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Home My WebLink AboutPR17-13120n.............�io��n Bim CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT ,SERVICES f!. 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-702 .) BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building is dbarca.t:ov JOB SITE ADDRESS ► `2 ' APN S 0 TRACT OWNER G $idA� I ADDRESS F CITY'Ch TEL. APPLICANT tr TEL. �^ CONTRACTOR_L,i� ADDRESS �tD'� G EF. CITY Gis ll ZIP rZ�717 EL. 1� EiJ ARCH/ENG/ DESIGNER ADDRESS CfTY ZIP TEL, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State L€cense 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, priarto its issuance, also requires the applicant for the permit to filo 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 7D00 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemptlon. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civ[ I penalty of not more than five hundred dollars ($500). (-) I, as owner of the property, or my employees with wages as their sole 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 Code: The Contractors' State Llcenss Law does not apply to an owner of property who, through employees' or personal affort, 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 -Builder will have the burden of proving that It was not built or improved for the purpose of sale.). { j 1, 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 rot apply to an owner of property who builds or Improves thereon, and who contracts for the projects with a licensed Contractor pursuantte the Contractors' State License Law.). L 1 ! 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 I must have resided for of least one year prior to complefron of the Improvements covered by this permit,€ 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 or at the following Web site: httplwww.ieg[nfe.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury thaf l 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. LICENSE CLASS: �'�� LIC. NO.: �✓�� 7 EXP, DATE: It/ 1 CONTRACTO . WORKER'S COMPENSATION EC Al I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will malntain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by 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 of the Labor Code, for the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Num�ecacsv�� j5 - CARRIER I� POUCY NUMBER �T d JHS 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 permit Is Issued, I shall not employ any perso-n in any manner so as to become subject to the Worker's Compensation Laws of Californle, And agree that if I should become subject to the Worker's Compensation provisions of Section 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 addltlon to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attomey'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 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,aabbove-m Boned properly for pectlon purposes. �'nttC � PERMITTEENA {pRIN _ SIGNATURE OF PER EE DATE APPLICATION DATE: � 1 "ted PIC# O l C ISSUE DATE: ��1 "7 i 1 "1 PERMIT# : TYPE CONST. GROUP: 1�OCC Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W otic eck w W W. Pool/Spa Re -Roof i Commercial m Valuali Adj. Area: QUANTITY DESCRIPTION FEE c� iY U J w cv z m d z x U CONSTRUCTION: q-Gj PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCEw - TOTAL FEES Olt COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT# 3�-1 %6 PAID BY: VALIDATION: I ,�— WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy SEIBACKILFT [ER IKAUI AIU LL[RiLti FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL I IOOD UG. PLUMBING I -BAR UG. ELECTRICAL ' INTERCEPTER LIFER GROUND HOT MOP/SHOWFRPAN SEWER LAI FRAL SEPTIC/CESSPOOL MA[N WATER LINE HERS REPORT RECEIVED. SEWER Cl EANOUT DEMOLITION ROOFS HFATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOLISPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MECHANICAL.ROUGH MECHANICAL _.. ROUGH ELECTRICAL W( ) C [) GAS TESL ROUGH PLUMBING PRE GUNITE INSUI ATION WALL POOL PRF DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE 1 GATE/ ALARM LATH (PRE) FINAL POOL _ LA' II EXTERIOR WAILS I_ATIIINTERIOR WALL FOOTING/STEEL CAS FEST WALL. S1 EEL 1 ST( ) 29 ) LIFT 9C MATCH COAL WALL BOND SEAM ELECTRIC METER RELEASI WAI L DRAIN/ SEAL _ GAS METER RELEASE WALL FINAL SPECIAL INSPI-0CN RO. FRAMING PLANNING APPROVAL FINAL BUILDING ' ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNTNG FINAL PLUMBING FINAL ENGINEERING/ PWT.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE