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Home My WebLink AboutPR14-041CL z 0 0 LUJ rn a 0 000 Coo . CITY OF DIAMOND BAR �,Vfl_ _ IT r 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 www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS Z CA.5 S APN LOT TRACT OWNER Z n ADDRESS N55Y CITY ZIPMO TEL. ! _ APPLICANT r 1 'A- O c4i - TEL. QM � U - SSG CONTRACTOR ADDRESS CITY ZIP 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). I, as owner of the property, or my employees with wages as their sole compensation, will do L_) all of or U portions f he 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' Slate 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 exemp from icensure under the Contractor's St t 'c ns le rise for the following reason(s): Date: 1 3 ) Sign: By my signature below I acknowledge that, except for my per nal re � e e in which I must have resided for at least one year prior to completion of the improvements covered by this permit,l ca of 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 force and effect. LICENSE CLASS: LIC. NO.: EXP.DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 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 POLICY NUMBER (MIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I cert fy 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 Compens`ati n pro .sions of Section 3700 of the Le or Cod all forthwi comply with th A e provision_s.I DATE: 1 % APPLICANT: �YeIZL./Y-'-�, (V 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 Rhe above-mentioned property for inspec'on purposes. X 6 PERMITTEE tIGNATUK OF PERMiTTEE"A DATE APPLICATION DATE: 3' '� P/C# ISSUE DATE: /;;A-1 PERMIT# : M ��I TYPE CONST. OCC GROUP: % Scope of Work qC # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport Patio/ eck W LL Pool/Spa ZRe -Roof Commercial m Valuation. .� Adj. Area: QUANTITY DESCRIPTION FEE a U U W z m J a Z_U Q x U CONSTRUCTION: PLAN REVIEW: t kO ob - 49 tam • ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: ' d • \ �::z SMIP: i Q S ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: RQ, - f BASF: f7C PLOT PLAN: ZONING CLEARANCE: 111,22. g� TOTAL FEES �� • « COMMENTS: g-S�s 9'� P/C:3 1 Z PAID BY: VALIDATION:_ RECEIPT VOf- PAID BY: 11��''S� VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy 0 Z.� CITY OF DIAMOND BAR INSPECTION RECORD :-.-.-IN PE, TION... At E: A N PECTOR. SETBACK/ LETTER�' I.NSPECTION. DATE .'INSPECTOR. - TRACT AND LEDGER FOOTINGS FORMS " SWITCH GEAR SLAB COMMERCIAL HOOD UG PLUMBING; •°" ;,' _ �; T BAR UG. ELECTRICAL-.' INTERCEPTER UFER"GROUND HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEAR"WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR _ ROUGH PLUMBING FRAMINGNENTING - , ": ROUGH ELECTRICAL ROUGH MECHANICAL,..' ROUGH MECHANICAL ROUGH, ELECTRICAL; W(. GAS TEST ROUGH PLUMBING ..'- . PRE GUNITE - INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE/.GATE/ALARM LATH (PRE) FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1ST( )2ND( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION R0. FRAMING PLANNING APPROVAL FINAL BUILDING, - FINAL MECHANICAL ; " , ROUGH FIRE APPROVAL FINAL FIRE -DEPARTMENT FINAL ELECTRICAL% =' FINAL PLANNING FINAL PLUMBING. '_l FINAL ENGINEERING/ PW T.0 of OCCUPANCY = ' ; FINAL COMMUNITY SERVICES CERT of""OCCUPANCY FINAL•HEALTH DEPT. " _ . FINAL INDUSTRIAL WASTE C MMENTS. LAS