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HomeMy WebLinkAboutPR17-9778DlAitil[1ND BAR mow° CI'T'Y OF DIAMOND BAR DEPARTMENT OF C07VLV1UNITY & DEVELOPMENT SERVICES "'Y 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buildin dtam FIRMLY ty g@ onoarca.gov i Y JOB SITEADDRFSS x ,.i �s, ) s APN LOT TRACT OWNER ADDRESS, CITY ZIP TEL. x APPLICANTV TEL CONTRACTOR ADDRE$k T nd r CITY 4 = P p 2s .1TEL s;,_:.�9 ARGH/LNCa6. 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 item(st [Section 7031 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 pursuant to the provisions of the Contractor's State License Law (Chapter D) 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. Any violation of Section 7W1,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500), () f, as owner of the property, or my employees with wages as their sole compensation, will do fU all of or LJ portions of the work, and the structure is not intended or offered for sale (Section 7044, Ruslnass and Professions Code: The Contractors' State License Law dues not appy 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 construct the project (Section 7044, Business and Professions Cade: 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 pursuantto the Contractors' State License Law.). si+Tam exempt from licensure under the Contractors State Li ehSo law for the f wing reason(s): Date'._ �.ro. Wye::.-- 51gn ''. eu _ _ .�.�" ......_..: By my signature below 1 acknov'ledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the 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 entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this applicauan is submitted or at the foficwing Wet site: httplwww.leglnfo.ca.govlcalaw.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 Professions Code, and my license is In full farce and effect. PE SE CLASS: CONTRACTOR: / r WORKER'S COM ENSATION 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. .r� I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance o1i workfor which this permit Is issued, My Worker's Compensation Insurance Carrier and Policy Number are CARRIER Y,"21r POLICYNUMRFR , (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the workfor 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'd I should become subject to the Worker's Compensation provisions of Section 3700 of the *or Code, I shall torRwA comply with those provisions. DATE- ==k - a 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 (5100,000), in addition to the cost of the compensation, damages as provided for In section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby atfirm under penalty of perjury that there Is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 30971 Clv. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and slate that the above information is correct. I agree to comply with all My and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the ahwri-mentioned properjy for Inspection p0ip052e. PERIFN1 ME (PRINT)_ SIGNATURE OF PERMITTEE bATE APPLICATION DATiiE: ISSUE DATE: P f t PERMIT# TYPE CONST. OCC GROUP; Scope of Work # DWEL. UNITS # STORIES e ` l # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport LO Patio/Deck L-1 L Pool/Spa ZRe -Roof Commercial Valuation: '° d" Adj. Area: QUANTITY DESCREPTION FEE r� U J w c7 2 a z a x CONSTRUCTION: PLAN REVIEW: ® P ELECTRIC: 3 5p PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: iCr X SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTALI=EES COMMENTS: izo6 P/C:S�� PAID BY: �! I� L✓ VALIDATION: RECEIPT # PAID BY: V t0®i VALIDATION: WHITE — Department Copy, YELLOW Finance Copy, PINK —Assessor Copy CITY OF DIAMOND LETTER 7 TRACT AND LEDGER 7FOOTING9FORMS __.-.�.._........ SWITCH GEAR_ _ ........ - COMMERCIAL HOOD .ING T BAR UG ELECIRICAL INTERCEPTER UFER GROUND HOT MOP/SHOWERPAN SEW FA LATERAL SFPTIC/CESSPOOL MAIN WATER LINE - HERS REPORT RLGFIVI D 51 WLIi CLEANOUT DEMOLIT[ON ROOF SHEATHING ROOF ©RAINS FLOORSHEATHING ROUGH CONDUII SHEAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIORROUGH PLUMBING __ FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( )C(- Aor®1 GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WAI..I POOL PRE DECK BONDING INSULATION LEll ING P -TRAP DRYWALL FENCE/ GATE/ ALARM LATH (PRE) FINAL POO/ LATH EXTERIOR WALLS: LATH INTFRIOR WAI.f_ FOOTING/STEEL GAS TEST WALL STLCI 'Is'( )2 ND( } LIFT SCR^TCH ({OAi WALL BONI) BEAM I_LLCTRIC METER RELE.ASH WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPE GIAL INSPECTION 130. FRAMING PLANNING APPROVAL FINAL BUILDING � �� � t r " ROUGH FIRE APPROVAL — - FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL �' FINAL PLAITING FINAL PLUMBING FINAL ENGINEERING/ PW T.G. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE COMMENTS: