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Home My WebLink AboutPR16-282810ND CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOB SITE ADDRESS 911 10 \ 70 APN LOT TRACT OWNER 11�61 Crkkd gkf 1. ADDRESS 'M N QCA Sol (-N CITY MAML CiAf ZIPRII(.ti TEL. `I A-1(015'30NS APPLICANT TEL. CONTRACTOR PIRA Qcyt r f 7l 6 '17nL ADDRESS _ 3(1Z ea1U V ��VI 1 CITY7[MAU PdXk ZIPgZ164 TEL.11q—Zq-7P& 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 Cade: 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.). (, 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 far my personal residence in which I must have resided for at least e year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built s an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the ap !cable law, Section 7044 of the Business and Professions Cade is available upon request when this application is sub ed or at the following Web site: http/www.leginfo.ca.gov/calaw.html. DATE: SIGN: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencin ith Section 7000) of Division 3 of the BusinessandProfessions Code, and my license is in full force and effect. LICENSE CLASS: `� /W LIC. NO.: - - r DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION I have and will maintain a Certificate of Consent to Self -Insure for Wor is Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for wh' h this permit is issued. I have and will maintain Worker's Compensation Insurance, as require by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My We er's Compensation Insurance Carrier and Policy Nu CARRIER mb r are: ^ n Alrx POLICY NUMBER,��_/�� (KA/f�✓!1 (THIS SECTION NEED NOT BE COMPLETED IFTHE PE/_d ONE HUNDRED DOLLARS ($100) OR LESS). I cerMy that in the performance of the work for which this permihall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of Califore that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I scomply with those previsions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation cov ge is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand Ilars (S100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor ode, interest, and attorney's fees. CON UCTION LENDING AGENCY I hereby affirm under penalty of perjury that ere is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. valm PERMI Z• 13-16 SIGN R ERMITTEE DATE PRESS FIRMLY APPLICATION DATE: h2i! J/1 V P/C# /C ISSUE DATE: l2I t3��c. PERMIT# t' A I UZ`g2$ TYPE CONST OCC GROUP ZONING SETBACKS FRONT W REAR SIDE/SIDE STREET RW SIDE Z ❑ ❑ ❑ ❑ PROPOSED USE &W, 4 FJ R Ga- a (4 SfWJ &VI _ C - # DWEL. UNITS # ST RIES _� # BEDROOMS DESCRIPTION SO. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport u) w Patio/Deck LL Pool/Spa ZRe -Roof O � Commerc' i m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a 2 U w w m J rL a U Q w CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: -Ob BSAF: TOTAL FEES COMMENTS: i.t 3.OZ RECEIPT# _Vm—n PAID BY: V VALIDATION: YJ� WHITE— Department Copy, YELLOW— Finance Copy, PINK —Assessor Copy, GOLDENROD— Fite Copy, GREEN —Applicant's Copy CITY OF DIAMOND BAR , INSPECTION RECORD SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING TRACT AND LEDGER SWITCH GEAR ;•_ COMMERCIAL HOOD IK, T-BAR " _ INTERCEPTER HOT MOP/SHOWERPAN I SEPI TIC"CESSP00L HERS REPORT RECEIVED _ DEMOLITION _ ROOF DRAINS _ ROUGH CONDUIT SHEAR,WALLS EXTERIOR SHEAR',WALLS INTERIOR F6AMING/UENTING ROUGH MECHANICALu,'' ' � ,R0UGH ELECTRICAC'W{ ) C R0UGN P-LU M B I IN G,;,4, ' INSULATION WALL INSULAT ION CEILING DRYWALL LATH (PRE) I LATH EXTERIOR LATH INTERIOR ,GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION I FINAL BUILDING' n ,FINAL: MECHANICAL„ FINAL ELECTRICAL ,' FINAL PLUMBING` " ,, , ' T.C. of OCCUPANCY . 'CE;T. of,QCCUPANCYz COMMENTS: