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Home My WebLink AboutPR17-8987DILVIOND' SAIF CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, GA 91765 ~ PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 F��L� BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@didfmondbarca.gov JOB SITE ADDRESS f r� X" APN LOT TRACT OWNER;n i%- fcp kiv';eid ',"`ti= ADDRESS b r 7 ca Pt 41� :s CITY 9..7,3 ZIP APPLICANT v `'ri+9 uAg.y a°u_ TEL.. CONTRACTOR ` >' ADDRESS `4 pg° r ^'a'r CITY. �..sg ZIP, . TEL. ARCH/ENGI DESIGNER ADDRESS C€TY ZIP TEL. OWNER -BUILDER DECLARAIRDN I hereby all under pcna6ty of perjury that I am exempt from the Contractor's State License Law for the reasons} indicated below by the checkmark(3), 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 far the permit to file a signed statementthat he or she is licensed pursuant in the provisions of the Contractor's State License Law (Chapter 9) Commencing with Scotian 7000 of Division 3 at the Business and Professions Code] 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 applicantto a civil penalty of not more than five hundred dollars (5500). 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 to an owner of property who, through employees' er 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 wlthln 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.). 0 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.). (_) € 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, exceptfor my personal residence In which I must have resided for at leastone year prior to completion attire Improvements covered by this pets l 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 at the j applicable law, Section 7044 of the Business and Professions Code is available upon request when this application Is submitted or atthe tollowing Web site: hdp/www leginfo ca govlcalaw,html. LICENSED CORTRACTOR'S DECLARATION iI hereby affirm under penalty of perjurythat 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. �e: 6 j LICENSE CLASS' A�LIC. NO.: `' i EXP DATE: rI _ CONTRACTOR: j WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will 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. 1 I have and *111 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's Compensation Insurance Carrier and Policy Number are: ,.., . L� ' CARRIER 2 POLICY NUMBER i (fH15 SECTION NEED NOT BE COMPLETED IF THE PERMIT I5 FOR ONE HUNDRED DOLLARS $106 OR LESS), l cerlhythat In the performance of the workfor which this permit is issued, I shall not employ any person In any manner so as to e become subject 10 the Worker's Compensation Laws of Callfomia. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 ofthe Labor Code, I shall forthwith complywith those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall suhject an employer to criminal 7 penalties and civil fines up to one hundred thousand dollars (S100,000), in addition to the cost of the compensation, j damages as provided for in section 3708 of the labor code, Interest, and attorney's fees. - CONSTRUCTION LENDING AGENCY 7 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: U L I cartify 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 5 enter upon the above-mentioned property for inspection purposes. J ❑ F �f S PERMITTEE NAME (PRINT) n E 513HATOPF OF PERMITTEE DATE APPLICATION DATE: Q ® r ^ PIC# PRI 71.- 8981 ISSUE DATE: yf PERMIT# : PR1 T ` EMT - TYPE CONST. OCC GROUP: Scope of Work # DWEL- UN€TS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFP/ADD/REM GaragelCarport T Patio/Deck LL LL Pool/Spa Q Rte-Roof JJ Commercial M . -, Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U U w w z m a a ZU_ d U CONSTRUCTION: PLAN REVIEW: ELECTRIC: Ri 13 Edq PLUMBING: MECHANICAL: INSPECTION FEC: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �® BASF: ' ®d PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: 9 ' S J PIC: PAID BY: VALIDATION: 7 _ PAID BY: SO �� VALIDATION: RECEIPT;V t WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL TRACT AND. LLDGER SWITCH GEAR COMMERCIAL HOOD T- BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/GESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT _ UFER GROUND SEWER LATEHAL MAIN WATER LINE _ SEWER CLEANOUT - - _ ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAM[NGNENTING ROUGH ELECTRICAL /TOUGH ECHANI('AL ROUGH MECHANIGAI ROUGH ELECTRICAL W( ) C ROUGH PLUMBING INSULATION WALI INSULATION CEILING DRYWALL LATH (PRE) LAT1 I f XTERIOR LATH INTERIOR GAS EE:ST SCRATCH COAT ELECTRIC METER RELLASEI GAS MLILR RELEASE SPECIAL. INSPECTION FINAL BUILDING FINAL MECHANICAL s°7 FINAL ELECTRICAL J,® - FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALL& WALL FOOTING/STEEL WAIL STEEL 1ST( ) 2NE( ) LIFT WALI. BOND BEAM WAIL. DRAIN/ SEA/_ W WALI FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ Pw FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE