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Home My WebLink AboutPR17-8435 (7)DEVIOND BAR CITY OF DIAMOND BAR 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 BUILDING PERMIT APPLICATION «=, ,.:'.ty .fdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS APN LOT TRACT OWNER ADDRESS Z % tel CSV r c� -- CITY ZIP 9 I J-%S-rEL. APPLICANT —0[,^�tz?!Ill TEL. Z2� 'Jj7y' Y t CONTRACTOR Cf ADDRESS% YI 6 7 ��, S Ae6�— L_�� CITY ZIP 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 reasons) Indlcated below by the checkmark(s), i have placed next to the applicable items) [Section 7031,5, Business and Professions Cade: 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 7000 of Division 3 of the Business and Professions Cade] or that he or she is exempt from licensure and the basis for the alleged exemption. Any via€ation of Section 7031.5 by any applicant for a permit subjects the app€icant to a civil penalty of not more than five hundred dollars Moo). (_)1, as owner of the property, or my employees with wages as their sole compensation, will to U all of or U portions of the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State Llcense Law does not apply to an owner of property who, through employees' or personal oflort, 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 completion, the Owner-Bullder will have the burden of proving that It was not buih or improved far the purpose of sale,), - (_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professloes Coca: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursaanttothe Contractors' State License Law.). (-) 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 € must have resided for at least one year prior to completion of the Improvements covered by this permlt,l 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 ar at the following Web site http/www.leglrfc.ca.gav/calaw html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wish Section 7000) at Division 3 of the Business and Professions Code, and my license Is in full force and effect, LICENSE CLASS: LIC, NC.; 9-!! i'� :1 EXP. DATE; f J!R CONTRACTOR 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 Section 3700 of the Labor Code, forthe performance of the work for which this permit is Issued have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work far which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Numberryare; CARRIER Gyt/'1Y- i POLICY NUMBER g f�r3l g7rd (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 work for which this pormlt Is Issued, I shall not employ any person In any manner so sate 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 Section 3100 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 10 criminal penalties and 6,41 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 code, Interest, and attorney's fees. CONSTRUCTION LENDING AGENCY 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 € 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 building construction, and hereby authorize representatives of this county to enter upon �the �abovve-mmeen�ti�ooned property for Inspection purposes. gC PERMITTEE'NA (PRINT) mm SIGNATURE OF PERMITTEE DATE APPLICATION DATE: T P/C# i ISSUE DATE: /Z�J' iIPERMIT#: PR 11 Eq,.3S TYPE CONST. OCC GROUP: Scope of Work 69 V r � # DWEL. UNITS # STORIES # BEDROOMS r _ ter DESCRIPTION SQ- FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/RENT Garage/Carport e7 W Patio/Deck W LL Pool/Spa ZRe -Roof 0 Commercial m Valuafl®n: T Adj. Area: QUANTITY DESCRIPTION FEE U U w c� z m a J Q U 4� Y U CONSTRUCTION: PLAN REVIEW:--- z=` ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: Z SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEL: PRE -ALT FEE: BASF: 0 PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: �[ r % �• t P P/C: PAID BY: ti - //,rte"" q VALIDATION: RECEIPT # PAID BY: _*5 03f (6! VALIDATION: WHITE— Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy SETBACK/ L€ Tl ER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL - LIFER GROUND SEWER I ATE -RAL MAIN Whf_2 LINE SEWER CLEANOUT ROOF:SIIf.ATHING FLOOR SI IEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGiVENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( } ROUGH PLUMBING INSIII ATION WALL INSId AT10N CEILING DRYWALL LATH (PRE) I ATH EXTERIOR I ATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RLI. FASF _ SPECIAL INSPEGI ION FINAL BUILDING FINAL MECHANICAL ? FINAL ELECTRICAL FINAL PLUMBING T.G. of OCCUPANCY CERT. of OCCUPANCY COMMENTS:- [ RACTAND LEDGER !,WITCH GEAR CCMMERCIAL HOOD I - LIAR INTERCEPTER - HOT MOP/SHOWERPAN SFPTIGIGFSSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT PODUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST _..._ PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE I GATE/ ALARM FINAL POOL WALLS: WALL FOOTINGISTFF.I.. WALL STEEL Is ( ) emu( ) LIFT WALL BOND M AM WALL DRAIN/ SLAL. WALL FINAL., f RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING... FINAL ENGINEERING/ PW _ _..- FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUST IAL WASTE