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Home My WebLink AboutPR17-15703LVIOND BAR r CITY OF DIAMOND BART DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21510 Copley Drive, Diamond Bar, CA Will PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 �I��L� BUILDING PERMIT APPLICATION www cityofdiamondbar.com building@diamondbarea.gov a JOB SITE ADDRESS. " APN LOT TRACT OWNER ° e C ADDRESS CITYTEL APPLICANT TEL. CONTRACTOR C.0 raiqA _X ADDRESS C€TY -° MZA 7 e— ZIP W1 4 ITE I ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contracter's State License Law for the reasons) indicated below by the checkmark(s), I have placed next to the applicable item(s) [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 for the permitto Nle a signed statement that he or she is licensed pursuant to the provisions of the Contrantar's State License Law (Chapter9) Commencing with Section 7000 of Oivislan 3 of the Business and Professions Codi or that he or she Is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7035.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500). L) I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or LJ 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 net apply to- an owner of property who, through employees' or personal effort, builds or Improves the property, provided that the Improvements are not intended er offered for sale If however, the building or Improvement is sold within one year of completion, the Owner -Builder will have to burden of proving that It was not built or Improved for the purpose of sale.). C } 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 case. not apply to an owner of property who builds or Improves thereon, and who contracts for the projects with a licensed Contractor pursi.irmi the Contractors' Stale License Law.). LJ I am exempt from liconsure under the Contractor's State License law for the following reasniii 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 of the Improvements covered by this permit,) cannot legally sell a structure that I have built as an owner -builder it it has not been constructed In Its entlrety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Buslness and Professions Code is available upon request when this application is submitted or at the following Web site: http/vvwN.loginto.ca.gav/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 th=I'C'. dons Code, and my license is in full force and elle LICENSE CLASS: NO.: EXP,DATE: rX - ONTRACTOR: WORKER'S COMPENSATION DECLARATION; I HEREBY AFFIRM UNDER PENALTY OF PFRJORY 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, forms performance ref the workfor whorl permit is issued. I have and wilt maintain Worker's Compensation Insurance, as required by Sealer 3700 ofthe Labor Code, for the performance ofthe work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Num are: _ " CARRIER .^F ..e,;�_ `: �'�, POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IF THE PSMIM FM ONE HUNDRED DOLLARS $100 OR LESSj. lcertlfythat [nthe performance ofthe work for which this permit isissued, lshall Pat employ an�y.�ersanir�a manner soasto become subject to the Worker's Compensation Laws of California. And agree that if I s ould"become ect tetra Worker's Compen on provisions of Section 3709 of the Labor Code, I shall forthwith compyy uvyith hose /3t v DATE: . PPLICANT: _ ,,.E^"' 1 -' " r . % WARNINGr Failure to secure Worker's Compensation coverage is t°nlawfui; and sha lsu5je tafi 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 1n 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, ON. C.). LENDER'S NAME: LENDER'S ADDRESS: I cerflfy that I have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state laws refating to buhding construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. PERMITTEE NAME(PRINT) w � SIGNATURE OF PERMITTEE DATE APPLICATION DATE: t i—I P/C# �® ISSUE DATE: f , `""l PERMIT# : F TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION BFR/ADD/REM Garage/Carport Lo Patio/Deck uLI LL Pool/Spa ZRe -Roof Q Commercial 7 Valua*lion: Adj. Area: QUANTITY DESCRIPTION FEE U U W m z m a J 4 U Z 4 x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: - SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES , COMMENTS: PlC: PAID BY: VALIDATION: RECEIPT # acs C- a PAID El VALIDATION: WHITE —Department Copy, YELLOW— Finance Copy, PINK—Assessor Copy SETBACK/ LETTER FOOTINGS FORMS COMMERCIAL HOOD SLAB UG. PLUMBING I -BAR UG. ELECTRICAL LIFER GROUND SEWER LATERAL ROOF DRAINS MAIN WATER LINT ROUGH CONDUIT SEWER CLEANOUT POOL/SPA ROOF SHEATHING FLOOR SHFATHING SHEAR WALLS EXTERIOR SHEAR WALLS INJ ERIOR FRAMING/VENTING _.._.. ROUGH ELECTRICAL. ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) ROUGH PLUMBING ._ . - INSUi ATION WALL INSIJL Al ION CEILING I)RYWALL PRE GUNITE [A FIT (PRE) POOL PRE DECK HONDING I ATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELLAyE: GAS METER RELEASE: SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY" CERTo of OCCUPANCY I IIACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD I -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVE -1) DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING _.._.. ROUGH ELECTRICAL. _ .......... _ ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK HONDING P -TRAP FENCE / GATF/ ALARM FINAL POOL WALLS: WALL F00T1NG/STEEL WALL ST"I 1:1.1''( ) 2N°( ) LIFT WALL ROND #SEAM .......... WALL. DRAIN/ SEAL WALL. FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL EN .......... FINAL COMMUNITY SERVICES FINALHEALTH DEPT. FINAL INDUSTRIAL WASTE