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Home My WebLink AboutPR17-26783DTA,►10iND SAR' CITY OF DLAMOND 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@diamondbarea.gov JOB SITE ADDRESS �-5 APN OT TRACT OWNER i dAl ADDRESS attxllz L5J7~,7, CITY 71P AA457TEL. f 3 APPLICANT TEL. CONTRACTOR ADDRESS" " CITY f '� ZIP EL. P 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 reason(s) indicated below by the checkmark(s), I have placed next to the applicable items) [Section 7031.5, Business and Professions Cude: 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 the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] orthe he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7 W 1.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than flue hundred dollars ($BCO), O I, as owner of the property, or my employees with wages as their safe compensation, will de U ail of or U portions of the work, and the structure Is not Intended or offered for safe (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to on owner of property who, through employees' or personal effort, builds or Improves the property, provided that the improvements are not Intended or offered far sats. If however, the building cr Improvement is sold within one year of completion, the Dwner-Bulider will have the burden of proving that it was not built or Improved for the purpose of sale,). LJ 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 ar Improves thereon, and who contracts for the pro]ects with a [icensed Contractor pursuantto the Contractors' State License Law.). (-) t am exemptfrom licensure under the Contractor's State License law for the following 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 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 15 its entirety by licensed contractors, I understand that a copy of the 6,3p1lcabie law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: httplwww.leginfo.ca.govlcaiaw,html, LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provislens of Chapter 9 {commencing with Section 7000) of Division 3 of the Business and Professlons Code, and my liceennsee Is In full force and effect. LICENSE CLASS .� LIC. NO. EXP. DATE: _ CONTRACTORS: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certficate 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. VI 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�'1.,3 V6,? �%� - POLICY NUMBER 9 r (THIS SECTION NEED NOT BE CUMPLaYlIFTFIEPERMITAFOR ONE HUNDRED DOLLARS $100ORLESS), I cartifythat in the performance of the workforwhich this permit is Issued, I shall not employ any person In any manner so as to r become subject to Worker's Compensation Laws of California. And agre that if I should become subject to the Worker's Compensado pr isions Secslon 3700 of the Labor Code, IaI forth it comply with ase provisions. DATE: PLICANT:,_ i WARNING allure to s ure Worker's Compernsatio coverage Is u awful, and she€I subject an employer to criminal i penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, i 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 is issued (Sec. 3097, Civ. C.). LENDER'S NAME' LENDER'S ADDRESS: - I certify That l have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to a enter upon the above-momiloned pr erty forp ion purposes. i PERMITTEE NAME (PRINT] SIGNATURE OF PERMITTEE DATE I APPLICATION DATE: P®//CJ# "� ISSUE DATE: PERMIT# :PM ® p TYPE CONST. OCC GROUP: Scope of Work # DWFL. UNITS - ` 't'Y Mz a� # STORIES # BEDROOMS DESCRIPTION SQ. LT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Carage/Carport W Patlo/Deck w L. Pco1/Spa ZRe -Roof ❑ Commercial m Valuairon: Adj. Area: QUANTITY DESCRIPTION FEE U U w uJi co is m J a a U z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: ° PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF:® PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: (r 0 P/C: RECEIPT # PAID BY: VALIDATION: PAID BY' VALIDATION: WHITE Department Copy, YELLOW — Finance Copy, PINK ----Assessor Copy FOOTINGS FORMS GEAR SLAB COMMERCIAL HOOD UG. PLUMBING I --BAR UG. ELECTRICAL INTERCEPTER — UFER GROUND SEWER LATERAL ..... - MAIN WATER LINE SF.wl 13 CLEANOUT ROOF SHFATHING FLOUR SHFATHING ROUGH ELECTRICAL W( ) C (} ROUGH PLUMBING — - IfOT MOPISHOWERPAN -- 5E"PTIC/CESSPOOL HERS REPORT RECEIVED DFMOL.ITION ROOF" DRAINS ROUGH CONDUIT INSULATION WAIT POOL PRE' DECK BONDING r—IN—SuLATION [ FII_IW'i P -TRAP SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR POOLISPA ROUGH PLUMBING ROUGH f LECTRICAL ROUGH MECHANICAL GAS TEST PRE GIXTE FRAMING/VENTING ROUGH MFGHANICAL ROUGH ELECTRICAL W( ) C (} ROUGH PLUMBING __ . _ -.. INSULATION WAIT POOL PRE' DECK BONDING r—IN—SuLATION [ FII_IW'i P -TRAP _ _ DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTINC/STEEL GAS TEST WALL STLLI V;( ( ) 2M0( ) LIFT SCRATCH COAT ELECTRIC METER RELEASL; GAS METER RELEASE SPECIAL INSPECTION WALL BOND BEAM WALL DRAIN/ SLAL 8 �� y WALL FINAL RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL ENGINEERING/ PW FINAL PLUMBING T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY MAL HEALTH DEPT. FINAL INDUSTRIAL WASTE