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Home My WebLink AboutPR16-1094DLVIOND BAR CITY OF DIAMW4b BAIL DEPARTMENT OF COMMUNITY & DEVfE06PMENT SF;RVICE$ 21810 Copley Drive, Diamond Bar, CA 9178'5 ' (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION wwwyf:scyofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS a"a,06! 1 APNg _01d'e11 LOTa3 TRACT 3-6407 A _ 1. OWNER U &4X Nf 1 ADDRESS r";51,06 ^E1Ge. ,o L rge L.0 CITY 0l 0A &WZIP '1L4i5_ TEL. &R&2 APPLICANT V _&h1g g dtt TEL. !104 - CONTRACTOR D4 -CONTRACTOR D 0 Is ADDRESS �� PCYV\Q_ 00,V- CITY1 (14 1 iQ,s ZIPTEL.��'33i+ FrI3 ARCH/ENG/ DESIGNER ADDRESS Q CI S ZIP- TEL. 33 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 Codel 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): 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 Cade is available upon request when this application is submitted or at the following Web site: httplwww.leginfo.ca.gov/calaw.htmi. 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: C5 3 LIC. NO.: DATE:,5/z(f 6 CONTRACTOR: lhlr, ` 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: ,�+ ► ,,� ,,f 4 CARRIER e0+Ck � 'C' L) POLICY NUMBER IA & O q t A& (MIS 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- 'ect to the Worker's Compensatio prov ions of Section 3700 of the bor Mde, I shall o wi com ly those prov' i 'ons. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is VIal, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($10n addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest,rney'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. �ah 6 PER M (PRINT) 1 SIGNATURE OF PERMITTEE DATE M PRESS FIRMLY APPLICATION DATE: J_ Zlld-01 pP/C# AA11,O -/0 ISSUE DATE: PERMIT#: / / /O TYPE CONST. OCC GROUP: Scope of Work '( i S # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport 'J) W Patio/Deck W LL Pool/Spa ZRe -Roof Commercial 5 m Valuation: 5 1BOD Adj. Area: QUANTITY DESCRIPTION FEE a U it J we o r 3 w co 1 M m J U z , CONSTRUCTION: PLAN REVIEW: S�7. ELECTRIC: PLUMBING: n MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: p RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: L ZONING CLEARANCE: 7a 7J TOTAL FEES COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT s__JJ21;3_2PAID BY:i/— VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF P, . IAAMIAD RAR`--. AlNSPE.IC`i IQN RECORD INSPECTION DATE INSPECTOR INSPECTION DATE ANSPECTOR TRACT AND LEDGER SETBACK/LETTER FOOTINGS FORMS SWI CCH 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 POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH MECHANICAL GAS TEST PRE GUNITE ° POOL PRE DECK BONDING ROUGH ELECTRICAL W( ) C () ROUGH PLUMBING INSULATION WALL INSULATION CEILING P -TRAP FENCE / GATE/ ALARM DRYWALL LATH (PRE) FINAL POOL WALLS: LATH EXTERIOR LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1ST( ) 2ND( ) LIFT 1 SCRATCH COAT WALL BOND BEAM ELECTRIC, METER RELEASE WALL DRAIN/ SEAL � GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL FINAL PLANNING FINAL PLUMBING FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. of'OCCUPANCY FINAL HEALTH DEPT. COMMENTS: FINAL INDUSTRIAL WASTE