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Home My WebLink AboutPR17-19396CITY OF DLAMOND BAR 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 �I��L� su�ss9 -. BUILDING PERART APPLICATION www.cityciffliamondbar.com. building@diamonribarca.gov JOB SITE ADDRESS 0S jl D,-. APN LOT TRACT OWNER ADDRESS X10 d Lavxd Dr. CITY Anil d Bar F ZIP q 1-71 TEL. ql --G `f7 -017C1 J APPLICANT All�P,ita�rn p-e� III f TEL. CONTRACTOR �N rn> lei IGG�n Nt!9j fTtif rn1p-(yt!n ADDRESS 40160 •13 • POI .--,4 -4 11 CITY (l@r'b rN ZIP - 5 TE(_. i I L� ` 2-18 -C75!6C. 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 reasons) indicated helow 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, er 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 efthe Contracter's State License taw (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from Ilcensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any appficantfor a permit subjects the appllcantto a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sale compensation, will do U all of oro 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' or personal effort, builds or improves the property, provided that the improvemonts are not Intended or offered for sale. If however, the building or improvement Is sold within ane year of completion, the Owner -Builder will have the burden of proving that it was not built or Improved for the purpose of sale,), CJ €, 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 does not apply to an owner of property who bullds or improves thereon, and who cortracisfarthe projects with a licensed Contractor pursuant teihe Contractors' State License Law.). U 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, 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 permlt,l cannot legally sell a structure that I have built as an owner -builder it it has not been constructed In Its entirety by licensed contractors. I understand that a copy of the applicable hw, Section 7044 of the Business and Professions Code Is available upon request when this application Is submitted of at the following Web site httplwwwAgrfo.ca.govlcalawhtml LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under previsions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and mylicenseis In full force and affect. LICENSE CLASS: C8 G LIC. NO.: 9-16E15 3 8 EXP. DATE: (Q( CONTRACTOR: •mull-AnLg^iU.n "f -e- A!J?(t ril 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, forthe performance of the work for which this permit Is Issued. I have and will maintain Worker's Compensation insurance, as required by Section 3700 ofthe Labor Cade, for the performance of to work for which this permit is Issued. My Worker's Compensation Insurance Carrier and Polley Number are: CARRIER.'i7�tUS Latko 1'e_ POLICY NUMBER S -fit 00 GG -70 —)o THIS SECTION NEED NOT HE COMPLETED IF THE PERMIT 15 FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the performance of the work for 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 if I should become subject to the Worker's Compensation provisions of Section 3700 of the L bar Code, I shall forthwith comply with those provisions. DATE:...1APPLICANT:mQ�f R� (Lll1'1,bi WARNING, Failure to secure Worker's Compensation coverage is unlawful, and sinal€ subject an employer to criminal penaitles and civil fines up to one hundred thousand dollars (S100,000), 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 at perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Clv, C.). LENDERS 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-mentioned property for Inspection purposes. fGm PER ME (PRINT) ! 1 SIGNAT PERMITTEE DATE APPLICATION DATE: ! 0A i p PP/C�#� ISSUE DATE:(v r 7*' PERMIT# : P R 17 -_11 301 (So TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO, FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport co Patio/Deck Lu LL Pool/Spa ZRe -Roof i Commercial LLl Valuation: Adj. Area: QUANTITY DESCRIPTION FEE V U w co m XPi E �t�xlsTl � a Lj O CE J z x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: 296-20 MECHANICAL: INSPECTION FEE: 8 ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRL -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES) "1 • SS COMMENTS: PIC: J PAID SY: �y VALIDATION: RECEIPT# 3 PAID BY; 4/' 87— VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACKILETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( } ROUGH PLUMBING INSULATION WAIT, INSULATION CRI IN(i DRYWALL LATH (PRE) LATH FX"ITRIOR LATH INTI RIOR ............................... GAS TES SCRAICH COAl LLE -.(',TRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY d CERT, of OCCUPANCY COMMENTS: (.I?ACI AND LEDGER SWITCH (AFAR COMMLRCIAL HOOD TBAH INII f{CEPEER 1-101" MO P/SHOWERPAN SEPTI C/(;ESSPOOL HERS REPORT RECEIVED DEMOLITION 130OF DRAINS HOUGH CONDUIT POOL/SPA ROUGH PLUMBING . .......... ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FFNCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTINGISTEEL WALL STEEL IST( ) 2N°( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL _ RO. FRAMING PLANNING APPiOVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT