The URL can be used to link to this page

Home My WebLink AboutPR17-7895UVIONDIBAR' CITY OF DIAMOND BAR y.r DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7017 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov 6711 JOB SITE ADDRESS f � �d:� f+�i APN LOT TRACT OWNER LA -e_. ADDS — CITY 1 d�i4+ LCA % ZIPi TEL. _ APPLICANT vi t TEL.~ CONTRACTOR l i EtI- 6L'C . ."OL ADDRESS ? 1 4T " , y CITY 5GLvd tot 9 JZIP 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 License 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 to Its Issuance, also requires the applicant for 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 Code] or that he or she Is exempt from Ilcensure and the basis for the alleged exemption, Any violation of Section 7935.5 by any applicantfor a permltsubjects the applicant to a civil penalty of not more than five hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, wifl 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' or personal effort, bullds or improves the pmperty, 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 -Bonder will have the burden of proving that It was not built or Improved for the purpose of sale.). U 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 does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from Ilcensure under the Contractor's State License law for the following reason(s): Date; Sign: By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one year prior to completion cf the improvements covered by this permlt,E 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 Code is available upon request when this application is submitted or attire following Web site: httpA=w.loginto.ca.gov/calaw.htrnl LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provlslons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and affect. LICENSE CLASS,„ LIC, NC,: 5-C f EXP. DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION (HERY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: W have and will malntain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by S tion 3700 of the Labor Cade, 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 Code, for the performance of the work for which this permit is issued My Worker's Compensation Insurance Carrier and Panty Numh re: y CARRIER 4. L�`�r�'".`� fi�jarfV�'�'LC$ 1✓ �'L� POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $1 OO 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 Campensa l n prov, sloes of Section 3700 of the Labor Code, shall forthwith com5tthosa DATE: q APPLICANT: WARNING; Failure to secure Worker's Compensation coverage Is unlawful, and shall rrernpfiSyer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in add to the co the compensation, damages as provided for in section 3708 ofthe 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 application and State that the above Information Is correct. I agree to comply with alt 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. PERMITTEE NAME {?RENT) SIGNATURE OF PERMITTEE PATE APPLICATION DATE: „�P/C# ISSUE DATE: 10 If I PERMIT# :1 [ 9,7 TYPE CONST. OCC GROUP: Scope of Work Tz,-7, # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. ARLANALUATION SFR/ADD/REM Garage/Carport LO Patio/Deck w w- Pool/Spa Re -Roof I Commercial m 1ff L � � ,n E �tl� Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a v 2 r v w w i41�, �Gt _,, J @y,�r��'/CJS{ L KL L c, `e_ y U z 4 x V CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: r� �� r� / • qb MECHANICAL: INSPECTION FEE; SUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: RECEIPT# W P PAID BY: VALIDATION: VALIDATION WHITE Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy SO SETBACK/ LETTER TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMBING T -BAR UG. ELECTRICAL INTERCEPTER LIFER GROUND HOT MOPISHOWERPAN SEWER LATERALSFPTIC/CESSPOOL ._....... _ MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT' DEMOLITION ROOF SHEATHING ROOF DRAINS5 FLOOR SHEATHINFA ROUGH CONDUIT SHEAR WALLS EX'ILRIOR POOL/SPA SHEAF/ WALLS IN FERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL_ W( ) C () GAS TEST ROUGH PLUMBING/` PRE GUNITE INSULATION WAI 1. POOL PRE DECK BONDING INSULJOTIQN (,FILING P -TRAP DRYWALI., FENCE 1 GATE/ ALARM LATIN (PRF) FINAL POOL LATH FXFf RIOR WALLS: I AI I I IN'fFRIOR WALL. FOOTINGISTI-FI GA`)'IISI WALL5TFFI 1'''( )?�`��( )JIFF SCRAI CH COAT WALL. BOND BEAM ELECTRIC METER REL(. ASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL _ ..... .... ......... - SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIDE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C, ®f OCCUPANCY _ COMMUNITY SERVICES _ CERT, of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE _ _ _