The URL can be used to link to this page

Home My WebLink AboutPR17-17501 (10)CITY OF DIAMOND BAR 1 Ii . � DEPARTMENT OF COMMMTY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909)839-7920 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building*dLamondbarca.gov JOB SITE ADDRESS t 4 APN LOT TRACT OWNER ADDRESS w r CITY ba$k'OV ems€ ZIP if6'TEL. APPLICANT A e"kill TEL. "MOJ^`�_.. d� CONTRACTOR Ig:a Sd • e% w tkA ADDRESS IT.WFJI �� i CITY a ZIP TEL. - 'g ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION l hereby affirm under -penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) €ndlcated below by the checkmark(s), 1 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 tate applicant for the permit to Nie a signed statement that he or she is licensed pursuantto the provisions of the Contractor's State License Law (Chapter 91 Commencing with Section 7000 of Division 3 of the Business and Professions Cade] of that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicartfor a permit subjectsthe applicant to a civil penalty of not more than flue hundred dollars ($500). U t, as owner of the properly, or my employees 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 Intended or offered for sale. If however, the bullding 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 ccmractsfortine projects with a licensed Contractor pursuantto the Contractors' State License Law.J. U 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 I must have resided for at least one year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an owner-bulider if it has not been constructed In Its antirety 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 subm'dted or at the following Web ste: httplwww.leglnfoca.govlcalaw4tml, 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 aFcLPrroff slops Code, and my license is In full force and effect. LICENSE CLASS �f LIC. NO.: _� EXP.DATE CONTRAcfaR j WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS S I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by ection 3700 ofthe Labor Code, for the performance of the work for which this permit Is Issued. r have and will maintain Worker's Compensation Insurance, as required by Section 3790 of the Labor Code, for the performance ofthe work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number 7.il,t `'�✓ - 'Pgf'p ,. CARRIER s art 3 POLICY NUMBER - {THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}, I certify that in the performance of the wcrktor 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 Celifom€a. And agree that ff I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shalt forthwith comply with those provisions, DATE: APPLICANT: 1 WARNING: FaNirs to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal 3 penalties and civil fines up to one hundred thousand dollars ($100,009), in addition to the cost of the compensation, g damages as provided for In section 3708 of the labor code, interest, and attorney's fees. - CONSTRUCTION LENDING AGENCY 7 1 hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for - which this permltis issued (Sec. 3097, Olv. C.). - LENDER'S NAME: LENDER'S ADURES& J 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 Sate laws relating to building constructlon, and hereby authorize representatives of this county to J enter upon the ab ov nt ned property for inspection purposes o¢" � Gr n PERMITTEE NAME (PRINT) c SIGNATURE 0 EE � DATE APPLICATION DATE: ISSUE DATE:;/// ~ TYPE CONST. l P/C# -Poe -17—t'7s� PERMIT# OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LU f atio/Deck W LL Pool/Spa zRe -Roof Commercial j m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U w z m n- U 4 V CONSTRUCTION: PLAN REVIEW: ELECTRIC: coo PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 5--7 SMTP: LNFRGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: _ BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: r PIC: PAID BY: �p C VALIDATION: RECEIPT# PAID BY: '" 1/' J VALIDATION: WHITE —Department Copy, YELLOW Finance Copy, PINK —Assessor Copy CITY OF DIAMOND INSPECTION EC , 37 SETBACKI LETTER _�_�: TRACT AND LL:UGFR FOOTINGS FORMS ...... _ .......7 _. SWITCH GEAR SLAB _ _ .. _ _. COMMERCIAL I {OOD UG. PLUMBING I-BAR UG. ELECTRICAL INTERCEPTER UFER GROUND HOT MOP/SHOWFRPAN SEWER LATERAL. SFPTIC/CESSPO01 MAIN WATER LINES HFRS REPORT REChVED SEWER CLEANOUT DFM(rLITION ROOF SHEATHING RO0I_ DRAINS _ FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXI"EHIOR __. POOL/SPA SHEAR WALLS INFERIOR _ ........... _ ROUGE{ PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL. ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WALL POOL PRE DECK BONDING INSLII ATION CEILING P-TRAP DRYWALL FENCE / GATE/ ALARM FINAL P001. LATH (PRE:) WALL& LATH IN TERIOR LATH iNTFRIOR WALL FOOT{NG/STEL WALL STEEL, I5T( ) 2"°( ) LIFT GAS TES F SCRATCH GOAT WALL BOND RLAM ELECTRIC METER RELEASE _._ WALL DRAIN/ SEAL GAS METE-A 11FLEASE WALL FINAL SPECIAL INSPI C I ION R0. FRAMING PLANNENGAPPROVAL FINALBUILDING �� : �;� - � �� F �� ,� �/ , 3 'ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL b Gsa ' y l' FINAL PLANNING FINAL ENGINEERING/ Pw FINAL PLUMBING T C of OCCUPANCY FINAL COMMUNITY SERVICES CERT. ® `f OCCUPAN FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: CITY OF DIAMOND BAR DEPARTMENT OF'COMMU VITY & DEVELOPMENT SERVICES 2181.0 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building( APPLICATION DATE: JOB SITE ADDRESS `� $ ISSUE DATE: i 7 PERM APN LOT TRACT TYPE CONST, OWNER ADDRESS f siwf . r CITY '�Zc�r, IA S-) ZIP i TEL. i t' ' APPLICANT, TEL. r CONTRACTOR A,�.. :�a „ d,� � ADDRESS CITY - ZIP ` L" STEL. i� Csf i i 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 reasons) indicated below by the chackmark(s), I have placed next to the applicable torn(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, Improve, demolish, or repair, any a structure, prior to its issuance, also requires the applicant for the permitto 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 c 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Sec0on 7031.5 by any applicant for a permit sublects the applicant to a civil penalty of not more than five hundred dollars ($300). (_) €, as owner ofthe properly, or my employees with wages as their sole compensation, will 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 Cade; The Contractors' Stale 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 net intended or offered for sale. If however, the building or j improvement is sold within one year of completlon, to Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). a U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section n7044, Ruslness and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contractsforthe projects with a licensed Contractor pursuanttothe Contractors' State jLicense Law.). } U I am exempt from licensure under the Contractor's State License law for the fallowing reason(s): l Dale: _ Sign; By my signature below I acknowledge that, exceptfor my personal residence In which I must have resided for at least one 3i year prior to completion ofthe improvements covered by this perri cannot legally sell a structure that I have built as an i owner -builder If It has not been constructed In Its entirety by licensed contractors. I understand that a copy of the ;5 applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web 5110; hitp/www.leginfo.ca,govlcalaw.htmk. j LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 7000) 01 Division 3 of the Bu�s/�,p�ess and_roVssiora Cade, and my_li06RSSO Is in full force and effect, cUop LICENSE CLASS I �" 1O ff��LIC. NO.: ExP� DATE.. con rRAcrDR: o WORKER'S COMPENSATION DECLARATION F I HEREBY AFFIRM FINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: o I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensallen, as provided by Section 3700 ofthe Labor Cotle, far the performance of the work for which thls permit is issued. I have and wi1E maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Cade, for the pertormance ofthe work for which this permit is Issued. My Worker's Compensation Insurance Carrier and PolicyNumbej�ar �, � ZCARRIER P'` >,�$,✓i*,, POLICY NUMBER (MIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}, p I c0rtify1hat In the performance of the work forwhich this permit Is Issued, l shall not employany person in any manner so as to On become subject to the Worker's Compensation Laws of Californla. And agree that ff I should became subject to the Worker's � Compensation provisions of Section 3700 of the Labor Code, I shelf forthwith comply whh those provisions. I DATE: APPLICANT; WARNING; Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to- cdminal LU penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, 0 a damages as provided for in section 3708 of the labor code, interest, and attorney's fees CONSTRUCTION LENDING AGENCY ,zw 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 (Sea. 3097, Civ C.}, h LEADER'S NAME; a LENDER'S ADDRESS LU I certify that I have read this application and state that the above information is correct. I agree to comply with all city and cm'-' county ordinances and state laws relating to building emstructlon, and hereby authorize representatives of this county 10 E enter upon t above-mentioned property for inspection purposes. rn PERMITTEE NAME IN V) ATE T SIGMA PERMITTEE Scope of Work P/C# OCC GROUP: # DWEL. UNITS # STORIES # BEDROOMS W W LL 0 Z Z) cc PRESS FIRMLY DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM (3arage/Carport Patio/Deck Pool/Spa Re -Roof Commercial Valf:ratl®n: Adj. Area: CONSTRUCTION: QUANTITY DESCRIPTION FEE PLAN REVII— xve c U U J w MECHANICAL: INSPECTION PEE: ISSUANCE: 3 - a SMTP: U_ zd L) ENERGY PERMIT: RETENTION FEE CONSTRUCTION: PLAN REVII— ELECTRIC PLUMBING: MECHANICAL: INSPECTION PEE: ISSUANCE: 3 - SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE P RE -ALT FEE: s PASF: LOT PLAN: ZONING CLEARANCE: 'OTAL FEES ;O M M ENTS: �/C; PAID BY: VALIDATION: RECEIPT #��PAID BY: VALIDATION: WHITE —Department Copy, YELLOW — Anarce, Copy, PINK—Assessor Copy SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELE(;LRICAL UFER GROUND SEWER LATERAL MA[N WA7LR LINE SLWER CLLANOUT ROOF SHEATHING FLOOR SHEATHING _ SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGAVENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( } C ( } ROUGH PLUNKING INSUI ATION WALL INSUI AT10N CL IL.ING DRYWALL LATH (PRE) LATH EXTERIOR LATH IN'LERIOR GAS TES I" SCRATCH COAT ELECTRIC ML.TER RELEASE GAS METER RELEASE SPECIAL MSPL.CTION FINAL BUILDING FINAL MECHANICAL FINAL. ELECTRICAL FINAL PLUMBING T.C, of OCCUPANCY CERT, of OCCUPANCY COMMENT e CITY OF DIAMOND INSPECTION TRAC i' AND LL:DGER L _ SWITCI I GEAR COMMERCIAL. HOOD — — T-BAfi INTERCEPTER HOT MOP/SHOVVERPAN SEPTIC/CESSPOOL HERS RL'PORT RFGEIVEI7 — I:iEMDLITION ROOF DRAINS ROUGH CONDUIT PODL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE _ POOL. PRE DECK BONDING_ -- P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALI FOOTING/STEFL WALU STEEL 'IST( ) 2"�( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE ®EPAATMEN FINIAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERWCES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE