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Home My WebLink AboutPR17-15973CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES r Y 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.cityofdiamondbar.com bvildinLr(a?diamondbarca.tzov en I JOB SIT E ADDRESS2.2&1 &k6qvte� APIA L T TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT Ti Z CONTRACTOR ADDR SS CITY ZIP EL, 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) [Sectiun 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 permitto 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 at Division 3 of 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 applicant to a civil penalty of not mars than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do O all of or (-) portions of the work, and the structure is flat 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' or 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 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 construetthe project (Section 7044, Business afld Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contractster 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]; Cate: Sign; By my signature below I acknowledge that, exceetfor my personal residence in which I must have resided for at least one year prior to completion of the Improvements covered by this permlt,l cannot legally sell a structure that I have built as an owner-bulider if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the appRcalc a law, Section 7044 of the Business and Professions Cade is available upon request when this application Is submitted or at the following Web site: http/www.loginfo.ce.gov/Daiaw.hlml. LICENSED CONTRACTDR'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 Professions Code, and my license Is In full force and effect. LICENSE CLAS//S�iLI � C. NO.: EKP, UATE:_JW- CONTRACTOR: t)IM W1 _ 77 WORKER'S COMPENSATION DEC R T ON I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION& ve and will maintain a Coriof Consent to Self -Insure for Worker's Compensation, as provided by ,orlon 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 of lire Labor Code, for the performance of the workfor which this permit is issued. My Worker's Compensatlan Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER THIS SECTION NEED NOT BE COMP ETED IF THE PERMIT IS F05 ONE HUNDRED DOLLARS $100 OR LESS}. I conNythat 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 Ard agree that if i should became subject to the Worker's Compensation provisions of Section 3700 of the Labor Cods, I shrrl forthwith comply with those previsions. 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 ($100,000), in addition to the cost of the compensation, damages as provided for in section 3706 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. Div. C.). LENDER'S Ni LEN DER'S ADDRESS: I cert€fy that I have read this application and state thatthe above Information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned prop, for inspection ur o5es. PFRMITT ME { If!(�!/s•�// SIG DAT APPLICATION DATEI !Z-/C3z i 3- _ P/C# 1y - -tf5q, ISSUE DATE: ! PERMIT# : m p p13 TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES �f -` # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport LO U Patio/Deck U- Pool/Spa Z fie -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U it U J LeJ i cu m cos s x CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: - SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: H. +;a j PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES 5 COMMENTS: PAID BY: VALIDATION: �^' RECEIPT# - ry PAID BY: � � VALIDATION: WHITE —Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy rs Z.-ONTY OF O ` R INSPECTION RECORD SETBACK/ LETTER TFIACT AND LEDGLH SWITCH GEAR COMMERCIAL HOOD L HALT -_ .. IN'I LRCEPTER HOTMOP/SHOWERPAN SFPTIC/GESSPOOI FOOTINGS FCRMS SLAB TSG. PLUMBING UG. ELECTRICAL _.._ UFER GROUND SEWER LATERAL. M0 WATER HNF SEWF R CLEANOUT ROOF SHEATHING FLOOR SHEATLIING SHEAR WALLS EKTERIOR SHEAR WALLS INTERIOR HERS REPORT RECEIVED DFMOLITION ROOF DRAINS HOUGH CONDUI"i POOL1SPA ROUGH PLUMBING ROUGH ELECTRICAL FRAMING/VENTING ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELEC I RICAL . W( ) C (} ROUGH PLUMBING INSULATION WAIL INSI)LATION CFIHNG DRYWALL I ATH (PRE) LATH EXTFRIOR I ATH INTERIOR GAS TEST ExAST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL IST( ) 2N°( ) LIFT ; CRATCH COAT ELECTRIC MLTER RELEASL WALL BOND REAM WALL DRAIN/ SEAL GAS METEH RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING�� f _ WALL FINAL I10. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANK WG FINAL ENGINEERING/ PVV T.G. of OCCUPANCY FINAL GoIVImum"I`Y SERVICES CERT, of OCCUPANCY FINAL }HEALTH DEPT. FINAL INDUSTRIAL WASTE