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Home My WebLink AboutPR17-8191CITY OF DLA -MOND BARS" DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS �$ (909) 839-7020 Fag: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamlondbar.com building(c diamondbarea.gov JOB SITE ADDRESS � APN LOT TRACT OWNER a 4/y/� t24!!'Lc ADDRESSi% "i CITY /'ti,P a rr Zl %,at TEL P 212 - Z4 APPLICANT TEL. CONTRACTOR B4% Al CITY rierI'Pe ZIP TEL.0?�a Y 3 f ARCH/ENO/ 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 reasons) 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, 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 [!censure and the basis for the alleged exemptlonAny violation of Section 7031.5 try any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500), 11, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (-) portions of the work, and the structure Is not Intended or offered for sale Section 7044, Busleess and Professions Code: The Contractors' State License Law does not applyto 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-Rullder will have the burden of proving that it was not built or improved for the purpose of sale.). O 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 cmtractsforlhe projects with a Ileensed Contractor pursuantte the Contractors' Stale License Law.). U I am oxemptfrom licensure under the Contractor's State License law for the following reason(s): Date: Sign: 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 parni 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: http/wvvw.leglnfc.ca.govloalaw.htrnI 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 ��Bustressand Professions Code, and my license Is In full force and effect. LICENSE CLASS: LIC. NO.: 962 - �'��f _ EXP. DATE: C 4 CONTHACTOH:_-- 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 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 WOO 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 $100 OR LESS). I cerl that in the performance of the workfor which this permit Is Issued, Ishd11 not employ any person in any manner so m to become subject to the Worker's Compensation Laws of.Gallfemia And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the LoopT Code shelf #Q 4f with comply with those provisions. DATEAPPLICANT: o ✓ WARNING: Failure to secure Worker's Cg� pe lsatlon coverage`Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hugdf�.d°thousand dollars ($100,000), in addition to the cast of the compensation, damages as provided for In section 3�bf 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 have read this application and state that the above Information !a correct I agree to comply with all city and county ordinances and state laws relating to b ding construction, and hereby authorize representatives of this county to enter upon the ab property npeetlon purposes. PERMITTEE NAME (PRI d._. SIGNATURE OFi -I . d= p DATE APPLICATION DATE:_7/13 i P/C# � ISSUE DATE: fV i -`t-PERMIT# : f! TYPE CONST. OCC GROUP: - I Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ, FT, FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport L Patlo/Deck Lu U- Pcol/Spa ZRe -Roof Commercial Cf] Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J r�3 U W w ca z m J a. J Q U Q x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:%- SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FILE: :7 f BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: PIC: PAID BY: VALIDATION: a— RECEIPT# PAID BY VALIDATION: a WHITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy `., 5SE:IBArK/ LE. I"I ER FOOTINGS FORMS SLAB UG PL€1M8INGT-BAR - UG ELECTRICAL UFFR GROUND. - ....... _.-....... — TRACT AND LEDGER SWfTCH GEAR COMMERCIAL HOOD --- ..... INTERCEPTER HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HEIS REPORT RECEIVED SEWER CLEANOUT DEMOLITION BOOP DRAINS HOI.IGH CONDUIT POOL/SPA ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR ROUGH PLUMBING .-... .... ........ ... .... . _._ FRAMING/VENTINGROUGH ELECTRICAL_ _._ _..... ROUGH MECHANICAL _.-_..--.. _ ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ROUGH PLUMBING INSULATION WALL GAS TEST IRE GUNIIE POOL KHF DECK BONDING P-FHAP FFNCF / GATE/ A[ ARM FINAL I"001 WALLS_ WALL FOOTINGASIFF1 WALL. STEEL VI( ) PK"( ) LIFT WALL BOND BEAM INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR -1 �'` j7 GAS TEST SCRATCH (,()AT ELECTRIC: MEI Eli RLI_EASE WALL. DRAIN/ SEAL. GAS MF:ILR M:I-EASE SPL i IAL. INSPL G I ION WALL FINAL RO, FRAMING PLANNING APPROVAL FINAL. BUILDING ROUGH FIRE APPROVAL FINIAL MIECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FILIAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW . ..................... T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT, of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: