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Home My WebLink AboutPR17-15963DI&V10IITD B�I j� zz CITY OF DIAMOND BAR DEPARTMENT OF CONLWUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com bailding(i JOB SITE ADDRESS ;S10 14Liujww� rN, APN LOT TRACT OWNER _ ]MA ( )X) ADDRESS �O C Y`D1 JrMAQ WYf ZIPgi1(h TEL. 0 --1,5 - a APPLICANT I On jrlCe6TEL. 0-Z�1,; --7 S SS CONTRACTOR 0 I ADDRESS Vas -S utin avl CITY ZIPg0&_ TEL. IM __'M -T-&55 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 reasen(s} Indicated below by the ci-eckmark(s), I have placed next to the applicable items) [Section 7f131.5, 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 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 Dlvfslon 3 of the Business and Professions Code] or that he or she is exemptfram licensure and the basis for the alleged exemption. Any vlobtlon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500), (_} I, as owner of the property, or my employees with wages as their sole compensation, will do O all of or (1 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 applyth an owner of property who, through employses' or personal effort, bullds 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 cf sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sect€on A44, Business and Professions Code The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Rod who contracts forthe projects with a licensed Contractor pursuantte the Contractors' State License Law.). U I am exempt from licensors under the Contractor's State License law for the following reasen(sj: 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 priorto completion ofthe improvements covered by this permlt,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 of the applicable law; Section 7044 of the Business and Professions Cade Is avallable upon request when this application is submitted or at the following Web site: httplwww.leginfoca.govlcalaw.htmi. 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 rIs Business y and Professions Code, and my licensee Iffect Is In full force and a LICENSE CI_6�3: {/ne� LIC NO.: � � r EXP. DATEdf -�� II CONTRACTOR: Cd d I 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. I have and will maintain Worksr'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, I (` cp CARRIER k _ _ ' 1"t 1 � 6 - 1cl' of c ('S POLICY NUMBER �� D _"7 _ (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS SIOO OR LESS), I certifythat in the performance of the work for which this permit is Issued, I shall not employ any person In any mannerso as to become subject to the Workers Compensation Laws of California. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Coda, I shall forthwith comply with those provisions GATE: APPLICANT WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminaf penalties and civil fines up tD one hundred thousand dollars ($100,000), in addition is 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 at perjury that there is a Construction Lending Agency for the performance of the work for which this permh Is issued (Sec. 3097, ON. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state thattha above informal€on is correct. I agree to comply with all city and county ordinances and state Taws relating to building construction, and hereby authorize representatives of lots county to enter upon the above-mentioned property for inspection purposes. L) .i i ort Re 6 PERMITTEE NAME(PRINT 6Cf _ �y SIGNATURE 90111EHM17EE DATE j APPLICATION DATE:_ / T P/C# ISSUE DATE: PERMIT# TYPE CONST. OCC GROUP� �1-1p Scope of Work x V if -f) Iho[�JX_ �It l # DWEL. UNITS # STORIES ;e ►. I tili # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport Patio/Dock LL ri Pool/Spa zRe -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a v w w e z cc a c� a z c3 g CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: _34 SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE:__ PRE -ALT FEE: f ..... BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: 36 0 PIC: PAID BY: ( p VALIDATION: RECEIPT # 39613 PAID BY: wf VALiDAT10N: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SE IBAW LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFFR GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXT LRIOH SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL _ ............._...- ROUGH ELECTRICAL W( } C ROUGH PLUMBING INSULATION WALT INSULATION l;Fil ING DRYWALL LATH (PRE) LATH E.XTI-HIOR— LATH INTLRIOR GAS T L:S I SCRAIC[ I COAT ELEGIRIC METER RELEASE GAS METER RELEASE SPEGIAL INSPECTION FINAL BUILDING; FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C, of OCCUPANCY CERTa of OCCUPANCY CITY OF DIAMOND BAR INSPECTION RECORD TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWFRPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST _-- _......_ _._....._... ..._..._.._.._...._._-- PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE/GATE/ALARM FINAL POOL _ - WALLS: WALL FOOT€NGA/STEEL. WALL STEEL I"( ) 2"°( ) LIFT WALL ROND REAM WALL DRAIN/ SLAL WALL FINAL _. ...... R0. FRAMINGPLANNING AI'PII(.IVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINIAL ENGINEERING/ IOW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL 4fllATE