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Home My WebLink AboutPR17-10451,1.00 , CITY OF DIAMOND BAR q My DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES - 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY mss BUILDING PERMIT APPLICATION www.cityofdiamondbar.com buildingCadiamoudbarca.gov JOB SITE ADDRESS ` 3[ � - C-O�€ � i i �>T Al LOT TRACT OWNER ADDRESS 'l.. -°.s CITY APPLICANT TEL. CONTRACTOR f ADDRESS CITY i1) a.f_�e'� '� � � ZIP �jTEL _�P �.-.r,",:; ._ 2 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER•BDILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmark(s), € 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 to its issuance, also requires the applicant tnr the permit to 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 of Division 3 of the Business and Professions Cade] 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 more than five hundred dollars ($500). (J I, as owner of the properly, or my employees with wages as their sole 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' Stale License Law does not applyto an owner of property who, through employees' cr personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sale. If however, the buhding or improvement Is sold within one year of completion, the Owner-Bulider will have the burden of proving that It was not built or improved for the purpose of sale.). (J 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 I or improves thereon, and who contracts forthe projects with a licensed Contractor pursuant to the Contractors' State License Law.). O 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, exception my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this perni 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, SDcr ion 7044 of the Business and Professlons Code Is avaliable upon request when this application is submitted or at the following Web site: http/www.leginfo,ca gcvlcaiawhtml, LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license Is In full force and effect. I DATE: � CONTRACTOR: a`T ;n..`i'-i's;i ¢"t --"ia --f WORKER'S COMPENSATION DECLARATION'�t_�rf 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 at 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 the Labor Cade, for the performance Df the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are'. CARRIER 7�"t POLICY NUMBER (IRIS SECTION NEED NOT BE COMPLETED IF THE PERMfF IS FOR ONE HUNDRED OOLLAHS $100 OR LESSj. cerillythat in the performance of the work for which this permit is issued. Isbell not employ any person in any manner so as to become subject to to Worker's Compensation Laws of California. And agree that If I should become subject to the Worker's Compensation provisions Df Section 37UD 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 psnalfies and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec 3097, Civ, 0.), LENDER'S NAME LENDER'S ADDRESS: I certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mantioned property for inspection purposes PERMITTEE NAME (PRINT) SITIF PE E w - �-" "" DATE APPLICATION DATE; Z `�7- p/C# pR_$� d®q-r7 ISSUE DATE: 1 q PERMIT# : pR1, - Ioil TYPE CONST. OCC GROUP: Scope of Work r e i- ;K. ( -c' C' k_,! P <C1 # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport co Patie/Deck W LL Pool/Spa ZRe -Roof. d Commercial Valuation: I ''' ° ' Adj. Area: QUANTITY DESCRIPTION FEE U U J W c� m a J Q U_ U U M CONSTRUCTION: PLAN REVIEW: ZZ , ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 36, j2l SMTP: _ Q ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT# lT [q.J PAID BY; CMSi� VALIDATION; L� WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SETBACK/ LETT ER i KAk; i AN Ltuuth SWITCH GEAR G0MMLRCIAL HOOD I - RAR IN 11MCEPTER H01 MOP/SHOWERPAN FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECI`RICAL LIFER GROUND SEWER L.ATFRAL MAIN WATER LINE SEWER CI-EANOUT ROOF SHEATHING FLOOR SI IEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING SIFPTIC/CESSPOOL BIERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT PUOUSPA m ROUGH PLUMBING ROUGH ELECTRICAL rROUGH MECHANICAL _ W( ) C () ROUGH PLUMBING r0 0" INSIII ATION WALL INSULATION CEILING, DRYWALL LAIN (PRE) I ATH EXTERIOR I ATH INTERIOR GAS TEST SC RAT, Ch CCA1 ELECTRIC: METER RELEASE: ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP .......... FENCE 1 GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STf:r.L WALL STEEL V'( ) 2r9 ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL. FINAL R0. FRAMING PLANNING APPROVAL RQUGH FIRE APPROVAL GAS ME:1ER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL FIRE DEPARTMENT