HomeMy WebLinkAboutPR17-0441..... ..
WuCITY OF DIAMOND BAR _ pr
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
„'9Rg BUILDING PERMIT APPLICATION www.city0diamondbar.com buildin2(a�diamondbarca.l
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DESIGNER
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(sj
indicated below by the checkmark(s), I have placed next to the applicable Items) [Section 7031.5, Easiness and
Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any
structure, prior to its issuance, also requires the applicant for the permit to fife 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 for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($560},
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do O all of or (-) 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 nut built
or Improved for the purpose of sale.).
L) I, as owner of the properly, 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
to
or Improves thereon, and who contractsforill projects with a licensed Contractor pursuant to the Contractors` State
License Law,),
U I am exemptfrom licensure under the Contractor's State License law for the following reason(s):
Date: Sion:
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By my signature below I acknowledge that, exceptfor my personal residence In which I must have resided for at least one
year prior to completion of the improvements covered by this permit,) 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: httplwww.leglnfo.ca.gav/CRlaw.html.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Cleansed under provisions of Chapter 9 (commencing with Sectloa 7000)
of Division 3 of the Business and Professions Code, and my license is in full force and effect.
LICENSE CLASS: LIG. NO.: 7 3
EXP, DATE; CONTFACTCR,
WORKER'S COMPENSATION DEC TION
I HEREBY AFFIRM LENDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will malntaln a Certificate of Consent to Salt -Insure far 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 3709 ofthe Labor Cade, for
the performance ofthe work for which this permit is issued. My Worker's Compensation Insurance Carrier and
PoIPoy Number are:
CARRIER
POLICY NUMBER
f7HIS SECTION NEED NOT BE COMPiETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS S100 OR LESS),
I urt;fy that In the 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 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 with those provisions.
DATE, APPLICANT:
WARNING: Fal€urs 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 Landing Agency for the performance of the work for
which this permit Is Issued (Sec, 5097, Civ. C.J.
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and slate 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 above-mentioned property for inspection purposes.
PERMITTEE NAME (PRI
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SIGNA E 07 PERMITTEE DATE
APPLICATION DATE: ,, 312-11 12-117- P/C# — PRI ryg- 0 d
ISSUE DATE: 9 T PERI iJT F
TYPE CONST. OCC GROUP:
Scope of Work RS E" fes'' ?Ay-*� 1
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD RE 36.6
Garage/Carport
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Patio/Deck
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Pool/Spa
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-Roof
Commercial
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Valuation:rcr '+ Adj. Area:
QUANTITY DESCRIPTION FEE
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CONSTRUCTION:x-
PLAN REVIEW:
ELECTRIC: 6q . 36r
PLUMBING: 1 &2,1 Z
MECHANICAL:, R 9 ifs
INSPECTION FEE:
ISSUANCE:,'
SMIP: .50
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE: 00
PRE -ALT FEE:
BASF: . 00
PLOT PLAN:
ZONING CLEARANCE: �•
TOTALFEES .97-
COMMENTS: o r stayieJ w10
P/C: PAID BY: VALIDATION:
RECEIPT# 86 PAID BY: 8! 6"VALIDATION: Pte•
WHITE— Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
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SETBACK/ LETTER
TRACT AND LEDGER
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FOOTINGS FORMS
SWITCH GEAR
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COMMERCIAL HOOD
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UG. ELECTRICAL
INTERCEPTER
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SHEAR WALLS EXTERIOR
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SHEAR WALLS fN FERIOR
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ROUGH MECHANICAL
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ROUGH MECHANICAL
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LATH EXTERIOR
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GAS TESTWAI
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SCRATCH COAT ' '
ELECTRIC MFTFR RELEASE
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WALL DRAIN/ SEAL
CAS MII_:IF:R RELEASE
WALL FINAL
SPECIAL INSPECTION
RO. FRAMING PLANNING APPROVAL
FINAL BUILDING i
ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
FINAL PLANNING
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FINAL PLUMBING
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FINAL ENGINEERING/ PW
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T.C, of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT, of OCCUPANCY FINAL HEALTH DEPS'.
FINAL INDUSTRIAL WASTE