HomeMy WebLinkAboutPR20200001269PERMIT #:
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMEHT
21810 Copley Drive, Oiamond Bar, CA 91765
839-7020 Fax: (909) 861-3117 Building tnspection Hotllne(so9)839-7027(eoel
PERMITBUILDING APPLICATION
SITE 3319 CA
T
LQI#:
NAME:
CITY:
ADDRESS:
ADDRESS:
DATE]PRri
DESCRIPTION FT
5FR/AD.D/REM
"ROOF
COMMERCIAI
TOTAI VALUATION:
PLAN CHECK FEES PERMIT FEES
CONSTRUCTION:
$s29.00
PLAN REVIEW:
ETECTRICAL:
PLUMBIN6
MECHANICAL;
ISsUANCE:
SMIP;
ENERGY:
$1.00
PLOT PLAN:
PFRMIT SYSTEM REPLACMENT FEE:521.16
$L,x77.49
PERMIT #: PR20200001259
CITY OF DIAMOND BAR
INSPECflON RECORD
TRACI( AND LEDGER
T.8AB
POOI" DEMOLITION
ROOF DRAINS
SEW€R LATERAT
SEWER CTE,ANOUT
MAIN WATER LINE
ROOF SHEATHING
FLOOR SHEATHING
WALIS:
WALL FOOTING/STEEL
wAu srEEr 1sT( ) 2ND{ ) LlFr
WATT OAAIN / SEAI
WALL FII{AI
INSUIATION WALL
INSUTATION CEIIING
HOf MOP/SHOWERPAN
DRYWALL
LATH TXTERIOR
LATH INTERIOR
GAs TEST
SCRATCH COAI
EIECTRIC METER REtEASE
GAS METER RETEASE
SPECIAL INSPECTION
COMMENTS:
::i::i;:litt:.:i,,ii ji
FENCE / CAIE /ALARM
FINAL POOt
FRAMING/VENIiNG
RAUGH TRE APPROVAL
FINALF'AE DFPAfrIMENT
HNAIP,',,NN'NG
FINALPW MNNi€NANCE
FINAL
'IEALr}I
OTPT.
FINAL INDUSIR'AL WASIE .r,:i:l;':r ; ' -l:lr:.
F{NALAuttailto
FINALMECHAN'CAL
F,,J[,ALEIjCTNCAI
F'NAL PLUK'A,,,G
SMOKE & CARSON
MONOXIDE DITECTORS
T.C. Of OCCUPANCY iii]:li.il::]..j'
CERT.9r OCCUPANCY
10/5/20
PERMIT #: PR20200001269
SIGNATURE F
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the contractor's state License taw for the reason{s) indicated
below by the checkmark(s) t iave ptaceA next to the applicable item(s) lSection 7031'5, Business and Professions Coder Any
city Or county that requires a perrnit to construct, alter, improve, demolish, or repair any stfucture' prior to its issuanee' also
requires the applicant for the permit to fite a sigrred statoment that he or she is licensed pursuant to the provisions of the
contractors, state License Law (Chapter g, 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
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500)']r
(-) las owner of the propertY, or my employees nrith wages as their sole compensation' will do (.-) all of or (-) portions of the
work, and the structure is not intended or offered for saG. (Section 7044, Business and Professions Code: The contractors'
state Licefise Law does nat 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, lf however, the building or improvement is
sold within one year of completion, the Owner-Builder will have the burden of proving that it was not built or improved for
the put pose of sale.)
(*) l, as owner ofthe property, am exclusively contracting with licansed contractors to cpnstruct the Broiect' {Section 7044'
Business and professions code: The contractors' state tiiense Law doe5 not apply to an owner of prowrty who builds or
lmproves thereon, and who contracts for the proj€cts with a llcensed contractor pursuant to the contractors' gtate License
Law.)
{_) I am Exempt from llcenrure under the Contractor's $tate License law for the following reasonts}:
By my signature belolv I acknowledge that, except for my personal residence in which t must havQ resided for at least one
year pricr to completion of the improvements covered by this permit, I cannot legally sell I structure that I have built as an
owner-builder if it has not been construcled in its entirety by licensed contractors" I understand that a copy of the appllcable
law SEction 7044 of the Eusiness and professions code ls available upon rcquest $,hen this apptication is submitted or at the
following Web site: http/www,leginfo'ca,gov/calaw'html'
OR
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7O00) of
Division 3 of the Business and Professions Code, and my license is in full force and effect'
DECTARAIIONTICENSED
LICENSE NUMBER:
SIGNATURE:
LICENSE CLASS:
EXPIRATION DATE;
WARNING; FAILURE TO SECUBE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND 9HALL SUSJECT AN EMPLOYER TO
C&IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S1OO,OOO}, IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTERE5T, ANO AfiORNEY,S FEEs.
I TIEREBY AFFIRM UNDER PENATTY OF PERJUhY ONE OF THE FOLLOWII{G DECTARATIONS:
I have and will maintain a certificate of consent to self-lnsure for workers' compensation, issued by the
Director of lndustrial ftelations as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this pefiItit is is5ued.
I have and will maintain workers' compeffiation insurance, as requlred by Section 3700 of the Labor Code, for
the performanee of the work for whie h this permit is issued. My workers' cornpensetldn iflsurance carrier and
policy number arer
WORKERS' COMPENSATION OECLARATION:
*>tii
EXPIRATION DA
9149160
CARRIER: StateCompenrationlnturance FOLICY#:
Fund 'u't/t/zt
subiect t6 the workers' compensation laws of California, and agree that, if I should become subject to the workers'compensation
provisions of section 3700 of the Labor code, I shall forthwith comply with those provisions.
DECIARATION [T6A8DIN6 COI{STRI}CfION IENOINq AGTNCY
I herehy affirm under penalty of perjury that there is a construction tending agency for the performance of the work for which this permit is
issued (Section 817a Civil code),
SIGNATURE OF APPLICANT:DATE:
IENDER'S NAME:
tENDER,S
any person in any mannel so as tondtwork for permit
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
of Bar to a bove-identified
Timothy Shur
I authorize
Fayment
CITY S
R
Transaction lD:
265305266409
Thankyou, your payment has been approved!
Retr-lrr: t* \rrlmb*it* Ul?1."
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