HomeMy WebLinkAbout16-2401O
0
w
a
w
w
f
O
U
0
w
s
�d
a
0
y
0
a
0
s
m
a
CITY OF DIAMOND BA
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 www.cityofdfamondbarcom building@dlamondbarca.gov
JOB SITE ADDRESS
APN LOT TRACT
OWNER
I AODRE S 7cZC5 -Au NU VEIJ PL
CITY 1��zIP 2ZZ,6S TEL 909- B'
APPLICANT EL
CONTRACTOR
ADDRE �ru,4e J'K%caeS --W—
CITY ZIP TEL
ARCH/ENG
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I hereby drum under penalty of Delay that I ism exempt from the Contractor's State License Law for the imprial
indicated below by the Coedmark(s) I haw placed next Io UN applicable Hams) [Section 703M BmWn and
Pro Mb= Code Any dry a ComAy tied iayw® a permil becmnaecl altar, brthmye, demdnlq a reple am
shucbue, prior to its Iuwmcoalso Reines to applicant for Depamllt to fib ae1O1eE 6bbnwml tleaMaYw
.1 peevsannd aleCmbactia%Salo Lice Law(ChMtcrg)Cwuv gwgh Secllm
d division 3 of to Bsa® and Profession Crdal or Dot he be she ls esenml hum Ommae and Da basis for
Uwaueged excemp on Amyddatbn d Secbm 7G31 5 by an 001C m fa a peMl mbjecb DaappkW W adW Wr alty
of not we than hw hundred dollars (SW
U I as owner of the Dmpemy, army emploweewM wages as theirsoie compensation, wen do U all Star U Dombm
of the work, and the structure Is not Intended or offered for sale (Secdm MIS Badness and Professlom Code The
Cmtraclme' Sole License taw does soh apply to an Omar of property who through emplayeas or personal effort builds
or Improves the property, presided that the Improvements are not Intended or offered far sale If hodewr the building be
Improwmenl Is add within One year of completion the Owner Builder will haw the tender of proving that It was not built
or Improve M the purpose of sue)
U I, are owner of the property, am exclusively contracting with licensed Contraclore to construct the project (Sectlm
7044, Busing and Profession Code The Cvnradom' Stata Lcense law does not apply to an owner at property Me
bulldsorkopmvestherann andw cxft tortheprlecbwithaINmcd CombacbrmrsonttotheCmnclss'State
Uceesse Low)
U I am exempt from Ilcenwre under the CmbxctuYs State Ucerue low for are following reason(s)
Data She
By my sgmbne below I acknowledge thel except fa my personal rrddernce In which I head haw rlosded M at bast we
yea prior to completion of the Improwmmb contend by this mrmiJI mind legally NO a structure that I Aare be es am
Indoor B It has not been Combucled In its entirely by Ilconsm parameters I undereMnd dal s copy of the
applkable low Sargon 704e of the Business and Prolesdms Code S awllWe upon request wean Nis applicebon is
wbmned or at the following Web site btuptww'w leglmo to ga/coiaw room
LICENSED CONTRACTOR'S DECLARATION
I hereby amid under penally of perjury that I am Ikensed under provisional of Chapter 9 (commending with Section 7000)
of MWod& the Budnessand ProfessionsCode andmylkonsebinfdllorceandeffect
/o Caro %4
ucrNSEcuss c3G uc xD
DIP GATE- CONTRACTOR �--rer-�--2-xng: r
WORIaR'S COMPENSI olfOEMWATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEa"TIDNS
I haw and will nalnbln a Umberto UI Consent to Shc bound for Wmfefs Canposallm a pmuded by
Seam 3700dthe Labor Code fa Uwmdmmanmdthewankkrma Riopemnisf W
haw end will mainWn WMar's funpee�tlm thsueance a requlmdby Section3700dthe Inbo Cade for
the performance of the wink for Min this Smelt Is Issued My Noel Compensation insurance Carder and
Policy Number are
CARRIER Fl
POLICY NUMBER
(MIS SECTION NEED NOT BE COMREIED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS)
I Cleft Rod In the perlamanm of In, wrltM which this permll is tell I dial one empO' my person In an manner seas to
&AIR fo In, WOWS Cmp m® laws SI Cad amet AM epees and 11 should therms suMod b the Work"
Commercial Seoddon UI Satbn 370D of Ua Labor Cade, I seal farOwM ell"WNI them peuWarn
APPLICANr
WARNING Failure m severe Werkefs Compensation raweege is mowiul and shoo seem an eropsyo to arounu
penalties and wive fines m fo are hf i rel Mol®red dollars (SIOD COOL In adaeon to the mtl at the mripemalbn
damages as presided la In section 370E of Uw labor Code InlercrL and ationwy, a fans
CONSTRLL'nON LBNDING AGENCY
I hefty affhm uncle penalty of perjury Thal them Is a Construction Lending Agency for the pedmnance of the work for
tlM permit 13 owed (Sec 3D97 N C)
LENDER'S NAME
LENDER'S ADDRESS
I away Gulf I haw read MIS appeal and stab that the Some Information S correct I 89M to comply with all city and
county experiences and Sae lows mining to building construction, and hereby SuNM79 representation of this county to
enter upon Ore mare m prapedy Mr vopecllm puNJ�/y
il
PEAMIRE j�% c�
SIGNATURE O PERkdrTEE Y/ f'�Fb DATE V (O
APPLICATION DATE P/C#
ISSUE DATE ' PERMIT# PR �6 - e-* /
TYPE CONST OCC GROUP
Scope of Work 141 Ile)
A DWEL UNITS A STORIES A BEDROOMS
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAUVALUATION
SFR/ADD/REM
Garage/Carport
w
Pato/Deck
LL
PcoVSpa
ZRe
-Root
9
Canmercial
in
in
Valuation Adl Area
QUANTITY
DESCRIPTION
FEE
a�a
F-i
es
m
EA
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
n
RETENTION FEE Lau
PRE-ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
TOTAL FEES
COMMENTS
P/C 'aPAID BY / VALIDATION
RECEIPT a jd / PAD BY Y f 7 VALIDATION
WHITE— Depabnent Copy, YELLOW —Finance Copy PINK —Assessor Copy