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Home My WebLink AboutPR17-5860w CD 0 LU rn J >r a u� a in 0 CC JOB SITE ADDRESS APN LOT TRACT OWNER ae. i ! o0- _ ADDRESS t cITyDJ^.A.,0 ZIP4L?bL9— TEL. APPLICANT CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY Z€P 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 below by the checkmark(sJ, I have placed next to the applicable Items) [Section 7031,5, Business and Professions Codec Any city or county that requires a permit to construct, atter, improve, demolish, or repair, any structure, prior to its Issuance, also requires Me 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 D) Commencing with Section 7000 of Division 3 of the Business and Professions Cade] orthat he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any appfmant for a permit subjects the applicant to 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 de U all of or U portions of the work, and the structure is not intended or petered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through annibl es' 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 completlon, the Owner -Builder will have the burden of proving that It was not built or improved for the purpose a1 sale.). L)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 contractsforthe prol with a licensed Contractor pursuantto the Contractors' State License Law.). (J I am exempt tram 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 parsocal residence in which i must have resided for at least one year prior to completion of the Improvements uevered by this permlt,I 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 at the following Web site: Ithi lwwwfeglnfo.ca.gevlcalaw.ntmI, 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. i i LICENSE CLASS: �=�_�_ L€C. NO.: ?10zQe�,p _ I EXP. DATE: CONTRACTOR:eroet 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 ecdan 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 workfor which this permit is issued. My Worker's Compensation Insurance Carrier and i Policy Number are: CARRIER POLICY NUMBER (PHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS), j I cridlythat In the performance of the worktor whlch tins permit is issued, I shall not employ any person in any manner so as to a become subject to the Worker's Compensation Laws of California. And agree first If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shRlf foritil comply with those provisions, DATE: APPLICANT: i WARNING: Failure to secure Worker's Compeneatlpn coverage is unlawful, and shall subject an employer to criminal penalties and civil flnes up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, 5 damages as provided for in section 3708 ofthe labor code, Interest, and attorney's fees - CONSTRUCTION LENDING AGENCY j 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, !agree 10 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize represeutal of this county to enter upon the above-mentioned property for inspection purposes. J_ 7 P � PEft ITTE N E RANT} R MI DATE APPLICATION DATE: P/C# ISSUE DATE: 2 PERMIT# TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LO Patio/Deck LL Pool/Spa ZRe -Roof aCommercial - LD Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J Y V wC7 g; e IF ---t Jr w co z m 4 U Z CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: �� • �® MECHANICAL: INSPECTION FEE: ISSUANCE: 3 Si ENERGY i'/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: PIC: PAID BY: ry VALIDATION: �y RECEIPT # PAID BY:y >5 i VALIDATION: �\� WHITE— Departrnent.Copy, YELLOW —Finance Copy, PINK—Assessor Copy CITY OF DIAMOND BAR I PEC i ION RECORD 7TJHAC[ND LEDGER GEAR COMM LRCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CFSSPOOL HERS REPORT RECEIVFf ) DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNIIE POOL PRE DECK 80NMNG P -TRAP FENCE / GATE/ ALARM FINAL POOL. WALLS: WALL FOOTING/STEEL WALL STEEL I"( )2 ND( } I. ITT WALL BOND {SLAM WALT DRAIN/ SLAT. WAIL FINAL RO FTVIMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL, FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ Pw FINAL COMMUNITY SERVICES (FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE SETBACK/ LE"II'EH FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FHAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) ROUGH PLUMBING �. INSULATION WALL a, ` INSUTATION CEILING DRYWALL LATH (PHE) LATII FXTFRIOR LATI I INT FRIOR GAS 1 LST SCRATCH COAT ELECTRIC METER RELEASE GAS v,L, ER RELEAaE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL_ FINAL ELECTRICAL _......... FINAL PLUMBING^' T.C. of OCCUPANCY CERT. of OCCUPANCY C®MMENTS l CITY OF DIAMOND BAR I PEC i ION RECORD 7TJHAC[ND LEDGER GEAR COMM LRCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CFSSPOOL HERS REPORT RECEIVFf ) DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNIIE POOL PRE DECK 80NMNG P -TRAP FENCE / GATE/ ALARM FINAL POOL. WALLS: WALL FOOTING/STEEL WALL STEEL I"( )2 ND( } I. ITT WALL BOND {SLAM WALT DRAIN/ SLAT. WAIL FINAL RO FTVIMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL, FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ Pw FINAL COMMUNITY SERVICES (FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE