HomeMy WebLinkAbout14-4520 �'`'?"r��;.__ CITY OF DIAMOND BAR • �QI tQ �a�Ip�Q y�1�'1� '.,
i I I I,.,I ' �I DEPARTMENT OF COMMUNITY&DEVELOPM�NT SERVICES �
�1I„� ;�- � 21810 Copley Drivc,Diamond Bar,cA 9i��s . , PRESS. -
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��,,�,,,�,,� (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839=7027 � FORMLY
- �J8�� : BUILDING PERMITAPPLICATION
� JOB SITE ADDRESS APPLICATION DATE: X^ �'�� Wl� / P/C#
oz APN LOT_TFtACT ISSUE DATE: �CI _��' �J"/ PERMIT# ��: L�.I�dd
o OWNER � O TYPE CONST. OCC GROUP:
� ADDRESS Clr SL-Q .
� CITY 1 WlOtil /ZIP TEL. ZONING F ONTCKS RW
� APPLICANT o TEG D REqq ' �
0
Q CONTRACTOR S�K S' � �� SIDE/SIDE STREEf RW ❑
o SIDE ❑
� ADDRESS � . P•
� CITY��y�l1_ZIP 9�TEL. 87—8 9L PROPOSED USE -e, r'Sh� 120�
o . / '' Ui 5. .� l Wo0
o ARCH/ENG/DESIGNER 4 � � Coe S�
o ADDRESS ' '
�i DWEL.UNITS #STORIES #BEDROOMS
z CIN ' ZIP TEL.
Q own�t-euan�oEcuwanoN DESCRIPIION SO.FT. FACTOR PSF ADJ.AREANA�UATION
o I hereby amrm under penatty of perjury that I am exempt hom the Ca�racta's State License Law for tt�e reason(s) SFFVADD/REM
o indicatetl helow by the checkmark(s),I have.placed next to Me aDDlicable ilem(s)[Section 7031.5,Buslness and Garage/Carport
o Rofesslons Code:Any city or counry that requires a permlt to wnstruct,alter,Improve,demo�Isb,a repatr,anr -
z sWcNre,prior to its Issuance,also requlres the applicant for tha permlt to file a slgned sfatertrent that he or she y Patio/Deck
� is licensed pursuant to the prorisions of the Contractor's Slate Llcense Law(Chapter9)Qomme�Ing with Secllon W
� 7000 of Division 3 of the Business and Professlons Cade]or that he or she is exempt hom Ilcer�sure and the basis tor u. PooUSpa
N the alleged exemption.Any violation of Sec6on 7031.5 by any aDVlicaM for a permit subjects me applicant fi a civil penalty C9 o^ �
N R�Roof
of not more than five hundred dollars(3500). � 2 pV� .SO�a
o I,as owner of the ro e or m em lo ees with wa es as thelr sole com nsation,wlll do all of or �
U P P rtY, Y P Y 9 Pe U U PorUons � Commercial
� of the work,and the structure is not Intended or ottered for sale(Section 7044,Buslness and Professlons Code:The �
� Contractors'State License Law does not apply ro an owner of property vfio,through employees'or personal etfort,builds m
� or impwves the properry,pmvlded that the Improvement5 are not Ir�ended or oTfered 1or sale.B however,the building or
� improvement is sold within one year oi compfetion,the Owner-Builder will have me burden al proving mat It was nat Cuilt
p- or improved for the purpose oi sale.). � �
U �
� .U I,as owner of the property,am eacluslvely conVactlng with Ilcensed Contractors to construct the project(Section .
z. �7044,Business and Professions Code:The Contradors'State Llcense Law dces not appy In an aumer of property wta Valuation: Adj.Afea: � � ��
�; �bul�dsorimproveslhereon,andwhocontractsfatheprojectswithalicensedContraclorpursuarrttotlieContractors'State QUANTffY DESCRIPTION � FEE
Y License Law.).
o U�am exempt trom licensure under the Contracror's State Ucense law for the following rea5on(s): . � �
�. �
LL By my si nature below I acknowled e that,erce t tor � �
9 g D mJl Personal residence In which I must have reslded tor at least one �
o year prior to completlon oT the Improvements covered by this permit,l cannot legalty sell a structure ihat I have buitt as an w . �
a owner-builder it it has nol been constructed In its entirety by licensed contractors.I undersTand ttiat a copy of ine applipble '
� law,Section 7044 01 the Buslness and Professlons Code is avallable upon request when thls apptlratlon Is su6mmed or at �
X the following Web site:httplwvrw.leginto.ca.gavlcalaw.htrnl. Z
. Q OATE: SIGN: � - � I
� LICENSED CONTRACTON'S UECLARATION � • � �
a
W I hereby aftirm untler penalty of perjury that I am licensed under provisions of Chapter 9(crommencing wRh Section 7000)
m ot Division 3 01 the Business and Prolessions Code,and my Gcense is in futl force and eftect. J .
� LICENSECLASS• ��� 1 LIC.10.: ���5S �
s
o �ATE: Z CONTRACTOR: . � .
� , WORKER'S COMPENSATIO UEC RATI � �
� 1 HE_ RE�Y AFFlRM UNDER PENALTY OF PERJURY ONE OF h1E FOLLAWING DECLARhT10NS: '
¢
. o _I have and will maintain a Certi�cate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION:� ���. 2 9
� Section 3700 0l the Laba Code,for Ihe performance of the wak for whlch thls pertnit I5 issued. PLAN REVIEW:
� I have and will maintain Worker's Compensation Insurance,as reQuiretl by Seclion 3700 of the Labor Code,for
z the peAormance ot the work for which this permd is issued. Waieer's Compensatlon huuurance Carrier and � ELECTRIC: �
¢ PolicyNum6erare: �^�C v� . PLUMBING:
� CARRIER � MECHANICAL:
� POLICY NUMBER �
INSPECTION FEE:
� (fHIS SEC110N NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE MINURED�OLIARS($100)OR LESS�. .r� �
ISSUANCE:
� I certify that in the peAormance al the work for which Ihis pertnit's issued,I shall mrt empby arry perspn In arry nqnner so as ro �
o hecome subjed ro me Workers Compensatlon laws ot Calitomia.Md agree Nat H I shald becar�a subject m the Wakerg SM IP:
LLCom n wision of Sedion 3700 of Iabo�Code,�tortrywitli complqrvilh those prwl�lprs.
J �� . � �" ` ENERGY P/C:
DATE:. PPLICANT: �ii��� (/[�� 1�� ENERGY PERMIT:
� WARNING:Failure to secure Worker's Compensadon co raev ge is unlawful,and shall subject�an empluyer to Grjminal. � O
� w penaftles and civil fines up to one hundred thouund dollars(5100,000�,In addwon to the cost M the compensation, REfENTION FEE:
o damages as prrnided tor in section 3706 ot me labor code,imerest,and attomey"s tees PRE-ALT FEE:
a CONSTRUCTIDN LENDING AGENCY _., �� BSAF. � I�DD
= I hereDy affirm under penalty ot perjury that there is a Construction Lending Agency la,ihe pedortnance o1 the work for �
� which this permit Is issued(Sec.3097,Clv.C.).
� LENDER'S NAME � �� !
,. � LENDER'SADDRESS: /
� I certify that I have read thls application and s[ate that the ahove I�ormation is cortect�:l agree N canpy with all cIty and TOTAL FEES
� county ordinances and state laws relating N building conshucdon,and hereby authorize representatives of this county to COMMENTS:
Z .
p enter upon the above-mentioned property for in ction purposes. � �
m � � Q � r�
a P R NAME RINn n . ,
"' ZS Z 8 1�,
� SIGN RE PERMI E � pATE RECEIPT It �71/�ll� � PAID BY: CG F'� VALIDATION:�
��—
WHITE—Department Copy,YELLOW—Fnance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy '
CITV�OF DIAMOND BAR
INSPECTION RECOR� '
• � , . � . . � � , . � .
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MAIN WATER LINE HERSAEPORT RECEIVED
SEWER CLEANOUT ' DEMOLITION ,
ROOF SHEATHING 4 ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
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LATH EXTERIOR WALLS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�'( )2N0( )LIFT
SCRATCH C�AT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAI INSPECTION �f30y FfiAMING PL}WfVINGAPPROVAL '�;;;;�£;;"rt,,:,7f `'� `��'"r"'��';� "''', ��Y``�L�
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COMM'ENTS: