HomeMy WebLinkAbout15-0937U11 10,11D BAR
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CITY OF DIAMOND BAR FI ALnD
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION I
JOB SITE ADDRESS / 7d SIYA AI l T / 111 A
APN NfLOT . TRACT
OWNER
ADDRESS
CITY ZIP TEL.6M 2410 S_ 7S
APPLICANT C_,,91LS7nL ATWJS TEL. 7 !V 2 711 7i S7-
CONTRACTOR
ADDRESS ��r,I%S /I VA
CITY C/�C%!/� Z. ZIP %TEL.
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 70315, 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 ( ) all of or U 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.).
CJ 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 permiLl 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: hnWwww.leginfo.ca.gov/ralaw.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 P Cessions Code, and my license is in full force Jan�d effect. /n
LICENSE C S: UC. NO.: f9(,I0C4 lU
DATE: Z I CONTRACTOR:
WORKER'S COMPENSTION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certificate of Consent to Seg -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 permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER 1
POLICYNUMBER '%f' (gI
THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($$100) OR LESS).
I codify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to
become sub'ect t the Worker's Compensation Laws of California. Antl agree that if I should become subject 10 the Worker's
Comped p ' b of Section 3700 of the Loboj.Code, II sh larthwith comp thos �isiorrs.
DATE: APPUCANi: lo,�ll
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and sal all subject an employer to criminal
penalties and civil fines up to one hundred thousand dollars (5700,000), in adtlition to the cost of the compensation,
damages as prov ded for in section 3708 til the labor code, irderest, 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 upon the above-mentioned property for insp ction purposes.
1 ac-g tS
PE tEME,(P NT) S_
SIGNA ITiE DATE G
S
APPLICATION DATE: T 2� �S
ISSUE DATE:—WI/
TYPE CONST.
P/C#
PERMIT# 1f _ 0'93 1
OCC GROUP:
ZONING SETBACKS
FRONT
REAR
SIDE/SIDE STREET
SIDE
RW ❑
❑
RW ❑
❑
PROPOSED USEO
Xwr
# DWEL. UNITS # STORIES
/G rlg
lwwlT U
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
co
W
Patio/Deck
LL
Pool/Spa
ZRe
-Roof
ca
Commercial
m
Valuation:
Adj. Area:
QUANTITY DESCRIPTION FEE
J
U
U
W
w
z
m
J
d
J
z
U
W
iP-_
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
•7�9 _7:
�7
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BSAF:
TOTAL FEES
COMMENTS:
rodr L70
J
RECEIPT# 4Y PAID BY:
VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy
GaSlimll CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION
D ATE
INSPECTOR
SETBACK/LETTER
COMMERCIAL HOOD
FOOTINGS FORMS -• : ``
INTERCEPTER
SLAB
SEPTIC/CESSPOOL
UG. PLUMBING
DEMOLITION
UG( ELECTRICAL
ROUGH CONDUIT
LIFER GROUND
ROUGH PLUMBING
SEWER LATERAL
ROUGH MECHANICAL` ,
MAIN WATER LINE
PRE GUNITE
SEWER CLEANOUT
P -TRAP
ROOF SHEATHING
FINAL POOL :.
FLOOR SHEATHING
WALL FOOTING/STEEL
SHEAR WALLS EXTERIOR.
WALL BOND BEAM
SHEAR WALLS INTERIOR
WALL FINAL
FRAMINGNENTING
ROUGH FIRE APPROVAL
ROUGH 'MECHANICAL
FINAL PLANNING' '
ROUGH ELECTRICAL W( ) C
FINAL COMMUNITY SERVICES
ROUGH.PLUMBING_
FINAL INDUSTRIAL WASTE
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
lf'
FINAL MECHANICAL`
FINAL ELECTRICAL
' rr.
FINAL PLUMBING .-
T.C. of OCCUPANCY
CERT. 4 OCCUPANCY
COMMENTS:
INSPECTIONDATE
INSPECTOR
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T -BAR
INTERCEPTER
HOT MOP/SHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOL/SPA
ROUGH PLUMBING
ROUGH ELECTRICAL -
ROUGH MECHANICAL` ,
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P -TRAP
FENCE / GATE/ ALARM
FINAL POOL :.
WALLS:
WALL FOOTING/STEEL
WALL STEEL 1-( ) 2nD( ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
RO. FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING' '
FINAL ENGINEERING/ PW •
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE