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Home My WebLink AboutPR17-10330DIAD►IOND`BAR CITY OF DIAMOND BAR DEPAR'T'MENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION wwwcityofdiamondbar.com building@diamondbarca.gov JOB SITL ADDRESS 4-:772- APN LOT TRACT OWNER 7 G ADDRESS Sir CITY21 PTEL. APPLICANT TEL., CONTRACTOR C r C-' ADDRESS rte' f CITYI'� ZIP S'/�l TEL. 7✓t�' �e'� ®1� ARCH/ENG/ 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 reasen(s) indicated below by the checkmark(sj, I have placed next to the applicable item(sj [Section 7031.5, Business and Professions Code: Any city ar 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 pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7090 of Division 3 of the Business and Professions Cade] or that he or she is exempt from licensure and the basis for the alleged exemption. Any viCailon of Section 7031.5 by any appllcantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do U 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 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. d however, the bullding or Improvement is sold within one year of completlDn, 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 11censed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuantto the Contractors' State License Law.). O I am exempt from licensure under the Contractor's State License law for the following reasons); Date; Sign: By my signature below I acknowledge that, exceptior my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permlt,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 applicable law, Sectlon 7044 of the Business and Professions Code Is available upon request when this application is submitted or attha following Web site: http/www.leginfaca.gov/calaw.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 license Is in full force and effect. LICENSE CLASS- I LED. INC.. /0()FaxCi J EXP.DATF, i CONTRACTOR: WORKER'S COMPE DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will mainfen 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 3700 oflhe Labor Code, for the performance of the workfor which this permit is issued. My Worker's Compensation Insurance Carrier and Pollcy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETE p IFTHE PERMIT 1S FOR ONE HUNDRED DOLLARS $100 OR LESS), I certityihat in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to became subject to the Worker's Compensation Laws of California And agree that if I should become subject to the Worker's CDmpensafan prowl Ions of Section 3700 of the b - if iorthwfih comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compo 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 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 thatthe above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby auiharize representatives of this county to enter upon the above-mentioned property for inspection purposes. PERM[TTEE NAM SIGNATURE OF R E-€--� DATE PRESS FIRMLY APPLICATION DATE:��i P/C# ISSUE DATE; �_Z7—!-/4 PERI ; P 1 " 10 37-3 TYPE CONST, OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/RFd[ Garage/Carport w Patio/Deck U LL Pool/Spa Z Fie -Roof Commercial m valuation: Adj. Area: QUANTITY DESCRIPTION FEE V_ U u� w c� m Q U_ U CONSTRUCTION: PLAN REVIEW: ELECTRIC: �1, 36, PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:, , f SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: G _ BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: RECEIPT # 3 5L,59 PAID BY: 4 VALIDATION: VALIDATION: L WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy S LBACKI LETT"ERi I I MAUI AIN U LtUUM FOOTINGS FORMS SLAB IJG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATFRAL MAIN WATFR LINE SEWER CLIANCUT ROOF SHFATHING FLOOR SIIFATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTER fOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( j ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATI I EXTERIOR LATI I INTERIOR GAS TEST SCRATCH COAT I71-E:6TRIC METE:fi RELEASE t%) GAS METER REI I -ASE SPECIAL INSPECI ION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPAUCY COMMENTS: I -RAR NIFRCEPTER 10"r MOP/SHOWFIiPAN ;FPTIC/CESSP001. IERS REPORT RECEIVED )EMOLITION ZOOF DRAINS TOUGH CONOUIT _- PDOUSPA TOUGH PLUMBING TOUGH ELECTRICAL TOUGH MECHANICAL aAS TEST 'RE GIJNITE �✓� .. __ _ __ _ -.__.. - 'OOL PRE DECK BONDING '-TRAP =ENGE I GATE/ ALARM =1NAL POOL NfALLS: MALL FOOTING/STEEL MALL STEEL 'IIT( ) 2"( ) LIFT uVALL BOND BEAM MALL DRAIN/ SEAL NfALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL. FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW - ........ FINAL COMMUNITY SERVICES FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE