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Home My WebLink AboutPR17-486O F c a c z c jZD,11D'ii rte:, CITY OF DIAMOND EAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Ear, 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 APN LOT TRACT OWNER ADDRESS CITY a:�T>.,°r, ZIP—Ti APPLICANT Ti CONTRACTOR ADDRESS CITY F ZIP Q µTi ARCH/ENG/ DESIGNER ADDRE CITY - v `7: e 4 TFL. OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons) Indicated below by the checkmariC(s), I have placed next to the applicable items) j5ect€on 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 statementthat 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( or that he or she is exempt from Ileensure and the basis for the alleged exempt€on. Any violation of Section 7031,5 by any applicantfor a permlf subjects the applicantio a civil penalty of not more than five hundred dollars ($500). U t, as owner of the property, or my employees with wages astheir sole compensation, will do U all of or (- portions of the work, and the structure is not €mended 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 ar improves the property, provided that the Improvements are not intended or offered for sale. If however, the bullding 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.). U 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 builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' Stalls License Law.). .''r, 1 mn exempt from licensure under the Contractor's State License law for the following reason(s): Data,_. Sign:— By my slgl,a,�,�.,,,:.... _ '.edge that, except for my personal r4sidence in which l must have resided for at least one year prior to completion of the improvements covered by this permil,l cannot legally sell a structure that I have hUlit as an owner-but€der 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 or atthe following Web site: httplwwvv.leginfo,ca.gov/Dalaw.html LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penall perjury that I am licensed under provisions o1 Chapter P (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE GLASS: LIC. N6 % ) EXP. DATE: CONTRACTOR. _ A' =" - 1 ` s WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING UECLARATIONS: I I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 ofthe 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 of the Labor Cade, for the performance of the work for width this permit is issued. My Worker's Compar len Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER i (THIS SECTEON NEED NOT BE COMPLETED IF THE PERMIT IS FUR ONE HUNDRED DOLLARS $100 OR LESS). I cart ly that inthe performance of the work for which this permit is issuod, [shall not employ any person In any manner so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject N the Worker's Compensation provisions of Section 3700 cf the Labor Cade, I shall fodhwith complywlththose provlsionl ➢ATF � 'tt�€`� APPLICANT,r°� i WARNING: Failure to secure Worker's Compensation coverage is unlawful, and steal sdGJaet an employees criminal i penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cast of the compensation, damages as provided for in section 3708 of the labor code, Interest, and attomay's fees. CONSTRUCTION LENDING AGENCY j 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 (Sea 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: J - I certify that I have road this application and state that the above information is correct. I agree to comply with ail city and county ordinances and state laws [elating to building construction, and hereby authorize representatives ofthis county to enter upon the above-mentioned property for inspection purposes. 3- a PEF TTEE NAME (PR!ND, 7. SIGNP- F PER - `' - DATE APPLICATION DATE: PIC# ISSUE DATE:PERMIT# : TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # SEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATiON SFRlADD/REM Garage/Carpert Patio/Deck LL I -L Pool/Spa zRe -Roof Q Cemmerdal m ' �. Valuation. Adj. Area: QUANTITY DESCRIPTION FEE J U u.a c7 m d U_ Z Q x CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:. Si ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: BASF: 6 PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: 9 s' • r Plc: PAID RY: _ t VALIDATION: GlAn RECEIPT # 3 5 IL -IPAID BY: � �^ � �Ci �. VALIDATION: WHITE —Department Copy, YELLOW— Finance Copy, PINY —Assessor Copy WOND A RECORD 7777- IRACT AND LEDGER `WITCH GEAR COMMERCIAL HOOD T-HAR IN]LRCEPTEA H07 MOP/SHOWERPAN SEP FIC/CESSPOOL HERS REPORT RECE W'D DEMO[ 1] ION ROOF [)RAINS ROUGI I CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE I)ECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STCLl. Lar( } 2i1°( ) Llf T WAI I RON11) ki AM SFTRAM LETTER FOOTINGS FORMS RO. FRAMING PLANNING APPROVAL. SLAB FINAL BUILDING UG PLUMBING ROUGH FIRE APPROVAL ...._._ ._. - .. UG ELLCTR1CAL FINAL. MECHANICAL UFEH GROUND ................ SEWER I Al FRAI . MAIN WATT R 11NL FINAL ELECTRICAL SEWER CLEANOUT FINAL PLANNING ROOF SHEATHING FINAL PLUMBING FLOOR SHEATHING FINAL ENGINEERING] PW SHEAR WALLS Ex LRIOR SHEAR WALLS INTERIOR FINAL COMMUNITY SERVICES FRAMINGNENTING - ROUGH MECHANICAL_ ROUGH ELECTRICAL W( } C ( ) j -Irl 7 ROUGH PLUMBING FINAL INDUSTRIAL WASTE INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) 1 AIFI EXTERIOR I ATI I INTERIOR GAS I EST SGHA'l CII COAT ELECTRIC MLII EH RELEASE GAS METER RELEASL WOND A RECORD 7777- IRACT AND LEDGER `WITCH GEAR COMMERCIAL HOOD T-HAR IN]LRCEPTEA H07 MOP/SHOWERPAN SEP FIC/CESSPOOL HERS REPORT RECE W'D DEMO[ 1] ION ROOF [)RAINS ROUGI I CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE I)ECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STCLl. Lar( } 2i1°( ) Llf T WAI I RON11) ki AM SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL. FINAL BUILDING ROUGH FIRE APPROVAL ...._._ ._. - .. FINAL. MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING] PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES - CT. of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE COMMENTS:-._