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Home My WebLink AboutPR17-13660C F CITY OF DIAMOND BAR { i . DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 �� (909) 839-7020 Fax: (909) 561-3117 Building Inspection Hotline (909) 839-7027 FIRMLY "ve�9 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov JOS SITE ADDRESS RIM m4k_ Vt APITRACT T OWNER P1 ��r ADDRESS CITY ZIP TEL. APPLICANT TEL, CONTRACTOR fA v,. 'r ADDRESS r5 . 0 - CITY ^ ZIP TEL. 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 mascn(s} indicated below by the checkmark(s), I have placed next to the appflcable 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 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 Ilcansure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfor a permltsubjects 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 sole compensation, will do U all of or (_y 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 empiayees' or personal effort, bullds or improves the property, provided that the improvemants are not Intended or offered for sale. It however, the bonding or improvement is sold wlthln one year of completion, the Dwner-Uulider will have the burden of proving that it was not hunt or improved iorthe purpose of sale,), �) 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 far the 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 N following reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence In which I must have resldcd for at least one year priorio completion of the improvements covered by this penal 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, t 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: httplwww.loginfo.ca.gov/calaw.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 Cade, and my license is in full force and effect. LICENSE CLASS' LIC. NO' � Ej7,2 as EXP. DATE: CONTRACTOR, WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS ave and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of 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 Code, for the partarmanca of ther;"' k fwhich this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER ' �� POLICY NUMBER C 1 ii Cep (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LE55}. I certify that in the performance Ythe work forwhich this permit is issued, I shall not employ any person in any mannerso asto became subject to the Worker's Compensatlon Laws of California. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: c WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal c 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 cede, interest, and attorneys fees. CONSTRUCTION LENDING AGENCY i ! hereby a firm under penalty of perjury that there is a Construction Lending Agency for the performance of the work far which this permit is issued (Sec. 3097, Civ, C.}, LENDER'S NAME: LEI ADDRESS: i 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 relatln to building construction, and hereby authorize representatives of this county to anter upon the above mentioned prop or spectlon purposes. 7 PERMITTEE NAME SIGNATURE OF PERMITTEE DATE APPLICATION DA ISSUE DATE:Jq TYPE CONST. L P/C# n-1 OCC GROUP: Scope of Work lstir+f�L lfl111 (,; Js # DWEL. UNITS # STORIES # BEDROOMS QUANTITY l DESCRIPTION J U U w �u cg z m J a a U Z Q x t> Area: FEE CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: 2-1 INSPECTION FEE: ISSUANCE: SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: 70NING CLEARANCE: !7 57 TOTAL FEES COMMENTS: P/CI PAID BY: VALIDATION: RECEIPT# PAIDBY: l VALIDATION: WHITE— Department Copy, YELLOW --- Finance Copy, PINK—Assessor Copy CITY OF DIAMOIND INSPECTION ® ® ® ® ® a ® ®1. 0 ® d ® m SETBAM LETTER 1HACIAND LEDGER FOOTINGS FORMS SWIICII GEAR SLAB COMMERCIAL HOOD UG. PLUMBING 1 -HAI i UG. ELECTRICAL INIE-HCEPTER UFER GROUND HOT MOP/SHOWERPAN SEWER LATERAL SI PTIC/( SSP0OL MAIN WATER LINE HERS RWORT RECEWD SEWER CLEANOUT DEMCI 1110N HOOF SHEATHING ROOF DRAINS FLUOR SHEA111ING` " ROUGII CONDUIT SHEARWALLS F_XTEMOR .... ---- _ _ � � POOL/SPA . SHEAR WALLS INTERIOR' ROUGH PLUMBING FRAMING/VENTING _ x w, .z, __: ROUGH ELECTRICAL ROUGHMECHANICAL_ ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C (} GAS TEST ROUGH PLUMBING PRE GUNITE _ INSUI AlION WALL POOL PRE DECK BONDING INSLII ATION [ FII LNGP-TRAP .......... ..... _ DRYWALL FEN CF / GATE/ ALARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH MTEFIIOR WALL FOOTING/STEEL GAS TEST WALL SIE 11ll( ) 2N'°( j LIFT SCRATCH COAT WALL BOND REAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUIL®ING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIREDEPARTMENT ............ FINAL ELECTRICAL - FINAL PLANK NG -....... __ .._.. -._.. - FINAL PLUMBING FINAL ENGINEERING/ PVJ T.C, of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE _....................._ COMMENTS;