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Home My WebLink AboutPR17-20427JOB SITE ADDRESS 2,WN APN LOT T CT OWNER71 ADDRESS CITY ZIP TEL. ' APPLICANT TEL.-11LI'SO1 - 3'9 CONTRACTOR ADDRESSO y Ayy-t CITY OMW ►OY1ZIP {STEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION i hereby aftlrm under penalty of perjury that I am exempt from the Contractor's State License Law for the reWDR(s) Indicated below by the checkmarkts), 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 pursuant to the provisions otthe Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Cade] or that he ar she is exemptfrem licensure and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicantfor a permit subjects the applicantta a civil penalty of not more than five hundred dollars ($500). ( j 1, as owner of the property, or my empioyees with wages as their sole compensation, will do U all of or (} 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 Improvements are not intanded or offered tar sale. If however, the building or Improvement Is sold within one year of completion, the Owner-Bullderwill have the burden of proving that it was not built or impraved for the purpose of sale.). CS 1, 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 builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State r License Law,), LJ 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 1 must haveYeslded for at least one year prior to completion of the improvements covered by this permit,l canned legally sell a structure that I have puilf as an owner -builder if it has not been constructed in Its entirety by licensed contractors. I understand that a copy of the j applicable law, Section 7044 of the Business and Professlons Code Is available upon request when this application is submitted or at the following Web site: hJplwww.laginio.ca.gov/calavv,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 license Is in full force and effect > LICENSE CLASS: Q10 LIC. NO.: � EXP, DATE: CONTRACTOR; WORKER'S COMPENSATION DECLARATION 1 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 Df the workfor 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 otthe work for which this permit is Issued. My Worker's Compensation Insurance Carrier and Policy Number are: I/� Till � CARRIER POLICY NUMBER a (iH15 SECTION NEED NOT BE COMPLETED IF THE PERMIT 15 FOR ONE HUNDRED DOLLARS $i OO OR LESS). j I certify that in the performance of the workfor which this permit is Issued, I shell not employ any person In any manner so as to become subject 10 the Worker's Compensation Laws of CalifomlaAnd agree that if I should become subject to the Worker's Ll J Component o provisions of Section 3700 he Lahor Code, l s I t rthwhh mply It those envisions. APPLICANT; WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal u panaltles and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, D damages as provided for in section 37DB of the labor code, interest, and attorney's fees. i CONSTRUCTION LENDING AGENCY Ei I hereby affirm under penalty o -t perjury that there is a Constructlon Lending Agency for the performance of the work for which this permit Is Issued (Sac. 3097, Civ C,). LENDER'S NAME: r LENDER'S 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 relating to hullding construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. n n 4 = SIGNATURE OF PERMITTEE DATE APPLICATION DATE: i0l I I 1 11 g�P/C# g ISSUE DATE; r �Z /11'T PERMIT# TYPE CONST. OCC GROUP: Scope of Work O ( VJCA( TT # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ, FT. FACTOR PSF ADJ. AREAIVALUATION SFPJADD/FIEM Garage/Carport u,1 Patio/Deck LLJL Pool/Spa ZRe -Roof O Commercial O] Valuation: Adj. Area: QUANTITY DESCRIPTION FEE V H ua z m M J a a yU_ Q U CONSTRUCTION: PLAN REVIEW: ELECTRIC: 5--3, 69 PLUMBING: MECHANICAL: INSPECTION FEE: _ ISSUANCE: -" SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: SAS F: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES q COMMENTS: PIC: PAID BY: p VALIDATION: RECEIPT At PAID BY:-/ ~i c _ VALIDATION WHITE— Department Copy, YELLOW Finance Copy, PINK—Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG, PLUMBING UG. ELECTRICAL UFEA GROUND SEWER LATERAL MAIN WATER LINE SE'WL:Ii CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR CITY OF DIAMOND INSPECTION E TRACT AND LEDGER I -BAR INTERCEPTER 110T MOP/SHOWERPAN SFPTIC/CESSPOOL HFRS REPORT RECEIVED DEMOLITION ROOF DRAINS COMMENTS: ItA4 -e— f �s5p1'dJ�Pi SHEAR WALLS INTERIOR ROUGH PLUMBING . .....INGNENTiNG ROUGH ELECTRICAL ROUGLI MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( } C (.) GAS TEST ROUGH PLUMBING PRE GUNITE POOL PRE DECK BONDING INSUE 1i7ION WALL . INSUI ATiON CEILING P -TRAP DRYWAI I. FFNCE 1 GATE/ ALARM LATH (I'RI:} FINAL POOL LATH EXTPRiOR_ -- WALLS: LATH INTFFRIOR WALL. FOOTING/STEEL GAS TESIs o WAI I STEEL 1 { } 2 {)LIFT SCRATCH COAT ELECTRIC METER RELEASE Ad -P3 -O) WALL BOND BEAM WALL DRAIN/ SEAL GAS METER RELEASE WALL. FINAL SPECIAL INSFECTION RO. FRAMING PLANNAG APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL ENGINEER3NG/ PNC. . . FINAL PLUMBING T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT, of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE COMMENTS: ItA4 -e—