The URL can be used to link to this page

Home My WebLink AboutPR17-28037LU 06 ZE 0 LLJ CD 00 T_ U_ 0 LUUJ LU U5 C) UJ CD f � J U. z C) C" n CD LLJ Lo 0 LU C2 LW 2z CD t LL CL 0 cc LU CL U3 a� CITY OF DIAMOND BAR DEPART T OF COMMUNITYDEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION wim.cityofffiamondbancom building@d JOB SITE ADDRESS �._� "� f r Y t ........... P N LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR rw Vc ADDRESS Ia- .0 CITY TEL.V4. et -f by? ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TE L4 OWNER -BUILDER DECLARATION I hereby affirm ander penalty of perjury that I am exempt from the Coritrac#or`s State License Law for the reason(s) IndIcated below by the checkmark(s), I have placed next to the applicable Item(s) [Section 7031,5, Business and professlons Godo. Any city or -county that requires a permit to construct, allot, €mprove , demolish at repair, any structure, prtar to Its Iesuianca, also requires the applicant for the penult to filo a signed statement that hs a she Is licensed pursuant to the provisions of the Contractor's State License Lave (Chapter 9) Commencing with Section 7000 of Div tun S of the Business and Prutesslons Cadal or that he or she is exempt from 11—censure and the his for the alleged exemption. Any violation of Section 7051 r5 by any applicant for a permit subjects the applfcant to a civil penalty of not more than five hundred dollars (SCC). I, as owner of the propel, or my e m ployees with wages as their so le compensation , will io U all of or portions of the work, and the structure Is not Intended or offered for sale (Section 7044, Busimss and Professions Code: The ntractcrs' State License Law does net apply to ars owner of property who, through employees' or personal effort, builds or Improves the propel, provided that the Irnp ve ents are not Intended or offered for sale. If however, the bullding or Improvement Is sold within one year of completion, the Ownar-Builder will have tine burden of proving that A was not built or Improved for ft purpose of sale.). It as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044} Bustness and Pratesslom Code. The Cont(actors' State Ucen a Law dos not apply to ars owner of propedy who bulfds or i mptoves thereon, a-nd who contracts for the projects with a licensed Contractor pursuant to the Contfactors I State License Law.). I arrt -exempt from licensure under the Contractorls Stale License law for the following reasonffl: Date: Sin; By my signature Wow f 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 tiffs permlt,I cannot legally self a structure that I have bulli as an ew r-bullder If it has not been constructed In Its entirety • by licensed contractars, I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is availabfe upon request when this appllcatlon Is submit d or at the following we b site. http/www.legfnfa.ca.gory/calaw, htm I. LICENSED CONTRACTOR'S DECLARATION I hereby aff Irm under penalty of perjury that I am licensed under provisions of Chapter 9 (cornrner ing with Section 7000) of Division S of the Business and Professions Cude, and my license is In full force and effect. r LICENSE CLASS: LIC. NO,- EXP. O,-S p. CAFE:CONTRACTOR: E• + - OIL 9a.... -V L.r . ..... e"s I HERESY AFFIRM ANDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Cert1ficate of Consant to Self -insure for Worker's CGMpensatlan, as prowrlded by Section 3700 of the Labor Cade, for the performance of the wafk for which this permit Is Issued. I hawse and will maintain Workers Compensation Insurance, as requlrsd by Section 3700 of the Labor Coda, for the pe neat eat the work for which this permit is issued. My Worker's Compensation tnsurance Carrier and Policy Number are: C R1 ER AR LO POLICY NUMBER gKS'StCtION NEED NOT BE COED IF THE PERM, IS FOR ONE HUNDRED WAS $I OD OR LESS) I certffythat in the pefformance of ft w for whM Ibis permit is issued, I shall not employ any peon In any manmr so as to become s juct to the Worker's rnpansatlon Laws of California. And agree that if I should de me subject to the Worker's Compensatim provIslans of &den 3700 of the Labor Codet I shall foMwfth comply with those provisions. A E: APPLICANT: WARNING: Failure to secure worker's Compensation coverage Is unlawful, and shall subject an employef to crl rn Inal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for In section 3708 of the tabor code, Interest, and attuney's fees, CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of penury that there Is a Constructlon Lending Agoricy for the performance of the work for Mich this permit Is Issued (Sec. 2097, Civ, .). LEN DER'S NAME: LEN CER' S ADDRESS: I certify that I have read this application and state that the above Information is correct. I agree to co ply w##tr all city and county ordinances and state laws relating to building cot troction, and hereby authorize representatives of this county to enter upon the above- mentioned property for fnspec#ion purposes. PER ITS AmE�i� IGNATURE OF PERMITTEE DATE ._/ PRESS iamondbarea.gov FIRMLY APPLICATION DATE: P # ISSUE DATE.'0m) PER#IT# TYPE CONST. OCC GROUP: Scope of Work ft.,��, �' -E, It DWELr KNITS # STORIES ...................... BEDROOMS DESCRIPTION SQ. Fr. FACTOR P F ADJ . AREA/VALUATION FF ADD/REISI Garage/ arpurt LU Matto/Deck W Pcol/Spa Re -Roof _3 Commercial adua floe: N t: ANTITY DESS RIPT[ EEE w J ------- CONSTRUCTION: PLAN REVIEW: ELECTRIC: F PLUMBING: MECHANICAL: INSPECTION EEE: ISSUANCE. ENERGIE P/C: ENERGY PERMIT: C6 RETENTION FEE: PRE -ALT FEE: BASF: �l PLOT is ZONING LE/\ RAN ; TOTAL FEES COMMENTS: P/C: Al BY: VALIDATION: RE EFPT #f3_ PAID BYj VALIDATION., WH ITE — Department Copy, YELLOW — F1nance Copy}, P I N K — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK/ LETTER ---------------------- TRACT AND LEDGER FOOTINGS FORMS A #IT H GEAR SLAB COMMERCIAL HOOD INTERCEPTER HOT i P/ HO E BAN UiG. PLUMBINGT—BAR UG. ELECTRICAL UFER GROUND 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 FRAMINGNENTING ROUGH ELECTRICAL ROUGH MECHANICAL ROUGH MEGHANICAL ROUGH ELECTRICAL ( )C( f f;rM r � �r- ::_ti GAS TEST ROUGH PLUMBING BRE GUNITE INSULATION WALL� POOL PRE DECK BONDING INSULATION CEI LI B—TRAP 1ALL I orfk r{ rf i{k FENCE GATE/ ALARM LATH RE Fr ��f,. . FINAL POOL LATH EXTERIOR ALL: LATH INTERIOR WALL FOOTING/STEEL GAS TEST MALL. STEEL I ST( !D( LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE ff s. u:::•:_:•_w.vww:. ra�i..v.w w.v R-:.w...R:--rR-tn— WALL DRAIN/ SEAL GAR METER ELEAE WALL FINAL SPECIAL I H SPE TI Hx R., FRAMING PLANNING APPROVAL FINAL BUILDING_:'='. ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE i I T E T ___ m.r. r. rvnn-- ,..,...:, .,�� FINAL ELECTRICAL FINAL PLANNING .,..M......M.... .., ..-,..-. FINAL PLUMBING r FINAL ENGINEERING/ P FINAL COMMUNITY SERVICES FINAL HEALTH DEPT, T.C. of OCCUPANCYr� f OCCUPANCY FINAL INDUSTRIAL WASTE COMMENTS: