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Home My WebLink AboutPR17-20293CITY OF DIAMOND BAR I I i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES i 21810 Copley Drive, Diamond Bar, CA 91765 f, PRESS (949) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building(u� Elr nondbarca.gov JOB SITE ADDRESS E t APN LOT TRACT OWNER ADDRES-- - CITY fae"y' ZIP, TEL. J S" APPLICANT # i ;Pi. TEL. = fc CONTRACTORf l y ADDRESS )' V U 'v �iT_ CITY `` P 1, �' ZIP _CTTEL. 9' U 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 ItErri [Section 7031.5, Business and Professions Code: Any city ar county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicantfor the permit to fife a signed statement that he or she is licensed pursuanttn the provisions of the Contractor's State License Law (Chaptei Commencing with Section 7000 of Division 3 of the Business and Professions Code] orthat he or she is exempt from licensure and the basis for the alleged Exemption. Any violation of Section 7031.5 by any appiicantfor a permit subjects the applicantto a civil penalty of rot more than five hundred dollars ($500). (_) I, as owner of the property, or my employees with wages as their sale compensation, will do U ail of of portions of the work, and the structure Is not Intended or offered for sale (Sectlor 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who, through emplayees' or personal effort, builds or improves the praperty, provided that the Improvements are not intended of offered for sale. It however, the building or improvement 18 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.). LJ 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 properly who builds or improves thereon, and who contractsfortheprojects with a licensed Contractor pursuanttoihe Contractors' State License Law.). O I am exempt from licensure under the Contractor's State License law for the following reasons}: Date: Signe By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year'. nor to completion of the improvements covered by this permit,l cannot legally sell a structure that I have I as an owner -builder ii 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 ProtEsslors Code is available upon request when this app€lcatlon is submitted Dr attire following Web site: htiplwwwAglnfo,ca.govlcalawhiml. LICENSED OONTRACTOR'S DECLARATION I hereby affirm ander penalty of perjury that I am licensed under provisions cf 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, �'"- ' Uc. NO.: L"`S EXP. DATE', _'ea f, "- t CONTRACTOR: .. -. a'0i e V WORKER'S COMPENSATION DECLARATION I HERESY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS' I have and will mairtain 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 afthe Labor Code, for the performance ofthe work for which this permit Is Issued My Worker's Compensation Insurance Carrier and Policy Number are: 17 CARRIER � .. K" f ar l` (r,' a. 1 [ ' POLICY NUMBER t' c ;x:) (PHIS SE70N NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). 1 certify that in the performance of the work for which this permit Is issued, l shall not employ any person In any manner so as to become subject to the Worker's Compensaflon Laws of California. And agree that If I should become subject to the Worker's Compensation provisions of Sedan 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 shall subject an employer to crlminal penalties and all fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, damages as provided for in section 3708 ofthe labor code, interest, and attomey's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Coostmation Lending Agency for the performance of the work for which this permit Is Issued (Sec. 3097. Clv. C.). LENDER'S NAME: LENUER'S ADDRESS: 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned grope for Inspection purposes. S PERMI t AM,(PAINT) ) y SIGNA R P RMITTft DATE APPLICATION DATE:/C# ISSUE DAT 07107/7 . PERMIT#: TYPE CONST. � ap OCC GROUP: Scope of Work U _ i # DWEL. UNITS # STORIES it - ,:" t # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LU LL Pool/Spa ZRe -Roof Commercial m Valuation: ; f �' ' Adj. Area: QUANTITY DESCRIPTION FEE a U it r U W J m z m rL J 4 U Z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: o BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID R RECEIPT # PAID BY: VALIDATION: VALIDATION: WHITE —Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL - UFER GROUND ';EWER LATERAL MAIN WATER LINE SFWFR CLEANOUT R00r SHEATHING I -.1,00R SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR _- ............. FRAMINGNENTING ROUGH MECHANICAL . ............... ROUGH ELECTRICAL W( ) C ( )Al ROUGH PLUMBING INSULA110N WALL INSULATIONCEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT _ ELECTRIC METER RF'1_EA SC GAS METER RELEASE; SPECIAL INSPECTION FINAL BUILDING - - FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING 0 1 !l T.C. of OCCUPANCY CERT, Of OCCUPANCY TRACTAND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER -- HOT MOP/SHOWERPAN SEPT0CESSPOOL - - HERS REPORT RECEIVED D1 MOLITION R00F DRAINS ROUGH CONDUIT ................. POOLISPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP... _.. ....... _. FFNf E: / GATE/ ALARM FINAI POOL WALLS: WAI 11_00TI N G/STEEL WAI I SITIT'I 1s1( ) 20( j LIFT ..................... WALL LIOND BEAM WALL D1`IAIN/ SEAL WALL FINAL. 110. FRAMING PLANNING APPROVAL ROUGH FIRE APPR0VAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH [SEPT. FINAL INDUSTRIAL WASTE