The URL can be used to link to this page

Home My WebLink AboutPR17-3284CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS M1,w R��y (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY 'ate= BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS93 + I T ! APN LOT y TRACT OWNER r 101 YL ADDRESS�� CITY 1) 11 ZIP C41Yd TEL. APPLICANT 'fia'aitts'l TEL. CONTRACTOR 66W 7. ADDRESS 130E e 9�� CITY ve* a Vih9, ZIP mak'" p TEL, CI -26 ARCH/EN G! 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 reason(s) indicated below by the chockmark(s), I have placed next to the applicable Items) j5eclion 7031.5, Business and Professions Code: Any city or county that requires a permit 10 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 Divislon 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any vloadlon of Section 7031,5 by anyapplicantfor a permit subjects the applicant to a civil penalty of not more than flue hundred dollars ($500), (j €, as owner of the property, or my employees with wages as their sole compensation, will do i-) all of or U portions of the work, and the structure is not intended or Dffered 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 €mpmves the property, provided that the improvements are not Intended ar offered for sale. If hoWOver, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was Rot built ori oved for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (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 to the Contractors' State License Law.). (� I am ex e�p tfrom lice sure u88nder the Contractor's States License law for the following reason(s): Date: ??11414'_..' 't 7 Sign: By my signature below 1 acknowledge that, except for my personal residence in which I must have reelded for at least one year prior to completion of the improvements covered by this permit,€ cannot legally set[ 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, httplwwwleginfo.cagoWcalaw.htm€. 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 m'yy license®is in full force and effect LICENSE CLASS C- LID, No, 76-;5""? �� EXP, DATE: T"" 3 1 CONTRACTORS, 'r,-t&Xl 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 SelfInsurefor 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 Cade, for the performance of the workfor which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number ara CARRIER },� 'Ri f14 POLICY NUMBER I.. 'geld 4Irc'"��/ (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certifythat in the performance of the workfor which this permitis 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 comply wltb these 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 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 (Seo. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS, I certify that I have read this application and state thatthe above information Is correct. I agree to comply with all city and county ordinances and state laws relafll-g to building construction, and hereby authorize representatives of this county 10 enter upon the above-mentioned property for inspection purposes. PERMITTEElAME R N SIGNATURE OF PERM17FE DATE APPLICATION DATE: � IP " �" � � r P/C# �- —3-28i ISSUE DATE:_ ° �� PERI :� 3 Z w. TYPE CONST. OCC GROUP: �4 Scope of Work m.,ye)fpps i��9Pg� Fsd� �71�-'� t kyr i err LPLI(V.�rl, i i 6G/ g,#]l� f i (e—Oe yye, # DWEL. UNITS # STORIES aG # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFFVADD/REM Garage/Carport LO Patlo/Deck tc LL Pool/spa ZRe -Roof { Q Commercial 5 Valiva'lion: 0q, Adj. Area: QUANTITY DESCRIPTION FEE U w CDW m rz 4 U Z Q x v CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: ; Si ENERGY P/C: ENERGY PERMIT: RETENTION FEE:. PRE -ALT FEE: ) BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: d P/C: PAID BY: d4 �y VALIDATION: y p RECEIPT# 5 [ PAID BY: } 6 �� VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITY OF C ) INSPECTIOND SE I BACK/ LETTER FOOTINGS FORMS SLAB ........... UG. PLUMBING UG. ELECTRICAL. ......._.. _. LIFER GROUND ............. SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL _..._.........-- ROUGH ELECTRICAL VII( ) C ( ) - ROUGH PLUMBING INSULATION WALL INSULATION # LILING DRYWALL LATH (PRE) LATH FXTFRIOR I.ATI I ]NTFRIOH GAS T L 5 I - _......... - .................. . SCHAICII COAT ELtf I11[C MLIER RELEASE - GAS MLILR RELEASE ... -- SPE{,IAL INSPECTION FINAL BUILDING FINAL MECHANICAL — FINAL ELECTRICAL FINAL. PLUMBING -- T.C, of OCCUPANCY CERT of OCCUPANCY COMMENTS: I IIACT AND I IDGER SWllGII GEAR COMML ICCIAL HOOD I -RAR IN f HiCEI'IER HOT MOP/SHOWERPAN SFPI"IC/GFSSP00L HERS RLPORT RECEIVED _ DEMOLITION _ ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL — GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: ................. WALL FOOTING/STEEL WALL STEEL 15=( ) 2N°( ) LIFT WALL BOND BEAM WALL 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