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CITY OF DIAMOND BAR $�
, -I ( e DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 4
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 1r !V0`f
All LOT TRACT
OWNER
ADDRESS 2 _
CITY r 1� 77-1P C_TEL.
APPLICANT arF i K1Ntt J TEL. 24 <_ 47
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the reason(s)
indicated below by the checkmark(s), I have placed next to the applicable tool [Section 7031.5, Business and
Professions Code: Any city at county that requires a permit to construct, alter, improve, demolish, or repair, any
structure, prior to its Issuance, also requires the applicantfor 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 Division 3 of the Business and Professions Code] orthat he or she Is exempt from licensure and the basis for
the alleged exemption. Any violation of Suction 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of rot more than five hundred dollars ($500).
(_} I, as owner of the property, or my employees with wages as their sole compensation, will do L) 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 License Law Jess 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 -Builder will have the burden of proving that it was not built
or Improved for the purpose of sale.).
L) 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 forihe projects with a licensed Contractor pursuantto the Contractors' State
License Law.).
U I am exempt from licensure under the Contractor's State License law forihe following reason(s):
Date: Sign;
By my signature below I acknowledge that, exceptior my personal residence In which I must have resided for at ]east one
year prior to completion of the improvements covered by this perni 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 Cade is ava irthle upon request when this application is
submitted or at the following Web slte: tttplwww.leginfo.m.govlcalaw.Mml,
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,
aandd my license is
in full force and effect.
LICENSE CLASS: �,[3 _C� LIC. NO.: I3T3 25 L L 7'
EXP. DATE: CONTRACTOR:
WORKER'S COMPENSATION DECLARATION
€ HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE Or THE FOLLOWING DECLARATIONS:
1 have and will wall a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
Section 3700 of the Lobar Code, for the performance of the work for which this permit is Issued,
l have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of to worktor which this permit is Issued. My Woftr's Compensation Insurance Carrier and
Policy Number are:
CARRIER
POLICY NUMBER L.td
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS)-
; I certifythat in the performance ofthe workiorwhich this peroitis issued, I shall rot employ any person in any manner so as to
become subject to the Worker's Compensation Laws of Callfomia. And agree that if I should become subject to the Worker's
Compensation provisions of Section 3700 cf the Labor Code, I shall forthwith comply with those provisions.
DATE: APPLICANT:
i WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
i penalties and civil Tines up to one hundred thousand dollars ($100,000), In addition to the cast of the compensation,
damages as provided for in section S708 Of the labor code, interest, and attorney's fees.
CONSTRUCTIDN LENDING AGENCY
i I hereby -di firm under penalty of perjury that there is a Constructlen Lending Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. Q.
- LENDER'S NAME:
LENDER'S ADDRESS:
i
I certify that I have read this application and state thatthe above information Is correct. I agree to comply with all city and
CCU
nty ordinances and state laws relating to building construction, and hereby authorize representatives of this county to
enter upon the above-mentioned property for inspection purposes.
J
7
} PERMITTEE IrAME (PRI
SIGNATURE OF PERMI DATE
APPLICATION DATE:a17- - % 1-
ISSUE DATE: ( � 1 ' PERI
TYPE CONST.
P/Cq ``1 gI � tt1
# g _ _ J
PR
OCC GROUP:
x7 /�-
Scope of Work { 2_ae-�
'2S—_
# DWEL. UNITS # STORIES
P
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
Al ARFAA/ALUATION
SFR/ADIOIRFM
Garage/Carpert
W
Patio7Deck
W
LL
Pool/Spa
ZRe
-Roof
J
Commercial
5
m
Valuation: '7
Adj. Area:
QUANTITY DESCRIPTION FEE
U
v
J
w
ca
z
m
J
a
_U
w
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:s$
.
R 89
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
-
SMIP:
ENERGY PIC:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
O
PLOT PLAN:
ZONING CLEARANCE::
TOTALFEES��
COMMENTS:
P/C: PAID BY: VALIDATION:
RECEIPT # .a `i 3 0. �PAIL BY: � � . e.......F� VALIDATION: f-�"A"
WHITE —Department Copy, YELLOW -- Finance Copy, PINK— Assessor Copy
UFER GROUND.
SEWER LATERAL
MAIN WATERLINE
SEWED CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
INSULATION WALL
INSULATION CEILING
D RYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
COMMENTS:
'k6'O"ITY OF DIAMOND BA;Fl
CL # ".
TRACT AND LEDGER
:
SWITCH GEAR
COMMERCIAL HOOD
T—BAR
INTERCEPTER
1ti HOT MOP/SHo WERPAN
SEPTIC/CESSPOOL
HEMS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
PDUI,�SPA -
R61, 14,01 i3hARINK,
CITY OF DIAMOND BAR
i DEPARTMENT OF COMMi NITY a DEVELOPMENT SERVICES
= 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
T (909) 839-7020 ]Fax: (909) 861-3117 Building Inspection Ilotline (909) 839-7027 (FIRMLY
``'g+�9" BUILDING PERMIT APPLICATION www.citvofdiamondbar.com building@diamondbarca.gov
0. JOB SITE ADDRESS 't 0
z
o APN LOT TRACT
LU0
OWNER
ADD
¢ CI %.
Co APPLICANT EL.
Q
o caNTRACTOR
ADDRESS
0
CITY Z€P TEL.
o ARCH/ENG/
z DESIGNER
0
o ADDRESS
CjTy ZIP TEL,
OWNER -BUILDER DECLARATION
CD I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s)
oindicated below by the checkmark(s}, I have placed next to the applicable items) [Section 7031.5, Business and
a Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any
`u structure, prior to Its issuance, also requires the applicant for the permitto File a signed statement that he or she
is licensed pursuant to the provisions of the Contractor's State License Law {Chapter 91 Commencing with Section
7000 of Division 3 of the Business and Professions Dodej or that he ar she is exempt from licensure and the basis for
the alleged exemption. Any vlolatlon of Section 7031,5 by any applicantfor a permlt subjects the applicant to a civil penalty
0
of not more than five hundred dollars ($500).
q U I, as owner of the property, or my employees with wages as their sole compensation, will do ) all of or C-) portions
a of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code: The
Lu 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. It however, the building or
p 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.)
1, 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
Y otAdsorimprovesthereon,andwhocontractsforthe,projectswithalicensedContractorpursuantlotheContractors'State
CD
License Law,).
L) I 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, exceptfor my personal residence in which I must have resided for at least one
year priorto completion of the improvements covered by this permlt,l cannel legally sell a structure that I have cult as an
d owner -builder It It has not been constructed in its entirety by licensed contractors. { understand that a copy of the
n applicable law, Section 7044 of the Business and Professions Code is available upon request when itis application[ is
O submitted or at the fallowing Web site: htiplwww.leglnfoca.govlcalaw.html.
H
LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commanding )
g with Section 7000
of Division 3 of the Business and Professions Code, and my license Is In full force and effect.
0
LICENSE CLASS Y LtC. Na
EXP, DATE: CONTPJICTOR:
a WORKER'S COMPENSATION DECLARATION
tL I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
o I have and will maintain a CertitEcate of Consent to Self -Insure for Worker's Compensation, as provided by
Q 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 ofthe Labor Code, for
the performance oflhe� tlworrwhi this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number �tf
p CARRIER
z
cD POLICY NUMBER
VF (CHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT ES FOR ONE HUNDRED DOLLARS $100 OR LEBB},
pI certify that in the performance of the work forwhich this permit is issued. I shall notemploy any person In any manner so as to
o become subject to th Wo[ker's Compensation Laws of Calif And agree that If I should become subject to the Worker's
JCompens prq�s' ns ection S700 of the La G hWlt ph}wl9r those provisions,
ri DATE: APPLICANT:
WARNING: Fallur to secure Worker's Compensation coverage i u lawful, and shall subject an employer to criminal
W penalties and civil fines up to one hundred thousand dollars ($1 ,000), In addition to the cast of the compensation,
p damages as provided for in section 37CS of the labor code, interest, and attorney's fees.
cr.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there Is a Consiructlon Lending Agency for the performance of the work for
whlcltthis permit is issued {Soo 3097, Clv. c.).
LENDER'S NAME:
LENDER'S ADDRESS:
w
CL I certify tat l have read this application and state that the above information is correct. I agree to comply with all city and
c -r3 county ordinances and state laws relating to building construction, and hereby authorlm representatives Df this county to
z
o enter upon thedabove-mentioned property for inspection purposes.
m
G PERMITTEE N R s�
= SIGNATURE OF PERMITTEE 61 DATE
APPLICATION DATE: P/C#
ISSUE DATE: g, PERMIT#:r i fel
TYPE CONST
OCC GROUP:
Scope of Work 0 F'
c - : [e
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFFLIADD/REM
Garage/Carporf
Patlo/Deck
Pool/Spa
Re -Roof
Commercial
Valuation: Adj. Area:
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RFTFNTIr]N FEE: _
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/0: PAID BY: VALIDATION:
RECEIPT # PAID BY: VALIDATION'.
WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
QUANTITY DESCRIPTION FEE
U
U
w
z
d
a
U
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RFTFNTIr]N FEE: _
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/0: PAID BY: VALIDATION:
RECEIPT # PAID BY: VALIDATION'.
WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
SETBACK/ LETTER
FOOTINGS FORMS
SLAB
UG. PLUMBING
UG. ELECTRICAL
UFFR GROUND
SEWER LATERAL
MAIN WATER f INE
SEWFR CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR
FRAMINGNENTING
ROUGH MECHANICAL
_
ROUGH ELECTRICAL W( ) C { )
ROUGH PLUMBING
INSULAI ION WAI I_
INSULATION CEIi_ING
DRYWALL
LATH (PRE)
I ATH EXTFRIOR
IATH INT=RIOR
CAS TES
SCRATCH COAT
LLECTRIC METER fiELEASE
GAS METER RELEASE
..
SPECIAL INSPECTION
FINAL BUILDING
_a=_,
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
4
T.C. of OCCUPANCY
CERT. of OCCUPANCY
COMMENTS:
-IRACT ANf) LEDGLR
SWITCH GEAR
COMMERCIAL HOOD
T-13AR
INLERCEPIER
HOT MOP/SHOWFRPAN
SHhTC/CESSPOOL.
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
P€DUSPA
ROUGH PLUMBING..
ROUGH ELECTRICAL.
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BUNDMG
P=TRAP
FENCE / GATE/ ALARM
FINAL POOL
VVAILLS: —
WALL FOOTING/STEFL
WALL STEEL Ill{ )1,0� } LIFT .
WALL BOND BEAM
WALL DRAINI SEAL
WAIL FINAL
R0. FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINIAL ENGINEERING/ PIN
FINAL. COMMUNITY SERVICES
FINAL HEALTH DEPT,
FINAL, INDUSTRIAL WASTE __—
