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Home My WebLink AboutPR17-26931C) LLJ CD CD im LU CD 2M LU CL U) C3 2z UJ Cn LL 2z CD LTJ ZD 60 Lo in Im Im a SPR C) 0 LL LU CL UJ cc LU M CITY OF DIAMOND BAR DEPARTMENT OF COMAIUNITYVELOP T SERVICES 21810 Copley r', Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING P APPLICATION mvw*dtyo di iDn b r* om buildiog@diamondbarea.gov JOB SITE ADDRESS ar-ct APN LOT TRACT-- OWNER RACT} ER r ADDR .. , IIT7&SEL.(� . APPLICANT Cam TEL. 69 1) t3�F: - r CO NTRACTO R 41- ADDRES CITE ZIP t&gTELI U2�C). 4� ARCH/ENG/ DESIGN ADDRESS .............._.... --- - ---- ---- -- - ..................... . IT ZIP TEL., OWNER -BUILDER DECLARATION I hereby affirm under pefrall� of pejury that i am exempt from the Contractor's State License Law for the reason(s) Indicated below by the chi Gkmafk(s), I have placed mxt to the appl Icahle Item(s) [Ceetlon 7051.5, Business and Profess [Dns Code,, Any eft or county that requires a permft to construct, after, improve, demolish, at repair, any structure, prior to Its Issuance, a o requires the applicant fa r the permit to MS a signed statement that he a r s he Is licensed pursuant to the provialens of the Contractor's Slate License Lein (Chapter 9) Gornmenctng with Seoflon 7000 of 01vislan 3 of the Business and Professions Coder or that he or she Is exempt from licensum and the basts for the alleged a empfion. Any violation of Sectlon 7031.5 by any applicant for a permit subjects the applicant to a 0101 penalty} of not more than five hundred dellars (500)t 10 as owner of the preperty, a my employees with Wages as their -safe co perisation, will do U all of or portions of the work, and the structure Is not Intend ad or offered for sale (Sectlon 7044, Business and profess es Cade: The ntractors' State License Lair does rot apply to an owner -o# proper who, through employees' or personal effort, bailds -or Improves the pfoperty, provided that the I m provemants are not intended or offered for sale. If however, the building or Impru ement Is sold within one year of completion, the Owner -Builder will have the burden of provfng that it was not built or improved fur the purpose of sale.). 1, a6, owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 70%4, Businm and Professions Code: The Contractors' State License Law does not apply W ars owmr of property who bur is or Improves thereon, and who contracts for the projects with a Ilcensed Contractor pursuant to the Contractors' State Llrenmlaw.)" (J I am exempt from ficensure under the Contractor's Mate License lair for the fallowing rea,sern(s): ]ate: Sign: By my sig -nature below I acknowledge that, except for my persomal residence is wh1ch i must have resided for at #cast ore year prior to eompietion of the Improvements covered by this parmltJ cannot legal sell a structure that t have built as an owner -builder If It has not been ccnstructed In Its enfiret} by licensed contractors. I understand that a copy of the appkable law, Section 7044 of the Business and Professions Code is avallahle upon request when this application Is submitted or at the following Web site: httpAvNw.leglnfo.ca.gov/calaw.htmi. LICENSEDCONTRACTOR'S DECLARATION I hereby} afl7Jrrn under penalty of perjury that l am llcens8d under provisions of Chapter 9 (commencing with Section 7000) Df DIvision 3 of the Business and Professions Code, and my license Is in full force and effect. LICENSECLASS: LI0. +I��o .: Or P. D LTE: CON } 1 it CTOR : Z-4 1I ORKER'SPEN ATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: - - I have and Wil ma.intaln a Certif lcate of Consent to self -Insure forWorker's Compensation, as provided by Sectlon 3700 of the Labor Code, for the performance of the work for which this perrnit is Issued. ave and will maintainWorker's Gumpensaflon insurance, as required by Seotlon 3700 of the Labor fie, for the performance of the wok for which this permit is issued, My Worker's C pensation Insur a Carrier and Policy Nuri be r ar CARRIER POLICY NUMBER ----------------- flM SE00N NEED NOT RE COMPLETED THE PERMIT IS FM ONE HUNDRED DSS $100 OR LLQ" cert€fy that In the performance of the work for +doh the parmit is issuedp I shall not employ any person In any manger so m to becorne sub*t to the Workes Co peosat cal Laws of California, Arid agree that if I show become stiboot to the Workers Cor ensaflon pmVISiom of SerAlon 3700 of the Labor Godes I shall fo hwfth Domply w1th those PfMslans. VA rE.' APPLI ALIT: WARNING: Failure to secureWorker's Compensation coverage Is unlavdult and shall subject an employer to cd m#nal pe naltles and ciuif fines up to one h undred thousand doltars ($100,000) p I n addition to the cost of the compensation, damages as provided for in saction 3708 of the labor code, Interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under panan Gf per]-uthat there Is a Construc on Lending Agency for the performs -ace of the work for which this permit Is issued (Sec. 3097, Giv. .). LEN DER'S NAME: LENDER'S ADDRESS: --- - - ------ - - ---- - ----------- - I ceMy that i have read this application and state that the above Information Is correct. l ag roe to comply with all co and country ordinances 9Xd Mate laws relating to building construotlon, and hereby authMze representatives of this county to eater upon the e- enticned property for Inspection purposes. PERMITTER NAME (PRINT) 00.10 SIGNATURE TT DATE APPLICATION DATE: / : ISSUE DATE: ERIT#�: TYRE CONST. OCC ROUP: Scope of Worklk R S ice. - . ..... ........ . D EL. UNITS #STORIESBEDROOMS DESCRIPTION SQ. FT. FACTOR P F ADJ . AREA/VALUATION FF ADOfRE Garage/Carport Patio/Deck LL Pool/Spa Re -Roof �j Commercial M Valuation: Adj. Area: QUANTITY ----------- DESCRIPTION F E E LU -------------------- CONSTRUCTION: } PLAN REVIEW: ELECTRIC: MECHANICAL INSPECTION FEE: ISSUANCE: .. ........ V SHIN: ENERGY P/: ENERGY PERMIT: RETENTION FEE: � PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES . COMMENTS: P/C. PAID BY: A P RATION: RE EIPT PAID B t-IDATIO : WH ITE — Department Copy' YELLOW — Finance Copy, PIN K — Assessor Copy COMMENTS: SETBACK/ LETTER TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG, PLUMBING T-BAR . ELECTRICAL INTERCEPTER JFER GROUND.' HOT MON HOWERPA -SEWER LATERAL SEPTIMESSPOOL MAIN WATER LINE HERS REPORT RECEIVED EWER CLEANOUT DEMOLITION GOOF SHEATHING HOOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR W LL E TEH I H POOL/SPA H EAR WALLS I NTER 10R ROUGH PLUMBING FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MECHANICAL ROUGH ELECTRICAL ( )C( IOWA=GAS TEST ROUGH PLUMBING PRE GUNITE INSULATION WALL FOOL PRE DECK BONDING IHIrATIOI CEILING-TAR DRYWALL FENCE / GATE/ ALARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS{LATH INTERIOR LL TING/STEEL GAS TEST WALL STEEL 2ND( )LIFT SCRATCH COAT WALL BOND REAM -ELECTRICMETER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL -SPECIAL I RECTIOH RO . FLING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINALL IN FINAL ENGINEERING/ R T., of OCCUPANCY FINAL COMMUNITY SERVICES CERTt of OCCUPANCY FINAL HEALTH DEPT, FINAL INDUSTRIAL WASTE COMMENTS: