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Home My WebLink AboutPR17-12234_ �-�"�� ___ CITY OF DIAMOND BAR f ! DEPARTMENT OF CO-�iV104iTY &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.cityofdiaCDondbar,c buildingna diamondbarca.gov JOB SITE ADDRESS APN L T TRACT OWNER pawl ADDR CITY ZIP J716TEL +� APPLICANT TEL. CONTRACTOR i ADD SS Cl ZIP TEL 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 reasan(s) indicated below by the checkmark(s), I have placed next to the applicable Items) [Section 70315, Business and 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 Code[ or that he or she Is exempt from licensure and the basis for the alleged exemption. AnyviolationofSection7031,5byanyapplicantfarapermitsubjectstheapplican toaC€vilpenalty of not more than five hundred dollars ($500), Q 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 Cade: The Contractors' State License Law does Fat apply to an ownor of property who, through employees' ar personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sale. If however, HE 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 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 10 an owner of property who ounce or Improves thereon, and who contracts far the projects with a licensed Contractor pursuantto 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, except for my personal residence In which I must have resided for at least one year prior to completion ofthe improvements covered by this permit,) cannot legally sell a structure that I have built as an owner-bullder If it has not been constructed in Its entlrety by licensed contractors I understand that a copy of the applicable law, Section 7044 of the Business and Professlons Code is available upon request when this application is submitted or at the following Web site: httplwvuwleginfo.cagov/calaw.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 and Profess{ons Code, and my license is In full force and effect. LICENSE CLASS: LIC, NO.: i O EXP. DAAI�3. CONTRACTOR; EJ I FERFBY AFFIRM�[�f UNDER PENALTY OF PERJURY ONE OF THE AFOLLOWING DECTLARATION$; € have and will malntafn a Certfflcate of Consent to Self -Insure for Worker's Compensatlon, as provided by Section 3700 of the Labor Cede, for the performance of the work for which this permit Is Issued. I have an0mairtain ker's Compensatlon Insurance, as required by Section 3700 ofthe Labor Code, for the perfoforwhichthis er ed.MyWork 's Cam ensaLou Insura a order and Policy NuCARRIERPOLICY N (MIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). t certify that In the performance of the work for 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 California. And agree that if I shaUld become subject to the Worker's Compensation provisions of Section 3700 of the labor Code, f shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($106,000), 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 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 t have read this application and state thatthe above information is correct I agree to comply with all city and county ordinances and state laws relating to building construct io , and hereby authorize representativas of this county to enter up a above -mentions property for i n purpos PERMI E (PRINT) SIGNATURE OF PERMITTEE 0 APPLICATION DATE: WIN ISSUE DATE: �� p RMiT# : TYPE CONST. P/C# i T — i 2 2,� OCC GROUP: Scope of Work Ail rne # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/9EM Garage/Carport W Patio/Deck W LL Pool/Spa ZRe -Roof 0_ Commercial M Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U V w z L n ii J U Z 4 x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: . MECHANICAL INSPECTION FEE: ISSUANCE:(,, p SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: 2 00 BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES5 COMMENTS: 3Z PAID BY: / VALIDATION: RECEIPT #' % PAID BY. r!- VALIDATION: WRITE— Department Copy, YELLOW— Finance Copy, PINK —Assessor Copy I SE TBACK/ LETTER I HAL; I ANU LI 06tH FOOTINGS FORMS _. SWITCH GEAR SLAB COMMERCIAL do OD UG. PLUMBING I -BAR UG. ELECTRICAL INTERCEPTER LIFER GROUND HOT MOP/SHOWERPAN SEWER LJVFFRAL MAIN WATER LINE PORT RECEIVED SEWER CLEANOUT rSEPTIC/CESSPOOL ION ROOF SHFATHING AINSFLOOR SI IEATHING _ CONDUIT _ SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTINGROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL.. W( ) C ( ) _ _ GAS TEST .. RD1lGH PLUMBING � _ PRE GUNITE __ __. ... rlNSCjLII ATION WALL POOL PRE DECK BONDING lATIDN CE[LING GP TRAP _.... DRYWALL FENCE/ GATE/ ALARM LATH (PRE) FINAL POOL I_ATII EXTERIOR WALLS: [ATI I INTERIOR WALL FOOTINGISTEEL GA._; TEST , �.. _. _ WALL STFf_L I sl( 2No.� LIFT ..� SCRATCH CONI WALL L30NO BEAM ELECTRIC MET[R RELEASE WALL. DRAIN/ SEAL GAS METER RELEASE WALL FINAL _._.. _ _........ SPECIAL INSP[CTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL i FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C, of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. LELNAL INDUSTRIAL WASTE COMMENTdv1� nactz