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Home My WebLink AboutPR17-10819CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 851-3117 Building Inspection Hotline (909) 839-7027 FIRMLY `ysy BUILDING PERMIT APPLICATION wwwcityotdiamondbancom building@diamondbarca.gov JOB SITE ADDRESS z Al LOT RACT OWNER{ Al =3. - CITYZIP STEL. M13 APPLICANT_TEL. l CONTRACTOR Tian # L• ADDRES l vY CITY EL. t ARCH/ENG/ DESIGNER '! it 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 reason(s) Indicated below by the checkmafk(s), I have p€aced next to the applicabie ifem(s) [Section 7031.5, Business and Professions Go ll Any city or county that requires a permit to construct, alter, improve, demolish, at 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 (Chapler O) Commencing with Section 70GO 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 Section 7031.5 by any applicant for a permit subjects the appilcant to a civil penalty of not more than five hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will do (-) all of or U portons of the work, and the structure Is not intended or offered for sale (Section 7044, BUs[ness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' ar personal effort, builds or improves the property, provided that the improvements are not fnten lsd or offered for sale, If however, the building or improvement Is sold within one year of completion, the Owner-Bufider will have the burden of proving that It was not built or improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who coniracts for the projects with a licensed Contractor pursuant to the Contractors' State Llcerl Law.). O I am exempt from licensure under the Contractor's State Llconse law for the following reason(s): Date: Sigrr. By my signature below I acknowledge that, except for my personal residence In which I must have resided tar at least one year prior to oompletron of the improvements covered by this permif,l cannot legally sell a structure that I have built as an owner-bullder 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: httplwwwleglnfo.ca.gov/mlaw.hhl 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, TCENS✓=CLASS: LIC. NO EXP. DATE: s CONTRACTOR: t �t-eI�6" �� ?'' "a WORKER'S COMPENSATION DECLARATION - I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: have and will maintain a CertIll of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the workfor which #his permit is Issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance ofthe work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER"-'"" POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS). I certifythat Inthe performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Worker's Compensatio ws of California. And agree that if I �ho�Vu�' to become subject tc the Worker's Compo so n Prov i n 1 Sectlon 3700 aft DL . L` Eotje, I holt rfhwith pl on ., .... DATE 'APPLICANT: - f% WARM Failure to sacure Worker's Compensatlon 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 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 I he ad this application and state that the above information is correct. I agree to comply with all city and county ordinan s a state laws relating to building constu on, and hereby authorize representatives of this county to enter upo 0 e d proper y for inspec an pup es. PEI EE NAGE (PHI SIGNATU OF RM ITT $ DAT APPLICATION DATE; 31 1 l ISSUE DATE: PERMIT#: TYPE CONST. P/C#? 'i OCC GROUP: Scope of Wo # DWEL. UNITS ,,,� It STORIES d # BEDROOMS DESCRIPTION SO, FT. FACTOR PSI✓ ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport Lo Peio/Deck Lid u. ZRe Pool/Spa -Hoof Commercial 03 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U s U w cV M a a J U_ U CONSTRUCTION: PLAN REVIEW: ff, ELECTRIC: get PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: d �` ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COM VENTS: PlC: PAID 8Y: RECEIPT# PAID BY:� VALIDATION: JeV VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy L'_ SETBACK/ I.LI I ER FOOTINGS FORMS SLAB UG, PLUMBING UG. ELECTRIGAL LIFER GROUND SEWER LAI ERAL MAIN WATLR LINE SEWER GI.EANOUT ROOF SNE ATHING, FLOOR SI IEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMING/VENTING ROUGH MECHANICAL ROUGH ELEGTRICAL W( ) C ( ) ROUGH PLUMBING INSUI ATION WAIT INSULATION GEII ING DRYWALL LATH (PRE) LAII�I EXTERIOk. I..ATH INTERIOFI GAS TEST SCRATCH GOAT ELECTRIC METER RELEASE GAS ME'LLR RELEASE: SPECIAL. INSPECTION 0 FINAL BUILDING FINAL MECHANICAI. FINAL ELECTRICAL. FINAL PLUMBING T.C, (,# OCCUPANCY T__ CERT, ®t flCGUPA CY a�uaa�a;area ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNI"iE POOL PRF DECK BONDING P -TRAP FENCE 1 GATE/ ALARM FINAL POOL WALLS: WALT LOOTINGISTEFI. WALL. STEEL 1ST( ) 2N1'( ) LIFT WALL BOND BLAM WALL DRAIN/ SLAL WALL FINAL ' HO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERINGA PVI FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE