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HomeMy WebLinkAboutPR14-4172•`CITY OF DIAMOND BAR ' DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS 909)839-7020 Fax: (909) 861-3117 Building Inspection Hotline (90 9) 839-7027 FIRMLY BUILDING PERMIT APPLICATION JGB SITE ADDRESS APN --� � , _ . LOT_ TRACT OWNER �`yf^/Wh\ JI 5-JI2A ADDRESS i .2 MP0t0CW"rN1 CT CITY x!\01.1 ftZIP 9 ('ll M TEL. APPLICANT QAN 66-(LL3S 1R6Ai- -TEL. 905 Z� I SSR V S CONTRACTOR OWNI P7U ��-IXCL ADDRESS 7G CITY if}Mt)IJDR ZIP 91 / TEL. ARCH/ENG/DESIGNER ISIS N L ADDRESS yr=ST-A-v sT - FRONT ©Nb qo9q11. REAR CITY ZIP%�74,2-TEL. SIDEISIDE STREET OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons) indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and Professions Gode: 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 fife 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 U 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 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.). Patio/Deck LJ 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.). U 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 -Roof year prior to completion of the improvements covered by this permiLl cannot legally sell a structure that I have built as an O � owner -builder if it has not been constructed in its entirety by licensed tractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions 's available on request when this application is submitted or at the following W b sit htt .leginfo.ca.gov/calaW.1h UATFk SIGN: LICENSED CRNTRA S DECLARATION I hereby affirm under penalty of perjury that I am liters d nder provisions of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Professions Code, and my license is in full force and effect. i LICENSE CLASS: LIC. NO.: r DATE: CONTRACTOR: J WORKER'S COMPENSATION DECLARATION r r 1 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 t i Section 3700 o1 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 2 Polity Number are: e CARRIER 5 POLICY NUMBER o (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). D 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 La of Calif 'a. And agree that if I should become subject to the Worker's Compensation rowsi ns of Section 3700 of- de, I s I forthwiitu/ comply with those provisions. DATE ��PWorke T: f V� � WARNING: Fa ure 1 secure Worker's Compens tion- ver ge 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. r CONSTRUCTION LENDING AGENCY u 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.). 433 013 LENDER'S NAME: PLAN REVIEW: Oi LENDER'S ADDRESS: Li I certify that I have read this application and state that the above information is correct.) 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 u he above-mentioned property for inspection urpo�s%es�.. ar' MECHANICAL: cc n ERMTTTEE NA PRINT) n = IGNATURE OF PE DA E -7 2f APPLICATION DATE: P/C# ISSUE DATE: PERMIT# PR \4 - 4\ 1 �+ TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE P7ctfk t Y�V`-� w\ G \ G\uS®%r # _gA�'�cmn # DWEL. UNITS # STORIES If BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREA/VALUATION SF AD EM Garage/Carport ro Patio/Deck W LL Pool/Spa ZRe -Roof O � Commercial m Valuation: di. Area: QUANTITY DESCRIPTION FEE J " EE F- U w w1 - e z, m J 114 v z Q x w 433 013 CONSTRUCTION: PLAN REVIEW: Oi ELECTRIC: PLUMBING: ar' MECHANICAL: INSPECTION FEE: 4'� �Q ISSUANCE: • SMTP: ENERGY P/C: J % 1 ENERGY PERMIT: RETENTIOUtFEE: a� ' Olt PRE -ALT FEE: 4 BSAF: `• cx:!, TOTAL FEES COMMENTS: a\Zw%JP RECEIPT N 7 PAID BY: ' IV) VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy v■ ✓1f lvlwlll&o ✓All '.K,'•. INSPECTION RECORD ' �4i4 v SHEAR WALLS EXTERIOR116 �L SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( )'C TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN / Sr SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT ROUGH PLUMBING ' . INSULATION WALL '�._`' -� INSULATION CEILING DRYWALL i ob 91h r LATH (PRE) LATH EXTERIOR All 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: TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN / Sr SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT • 9'g Building & Safety Division 21810 Copley Drive Diamond Bar, California 91765 ; - (909) 839-7020 Fax (909) 861117 3 : job Address: \ 2a!5 �rY1 �ti.getrl. . C Dear Property Owner: An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified.,ecified. r s onsible ar of For your protection, you should be aware that as owner -builder .you are the e p p ty record on such a permit. Building permits_ are not required to be signed, by, property owners unless they are personally performing their own work: If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his.or her name:. Contractors are,required by law to be licensed and bonded by .the State of California and to have a business license from the Cityof County. They are'also required by law to put their license number on all permits for which they apply: If you employ or otherwise engage any persons other than your immediate family,. and the work (including materials and other costs) is'$200.00 or more for the entire project, and such persons are not. subcontractors, then you'may be employer. as contractors or su licensed Y Y Ifyou are, an employer; you must register with the state and federal government as an .employer and to several obligations including state and federal income tax social'. withholding, federal socia you are subject' security taxes, workers compensation insurance; disability insurance costs, and unemployment compensation contributions. There may be, financial risks for you if you do not carry out these obligations, and these risks are compensation insurance. especially serious with respect to workers com p For more specific information about your obligations under the federal law, contact the Internal .: . Review Service (and if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State law; contact.:the Department of Benefit -Payments and the Division of Industrial Accidents. If the structure is intended for sale, the property owners who are not. licensed contraetor_s are allowed to perform their work personally or through their own employees, without a licensed contractor or.. subcontractor, only under limited conditions: A frequent practice of unlicensed persons professing to be contractors is to secure an"owner- builder" building permit, erroneously implying that the property owner is providing his or her own labor and materials personally. Building permits are not required to be, signed by the property owners unless they' are performing their own work personally. Information about licensed contractors may obtained by contacting the Contractors State License Board at 9821 Business Park Drive, Sacramento,,CA 95827; www.cslb.ca.gov or at (800) 3217CSLB:(2752) Please complete and return the enclosed "Owner-Builder':verification form'so that we can confirm that you are,aware of these matters. The building. permit will not be 'issued until the verification is . returned. . <.