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Home My WebLink AboutPR17-9111a 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 www.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS ' APN LOT TRACT OWNER ADD E55 " f: CITY 'i fid` ZIPaA I '7&5 TEL. APPLICANT �y TEL.ItSet CONTRACTOR t " Y 3J4 I t ' ADDRESS[.0,1VQ CITYZI€ TE 004, _,D ARCHIENG/ 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 remcfl(s) indicated below by the checkmark(s), I have placed next to the applicable Item(s) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, altef, 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 pursuant to the provisions of the 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 Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of nut more than five hundred dollars ($500). (-) €, as owner of the property, or my employees with wages as their safe compensation, will do ( } 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' 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 -Bulkier will have the harden 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 protect (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 contracts for the projects with a licensed Contractor pursuant the Contractors' State License Law) U I am exempt from licensure under the Contractor's State License law far 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 prier to compietion of the Improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if It has not boon 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 Wen site: httplwww,ieginfc.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that € am licensed under provisions of Chapter 9 (commencing vvfh Section 7000) of Division 3 of the Business and Professions Code, and my ilcense Is In lull force and effect, LICENSE CLASS: C- � � I LIC. NO.: C) LICENSE C�' EXP. DATE, - i _`Sl CONTRACTOR: �" -.. V4 - r WORKER'S COMPENSATION DECLARATION j I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Carl of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Cade, for the performance of the wDrk for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 oflhe Labor Code, for the performance of the work -for which this permit is issued My Worker's Compensation Insurance Carrier and Policy Number are: g CARRIER .� �, 0`0, -, en, ,- 'S- �g W6,15V,e-61, e.7",'. POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS), 1 certify that in the performance of the work fer 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 Section 3700 o1 the Labor Code, I shall Iorthwlth 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 of the compensation, damages as provided for In secton 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of parjury that there is a Construction Lending Agency for the performance of the work for which this permh Is Issued (Sec. 3097, 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 construction, and hereby authorize representatives of Ols county to enter upan the above-menimned property for inspection purposes. \A l1a S P W l'f�E NAME (PRINffe"'? _ a [IG TURE OF PERMITTE �T ATE APPLICATION DATE: / ��/ P P/C# PR 1 } - 9 l ISSUE DATE: d ZO�� PERMIT# TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES � # BEDROOMS DESCRIPTION SQ, FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LE Patlo/Deck L L� Pool/Spa ZRe -Roof 0 Commercial m Valuation: d,•: ,s Adj. Area: QUANTITY DESCRIPTION FEE s U w w co a m rz U 2 x U CONSTRUCTION: PLAN REVIEW: 194 .�83 ELECTRIC: Q _ rp PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: :7Z. Z`I SMTP: 2.08 ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRL -ALT i '4Z. oo BASF: 1-00 PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: / 1 p VALIDATION: t �- RECEIPT# J5J 4 PAID BY! VALIDATION: !� WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITE OF DIAMOND INSPECTION SETBACK/ LETTER TRACT AND LL:DGER SWITGI I GFAH COMMUICIAL HOOD IN i k I1C13'1 LR FOOTINGS FORMS SLAB UG. PLUMBINGT-BAH _ UG. ELECTRICAL .. . UFFR GROUND HOT MOP/SHOWERPAN 9FP LI{'/CFSSPOOL HERS REPORT RECEIVED DLMOLITION ROOF DRAINS ROIIGh CONDUIT SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR POOL/SPA ROUGH PLUMBING HOUGH ELECTRICAL SHEAR WALLS INTERIOR FRAMING/VENTING ....... _ .... ROUGH MECHANICAL - _ _..._ _.... RO[IGH MECHANICAL GAS TEST PRE MINITE POOL PRE DECK BONDING ROUGH ELECIRICAL W( )C( ROUGH PLUMBING INSULATION WAI I €NSULATION (,FII [NG DRYWAI L LATH (PRF) LATH FXTF.RI011 LATH INTmIOR CAS l LSI SCRAI CH COAT P-IRAP FFNCF / GATFI ALARM FINAL POOL WALLS: WALL FOOTING/STEEL ^ WALL STEEL 1ST( ) 2`( ) LIFT WALL BOND BEAM ELL(; I RIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL _.._..... -- RO FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINALTEE. ENGINEERING/ PW - FINAL COMMUNITY SERVICES — _ ..........._ IIEALTH DEPT. FINAL IND STRIAL WASTE ....,. .... . - - ....... ......_. _.. _ .... _.. - -- SPECIAL INSPECT [ON FINAL BUILDING - ._. .._ FINAL MECHANICAL _.. FINAL ELECTRICAL FINAL PLUMBING _.._... -..., T,C, of OCCUPANCY ... �_._. CERT. of OC UPANCYFINAL _... _ COMMENTS: