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Home My WebLink About16-2380CITY OF DIAMOND BAR' DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �pl 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov FIRMLY JOB SITE ADDRESS ` 5fiLV tFfZ- R A IN 1A, APN LOT -TRACT OWNER ADDRESS 3 1 CITY Pt, ZIP TEL. i APPLICANT TEL. CONTRACTOR S SAN S' G ADDRESS ILL- r CITY ZIP 7 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 U 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.). U 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): Date: Sign: 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 permiLl 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 1 h •reby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of ivision 3 of the Business and Professions Cod ddd m li[cxelnse is in full force and effect. ENSE CLASS: s✓ LIC. NO.: l f/ I O EXP. DATE: + r CONTRACTOR: cC-��-� .� WORKER'S COMPENSATI iDECLARATION 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 �(��V'✓ POLICY NUMBER�3 i7 (THIS SECTION 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 if 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 enter upon the above-mentioned property for inspection purposes. +Vj IS- ; PERMITTEE NAME (PRIN SIGNATURE OF PERMITTEE DATE V APPLICATION DATE: la -4; _/46 P/C# ISSUE DATE: & / PERMIT# : TYPE CONST. 611 _. OCC GROUP: Scope of Work ?OV i WM0 If DWEL. UNITS It STORIES If BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport WL Patio/Deck LU LL Pool/Spa zRe -Roof Commercial C0 C0 Valuation: — Adj. Area: QUANTITY DESCRIPTION FEE U it U w ca z m J a ZU_ Q x U CONSTRUCTION: PLAN REVIEW: �� • . S3 ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: Q ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: am BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: S 4,p P/C: PAID BY: RECEIPT # [` m 3Z //61' PAID BY: VALIDATION: VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY .OF DIAMOND BAR INSPECTibN RECORD ► R�l'v►ov� ►m Cp 3 l s t L-veFk, "I0 DR INSPECTOR'S DRILY REP6RT OF COMPACTED FILL Job Name ool cciio� TeS- Job Location Jo -1,N o 163 SilVer (lain [)r, QljI.6-0z0-036 Page of 1-1 General tontractor Grading Contractor Dale 10/Mit Day of Week Fridtx Grading Shift Hrs Contractor's Supt of Foreman 8 Signature Field Tech r V I Hrs onSite From 8:00AU4 To Source and Descriptions of Fill Materials /1 1 /� 1 A( 1 OWE (�� St l 1 i✓ SaR ' � f , Approximate Fill Yardage Total Req'd I Placed this shift Total to date Weather RepW Sequence No. Fill Test Dry % of Max Remark Moisture Density Dry % Ibsrcu tf Density Test Test Elevation Soil No Locabon or Type Depth —1boot - 4 %� 14.1 102. q0. i 0 -2 13.5 1033 U0 Remarks Describe equipment used hauling. spreading, watirin�. condition and compacting; also report thickness H Ilfts, removal of poor soil insufPiciently'compacted, and comment in unusual events.) e2n n the rn 001 f L S w .e n* t J kA s 7. 0 R I oh'S e !,0 biihl 0 noM 0CL L U& At 126k Sketch � x 2 9,0VEss10N K CC. C,�c�cty i�153 m No. 2 M It w E)(p ! 3D *�rr4�4TEC 0 �� Copy to Client( ) Copy to OCI ( ) Company Policy Four (a) hours mmrmum Charge lincluding Iravol time) CAL LAND ENGINEERING, INC. Quartech Consultants, Inc. by: Q G' v LUc! LL- -1 (P L._tb 31 S►LwG-P, PA; ts_ DIAMONDAR�, P� 16- 020, 03� DEM v f Cp 3 l S 1 L.vEFk, RA I►J D R D iAvv\oN p aAR CA ,