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Home My WebLink AboutPR17-26145�a 3 CITY OF DIAMOND BAR � 'I I I 17AI 11 DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �� F 21810 Copley Drive, Diamond Bar, CA 91765 )y PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@d m barca.gov APPLICATION DATE: IN I �^I 11 1 PIC# I ISSUE DATE:1 �� Ii—IPERMIT#:__V!)(2_\, — 4;)1) TYPE CONST. OCC GROUP: C� 10 0 61�_ ,x JOB SITE ADDRESS All LOT TRACT OWNER Al�iC1 CITY " �d �,2IP (3 2 APPLICANT CONTRACTOR ADDR SS CPd�Y� CITY oii iP A e ZIP TEL C� { § 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 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 applicantfor the permit to file a signed statement that he or she is licensed pursuantto the provisions ofthe Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Cade] orthat he or she Is exempt from licensors 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). i I, as owner of the property, or my employees with wages as their sole compensation, will do i 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 If however, the building 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.). LJ f, 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 pursuanttothe Contractors' State Llcori Law.). (_) f 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 personale residence In which I must have resided for at least one year prior to completion of the improvements covered by this permit,l cannot legally self a structure that I have built as an owner-Lullder If It has not been constructed In its entirety by licensed contractors I understand that a copy of the applicable few, Section 7044 of the Business and Professions Cade Is available upon request when this application Is submitted or at the following Web site http/www.legicfo.ca.govlcalaw 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: �- 's1 LIC NO' 11 FXP. DATE: X CONTPACTOR. Atiii p- li ! -� 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 tot Worker's Compensatlon, as provided by ton 3700 of the Labor Code, for the performance ofthe work for which thus permit Is issued. ?.,�.. have and will maintain Worker's Compensa#ion Insurance, as required by Section 3700 ofthe Labor Code, for the performance of the workfor which this permit is issued, My W rker's Ccmpensa ,insurance Carrier and Policy Numberar CARRIER I + r POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS) I certifythat in the performance ofthe workfor which this permit 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 if I should become subject to the Workers Compensation provisions of Section 3700 of the Labor Code, I shall forlhwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is un€awfW, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (5100,000), in addition to the cast 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 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 authorrze representatives ofthis county to enter opoth hove -mentioned property for inspection p rposes. qZ T U PERMITTEE NAME (PRINT} SIGNANRE OF PE E DATE APPLICATION DATE: IN I �^I 11 1 PIC# I ISSUE DATE:1 �� Ii—IPERMIT#:__V!)(2_\, — 4;)1) TYPE CONST. OCC GROUP: vr - Scope of Work r' i r' _, _f # DWEL. UNITS # STORIES r E'er 5 4ir1l 7 # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck LL Pool/Spa ZRe -Roof Commercial 7 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U r U w w m m J a U qZ T U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: ��LL T 3� SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �,'. 3, BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: � Ar rb S P/C: PAID BY: /� VALIDATION: RECEIPT d D�I`� PAID BY: �Q TVALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITE OF DIAMOND INSPECTION FC SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGIVENI ING ROUGH MECHANICAL ROUGH E LFCTRLAL W( ) C ( j ROUGH PLUMB INU INSIIlAlION WAI.I. INSULATION GFu_ING — I)RYWAI € I_AT}1(PRI".) LATI I LXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ............. ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION ............................... . FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING 1 4 T.G� of OCCUPANCY CERT of OCCUPANCY COMMENTS: -1HA(l AND LEDGER .SWI I Cl l CSAR CCMMLRCIAL IfOOD I -BALI INTERGEPI LR HOT MOPISHOWERPAN SFPTIC/CFSSP001. HERS REPORT 13FI FIVED _-T DEMOLITION ROOF DRAINS ROUGH CONDUIT PODUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE I GATE/ ALARM FINAL POOL WALLS: WALL. FOOTINGISTEEL WALL STEEL 1sT( ) 2N°( ) LIFT WALL. BOND BEAM WALL DRAIN/ SEAL WAI. I. FINAL 110. RIAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ IOW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIA. WASTE