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Home My WebLink AboutPR17-3707 (7)-------------- a CITY OF DIAMOND BAR F I 0 i 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 www.cityofdiamondbarcom building@diamondbarca.gov JOB SITE ADDRESS�- Scope of Werk s ✓ # DWEL. UNITS # STORIES $ APN -11 l LOT TRACT ®� OWNER }iv L - ADDRESS rvo L ro®A-- CITY ZIP 9 (76. S TEL. (,,-2-c 3 APPLICANT C5`c, ZLIkill TEL. 15G.4-"g{°fi- Ip CONTRACTOR Wim( ADDRESS CITY ZIP O TEL.Sill 1-1 3s ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. DWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the remoh(s) Indicated below by the checkmark(s), I have placed next to the applicable items) [Section 70315, Buslmess 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 7000 of Division 3 of the Business and Professions Cade] or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any vlolatlonofSection 7031.5byany applicantforapermit subjectstheappl€ siattoacivil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) 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 building or Improvement is sold within one year of completion, the Owner-Bullder will have the burden of proving that it was not built or improved forthe purpose of sale,}, U I, as owner of the property, am exclusively contracting with licensed Contractors in construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properly who I or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the 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 slgnature 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 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 Cade is available upon request when this application is submitted or at the following Web site: http/www.leglnfo.ca.govlcalaw.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 ffJI force and effect. LICENSE CLASS: LIC. NO.: EXP. DATE: CONTRACTOR; WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certficats of Consent to Self -Insure for Worker's Compensat€on, as provided by Section 3700 of the Labor Code, for the performance of the work for whlch this permit Is Issued. I have and will malntaln Worker's Compensation Insurance, as required by Section 3700 ofihe Labor Code, for the performance of the work for which this permit Is Issued, M Worker's Compensation Insurance Carrier and Policy Number am: _ _ CARRIER f"' a ®+_" , e""" POLICY NUMBER __ C 0 l�j (,2!t (ob0—i— (TRIS 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 iMs 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 Section 3700 of the Labor Code, I shall forthwith complywlth those proVlelen5. DATE: APPLICANT: WARNING Failure 10 secure Worker's Compensation coverage is unlawfu€, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars {$100,000}, in additimn 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 pertcrmance of the work for which this permit is issued (Sec, 3087, Civ. C), LENDER'S NAME: LENDER'S ADDRESS: 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 building conslru d hereby authonze representatives of this county to enter upon the above- ioned property for Inspection pu oses. PERMITTEE N E (PRI r� SIGNATURE DF PER TTEE I DATE APPLICATION DATE:. -t P/C# VR %-1- 27-9-- [ ISSUE DATE: I il ^� 4" PERM€T# : PKII I - 34c) TYPE CONST. OCC GROUP: Scope of Werk s ✓ # DWEL. UNITS # STORIES $ .e ( # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport W PatiD/Deck Lid LL Pool Spa ZRe -Roof Commercial 7 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U o= U W J W cs z m W d a U Z U CONSTRUCTION: PLAN REVIEW: '' C ELECTRIC: 1 31 PLUMBING: MECHANICAL: INSPECTION F=EE: ISSUANCE: SMTP: 4 ref ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: L� PLOT PLAN: _ ZONING CLEARANCE: TOTAL FEES 49 %' %4 COMMENTS: q01, I P/C: 7S's'S—+ PAIDBY:,�-.1 VALIDATION: CV'Of1 RECEIPT# - � PAID RY:'� j 6 tl t r.� VALIDATION: WHITE -- Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy SETBACK/ LET I ER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER GROUND SEWER I.ATFRAL MAIN WATLR LINE SEWFT? CLEANOUT ROOF SI IFATHING FLOOR 5I1EATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMING/VENTING ROUGH MECHANICAL ROUGH ELECTRICAL W'( ) C ( ) ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) I ATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION .................. FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY 1/l CITY OF DIAMOND BAR INSPECTION RECORD TRACT AND LEDGIR SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SFIOWF RPAN SEPTIC:/CE,SSPOO HERS fiEPORT RF(,FIVLL) DFM01-ITION ROOF DRAINS ROUGH (ONDUFT . ........ . POOLIEPA _....._.....__._._.. _ _ ....... - ..... ..... ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL ..._ ... _._._....._ __....._._............... GAS TEST PRE GUNIrE POO[ PRF DECK ROND€NG P -TRAP FENCE=/ GATF/ ALARM FINAL.. POOL. WALLS: WAIL FOOTING/STEEL WALI.. STEEL 1sr( ) 21�u( ) LIFT WALL BOND BEAM WAL.[_ DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE