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Home My WebLink About14-5278 . , �a . � -�'�°�-.::.:.-.-. . CITY OF DIAMOND BAR ` ; I ;� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��\�� `,' c� 21810 Copley Drive,Diamond Bar,CA 91765 PRESS \`,:��,�a:�� (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY '"��`'" BUILDING PERMIT APPLICATION x JOB SITE ADDRESS �� APPLICATION DATE: P/C# � � 9i ` �/ p/ i ISSUE DATE: �d.��1 y PERMIT# � /��d'�d z APN LOT T CT �—�—� � OWNERX " TYPE CONST. OCC GROUP: n ADDRESS� ZONING SETBACKS � CITY /\ O �r ZIP TEL. Z FRONT RW ❑ ¢ APPLICANT � TEL REAR ❑ x � ( SIDE/SIDE STREET RW ❑ n a CONTRACTOR SIDE ❑ � � ADDRESS PROPOSED USE s CITY ZIP TEL. � � ARCH/ENG/DESIGNER � = ADDRESS #DWEL.UNITS #STORIES #BEDROOMS z CITY ZIP TEL. I � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION a OWNEH-BUILDEH DECLARATION s I hereby affirm under penalty of perjury that I am exempt from the Contractor's STate License Law for the reason(s) SFFt/ADD/REM I � indicated below by the checkmark(s),I have placed ne#to the applicable item(s)(Section 7037.5,Business and Garage/Carport I '-� Prohssions Code:Any clty ar county that requires a permit to conshuc[,alter,improve,demolish,or repair,any z shucture,prior to Its Issuance,also requires the applicant for the pertnit to file a signed statement that he ar she � Patio/Deck I i is licensed pursuant to the pravisions of the Contractor's State License Law(Chapfer 9)Cammencing with Section w I � 7000 of Divlslon 3 of the Business and Professlons Code]or that he or she is ezempt fmm licensure and the basis for � Pool/Spa � the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjechs the applicant to a civil penalty � I ;� Z Re-Roof.. of not more than five hundred dollars($500�. p �� (�I,as owner of the property,or my emplayees with wages as their sole compensation,will do(J all of or(�portions� � � Commercial I y of the work,and the structu2 is not intended or offered for sale(Section 7044,Business and Professions Code:The m Z Contractors'State License Law does not apply to an owner of propert/who,through employees'��or personal effort,builds _ � or improves the property,provided that the improvements are not intended oroffered for sale.If however,the building or � I � improvement is sold within one year of completion,the Owner-Builde��will have the burden of proving that it was not built - � or improved for the purpose of sale.). ,. ' ' I "�. (J I,as owner of the property,am exclusively cont2cting with licensed Contractors to construct the projed(Section - Z 7044,Business and Professions Code:The Contractors'Stafe License Law does not apply to an owner of property who� V81u8tiOn: Adj.Afea: I .n buildsorimprovesthereon,andwhocontractsforlheprojeclswithalicensedContractorpursuanttotheConhactors'State QUANTITY DESCRIPTION FEE I Y License Law.). s � (_)I am exempt irom licensure under the Contractor's State License law for the following reason(s): � I 3 s L By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one w I � year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an w I owner-builder if it has not been construded in its entirety hy licensed contradors.I understand that a copy of the applicable � law,Section 7044 of the Business and Professions Code is available upon reques[when this application is submitted or at I i the following Web ite: p/vrMv ginfo.ca.gov/calaw. � z � DATE:� I SIGN: °� _ � I — LICENSED CON flACTOH'S DECLAHATION � y I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Sedion 7000) I � of Division 3 of the Business and Professions Code,and my license is in full force and eftect. J � � U i ._ n LICENSE CLASS: LIC.NO.: a I � DATE: CONTRACTOR: � ' I Q WORKEH'S COMPENSATION OECLAf1ATI0N � I � I HEREBY AFFIRM UNDER PENALTY Of PERJURY ONE OFTHE FOLLOWING DECLARATIONS: � � I have and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION: � Section 3700 of the Labor Code,for the pertormance of the work for which this permit is issued. p�qN REVI EW: � I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for /� , /� � the performance of the work tor which this permit is issued.My Worker's Compensation Insurance Carrier and ELECTRIC: J 7�/L' ¢ Poli�yNumberare: PLUMBING: � CARRIER MECHANICAL: � � PouCrNUMBER INSPECTION FEE: � (THIS SECIION NEED NOT BE COMPLEfED IFTHE PERMR IS FOR ONE HUNDRED DOLLMS($100)OR LESS�. ISSUANCE: �i��`I � I certify that in the perfortnance of tl�e work for which this permit is issued,I shall not employ any person in any manner so as to SMIP: become subjed to the Nbrker's Compensation Laws of Califomia.And agree that if I should become su6ject tn the Worker's J Compensatio pro isions M Section 3700 of ihe Labor Code,I shal/l f/°�ith I with tltose provisions. ENERGY P/C: i DATE:j��Z��APPLICAN7:X�ia/ � ENERGY PERMIT: � WARNING: ailu to ecure Worker's Compensation coverage is unlavrful,and shall subject an employer to criminal RETENTION FEE: -r/�� y penalties and civil fines up ta one hundred thousand dollars(3100,000�,in addition to the wst of the compensation, � 1 damages as provided for in section 3708 of the labor code,interest,and attorney's fees. PRE-ALT FEE: � Y CONSTNUCTION LENDING AGENCY BSAF: i y I hereby affirm under penalty of perjury that there is a Construction Lending Agen�y for the performance of the work for � which this permit is issued(Sec.3097,Civ.C.). LENDER'S NAME: � LENDER'S ADDRESS: i I certity that I have read this application and state that the a6ove information is correct.I agree to comply with all ciry and TOTAL FEES g 9� r1 �1 � county ordinances and state laws relating to building�construction,and hereby authorize representatives of this county to COMMENTS: � V V � z � enter upon e a ve-mentioned prope for inspection purposes. J � � � _/ �� ¢ ERMITTEE N (PRINn /1�/ � = IGNATU ERM E DAlE RECEIPT N��y� PAID BY:�� .r I VALIDATION: �J�'/ ' � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy CITY OF` DIAt�IOND BAR INSPECTIC?N RECORD � � � � � - • � � . � . ;SETBACIG LETTER��"� "�'� � � �'�,��;��, :' ,, g� TRACT AND LEDGER FOOTINGSgFORMS �� " �, �k`= �'�`' '' _�� `�- ; j � � _�u "� =�_�_._ :_- � � SWITCH GEAR �SLAB-:;,� `�° � �� ;" ��, �a° � �CQMMERGAL HOOD � UG�'PI:UMBING;�' �' � �� ' � ' 3�'��, ..�� ''��''��.�__.� +�',x�. � �T-BAR IIG.ELECTRICAL °�s�'�� "�`� "`' � ��;��,;�. ��" 4 ra " �; � INTERCEPTER �UFER;GROUND� ��.��, ,��',��, ��.- ,�� "�� '�' HOT MOPISHOWERPAN SEWEFi lr1TERAL !SEPTICr'CESSPOQL MAIN WATER LINE I �HERS REPORT RECEIVED SEWER CLEANQUT j I DEMOLITIQN ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ---� ROUGH CONDUIT - : . 3SHEAR lNA'L�LS EXTERIOR�: ; ' �"'` � �.��<&,,.�;��. � . , � ,Y ' �POOUSPt1` `4 ,: � , _ �. ._ ,: - �,, . � � _.� �:� �SHEAR,WALL.SINTERIOR�:�� _ _--�. �,'�� . --� _ OUG UMSlNG; � � �� r __ � _ __,. � � � � � ,, ,�� ,r�� r � : �R H PL,�... _.:_ -�� ,s ,�, r,�,� ��: ;ri�:.. , ._ w�.. � �'.,,�� . �FRAMINGNENTING . �� ,�, �� ,,. � � � `�`° �? �,.,,. �'��^� ��,, � ��, � � ;�� . RROUGH ECEGTRICAL ,�, ,� � ��.;. - �. �t � , r -� �_ .. ROUGH MECHANICAL �" � • � � � � �� ,' ��' ,�„ROUGH MEGNANIG�AC '"� '��" ��' �� n �� . e�,��:�_ `��; m_�'�,,. ROUGH ELECTRICAL:Nl{�.)�G( ) ::._ .� � , s..�.� " `_� ,aw.. a»;�� '� ��'�%� ,GAS,�TEST,.;� `� : _,;,�, ,��'6 �,,��' �� h,. � � � �.. � ' � ... _ .: ,..�.. ,._ . _�. _ =" �ROUGH PLUMBING ��- � � ��'�� ` `„�M �� ,�,. ;F'FlE Gt1Nlt€� � �„� �� , � , � . �,o, T� , .�. - -� � � �..b. _ ,, . , ..< . , ,� INSULATION WALL ;P(IOL PRE-:DECK,BONDING�` �''� � �":_�.��,a� , +,�� r � INSUTATIQN CEILING � , �;F<TRAP � . �, �°•� ��-- ��; '° �'�'s.�- �,.�;; .__., DRYWALL FENCE I�GATE/ALARM� �� __--_------�—.._ _..— --- -- - LATH(PREi � .FINA�POOE.• ��,� � ��,, �!. �,% �;� �� , � � ,. ._ v. , . _� ,._ n LATH EXTERIOR I WALLS: LATH INTERIOR (WALL FOOTING,'STEEL GAS TEST �WAL�STEEL 1s�( )2N°( j LIFT SCR,4TCH COAT ;WALL BOND BEAM ELECTRIC METER RELEASE �WALL DRAIN/SEAL GAS METER RELEASE _ WALL FINAL SPECIAL INSPECTION � � � ;RO�FFiAMING Pi.MJhJINGAPPRWAL �.c ;��,. x.�';�.. , � � '"' p� ��-� �. ,�.W - , .�� : ,� � _ � ' �� a" : �`�_.. � �F�: �FINAL BUILDING . -,��,�•� � _, :'� °,� ,' �Y �ROUGH FIREAPPR_d,VAL .% ,. , FINAI*MECHAN(CAL `,� °4� �� `�� ` � � �� ,-�, �„ �: s ,;; _ ... .r �n. � � _ �� E��INAL�FIRED£PA ,,>`� ��il, �� , -= _ - �« r�— .. FINAL"ELECTRIGAL, .,�; , ��Z! �� '�<. ;{ ,;,�i � � ".`,.� `FINAI'PIANNtlVG ., � A„�,�� ,��..,. ., ` � ,.F, �'r, '' , ,�„;.�. �a�� . . � 9 � � FINAL'-�PLk1MBING �- � � �� ._�,� �� FINAL.ENGINEERING � , .�. �, � �a� - - � `� - �%PW �� - v:. � : � � �7.C.of.00CUPANCY �`�� , ,a . �� <�g�'��,� ` 'F[�1AE.COIVIMUNITY,SERVICE$ .,� `� �e„ _, ��= ,�" � ; ��.� � � ��_ ��, �� . a.;� ,CEBT.of OCCUPpNCY'' ;� ;�� r �' ��e ,FINAI NEALTH dfP,Tr,�-��. �2;, ��'� �� ''� EINAL INDIISTRIAL WA3TE' ' � ' '�� , "`�� ' �: .�. ';� COMMENTS: � • .� .t �' � ��` _ � ' � T �� . ��t:rue�r�u,�c�o` �b8� Building & Safety Division 21810 Copley Drive Diamond Bar;California 91765 (909)839-7020 Fa�c (909)861-3117 �,� � Job Address:� �, �r t ��- Dear Property Owner: An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified. For your protection,you should be aware that as"owner-builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by properiy owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City of County. They are also required by law to put their license number on all permits for which they apply. If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs)is$200.00 or more for the entire project,and such persons are not licensed as contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under the federal law,contact the Internal Review Service (and if you wish,the U.S.Small Business Administration). For more specific information about your obligations under State law,contact the Department of Benefit-Payments and the Division of Industrial Accidents. � If the structure is intended for sale,the property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an"owner- builder' building permit,erroneously implying that the property owner is providing his or her own labor and materials personally. Building permits are not required to be signed by the property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board at 9821 Business Park Drive,Sacramento,CA 95827,www.cslb.ca.�or at(800)321-CSLB(2752). Please complete and return the enclosed"Owner-Builder' verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. . , . r ..� _ �._ -- _�. .�� ,,,r:,�.,�„��n' ��s� Building & Safety Division 21825 Copley Drive Diamond Bar,California 91765 (909) 839-7020 Fax (909)861-3117 Attention Property Owner: An"Owner-Builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received by us. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement(yes or no). 2. I (have/have not) signed an application fbr a building permit for the proposed work. �I have cQ�ntra ted with the following person(firm)to provide the proposed construction: Name _�Wo� ;it 1,GtGf Address�� ;('o f�►�P City -So H {� ,T� jt/f��e' PhonebZ� .��D� �� Contractors License No. / � / � � � 4. I plan to provide portions of the work,bizt I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed Property Owner Date