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Home My WebLink AboutPR17-11917CITY OF DIAMOND BAR 0 i ° DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS 1 'y APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT { 1. le TEL, CONTRACTOR ;"C' ADDRE 1 CITY Com'" "'! ZIPt'`S TEL. ARCH/ENG/ DESIGNER ADDRESS CITY 71P TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State license Law for the raason(s) indicated below by the checkmark(s), € have placed next to the applicable items) [Section 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, after, 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 Division 3 of the Business and Professions Code] or that he or she is exempt from Ilmnsure and the basis for the alleged exemptlon. Any violation of Section 7031.5 by any applicant for a permit subjects the applicantio a clyll penalty of not more than five hundred dollars ($500). L) I, as owner of the property, or my employees with wages as their sole compensation, will do I all of or [ j 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 applyto an owner of property who, through employees' or 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 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 forthe projects with a licensed Contractor pursuant to the Contractors' State License Law,), U I am exempt from licensure under the Contractor's State License law for the following reason(s): Dale: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have reslded for at least one year prior to compietIon of the improvements covered by this permit,l cannot legally sol I a structure that I have built as an owner -builder If it has not been constructed in Its entirety by licensed conlractors. 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 at the following Web site: httpAwwwfeg€nto.Ca.govlcaiaw.html. 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 Business and Professions Code, and my I [Sense is in full force and effect. LICENSE CLASS: 7 LIC. NO.:kf i EXP. DATE: �`-' " %i � ONTRACTOR:�ryd°:bt �` � 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 Cade, for the performance of the workfor which this permit is issued. I have and will maintain Worker's Compensation insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: - CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS S100 OR LESS). I certify that in the performance of the workfor which this permit is issued, I shall not employ any person In any manner so as fa became subject to the Workers Compensation Laws of California. And agree that if I should became subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pmvislons. DATE: APPLICANT: WARNING: Failure to secure Worker's Compennillon 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 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 workfor which this permit is issued (Sec. 3097, ON. 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 all city and county ordinances and state laws reiating to building construction, and hereby authorize representatives ofthis county to enter upon the above-mentloned prgperfy for inspection purposes. ,"E M 7FF NAME (PRIND1,"-- r' "SI NATU PERMI EE DATE APPLICATION DATE:_ -� . .. P/C#��g' `iy� �I ISSUE DATE; G� �� PERMIT# : P 121 I i 1 1gt i TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport Patio/Deck Lu LL Pool/spa ZRe -Roof Commercial n m Valuatf®os: Adj. Area: QUANTFY7 DESCRIPTION FEE U s U W iu z m -- J 4 J v a d z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: ..5t.. 17— SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: 2, oc) BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: q-351ISS P/C: PAID BY: VALIDATION: RECEIPT# . "&Ql PAID BY: J9 "' 0 VALIDATION:_ WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy SETBACK/ LEJI ER FOOTINGS FORMS SLAB UG. PLUMBING ............. UG. ELECTRICAL UFER GROUND SEWER I ATE TIAL MAIN WA7.11 LME SEW[R CLEANDUT ROOI SHLATHING FLUOR Sl IEATHINC SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMING/VENTING ROUGH MECHANICAL HOUGH ELECTRICAL W( ) C _ 1101iGH PLUMBING INSIII.ATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TES T SCRATCII COAT ELECTRIC METER RELEASE GAS M11 RELEASE SPE.CIAI INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUINBING T.C. of OCCUPANCY ITS OF DIAMOND INSPECTION RE TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD — T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVID DEMOLITION ROOF DRAINS ROUGH CONDUfl ............ POOL/SPA ROUGE! PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST i PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE 1 GATE/ALARM FINAL POOL. - WALLS: WALL FOOTING/STEEL CERt of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE _ WALT. SIf E'.L, lsr( ) 2ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL. RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT EN ..... ....... _..... FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES CERt of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE _