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Home My WebLink AboutPR17-19782lsillll ,E^ yt�sg� L, f CITY OF DIAMOND 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 ;,n nv.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS I Zo S. jSaCFA.CArJ ►) APN LOT TRACT OWNER SbcATR6'2rJ C&L-LRO tz iA GX}-5 CAA4mo� ADDRESS r fob L.E A V6. CITY G NATIwaxrt f ZIP '71111 TEL. iS( L) h,L-L -02.7 V APPLICANT &ILLIP U69- TEL. (3 to)L70-3f(!J1 CONTRACTOR rFAtOEIT COMM01100 Co%sTrtyG ADDRESSI2r�L E6F,11TV '60 v • CITY Rogim ZIP r_a, TEL. (310)537_-`T5'ZLJ` ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TET.. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's Stale License Law for the reason(s) Indicated below by the checkmark(s), I have placed next to the applicable liem(s) [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 permll to file a signed statement that he or she Is licensed pufsuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Codej or that he or she Is exempt from licensure and the basis for the ailcged exemption. Arty violation of Section 7031.5 by any applicant for a permlt subjects the applicant to a civil penalty of not more than five hundred dollars (5500). O I, as ownerof the property, or my employees with wages as their sole compensation, will do ( j all of or (-) portions of the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Code: The Conb utors' State License Law does not apply to an owner of property who, through employees' ar personal effort, builds ar 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 vias not built or improved for the purpose of sale.). U 1, as owner of the properly, 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 conlraclsfarthe projeclswith a licensed Contractor pursuant to the Coniractors' State License Law.). U 1 am exemptirom licensure under the Contractor's State License law for the following renson(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 permit,l cannot legally sell a structure that I have built as an owner -builder 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 at the following Web site: htiphwnv.leginfo.cagov/calaw.hlml. LICENSED CONTRACTOR'S DECLARATION t 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 CLASSCI MY 7 A LIC. NO.: ZLI S Z -1 Z-• EXP, DATE:7 CONTRAofmirACLUfUT Cb2RQS.oJ &.JTK+L Cn• WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE 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. 1 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: CARRIERGIXAJ 1 e L rJSµA-RnICk 1'Gt S POLICY NUMBER _LJ Q,12 (i 103 (.6 R -71 q-7 (THIS SECTION NEED NOT BE COMPLETED IF THE PEAMfT IS FOR ONE HUNDRED DOLLARS $100 OR I.M. I cortily that in the performance of the workforwhtch this permit Is Issued, I shall not employ any person In any manner so as to 4ecome subject to the Worker's Compensation Laws of Calffomla. And agree that If I should become subject to the Worker's Compensation pruvislons of Section 3700 of the Labor Code, I shalt forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer 10 criminal penalties and civil tines up to one hundred thousand doflars ($1DD,000}, in addition to the cast of the compensation, damages as provided for in section 3708 o1 the labor rode, 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 suthadze representatives of this county to e4i nter upon t�he above-mentloned properiyfor inspectfon purposes. 10/4/17 SIGNATU OF PERMITTEE DATE APPLICATION DATE: t, -I t.* hn P/C# ISSUE DATE: tD/C- .......-__PERMIT#: FXe r—I— IL TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport Patio/Deck LLr LL POol/Spa ZRe -Roof I Commercial 03 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE 10 P SOW (a LC JOHAS r 3 V r' E J n1Eren_ Peee rA L c� z m J rL 4J U z L) U CONSTRUCTION: PLAN REVIEW: ELECTRIC:,' PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:r SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE:_ PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: AM 9-70e P/C: PAID BY: RECEIPT PAID BY: CZ�%_ VALIDATION: VALIDATION: WRITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy CITY W • , D BAR INSPECTION RECORD rSETBACqK/LETTER _ TRACT AND LEDGER S FORMS' __. SLAB SWITCH GEAR _ COMMERCIAL HOOD UG, PLUMBING T -RAR INTERCEPTER HOT MOP/STIOWF SEPTIC/Cf SSPOOI ........ ... _...._ HERS REPORT RECEIVED UG. ELECTRICAL UFER GROUND SEWER LATERAL _.. _........ _ MAIN WATER LINE SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VENTINGROUGH ELECTRICAL BOUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C O GAS TEST ROUGH PLUMBING PRE GUNITE mm� INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING DRYWALL LATH (PRE) LATH FXTERIOR LATH INTERIOR .._...._ _ .._ - GAS ILS-TWALLSTEEL SCHAIGH COAT P -TRAP ............ ._ _....... FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL 1ST( )2ND( ) LIFT _... ..... _ — ..._.._..__ WALL BOND BEAM WALL DRAIN/ SEAL ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION WALL FINAL RO. FRAMING PLANNING APPROVAL FINAL BUILDINGROUGH FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY !A 1'i FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ P.W. FINAL COMMUNITY SERVICES CERT. of OCCUPANCY — - _....._.._......._..__. ..._..._.._._.... _.___.___------ FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: