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HomeMy WebLinkAboutPR15-1214z n Y x 1. z CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOB SITE ADDRESSf APN LQT TRAC� OWNER .. r ADD SS CITY %i ZIP.�..TEL.a` APPLICANT TEL- CONTRACTOR€ ADDRESS C€T Y:s ZIP ARCH/ENG/DESIGNER ADDRESS CITY 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 to the applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, Improve, demolish, or repair, any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuanttethe provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfara permitsubjects the applicantto a civil penalty of not more than five hundred dollars ($500). ()1, as ownerof the property, or my employees with wages as thelrsole compensation, will doLJ all of orU portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' 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. If hawaver, the building or Improvement is sold within one year of completion, the Owner-Builde(will have the burden of proving that itwas not built or Improved for the purpose of sale.). (J 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: 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 Ifeensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge that, except for my personal residence in which € must have resided for at least one year prior to completion of the Improvements covered by this permitJ cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirely 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: http/mAy.leginfo.ca,gov/calaw.html. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION t hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 0 (commencing with Section 7000) of Oiv€sign 3 of the Business and Professions Code, and my license is In full force and effect. LICENSE CLASS: LIC. NO.: DATE: CONTRACTOR:�- WORKER'S COMPENSATION DECLARATION r HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Sett -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work iorwhlch this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the perlormance of the work €orwhich this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER ................ (THIS SECTION NEED NOT BECOMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS($100) OR LESS). I certify that in the performance of theworkfor which this permit is Issued. I sha11 notemploy any person in any manner sons to become subject to the Workers Compensation Lai f California And agree that if I should become subject to the Workers Compenr tes rtovislons of Section 7oo of e, l s fora _ -comply DATE: APPLICANT-F. h #Irih aaa : WARNING: Fallure to secure Worker ompedsation coverage is unlavf&' and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (S100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, 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 cerh'fy that I have read this application and state that the above information is comet. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upo the above ¢-mentionfeed�property for Inspection purposes. it PERMI ,(PR�I'11�1��I.UT€ 1. APPLICATION DATE. I� ISSUE DATE: b AZ"Ijam PERMIT# PC /J TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE ❑ R ❑ ❑ PROPOSED USE If DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. Fr. FACTOR PSF ADJ. AREAfVALUATION SFR/ADD/REM Garage/Carport rD w Patio/Deck Lwr. Pool/Spa Z Fie -Roof O J M Commercial m = Valuation:` =` Adj. Area: QUANTITY DESCRIPTION FEE J U � w w z m a J U a v CONSTRUCTION: PLAN REVIEW: j ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: V i ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: I r I USAF: TOTAL FEES B COMMENTS: ! a ! j RECEIPT # �� PAID BY., VALIDATION: WHITE— Department Copy, YELLOW --- Finance Copy, PINK —Assessor Copy, GOLDENROD — File Copy, GREEN —Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SIACiC/LETER l!? //i� TIiAGTAND LEDGER FOOTINGS FOR�IS SWITCH GEAR - - - SLAM. ... ' COMMERCIAL HOOD LfC LUiII[iVl; T-BAH _ UO,;FLECTRICAL INTERCEPTER — AA GROUND HOTMOP/SHOWERPAN SEWER LATERAL, - SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEINER GLEANOUT DEMOLITION ROOF SHEATHING -- ROOF DRAINS FLOOR SHEATHlN�; ROUGH CONOUIT - -- S AF(�AI_L�EX'ERIiIR SHEAR dA LS iNTE I©fi i oum P ummaG: FRA4INGIVEI�ITIN(� ,. mm DOUGH ELECTF A - ROUGH MEOHANIICAL,: Y ROIIGH'11+TFCHANICAL, O GH"I GAS TE$T DIRT H PLUWWw — � - PRE GI3Ni`I E INSULATION WALL POOL PRE DECK 660DING INSULATION CEILING P;TAAP-", DRYWALL � FENGEt(lATUALIi RM , , LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1-( ) 2"( ) LIFT SCRATCH COAT WALL BOND REAM ELECTRIC METER RELEASE -- — WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL — -� SPECIAL INSPECTION€O;FRAIiGPLAIfUC�AP'HOVAL — Pl�fAt_ OUILMNG ! `' "': � HOUGH FIRE APPR01lAL FINAL MECHANIC �IRIALFf OEI'ATNT :. FIAT ELOi(GAL . " FINAL PLANNIN FINALPLOMBI. G T.i"0 (iCCUPANCY _. FI NAL C INIIVI I Y ERfIGE .. t, �OCCIJFAUCV' - IM HEACM De FINAL.) OUSTRIA4; WASTE''` . �. COMMENTS: