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Home My WebLink AboutPR17-18558CITY OF DIAMOND BAR F I i DEPARTMENT OF COMM -UNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7029 fvaa. ` BUILDING- PERMIT APPLICATION www.cityofdiamondbar.com building*diAmondbarca.gov JOBSITEADDRESS�4�r"� APN LOT TRACT OWNER ADDRESS CITY `i�7 97'mt4 �jP TEL. (�` d fit. -3[ APPLICANTjP� `� CLck O TEL CONTRACTOR 'v I Ltd (Li -y Lt vc a ADDRESS L * yI S f CITY Lf -i, 4s 1'l. zip TL -TE Al ' L 7 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION E hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasorl Indicated below by the checkmark(s), 1 have placed next to the applicable items) (Sectlon 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to Ns issuance, also requires the applicant for the permit to file a signed statement that he or she Is licensed pursuant to the provisions at 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 Oasis for the alleged exemption. Any violation of Section 7031.5 by any aplicantior a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). {_) I, 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, 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 binding or improvement is sold within one year of completion, the Owner -Rudder will have the burden of proving that it was not built or improved for the purpose of sale.}, U 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 improvesthereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the fallowing reason(s): Date: Sign. By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion otthe improvements covered by this permit,l 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 p applicable law. Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Woo site: httplwww.leglnfo.cagov/caiaw,html. 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 my Il�cense is in full force and effect. I q LICENSE CLASS �' L€C. NO.: �] r EXP. DATE;-,. CONTRACTORC-'I thei �"� n•`t j WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: s I have and will maintain a Certificate of Consent to Selt-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. a I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number ar : 9 CIRRIER � POLICY NUMBER V i ITRIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FDR ONE HUNDRED DOLLARS $100 OR LESS). D i I certify that In the performance of the work forwhichlhis permit Is issued, I shall not employ any person in any manner so as to a become subject to the Worker's Compensation Laws of Cal forpla. And agree that If I should become subject to the Worker's Compensatlan provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure tD secure Workers Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000j, in addition to the cost of the compensation, j damages as provided for in section 37US of the labor code, Interest, and attorney's fees. E CONSTRUCTION LENDING AGENCY I hereby afflrm under penalty of perjury that there is a Construction Leading Agency for the performance of the work for t which this permit is Issued {Sea 3097, Civ. C.). LENDER'S NAME: LENDERS ADD SS: U L I certify that I av read this ap Iicatlon and state that the above informatlon is correct: I agree to comply with all city and county nce and state s relating to building construction, and hereby authorize representatives of this county to enter on a. e-men d property for inspection purposes. � F n ER NAM�{P INTj i c„ p . LS 1 n = SIGNATURE OF PERMITTEE ATE Em APPLICATION DATE: ISSUE DATE: 111171PERMIT#:'J� I��J TYPE CONST. 6i i- OCC GROUP: Soope of Work t/` e it If DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport CO Patio/Deck LU LL Pool/Spa ZRe -Roof j Commercial. 5 m Valuation: 0 w Adj. Area: QUANTITY DESCRIPTION FEE U Lu w cs z m rz a U_ U CONSTRUCTION: PLAN REVIEW: ELECTRIC: gg PLUMBING: MLCHANiCAL: INSPECTION FEE: ISSUANCE: ' SMTP: ENERGY PIG: ENERGY PERMIT: RETENTION FEE: Q PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES Ll 3 - 4� COMMENTS: P/C: PAID BY: t' y g VALIDATION: RECEIPT #� g PAIL) BYE! a (Q _ VALIDATION: LC- WHITE—Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy CITY OF DIAMONDA INSPECTION E SET BACK/ LET] ER TRACT AND LEDGLH FOOTINGS FORMS SWITCI-I GEAR SLAB UG. PLUMBING UG. ELECTRICAL COMMIACIAL HOOD' T -BAR INTERCEPTER UFER GROUND SFWER LATERAL MAIN WAFER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING _. HOT MEJP/SHOWERF'AN - _ SEPTIC/CESSPOOL HERS REPORT RECEIVL:D DEMOLITION ROOF DRAINS ROUGH CONDUIT SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR _ _ PODUSPA '. . ROUGH I LUMBING FRAMING/VENTING ROUGH ELECTRICAL ROUGH MCCHANICAL _. _. ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) ROUGH PLUMBING INSULATION WALL GAS TEST PRE GUNITE POOL PRE DECK BONI]ING _. _ - _ ._ ._. _ _ INSULATION CDUNG DRYWALL lATH (PRE)_ I AfH EXTERIOR I ATH INTER OR GAS TEST S(';LiATCH COAT Elf'.CTRIG ME EER RELEASE _ P. -.TRAP FENCE/GATE/ALARM FINAL POCI __. WALLS: WALL FOOTING/STEEL. WALL STEFI 'I ST( ) 2N6( )LIFT WALL BOND E3EAM WALL DRAIN/ SEAL GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL MECHANICAL FINAL ELECTRICALi� FINAL PLUMBING T.C. of OCCUPANCY �% _- �p� FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMINITY SERVICES HEALTH DEPT. [FINAL INDUSTRIAL WASTE CERT. of OCCUPANCYFINAL COMMENTS,