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Home My WebLink About15-1265EIIIIND. BAR .'. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY eDEVtLOPMENT 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 / Q Ck 4) / 1 ' A ' v r7t U71 APNLOT TRACT OWNER W N — pr -5 ADDRESS C CITY ZI TEL. 0 APPLICANT L' I jr;J & (,/JLO TEL. CONTRACTOR ADDRESS ZTA A kkh I 1 CITY a4 ZIP �[(�TEL.1�C%� ARCH/ NG/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 () 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.). (11, 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 forthe 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 permit,l 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 Code is available upon request when this application is submitted 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. _ se 3z LICENSE C SS: � � LIC. NO.: ^ DATE: CONTRACTOR: --r —n � E1 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 per itis issued. My Worker's Compensation Insurance Carrier and Policy Number are: Q Q CARRIER 7 /TD POLICY NUMBER JI_Q Zt3 Z THIS 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 pe .. i ue I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws peg And ree that if I should became subject to the Worker's Compensatio rovisicns ofd on 3700 of the e, h fart th co ly wt se ovisions. DATE: �� APPLICANT. WARNING: Failure to secure Worker's ensafion Covera unlawful, an a 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 certfy'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- entione property for insp tion purpoosses. !` '/ P RMITTEE NAME (PRI SIGNATURE OF PE EE DATE IOWit ""C4 11619 eJ-ptjI f, PRESS FIRMLY APPLICATION DATE: +/ P/C# 1 ISSUE DATE: I �D &f" PERMIT# TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE oJI/ # DWEL. UNIT//S # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport rn LU Patio/Deck LL Pool/Spa ZRe -Roof 00 Commercial- m II h Valuation: Adj. Area: QUANTITY DESCRIPTION FEE Q U 2 F- U J w cv z m a U w � CONSTRUCTION: PLAN REVIEW: pr •,l/r' ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: r r] SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: Gri BSAF: i O� 1T— TOTAL FEES COMMENTS: a ; a n �1 7 b pp�� r RECEIPT # -4 PAID BY: VALIDATION:—A—T-- WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTVaNf,KECORD JCIbAUtV LGI IttS �FOOTIN65 FORMS , SLAB ,, M�._ - UO.tPLUMBING ELECTRICAL e g UFtR GROUND 3 - SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR ;SHEAR WALLS INTERIOR FRAMING/VENTING � ROUGH MECHANICALS ` ROUGH ELECTRICAL W(s) C ( } ROUGH PLUMBING ,. INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING, FINAL MECHANICAL � FINAL ELECTRICAL r�INALPLUMBING,a� STC. of OCCUOANCYT - 'CERT.nf lP.t:11PANGY� � q � COMP ,r; TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ` ROUGH ELECTRICAL ° ROUGH MECHANICAL s n GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1 ST( )2 ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE ' '