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Home My WebLink AboutPR17-16471CITY OF DIAMOND BAR. __. i DEPARTMENT OFCOMMUDEVELOPMENT SERVICES & DEVELOPMESERVICES �/� 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 building@diamondbarea.gov JOB SITE ADDRESS APN �g LOT TRACT OWNER Vf ADDRESS d CITY!v ZIP` TEL. APPLICANT TEL. CONTRACTOR Al S OZ CITY ii 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 Llcense Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable items) [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 In its Issuance, also requires the applicant for the permit to file a signed statemomthat he or she is licensed pursuant the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Divis€an 3 of the Business and Professions Cade] or that he or she is axemptfrom licensure and the basis for the alleged exemptlon. Any violation of Section 7031.5 by any appl[cant for a permit subjects the applicant to a civil penally of hot more than five hundred dollars ($500). (-) I, as owner of the property, or my employees with wages as their sale 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 Code: The Contractors' State License Law does not apply to an owner of property who, through employees' er 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 wlll have the burden of proving that It was not built or improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The ContractorsState License Law does not apply to an owner of property who bullds or improves thereon, and who contracts for the projects with a licensed Contractor pursuanttothe Contractors' State License Law). Q 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, exceptior my personal residence in which I must have resided for at least one year pricrto completion of the 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 7G44 of the Business and Professions Cade is available upon request when this application is submitted er at the following Web site: http/www.[eginfo.ca.gov/calavv.html. LICENSED CGNTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that i am licensed under provisions of Chapter 9 (commencing with Section 7000} Of DIVlsion 3 of the Business and Professions Code, and my license Is In full farce and effect. LICENSE CIA: .P LIC. NO,: 7 0 - EXP. DATE: CONTRACTOR: y, - 6W -4r,; 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-lnsurm for Worker's Compensation, as provided by Sceiloa 3700 of the Labor Code, for the performance ofthe work for which this permit is issued. I have and will maintain Worker'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 re; CARRIER' POLICY NUMBER p 60 (NIS SECTION NESID NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS VOG OR LESSJ. I cedlfythatin the performance of the workfar which this permit is Issued. I shall not Birri any person In any mannerso a; to become subject to the Worker's Compensation Laws of California And agree that if I should become subject to the Worker's Compensation provisions of Sectlon 3700 of the Labor Code, I 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 ($100,000), in addition to the cast of the compensation, damages as provided for in section 3700 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 I have read this applicatlon and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter up tta a e -mentioned property for inspection purposes. V PERMITTEE NAME (PRINT) SIGNATURE OF PERM17FF DATE APPLICATION DATE:9//z,zd PIC# pp�� ISSUE DATE: VII � 1 � PERI: I`e I 4 lCl TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. ARLANALUATION SFR/ADD/REM Garage/Carpert co Patio/Deck LU LL Pooi/Spa zRe -Roof i Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U s U w w a J c45 z max' v CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: �& SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: ' L I PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES I 32— COMMENTS: P/C: PAID BY: VALIDATION:— ALIDATION:RECEIPT# PAID BY: VALIDATION: RECEIPT # WHITE — Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy SEIBAM LETTER FOO'iINGS FORMS SLAM UG, PLUMBING UG, ELECTRICAL IIFFR GROUND SFWER LATERAL. MAIN WATER I.I SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATIIING SHEAR WALLS EXTERIOR 5HEAR WALLS INTERIOR FRAMiINGNENTING ROUGH MECHANICAL ._ .. ROUGH ELEGf RICAL 1N( ) C ( ) ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXIT RI{)R LATH INT'I'MOR GAS TES I SCRATCH COAT ELECTRIC METER RELEASL GAS MI.IER RELEASE SPECIAL INSPECTION FINAL BUILDING — FINAL MECHANICAL- _ . __. FINAL FLECTRICAL FINAL PLUMBING T.C. isf OCCUPANCY CERT. of OCCUPANCY (-nNAnnF=NTq- CITE OF DIAMONDAR INSPECTION 7TRACTANDGLR C0MMERCIAI. I I00D T -BAR INTERCEPTER HOT MOP/SHOWFIIPAN SEPT0GESSP001. HERS REPORT 13I:CElVED DEMOLITION ROOF DRAINS ROUGH CONUUII' POOLISPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNTE POOL PRE USCI( BONDING P -TRAP FENCE / GATE/ ALARM _.... FINAL POOL. ........ ... __ WALLS: WALL FOOTING/STEEL WALL STE Fl 'I S'( ) 2"0( ] LIFT WALL BONI) BEAM WALL DRAIN/ SEAL WALL F1NAI_ RO. FRAMING PLANNING APPROVAL -_ - ROUGH FIRE APPROVAL - f -IPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUIRIITV SERVICES FINAL HEALTH DEPT.