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Home My WebLink AboutPR16-2722CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES DLIVIO 'D HIM 51! 21810 Copley Drive, Diamond Bar, CA 91765 R PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 NA BUILDING PERMIT APPLICATION �MLY JOB SITE ADDRESS ' APN LOT TRACT OWNER e- QQ \--t e, ADDRESS W CITYD\QM13P% A bLV- ZIP gZA_\�DC)TELfAZ - APPLICANT TEL r O CONTRACTOR M f O r Mck b 1 f %J ck -1ir e Y N eci -t- f r S ADDRESS e Q CITYy a\tn6O ZIP CI3SS TEL. ` S. O 1 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 70M 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). L) I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (J 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 w buildsorimprovesthereon,andwhocontractsfortheprojectswithalicensedContractorpursuanttotheC.ntract. ate License Law.). (-) 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 h sided for at least one year prior to completion of the improvements covered by this permit,) cannot legally sell a s ture that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I and rid that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request en this application is submitted or at the following Web site: http/www.leginto.ca.gov/calaw.html. DATE: SIGN: 7�nLse NTRACTOR'S I ARATION I hereby affirm under penalty of perjurynsed unde revisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profeand my ense is in full force and effect. LICENSE LASS: LIC. NO DATE: ,1 COAOMPENS N DECLARATIONI HEREBY AFFIRM UNDER PENALTY OF OFTHE FOLLOWING DECLARATIONS: I have and will maintai a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the or Code, for the performance of the work for which this permit is issued. I have and will ntain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performa a of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Nu er are: y. POLICY NUMBER e h, 14 q, O D (THIS SECTION NEED NOT BE COMPLETED IFTHE 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 Comp on provisions of Section 3700 of the Labor Code, stall forthwith comply with those provisions. DATE. 7. 1�D APPLICANT: WARNINure to secure Worker's Compensation keo4rage 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. r O PERMITTEE NAME (PRINT) 12 ( SIGNATURE OF PERMITTEE _ DATE APPLICATION DATE: 7 ISSUE DATE: I i/2PP TYPE CONST. D1 P/C�#-� i / {R I l0 PERMIT# f - 24 M OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW ❑ ❑ RW ❑ ❑ PROPOSED USE # DWEL. UNITS # STORIES �-' EDROOMS DESCRIPTION SQ. FT. FACTOR ADJ. AREANALUATION SFR/ADD/REM Garage/Carport rn w Patio/Deck LL Pool/Spa zRe -Roof � 00 Commercial m Valuation: O . O O Adj. Area: QUANTITY DESCRIPTION FEE J U IL w w z m J O o = (L a U Q CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: L �V BSAF: TOTAL FEES COMMENTS: RECEIPT # 3 7L11 PAID BY:�._ VALIDATION: L WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK(LETtER : FOOTINGS fORMS m ;UG ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING rn n^ INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION COMMENTS: TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T-BAR INTERCEPTER HOT MOP/SHOWERPAN �I SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS I ROUGH CONDUIT FENCE / GATE/ALARM m ANA POOL " WALLS: WALL FOOTING/STEEL WALL STEEL 1 ST( ) 2N°( ) LIFT WALL BOND BEAD WALL DRAIN/ SEAL WALL FINAL ' FI LF1 y �:l Fl FI a I Fl FI