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Home My WebLink AboutPR17-10817w z 0 CITY Or DIAMOND BAR l I DEPARTMENT OF COMMUNITY 8- T' ELOPMENT 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@diamondbarca.gov JOB SITE ADDRESS S_.via—iC—Ai Dr APIA LOT TRACT OWNER i CAVI k- V 1 Ll1t-rl0 ADDRESS'7 1 mo=w C CITYallm,,aa (5A C ZIP TEL. "-7 iq - 5�-O 14 Z APPLICANT i` .�ht-, CWIA(-�Ze TEL. t00-gq;LJ 53A CONTRACTOR �6ti°%il�Y {�c€° aces ADDRESS igb X(IlS�C *-'- 2,C12 CITY ot`rhrio ZIP A 1-7411—TEL. gOcilqje ARCH/ENG/ DESIGNER ADDRESS C6TY 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 10 the applicable items} [Section 7031.5, Business and Professions Code: Any city nr county that requires a permit to construct, after, improve, demolish, or repair, any structure, prior in its issuance, also requires the applicant for the permit to file a signed statement that he or she Is licensed pursuant in the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 at the Business and Professions Code] or that he or she is exempt from Iloersaa 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). La I, as owner of the property, or my employees with wages as their sole compensation, will do (-) all of or (-) portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Pmfess€ans Code: The Contractofs' 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. It however, the buliding or Improvement is sold within ane year of completion, the Owner -Builder will have the burden of proving that It was rot built or Improved for the purpose of sale.}, (_} 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 for the projects with a licensed Contractor pursuant to the Contractors' State License Law) (_) I am exempt from I€censure under the Contractor's State License law far the following reason(s): Date: Sign: By my signature below i Acknowledge that, except for my persona! residence In which I must have resided for a. Nast can 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 if 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 PrOfeaslDrs Cade is available upon request when this application is submitted or at the following Web site: cagov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter S (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.: 6 �� EXP. DATE: f Y i CONTRACTOR' r WORKER'S C PENSATION DE RATION 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 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 Code, for the performance of the workfor which this permit is issued. My Worker's Compensation insurance Carrier and Policy Number are CARRIER ,. , -5i ilx'-ie- POLICY NUMBER 112 (Q .. -1 i g (-HIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 OR LESS). I certifythat in the performance of the workfor which this permit Is issued, I shall not employ any person in any mannerse as to become subject to the Workef's Compensation Laws of Callfomia. 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 floes up to one hundred thousand deilars ($100,000), in addition to the cosi of the compensation, damages as provided for In seal it 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 (Sea 3U97, Civ C.). LEN DEB'S NAME: LENDER'S ADDRESS: i I certify that I have read this application and slate that the above information Is correct. I agree to comply withall city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentloned property for Inspection purposes. D1V tidy i PERM1TTEf NA PRINT} -3 - h SIGNATOR E DATE APPLICATION DATE: I I P/Cla ISSUE DATE: PERAIIIT# TYPE CONST. OCC GROUP: Scope of Work i �+ Te`C J LaA k X p V.J, t� a �s € A, 4 GAS ft DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ, FL. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck ii Pool/Spa' ZRe -Roof Commercial m Valuation: in!T; Adj. Area: QUANTITY DESCRIPTION FEE jr L j-., Strata �V; 6 w C A, f Gf Y't d U z a x U CONSTRUCTION: e � PLAN REVIEW: (eq el e J� ELECTRIC: 62.5. PLUMBING: (� I , MECHANICAL: INSPECTION FEE: ISSUANCE: r E. ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: C? BASF: Z C 6 PLOT PLAN: ZONING CLEARANCE q3, 3 TOTAL FEES 1� � •�� COMMENTS: 1 1 � ; 1 `� PIC: PAID BY: �� RECEIPT ff G 08 PAID BY. I:? VALIDATION: z VALIDATION: WHITE— Department Copy, YELLOW -- Finance Copy, PINK— Assessor Copy SETBACK/ LETTER _._.. _.. TRACT AND LLOG1,11 ...... _ SWIfOH GEALi COMMERCIAL. ROOD T BAIT i LI;Cf P 1 LR HOT MOPISHOWERPAN 3 ''ICFSSPOOL HERS REPORT RECEIVED _ FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICALIN UFER GROUND SF:WL li I A'TFHAI MAIN WAI I. H I INC: Sf Wl R I I_LANOUT R001SLIEATHING f 100R SHEATHING DEMOLITION ROOF DRAINS ROUGH CONDUIT SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR POOL/SPA ROUGH PLUMBING FRAMINGNENTING: ROUGH ELECTRICAL. . ROUGH MECHANICA GAS TEST r PRE GUNITE POOL PRE 0 D NG �► P -TRAP a FENCE 1 GATE/ ALARM FINAL POOL ROUGH MECHANICAL ROUGH ELECTRICAL W( } C ( ) ROUGH PLUMBING INSULATION MALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIORWALLS: LATH INTERIOR __. _ WALL FOGTING/STEEL GAS TEST WALL STEEL 1sT( )2ND( ) LIFT SCRATCH COAT ELECTRIC METER RELEASE WALL BOND BEAM WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIDE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of OCCUPANCYFINAL _ HEALTH DEPT. FINAL INDUSTRIAL WASTE