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Home My WebLink AboutPR16-0566a z C-9 W CITY OF DIAMOND BAR M ? r I i DEPARTMENT OF COMMUNITY & D&ELOPMENT 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.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS / % 8'4l� (7) APN LOT TRACT OWNER ADDRESS R t2A M If D CITY 14ah4::` BAt? ZIP TEL. APPLICANT TEL. CONTRACTORn/+!�%�G�lr-� / l* �!1 ADDRESS 20 ) 'T CITY Z ZIP -4 ^ - r ARCH/ENG/ 1. DESIGNER '% ADDRESS e9. CITY LyQ ZIP O!Ao TEL._24o-ZS/,,I 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,y dor to its issuance, also requires th^r licaa�."tllppermit to file a signed statement that he or she is license an or i9 mencing with Section 7000 of Divrsron'o a e e P nsure end the basis for the all .Any 7.. ,tiy,a r a d )ec pplicant to a civil penalty of not more than five hundred dollars (_1I,asowner ofthe p ormya 1: s �§astheirso p in o U all of or U portions of the work, and the is not int ed 0 d for sale (Sec i n e=w°rµvtl►d Professions Code: The Contractors' State Lice L does not I to er ofe g r Ic or personal effort, builds or improves the property, provide noroin ended or offered far 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 pur of sale. U I, as owner of the i1� y�pnry ddt * n truct the project (Section 7044, Business and Profs s Code: The Co ctprs' State License Lal" oes not ppl o an owner of property who buildsorimproves thereon n s to Is�d`iT! errr ant to the Contractors' State License Law.). www�r �w�� U I am exempt fro e}, r�}e�uRpCrBhefr nffiellaw�lfilyQi J (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 available upon request when this application is submitted or at the following Web site: http/www,leginfo.ca.gov/calaw.html. 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 farce and effect. LICENSE CLASS: I LIC. NO.: 3 ri DATE: � CONTRACTOR: AML+t.✓ I "NLu H."IA 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. I 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 CARRIER "ice POLICY NUMBER Q fd 9. — -2-- Z/a (THIS SECTION NEED NOT BE COM LEfED IF THE PERMfT IS FOR ONE HUNDRED 6oLLARs ($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 if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Cede, I shall f with compl �y with th ravie er s—� DATE:(11 //,_ APPLICANT: ff IL 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 enter upon the above-mentioned property for inspection purposes. C�yt� PERMITTEEN RINT) SIGNATURE TTEE DATE APPLICATION (DATE: y /�� Ja I P/C# P ` / 9 - [ ISSUE DATE: J �W/ PERMIT# : -U,16 - ®.r/f+ TYPE CONST. OCC GROUP: Scope of Work[e, If DWEL. UNITS _� # STORIES / # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION J1 Garage/Carport LO L Patio/Deck W LL PooVSpa ZRe -Roof o Commercial m �o6,5a- Valuation: c7U- ° O Adj. Area: i QUANTITY DESCRIPTION FEE Q Y tr U00 U w z M J a U_ zd x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: rat PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: /d6 �- SMIP: ENERGY P/C: 7! 49 q �• ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: J a +00 BASF: PLOT PLAN: 1 , 0(y ZONING CLEARANCE: TOTAL FEES COMMENTS: 74 CC## P/C: PAID EICff 0 RECEIPT #nn PAID BY: � VALIDATION: VALIDATION. WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY &F -DIAMOND BAR INSPECTI6N RECORD INSPECTIONDATE INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR ,r I SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C () / ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: INSPECTIONDATE INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRItlk�,Vv ROUGH MECHAN GAS TEST PRE GUNITE P ; • ' , POOL PRE DECK P-TRAProw FENCE / GATE/ ALARM FINAL POOL WALLS: 4 WALL FOOTING STE m WALL STEEL 1 ) C imly na im WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW 6 FINAL COMMUNITY SERVICES y FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE a