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Home My WebLink AboutPR17-15976DIAOiID�B ' CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-31.17 Building Inspection Hotline (909) 839-7027 FIRMLY BtiILDING PERMIT APPLICATION www.cityo€diamondbar.com building@diamondbarca.gov JOBSITEADDRESS Zby(1S5 6Z)L*1" SRZ,10G� RD' Al LOT TRAGI 0r1 N\.c DO 974L - DRESS 0 tCkill AIN " \Jhy 411 20 CITY (.6pc - L1 ZIP q690 TEL, -42- `7'7 C2 1 APPLICANT b L J r{Yr��Cr TEL. C1149 C2�Jg dQi CONTRACTOR {� ADDRESS CSO APA W 7 CITY L0l'--3& 9V4l ZIPSCTEI 5 BS ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penahy 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 applicant for the permitto file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 91 Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any vlolation of Section 7031.5 by any applicant for a permit subjects -the applleantte a civil penalty of not more than five hundred dollars ($500). L) I, as owner of the property, or my employees with wages as their sole compensation, will do O all of or O 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 hof 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 bullt or Improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the pro{ect (Section 7044, Business and Professions Cade: The Contractors' State 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 pursuantte the Contractors' State License Law.). L) I am exemptfrom licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my Signature below I acknowledge that, excoptfor my personal residence in which I must have resided far at least one year prior to compleilon of the improvements covered by this perri l cannot legally sell a structure that l have built as an owner-bulider 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 Cede is available upon request when this application is submitted or at the following Web site: httplwww,leglnfo 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 licenseisin full force and effect LICENSE CLASS: �`E� LIC, NO.: EXP. DATE: 2' 2� ' f 9 CONTRAcrOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS' 1 have and will maintain a Cerii4cate of Consent to Self -Insure for Werker's Com pensatlon, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. k 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 019 5 UA {"{-t POLICYNUMBER Qg Z`t`7Z_9O Aa (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). n I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so ae to become subject 10 the Worker's Compensation Laws of Califamia And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall 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 addltlon to the cost of the compensation, damages as provided for in section 3708 of the labor coda, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY i 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, ClvC.). LENDER'S NAME: LENDER'S ADDRESS: i I certify that [have read this application and state that the above information Is correct I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this county to enter upon the abov-merdianed property for Inspection purposes, ��P� PERMITTEE NAME (PRIN SIGNATURE OF PERMITTEE DATE . APPLICATION DATE: 'l ' SCJ ` 1'I ISSUE DATE: q 12B10- PERMIT# : TYPE CONST. P/C# i l - I 9 & PI1--7 - (S 9 -� DCC GROUP: Scope of Work (�6�-�i IrJSZ�1 1 2. 111—m si`V� 61AV D0JA 5 1) 1 Go f tc urya f PA tc)' &O 51 S LcoAnF" 5[G1`�� 2 Wil RAHtur-K7 Atbb 1 # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ, FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport W PaticYl Lu LL Pool/Spa ZRe -Roof in J Commercial W lfaluation: 00 Adj. Area: QUANTITY DESCRIPTION FEE J a U U w c� z co J a J4 U Z d x ca CONSTRUCTION:y PLAN REVIEW:1J. ' . iii ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: 5_0q ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF. & �® PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: (�M - 00 P/C: '7_ PAID BY: 1- VALIDATION: RECEIPT# 3(olql PAID BY: U9. _ VALIDATION:°' WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy *01ITY OF K BAR INSPECTION :::: SETBACK/ LETTER TRACTAND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMBING T -BAA UG. ELECTRICAL INTERCEPTER UFFR GROUND ................ HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTING HOUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C (} GAS TEST ROUGH PLUMBING PRE GUNITE INSUTAI ICN WALL PO01_ PRE DECK BONDING INS111 ATION CEILING P TRAP DRYWAI_I FENCE 1 GATE/ ALARM I ATH (()W.) FINAL. POOL LATH LXTFRIOR WALLS: LATH INTERIOR WAI I. F0O7IN(;/STFFl. GAS TFS I WAI I STI C 1 1`1 t }IND( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL. DRAIN/ SLAL GAS METER RELEASE WALL. FINAL SPECIAL INSPECTION R0. FRAWNG PLANNING APPROVAL FINAL BUILDING r� ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL rr�,�� - FINAL PLANNING _ FINAL PLUMBING FINAL ENGINEERING/ PW TZ. 0 OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCY FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE