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Home My WebLink About15-0707L1NOND ti Al: CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DF VELOPMENT 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 / YZ APN LOT n TRAC OWNER I6 ADDRESS CITY Q TEL. i APPLICANT TEL. CONTRACTOR r AD RSS (� CITY ZIP TEL -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 items) [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.). (-) 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 permit,) 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.htmi. 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 i full fof an eftt. �� LICENSE CLASS: v L 0 ✓ DATE: CONTRACTOR: 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 fiction 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 Nuriper ar y CARRIER -L LA POLICY NUMBER L (THIS SECTION NEED NO BE COMPLETED IF E MIT 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 Workers Compensation provisions of Section PLIC NT of the LabgrCbdp„I shall forthwith cpq�py7vvioVQq eo& provisions. DATE: APPLICANT: _�/ y��L/�. � �I \7�x l� WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shalk9bject 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 upo he above-mentioned pro any for inspection purposes. PERMITTE NAME SIGNATURE A LME9RESS FIRMLY APPLICATION DATE: [ P/C# fi ISSUE DATE: J6 IDI PERMIT# ),r TYPE CONST. OCC GROUP: n ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW RW ❑ ❑ ❑ ❑ PROPOSED USE # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport rA w Patio/Deck LL Pool/Spa ZRe -Roof 0 j Commercial I M I Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a 2 I J w GA y i c� z M i a U Q CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: I ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: TOTAL FEES COMMENTS: �D I RECEIPT # PAID BY: SIU VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy UGPLUMBING WALL FOOTING/STEEL T -BAR UG.,ELECTRICAL WALL STEEL 1ST )2 ND( ) LIFT SCRATCH COAT INTERCEPTER_ UFER'GRdUNG WALL BOND BEAM WALL DRAIN/ SEAL HOT MOP/SHOWERPAN SEWER LATERAL e�g WALL FINAL SPECIAL INSPECTION SEPTIC/CESSPOOL MAIN WATER LINE _ FINAL BUILDING :- Vie. HERS REPORT RECEIVED SEWER CLEANOUT FINAL FIRE DEPARTMENT DEMOLITION ROOF SHEATHING Q r oN FINAL PLANNING 'FIN/1LAUMBING "' � ROOF DRAINS FLOOR SHEATHING �— -FINAL ENGINEERING/ PW _ ROUGH CONDUIT SHEAR "LLS,EXTERIOR, CERTmnf OCCi1PANCY FINAL 'HEALTH DEPT. POOL/SPA SNFRWALL INTERIOR` FINAL INDUSTRIAL WASTE COMMENTS: ROUGH PLUMBING FRAMINGNENTING ;'rt- ROUGH ELECTRICAL ROUGH MECHANICAL', ROUGH MECHANICAL �' E ) C ( ) ROUGH ELECTRICAL W GAS TEST 'ROUGH PLUMBING _F x:r PRE GUNITE INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL GATU ALARM LATH (PRE) -FENCE/ FINAL POOL _ LATH EXTERIOR f WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1ST )2 ND( ) LIFT SCRATCH COAT A WALL BOND BEAM WALL DRAIN/ SEAL ELECTRIC METER RELEASE - j GAS METER RELEASE e�g WALL FINAL SPECIAL INSPECTION RO. FRAMING PLANNING APPROVAL FINAL BUILDING :- Vie. ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL . 7� Ali , Q r oN FINAL PLANNING 'FIN/1LAUMBING "' � aka � -FINAL ENGINEERING/ PW ilt. of OCCUPANCY ,- FINAL COMMUNITY SERVICES CERTmnf OCCi1PANCY FINAL 'HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: