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Home My WebLink AboutPR17-6244CITY 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 { ) � ) g P � ) BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov FIRMLY JOB SITE ADDRESS Z,1 2 �'i ,i 1tiy APN LOT TRACT OWNER •� s/r ADDRESS CITY. _,, W ZIP 4® TEL. d APPLICANT �LWd5 TEL. CONTRACTOR•�— �r ADDRESS -;5; CITY'P,- ZIP TEL. Ow AKeo ARCH/ENG/ ;� DESIGNER �� t G�/%J IiO i'iL j."i9�C� i'!` o ADDRESS f�� CITY_/�%GJ�a/�� ZIPX�gzL-TEL. &fi!) 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 appficant fur the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Stale 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 llcenscre and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500} IV I, as owner of the property, or my employees will wages as their safe compensation, will do aR 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 10 an owner of property who, through eir epees' 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 withln one year of completion, the Owner-Buifdar 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 improves thereon, and who contracts forthe projects with a llcensed Contractor pursuanttathe Contractors' State License Law.). (-)I am exempt from licensure under the Contractor's StaterLicers 'laww for )he offowi n reasons Date: 4-' �7�y- 2017 Sign By my signature below I acknowledge that, exceptfor'y perresidence in which 1 must hav sided for year prior to completion of the Improvements covered by this permit,[ 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 cr atthe following Web site: httplwww leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION 1 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 LIC. NO,: EXP. DATE: CONTRACTOR: 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 ofthe work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the 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 cerhfy that a the performance of the work for which this permh is Issued, I shall not employ any person In any manner so as to become subject to the Worker's Compensation Laws of California. And agree that ff I should become subject to the Worker's Compensation provisions of Secfion 3700 of the Labor Cade, I shad forthwith 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, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit I5 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 Is correct. I agree to comply with all cfty and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspe�cytloor purposes. PERMITTEE NA (PRINT) SIGN, RMITTEE DATE APPLICATION DATE:` P/C# O ISSUE DATE:y Tm PERMIT#: t"eyfa TYPE CONST. OCG GROUP: /d Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport LU ,aft Deck our LL Poo/Spa ZRe -Roof J Commercial C0 valuation: Adj. Area: QUANTITY DESCRIPTION FEE U L) U w w cv z i J Q U 4 x L) CONSTRUCTION: , PLAN REVIEW: 5 en— n—ELECTRIC: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: A- It 7_. SMTP: < - l ENERGY PIC: ENERGY PERMIT: RETENTION FEE:.` PRE -ALT FEE: BASF: - t PLOT PLAN: ZONING CLEARANCE: '43, 111 TOTAL FEES Z . 2-7) COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT#_'3"PAID BY:'-"..�i-. VALIDATION: WHITE Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy SETBACK/ LETTER FOOTINGS FORMS ......... .... _ SLAB UG. PLUMBING UG.ELKTRICAL FINAL POOL UFER GROUND SEWFIiLATERAL MAIN WATER LINE SE.WFH CLEANOUT ROOF SHEATHING FL0011 SHEATHING SHEAR WALLS F-XTEB109 WALL FOOTING/STEEL SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL.. HOUGH ELECTRICAL W( ) G i ) ROUGH PLUMBING INSULATION WALL. INSULATION CE11 ING WALL BOND BEAM DRYWALL LATH (PRF) LATH EXTERIOR LATH INTERIOR GAS I EST SCRATCH COAT ELECTRIC MI TER RELEASE GAS METLA RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL_ MECHANICAL p FINAL.. ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY - . FENCE / GATE? ALARM ......... .... _ FINAL POOL WALLS: WALL FOOTING/STEEL WALL STFFL.. IU( )1a'( ) LIF i WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL _ FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING;/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT FINAL INDUSTRIAL WASTE