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Home My WebLink AboutPR17-15847 (12)- CITY OF DIAMOND BAR � � � vc-"'"" DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY `b 9 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS l'AO ! Cli- APN LOT TRACT OWNER ��$ ptt � d+ i 0, ADDRESS CITY zAla nsr J RASA. -ZIP i'[LoS TEL. APPLICANT TEL. CONTRACTOR' ADDRESS CITY CITY" Ss ZIP ��i2 I TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION € hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmark{s), 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 pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7GDO of Division 3 of the Business and Professions Oedej or that he or she Is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicantfor a permit subjects the applicamto a civil penalty of not more than five hundred dollars ($500), 11, as owner of the property, or my employees with wages as their sole compensation, will de U all of or (2 portions of the work, and the structure Is not intended or offerad for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through emp€oyas' cr personal effort, builds or improves the properly, 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 Cade: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts forth& projects with a licensed Contractor pursuantto the Contractors' State License Law ). U I am exempt from Ilconsure under the Contractor's State License law for the following reasen(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 pernri 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 submlfted or at the following Web site httpA ww.leginto.ce.govlcaiaw.html LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I are licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pretesslone Code, rand my license Is In toll force and effect. LICENSE CLAS : �"1 LIC. NO,: "``r I " " q EXP. DATE �`s CONTRACTOR• _ =��_•^ -� WORKER'S COMPE N-BELCA'RATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIDNS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3709 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 performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number CARRIER D TvE_ Tom' POLICY NUMBER d'3D . l I "ai I&, (11 -IIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}. I certify that in line performance of the workfor 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 California. And agree that if I should become subject to the Worker's Compensation provisions of Sectlan 3700 of the Labor Code, I shall forthwith comply with those provisions, DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation 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 at the compensation, i damages as provided for in sectlon 3700 of the labor code, interest, and atfomey's fees. CONSTRUCTION LENDING AGENCY 'r I hereby affirm under penalty of perjury That there is a Construction Lending Agency for the performance of the work for i which this permit is issued (Soo, 3097, Civ. C.), LENDER'S NAME' LENDER'S ADDRESS: i 1 certify That I have read this application and state that the above Iniormatien is correct. I agree to comply with all city and s county ordinances and state laws relating to building construction, and hereby authorize representatlues of this county to r enter upon the above-mentioned property for inspection purposes. PERMITTEE RI RMITTEE DATE APPLICATION DATE: ISSUE DATE: TYPE CONST. P/C# PEq� '?F_ RMIT#: 1" F—I I — I B OCC GROUP: Scope of Work 1__D ha F # DWER. UNITS tt STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION 3FR7ADD/REM Garage/Carport W Patio/Deck LL Poopspa ZRe -Roof Commercial LO Valuatlara: Adj. Area: QUANTITY DESCRIPTION FEE U w w co z in J d a V Z d U CONSTRUCTION: PLAN REVIEW: ELECTRIC: ° PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C:------ ;;�� BY: e OL_VALIDATION: RECEIPT# PA€DBY'. � � VALIDATION — WHITE --- Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy SETBACK/ LEI TEHI - FOOTINGS FORMS SLABCOMMERC ..... UG PLUMRING UG ELECTRICAL I.1FFR GROUND HAM AND I_EI�)GER - SWifG''If GEAR IAL H - I HAfi INIL{tCEPIEfI HOT MOP/SHOWFRIIAN SFPTIC/CFSSPO01 HERS REPORT RCC [.IVCD DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ...... ... - SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS.[NTERIOR FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP ROUGH ELECTRICAL W( } C () ROUGH PLUMBING INSULATION WALL .......... _ INSULATION CEILING DRYWALL - FENCE / GATE/ ALARM LATH (PRE) FINAL POOL - LATH EXTERIOR WALLS: WALL FOOTING/STEP[. WALL STEEL 1sT( ) 2ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ Pig FINAL COMMUNITY SERVICES LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECLION FINAL BUILDING FINAL MECHANICAL "FINAL ELECTRICAL FINAL PLUMBING T.C.of OCCUPANCY ERF of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE CC)MMENT& „ CITY OF DIAMOND BAR FJTKV i � 0 i o.:l I DEPARTMENT OF COMMtiNITY & DEVELOPMENT SERVICES ' 21810 Copley Drive, Diamond Bar, CA 91765 PRESS {909) $39-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY I. �4aA' TtrT,i nTivCi' PF':RMTT APPT,TCATION %,%vw.citvofdiamondbar.com building(& diamondbarea.gov r.. n JOB SITE ADDRESS 7 APN LOT TRACT s OWNER ADDRESS e CITY ZIP TEL. 5 APPLICANT TEL. � CONTRACTOR 5 ADDRESS CITY ZIP TEL. ARCHIENG/ DESIGNER ADDRESS p= CITY 71P TEL. C OWNER-BLALOER DECLARATION ] I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) Indicated below by the checkmark(s), I have placed next to the applicable itam(s) (Section 71 Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, of repair, any L structure, prior to its issuance, also requires the applicant far the permit to file a signed statement that he or she fo is licensed pursuant to the provisions ofthe 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 licensure and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by any applicantfor a permitsutiects the apppcantto a civil penalty r of not more than five hundred dollars ($500). 7 O I, as owner of the property, or my employees with wages as their sale compensation, will do U all of or (-) pardons of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code: The Zi Contractors' Slate 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 building or j improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not bulli or Improved for the purpose of sale.). D (_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section Jo n 7044, Business and Professions Code: The Contractors' State I-icense Law does not apply to an owner of property who � pulldsorimprovesthereon,andwhocontractsfortheprojeclswilhalicensedContractorpursuanttoiheContractors'State License Law,}, (-) I am exempt from licensure under the Contractor's State Llcense law for the fo0owing reason(sp, Dai 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,] cannot legally suit 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 applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is p submitted or atthe following Web site; httpiwww.[eglnfoca.govlcalaw,hi v LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 7000) C , of Division 3 ofthe Business and Professions Code, and my license is in full force and effecl, rn LICENSE CLASS: LIC NO D Q EXP. DATE;` CONTRACTOR'S -%`.- o WORKER'S COMPENSATION DECLARATION H I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS', ¢o I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by 3 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 ofthe Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Pallcy Number are: LU CARRIER z POLICY NUMBER _ to � {rH15 SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). 0 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so roto o become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's JCompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. CE: DATE: APPLICANT: WARNING: Failure 10 secure Workers Compensation coverage is unla�Ahul, and shall subject an employer to criminal r� penalties and civil fines up to one hundred thousand dollars {$100,000), in addition to the cost of the compensation, o damages as pmvlded for in section 3708 of the labor code, interest, and attorney's fees. cc CONSTRUCTION LENDING AGENCY w I hereby affirm under penalty of perjury that thefe Is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. Ch. H LENDER'S HAVE: LENDER'S ADDRESS: ua CL I certify that l have read this application and state that the above Information is correct. I agree to comply with all city and o3 county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to z FM enter upon the above-mentioned property for inspection purposes. ca m PERMITTEE NAME (PRINT}.: U) rn E SIGNATURE OF PERMITTEE DATE I— APPLICATION DATE: ISSUE DATE: TYPE CONST. PIC# PERMIT# DCC GROUP: Scope of Work # DWLL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT- FACTOR PSF ADJ. ARLA/VALUATION SFR/ADDIREM Garage/Carport LO Patio/Deck LL Pool/Spa ZRe -Roof II Commercial f0 Vadluafdc7►S: Adj. Area: QUANTITY DESCRIPTION FEE �i w z a z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PLRMii RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: RECEIPT# ,PAIQ BY: PAID BY: - ,.VALIDATION: VALIDATION', WHITE — Department Copy, YELLOW — Finance Copy, P1 NK Assessor Copy CITY OF DIAMOND INSPECTIOND SI N3ACYJ LETTt 11 TRACT AND LEDi.# ft FOO'l IN GS FORMSl sWIT[;f I GEAR _ _._ Si Ai; LINEM lI RCIAL 1-1000LIG, P] I.)MBING UC 1 I I.CTRICAL ;I}'TER UFr H GROUND HOT MOP/SIHOWFI WAN SEVYIA I ATFRAL SEPTICK:: SSPOOL.. MAIN WA FR LINE HERS RI.I'ORT RECEIVED SEINER Cl FANOUT DEMOLfLION ROOF SI I# AfHING GOOF D#TAINS FLOOR SWATHING BOUGH CONDUIT SHEAR WALLS EXTE OR � DUSPA SHEAR WAL i..S INTERIOR ROUGH 1Iiv1BING FRAMING/Vf NTING ROUGH FI. I:CTRICAI. ROUGH M#I;I-IA,NJCAL ROUGH MICHANICAI ROUGH E1 E CTftiCAL W( } i, { ) (,AS TES] _ ROUGH PLUMBJNG f'RE GUNIR INSULATION WALL POOL PRI I)ECK BONE )ING INSULATION CiILING I' TRAP DRYWALL i ENCF / GA E/ ALARM I ATH (PRE) rJNAL P001 I AJH EXTEND WALLS: I Arri [NTERI01i WALL FOOL ING/STEE.I. GA„ TEST WALL STEL1. f IT( ) 2[41 )LIFT ...._ "CRAI'CH COAT V�IAI_L BONr) I)EAIV ,TRIC METE+i RELEASE WALL DRAIN/,SEAL W (,AS DETER REIJ ASE WAIL FINAI S#'I (IAL INSPE[;11{)RI R0. FRAMING, 0-A1iNING APPROVAL FINIA# EUILDING ROUGH F!RE t'€PPROVAr FINAL MECHANICAL. � � FINAL FIRE DEPARTMENT FPAX ELECTRWAI F9r Al PLANNING FINAL PLUMBING FfNA! ENG#NFERSfVC9 NW T.C� of OCCUPANCY FINAL COMMUNITY SERVICES CERT. d OCCUPANCY FINAL EAf.T 9 DEPT, F9NfAL INDUSTRIAL WASTE COMMENTS:-