the Improvements are rat Intended or offered for sale, If however, the building or improvement is sold wlthh one year of completion, the Owner-Bullder will have the burden of proving that 11 was not built or improved for the purpose of sale.). L) I, 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 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 licensors under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknowledge that, except for my persanal residence in which I must have resided for at least one year prior to completion of the improvemenis 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 llcensed contractors. I understand that a copy of the applicable law, Section 7044 of the Buslness and Professions Cade is available upon request when this applicatlon is submitted or at thefollowing Web Site: hdp/www.leginfaca,govlcalaw.timl, LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectlon 7000) r of Division 3 ofthe Business and Professions Code, and my license Is in full force and affect. LICENSE Cl LIC. NO.: EXP. DAT . CONTt1ACTOR; . WORKER'S COMPENSATIO DECLARATION I HEREBY FIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS' I hve aand will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by I Section 3700 of the Labor Code, for the performance of the work for which this perms Is issued. I have and will manta€n Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, foT the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and z Policy Number are'. � CARRIER 3 POLICY NUMBER i THIS SECTION NEED NOT HE COMPLETED IF THE PE ITIS FOR ONE HUNDRED DOLLARS $100 LESS). j I certifythat in the performance attire workfor which this per Is Issued, I shalt not employ any person 1 manner so as to o homme subject to the Worker's Compensation Laws of Cal' m1a. An gree that if I sh 15 came Iecf to the Worker's ICDmpens , ra islans f Section 3700 of t e with comply tho previsi s. CATE�� PPLICANT: " WARNING: Fallure to secure Worker's Com tion coverage Is unlawful, d shall au j ct an employer criminal 1 penalties and civil floes up to one hurdr ousand dollars (5190, 00 ddWon t of the cam ensation, j damages as provided for in section 5708 a labor code;-mnT_esi, and a ey'. s. CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a Cmstructlor Lending Agency for the performance of the work for y which this permit Is issued (Sec, 3097, Civ. C.). LENDER'S NAME' LENDER'S AODfiE55: � I certify that I have read this application and state That the above Information is correct I agree to comply with all city and county ordinances and state laws relatIgg to building c structPon, and hereby authorirepresentatives of this county to 5 enter upon the above-mentioned pro f inspectio purposes. " 6 � z: PERMITTEEN (PRINT) 0 174 E SIGNATURE OF P RMI �EB'"-" DATE, § •°- ' APPLICATION DATE: PIC# ii ISSUE DATE: 100 PERMIT# : I — 6 q I TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNfTS # STORIES ' # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADDYREM - Garage/Carport Patio/Deck LU LL Pool/Spa ZRe -Roof Commercial EO Valuation: Adj. Area: QUANTITY DESCRIPTION FEE c�a 2 w co z m a c5 z a U CONSTRUCTION: PLAN REVIEW: ELECTRIC: 76.8 9 PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: Sl ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: 70NING CLEARANCE: TOTAL FEES COMMENTS: -- PAID BY: VALIDATION: ���' RECEIPT # 6 1 �T`l PAID BY: �1 VALIDATION: 'P WHITE: — Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy SETBACK/LELiER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER GROUND SEWER LATERAL. MAIN WATER LINE. SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SIIEARWALLS EXTERIOR SHEAR WALLS INTERIOR FRAMING/VENTING ROUGH MECHANICAL. ROUGH ELECTRICAL W( ) C { ) ROUGH PLUMBING INSIII ATION WALL INSULATION CEILING DRYWALL LATIi (PRE) LATH EXTERIOR LATH INTFRIOR GAS TkST SCRATCH COAT ELECTRIC METER RELE=ASE: GAS METER RELEASE SPECIAL. INSPECTION 1 FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT of OCCUPANCY .... COMMENTS: CITY OF DIAMOND INSPECTION 7TRACAND LEDGED I GEAR ERCIAL H00D T -BAIL INTEIICEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL BIERS RFPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOLiSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUN II E POOL PRE DLCK BONDING P -TRAP FENCE 1 GATE/ALARM FINAL POCI. WALLS: WALL FOOTING/STEEL WALL STEEL 'I s'r( )2ND( ) LIFI WALL BOND 11LAM WALL DRAIN/SIAL WALL FINAL fi HO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PIN FINAL COMMUNITY SERVICES FINAL. HEALTH DEPT, FINAL INDUSTRIAL WASTE ,._ CITY OF DIAMOND BAR W01,_ 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.cityofiliamondbancom building@drama#dbai`ca.gov x 8+A Gill Bend Dr. - CL JOB SITE ADDRESS Q APN LOT TRACT OWNER " 2 ADDR S t. ¢ CITY ZI TEL. APPLICANT !-_TEL. CIO ¢ CONTRACTOR t'a c co ADDRESS d Qe�®!�a L:L Anna 1,KT�i 0 0 O LU z CL ul CD 0 13 U LE 0 O U 0 z u] Y CD 0 ri LU 2 X CD h CS UJ on co co 0 LU d_ 0 zd 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 reason(s) Indicated below by the checkmark(s). I have placed next to the applicable trams [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 appllcantfor the permltlo file a signed statement that he or she is licensed pursuantto the provisions of the 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 exempiion. Any violation of Section 7031.5 by any appilcant for a permit subjects the applicant to 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 L) all of or L) 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 ar 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 forthe purpose of sale.). L) I, 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 bunds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exemptfrom Ilcensure under the Contractor's State License law for the following reason(s): By my signature Usti I acknowledge that, except for my personale residence in which I must have resided for at least one year prior 10 completion of the Improvements covered by this permit,l cannot legally soil 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, Sectton 7044 of the Business and Professlons Code Is avallable upon request when this applaation Is submitted or attire following Web site: httplwww.leginfo.ca.govlcaiaw:himl, 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 ofthe Business and Professions Code, and my license is In full force and effect. LICENSE CLASS: LIC. NO.: f 0 I P L i 1 - EXP. DATE: ONTRACTOR: ` �+- �� Y��r-'g WORKER'S COMPENSATION DECLARATION I HERE AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS'. I have and wilt maintain a Certificate at Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for whlch this permit is Issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Numter are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS). I certify that In the performance of the work for which this go its issued, I shall not employ any person harry manner so asto become subject to the Worker's Compensation Laws of rfornia. And agree that if I shad become subject to the Worker's Compo anon provisions of Section 3700 of Labor de, ptlraW se provisions. APPLICANT: -+ WARNING, Failure to secure Worker's ensa efi�coverage Is un wfnl d shall subject a employer to criminal penalties and civil ftnes up to one hu d thousand dollars {$100,000}, In addifiarr-4e`the`d St of the compensation, damages as provided for In section 37 of the labor code, interest, and attorney's flees. 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 (Sec. 3097, CIV. C.). LENDER'S NAME: LENDER'S ADDRESS: .. I certify that I have read this application and state that the above Information Is correct. I agree to comply with all clty and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter uponlihe above-mentioned property for Inspection purposes. IAI Al, PER NAME (PR c,r.,ni„oc c nnul`'rr "-:�. .. DATE .+ , APPLICATION DATE: S� t PIC# g ISSUE DATE: C3 f T PERMIT# : P R %4 7 � 1 a T TYPE CONST OCC GROUP: Scope ofrbc (3fzi�_ # DW EL. UNITS # STORIES # BEDROOMS Lo-ov LA, -,l 1 , . � V WDESCRIPTION. FACTOR PSF A J. AREANALUATION ZRe -Roof tRmercial0. r Valuate Adj. Area: CONSTRUCTION: r30•e o © PLAN REVIEW: o 3.0-1 ELECTRIC: PLUMBING: NI tILIHAN IGAL: INSPECTION FEE: ISSUANCE:, SMIP: QUANTITY I DESCRIPTION FEE ENERGY PIC: 4 �p -®0-_. H 1106 ua ZONING CLEARANCE: 3 z co TOTAL FEES COMMENTS: 2-46' 8 a PIC: ry PAID BY: RECEIPT# 676—PAID BY: .�VALIDATION: VALIDATION: LG zC U CONSTRUCTION: r30•e o © PLAN REVIEW: o 3.0-1 ELECTRIC: PLUMBING: NI tILIHAN IGAL: INSPECTION FEE: ISSUANCE:, SMIP: --gg�� • �Z �® ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �p -®0-_. BASF: 1106 PLOT PLAN: ZONING CLEARANCE: 3 TOTAL FEES COMMENTS: 2-46' 8 PIC: ry PAID BY: RECEIPT# 676—PAID BY: .�VALIDATION: VALIDATION: LG WHITE —Department Copy, YELLOW — Finance Copy, PINK --Assessor Copy CITY OF DIANIOUP BAR INSPECTEON SETBACK/ LETTER _. ROUGH ELECERICAL TRACT AND LEDGER ROUGH MECHANICAL FOOTINGS FORMS _.. 4R ,WITCH GEAR SLAB _- COMMERCIAL HOOD T -BAR ._ INTERCEPTER UG. PLUMBING UG. ELECTRICAL. LIFER GROUND INSUI ATION CEILING fiOTMOP/SHOIfdERPAN SE=WER LATERAL DRYWALL SEPTIC/CFS8I1O01 —.� .. ITERS REPORT RECEIVED 11EMOLITIQN ROOF DRAINS ROUGH CONOWT POOL/SPA MAIN WATER LINE' SEWER CLEANOUT— ROOF SHEATHING FI OOR SHEATHING SHEAR WALLS EX F RIOR SHEAR WALLS IN"fERIOR HOUGH PLUMBING Ff2ANIING/VENTINC' ROUGH ELECERICAL ROdGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) _ GAS TEST ROUGH PLUMBING PfiF GUNITE INSUr ATION',NALL POOL PRE DECK BONDING, INSUI ATION CEILING P -TRAP DRYWALL FFNCE / GATE/ ALARM LATH ('RE) FINAL POOL LATH FXTFRIOR' ' WALLS: LATH INTERIOR WALL FOOTINC/STEEL GAS TLS WAI.I STEEL �sr( ) 2ND( I..II r SCRATCH C AT j / WALI, E3OND BEAM ELECTRIC; IVETER RELEASE: WALL DRAIN/ SEAT. GAS METER RELEASE WALL FINAL SPE{ IBL INSPECTION FINAL BUILDING RO. FRAMING PLANNING APPROVAL _ ... ROUGH FIRE APPRp1iAL FINAL MECHANICAL ^ FINAL EIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ Pw T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE — —