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Home My WebLink About16-0809 .�n��"�_� ,,.._ CITY OF DIAMOND BAR I I 1 i DEPARTMENT OF COMMUNI'a'Y�D�VE�,OPMENT SERVICES �� II��' - " 21810 Copley Drive,Diamond Bar,cn 9»6s - PRESS (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 F�RMLY C 'e"�� BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov � + V �� .+"v ' ,� ""� APPLICATION DATE• P/C# a JOB SITE ADDRESS 1 � � � � P�vs�►2{(/ � / � � � APN LOT TRACT ISSUE DATE: � PERMIT#: �� N OWNER S �✓ V✓� P( �� TYPE CONST. OCC GROUP: � ADDRESS I 1C'/1�l• � �IPifQfLl� Y ` ¢ —�"� t�a � 2� CITY ZIP TEL. � ( 5� � � Scope of Work o APPLICANT ��D n �C'�1 y i I Lvl TEL. y l � `3 f v 3 Q(( N � � � y ¢ CONTRACTOR � ADDRESS � 4 ��-' � ✓�I 'I�u�U �l �GZ- UI #DWEL.UNITS #STORIES #BEDROOMS o ciTv '1"G�i"'—can c, ziP l �i �STEL. K� � 7 `�2� 2 q � '7 o ARCH/ENG/ z DESIGNER DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION ZADDRESS SFR/ADD/REM m CIN ZIP TEL. Garage/Carport ¢ � Patio/Deck ac OWNEH-BUILDER DECLAFIATION w oI hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) LL- PooVSpa � W intlicated below by the checkmark(s�,I have placed ne#to the applicable item(s)[Section 7031.5,Business and � z Professions Code:Any city or couMy that requires a permit to consUuct,alter,improve,demalish,or repair,any Z Re-Roof � shvcture,prior to its issuance,also requires the applicant for the permit to file a signed statement that he or she � Commercial � is licensed pursuant W the provisions of the Comractor's State License Law(Chapter 9)Cammencing with Section � N 7000 of Division 3 of the Business and Professions Code]or that he or she is exempt from licensure antl the basis for m � the alleged exemption.My violation of Section 7031.5 by any applicant tor a permit subjects the applicant to a civil penalty 0 of not more than five hundred dollars($500). e (,I,as owner of the praperty,or my employees with wages as their sole compensation,will do(�all af or(,portions � of the wark,antl the structure is not intended or otteretl for sale(Section 7044,Business and Professions Code:The V8luati0/7: Adj.Area: � ConVactors'State License Law does not apply to an owner of propeAy who,through employees'or personal ettort,builds I � or improves the property,provided that the improvements are not intended or offered for sale.If however,the builtling or QUANTITY DESCRIPTION FEE p improvement is sold within one year of completion,the Owner-Builder will have the burden oi proving that it was not built � or improved for the purpose ot sale.). � Z ()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 � Y builds or improves thereon,and who contracts for the projects with a licensed Contractor pursuant to the Contractors'State � o License Law.). w � (,I am exempt 6om licensure untler the Contractor's State License law for the following reason(s): .� � .� � ��t J � c� Z � �� Z m 0 � By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one � n� � � year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an a ' �'� �� "�� Xowner-builtler if it has not been constructed in iLs entirety by licensed contractors.I understand that a copy of the w applicable law,Section 7044 of the Business and Professions Code is available upon request when this application is � o submitted or at the following Web site:http/www.leginfo.ca.gov/calaw.html. � v IJCENSED CON7lIACiOH'S DECLAMTION � x m 1 hereby affirm under penalty of perjury that I am licensed untler provisions of Chapter 9(commencing with Section 7000) � N of Division 3 of the Business and Professions Code,and my license is in full force antl effect. N LICENSECLASS: �� 1 �" 7 U / �' LIC.NO.: ¢ DaTE: �I ' `I ' I � CONTRACTOR:_�� i p� y CONSTRUCTION: p WORKEfl'SCOMPENSATIONDEC TION P�NREVIEW: ¢ I HEREBY AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECIARATIONS: ELECTRIC: � I have and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided 6y PLUMBING: �� i T' /' � �Section 3700 of the Labor Cotle,for the pertormance of the work for which this permit is issued. MECHANICAL: ! o V I have and will maintain Worker's Compensation Insurance,as required by Section 3700 0(the Labor Code,for ¢ the performance of the work for which this permit is issued.My Worker's Compensation Insurance Carrier and INSPECTION FEE: Z Policy Number are: /� �`� w CARRIER r' � �' U/I q � ISSUANCE:_ � POLICYNUMBER �Y L I �I ti F�� y �I� SMIP: � (IHIS SECiION NEED NOT BE CAMPLEfED IF THE PERMfT IS FOR ONE HUNDRED DOWIRS($100)OR LESS). ENERGY P/C: p I certlfy that in the peRormance of the work tor which this permtt is issued,I shall not employ any person in any manner so�to EN ERGY PERM IT: o become subject to the Worker's Compensation Laws of Califomia.And agree that if I should become subject to Ne Worker's � JCompensation provisions of SecUon 37Q0 of th�bor de,I shall fo with comply with those provisions. RETENTION FEE: t � DATE: L�" �'�� APPLIGwT: PRE-ALTFEE: � WARNING:Failure to secure Worker's Compensation coverage is unlawful,antl shall subject an employer to criminal gASF: � penalties and civil fines up to one hundred thousand dollars($100,000),in adtlition to the cost of the compensation, p damages as provided for in section 3708 of the labor code,interest,antl attorney's fees. PLOT PLAN: ¢ � CONSTflUCTION LENDING AGENCY ZONING CLEARANCE: w I hereby affirm under penalty ot perjury that there is a Construction Lentling Agency for the peAormance of the work for � which Nis permit is issuetl(Sec.3097,Civ.C.). � LENDER'S NAME: WLENDER'SADDRESS: TOTAL FEES � . � � I certity that I have read this application and state that the above information is correct.I agree to comply with all city antl Z county ordinances and state laws relating to building construction,and hereby authorize representatives of this county to COMMENTS: o enter upon the above-mentioned property for inspection purposes. m �n I�i� �i � ( an �l � PERMITfEE NAME/(P$IpJ�n � I, �r _/� fi/G'. PAI BY � VALIDATION: N - " ' �� RECEIPT# PAID ✓ �VALIDATION: � SIGNATURE OF PE! E DATE WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy S-.� � CtTY OF D1�►-i�it��'.�D BAR �� :�� INSPECT��'d�-R�CQRD • � � . . � . . i * i i � SETBACK/LETTER TRACT AND LEpGER FOOTINGS FORMS SWiTCN GEAR S�g COMMERGIAL NOOD UG.PLUMBING T-BAR UG.ELECTfllCAL lNTERCEPTER UFER GRQUND HOT MOP/SHOWERPAN SEWER IATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPpRT RECEIVED SEWER CLEANOUT DEMOLITiON ROOF SHEATHING ROdF DRAINS FLOOR SHEATHING RpUGH CONDUIT SHEAR WALLS EXTERIOR POOUSPA SHE,4R WAIIS INTERIQR ROUGN PLUMBING FRAMINGNENTING RQUGH ELECTRICAI. ROUGH MECHANICAL RQUGH MECHANICAL ROUGH ELECTRICAL W( )CO GAS TEST ROUGH PLUMBING ,( /GP PRE GUNITE fNSULATION WALL PQOL PRE DECK BONDING INSULATiON CEiLING P-TRAP DRYWALL FENCE 1 GATEJ ALARM IATH{PRE} FlNAL P44L IATH EXTERI4R WAtLS: LATH INTERlQR WALL FOQTINGlSTEEL GAS TEST WALL STEEL 1sr� �2No� )LIFT SCRATCH GOAT WALL BOND BFAM ELECTRIC METER RELEASE WALL DRAIN/SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION R0.FRAMING PI.ANNING APP(iOVAL FINAL BUlIDING �/ � � ROUGH ftRE APPRQVAt. fINAL MECNANICA� FINAL FIRE�EPAR7MENT FINAL ELEGTRICAL FlNAL PLANNIN6 FINAt PLUMBING „�f FINAL ENGINEERING/PW T.C.of QGCUPANCY FINAL COMMUNITY SERVICES CERT.of OCCUPANCY FINAL HEALTN DEPT. fINAL INDUSTRIAL WASTE COMMENTS: