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Home My WebLink AboutPR17-9106w 0 LLJc w a 0 c z co cI1 - T CITY OF DIAMOND BAR" 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 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@dianiondbarca.gov JOB SITE ADDRESS-. -.iz r7Q' » -Z5--ff "-,4 ty d APN LOT TRACT OWNER ADDRESSLffO CITY ?c y--- ZIP TEL. } APPLICANT Pied "r r i�, TEL. CONTRACTOR ADDRESS CITY ZIP TEL.- ARCH/El 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 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 licensure and the basis for the alleged exemption. Any violation of Soudan 7031,5 by any appllcantfor a permit subjects the appllcartto a civil 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 (., 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' er personal effort, 1ruilds 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 at proving that it was not hunt or Improved for the purpose of sale,), U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sectlon 7044, Business and Professions Code: The Contractors' State Llcense 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), (a I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknawledge, that, except for my personal residence in which I must have reslbed 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 ar 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 avallablo upon request when this application is submitted or at the following Web site: http/wwwAginfo,ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provis€ons of Chapter 9 (commencing with Sectlon 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. LICENSE CLASS:. , LIC. NO.: - EXP'.DATQ CONTRACTOR: WORKER'S COMPENSA71ON 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 Coda, for the performance ofthe work for which this permit Is Issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 offhe Labor Code, for the performance of the workfor which this permit is issued, My Worker's Compensation Insurance Carrier and Policy Number are', CARRIER P' POLICY NUMBER (f HIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). i certify that in the performance of the workfor which this permit is issued, I shall not employ any person in any manner so se to became subject to the Worker's Compersatlon 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 tartwilh 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 addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, dieresi, and attorney's tees. 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, Clv. G,), LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state fhat the above information is correct. l agree to comply with all city and county ordinances and state laws relating to bullding construction, and hereby authorize representatives of this county to enter upon the above-mentioned prope for Inspection purposes. PERMITT . IVA NT) SIGNATU4 OF PERMITTEE ,�..:��''DATE APPLICATION DATE: ISSUE DATE:�Z�® PERMIT#: TYPE CONST. �r_9 Q��g1QW OCC GROUP: Scope of Work ' �C '4 '' f:sp # DWEL. UNITS # STORIES a` # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport Patio/Deck W u- Pool/Spa dCommercial [0 Valuation:. Adj. Area: QUANTITY DESCRIPTION FEE a U U W J W z J Q 7 ca z x U CONSTRUCTION: PLAN REVIEW: g2.2-1 ELECTRIC: PLUMBING: k .621 MECHANICAL: INSPECTION FEE: ISSUANCE: ��tt 2, 4 SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: Z • Od BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: / VALIDATION: RECEIPT # S _�_ PAID BY: V 1 ®� VALIDATION: WHITE — Department Copy, YELLOW — Finance Cepy, PINK —Assessor Copy CITE OF DIANK INSPECTION REtORD SETBACKI LETTER TRACT AND LEDGER j FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD _ UG. PLUMBING ,.� ® 7 ;�` .. rr T -BAR UG. ELECTRICAL INTERCEPTER UFER GROUND HOT MOP/SHOWFRPAN SEWER I, Al SEPTIC/CESSFOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF91IEATHING ROOF DRAINS _ .... FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING ROUGH ELECTWCAL ROUGH MECHANICAL ROUGH MECHANECAL ............... ROUGH ELECTRICAL W( ) C ( ) GAS TES.'F., ROUGH PLUMBING PRE GUNITE INSUI ATION WALL. POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE / GATF/ ALARM I ATH (PRE) FINAL. POOL I ATH EXTERIOR WALL& LATH INTERIOR WALI. FOOTING/STEEL GAS TEST WAI i- STEEL I GT( ) 2ND( ) L IFT SCRATCH CGAI WALL [iOND BEAM ELECTRIC MF I ER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING f J f °7 ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING X L FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES [C--ER—T-of OCCUPANCY FINAL HEALTH DEPT FINAL INDUSTRIAL WASTE COMMENTS: ----