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Home My WebLink About16-0671-e DIVIOND BAR CITY OF DIAMOND BAR��0 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 JOB SITE ADDRESS APN OT— TRA T OWNER HM Pr hA Aq�, ADDRESS CITY Z TEL. APPLICANT61 TEL. CONTRACTOR S ADDRESS CITYi.JZIP�011 TEL. 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 item(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, 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 pursuant to the 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 applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do () all of or (, portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: 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 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 purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: 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 licensure 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 I must have resided for at least one year prior to completion of the improvements covered by this permit,) cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is availableupon request when this application is submitted o� at the following Web site: http/www.leginfo.ca.gov/Galaw.htmi. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, LICENSE SS: LIC. NO.: DATE: i i CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. XI have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECDON NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that f I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal 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 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 certify that I have read this application and state that the above information is correct. 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 enterp n the above-mentioned propertyforinspection purposes. PE MI EE A N611 2 AN ✓ _ I SIGNA E OF RM DATE APPLICATION DATE: ISSUE DATE: ✓ .I TYPE CONST. P/C# PERMIT# OCC GROUP: / ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW RW ❑ ❑ ❑ ❑ PROPOSED USE # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck LL Pool/Spa ZRe -Roof D Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a U J w • L_f:� 2 J rL Zd w CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: c SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: TOTAL FEES COMMENTS: RECEIPT # PAID VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy (33SUAN11 CITY OF DIAMOND BAR INS'P'EC-TION RECORD LETTER TRACT AND LEDGER FORMS � �s;;a,�� MAIN WATER LINE SWITCH GEAR _ _ HERS REPORT RECEIVED SEWER CLEANOUT COMMERCIAL HOOD BING .. DEMOLITION ROOF SHEATHING T—BAR RI,CAL_ „ ;' FLOOR SHEATHING INTERCEPTER ROUGH CONDUIT SHEAR WALLS EXTERIOR _ HOT MOP/SHOWERPAN SEWER LATERAL P TRAPSr„ ; SEPTIC%CESSPOOL MAIN WATER LINE FINAL POOL— _ _ HERS REPORT RECEIVED SEWER CLEANOUT WALL FOOTING/STEEL _ DEMOLITION ROOF SHEATHING WALL BOND BEAM ROOF DRAINS FLOOR SHEATHING WALL FINAL ; ROUGH CONDUIT SHEAR WALLS EXTERIOR ; ; . FINAL FIRE DEPARTMENT POOL/SPA ,SHEAR WALLS INTERIOR ' FINALa ENGINEERING/SIN`'" y ROUGH PLUMBING FRAMINGA!ENTING_ _ _ ROUGH ELECTRICAL _ .ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( } fiQUGM`PLlltVIBING INSULATION WALL INSULATION CEILING DRYWALL _ i LATH (PRE) _ LATH EXTERIOR LATH INTERIOR j GAS TEST _ SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION COMMENTS: I l FINAL:CWMbNITY.SERVICES ` I P TRAPSr„ ; I`FENCE / GATE/ ALARM.-' FINAL POOL— WALLS: WALL FOOTING/STEEL _ WALL STEEL 1-( ) 2ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL ; RO: FRAMING PLANNING APPROVAL. ROUGH=FIRE APPROVAL , FINAL FIRE DEPARTMENT FINALPLANNINfi''` FINALa ENGINEERING/SIN`'" y I l FINAL:CWMbNITY.SERVICES ` I 01 CITY OF DIAMOND BAR Community and Development Services Department -� 21810 E. Copley Drive • Diamond Bar, CA 91765 Building Inspection Request Hotline .,�fi> (909)839-7027 crigi. Building Planning Engineering (909)839-7020 (909)839-7030 (909)839-7040 CORRECTION NOTICE a.m. PERMIT NO. - D DATE: IF/d, / TIME: p.m. CONTRACTOR/ OWNER BUILDER ADDRESS (Project Site) �� Q{i� `�► h �i �� Tf- P P 1` r e FAQ it C. C, S ro r nge d ❑ PLEASE CONTACT THE UNDERSIGNED PLEASE MAKE CORRECTIONS AND CALL FOR REINSPECTION ❑ REINSPECTION FEE REQUIRED ❑ PLEASE MAKE CORRECTIONS AND PROCEED WITH WORK INSPECTOR: ra,C 1-0L (print name) SIGNATURE OF INSPECTOR: