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Home My WebLink AboutPR17-1009s LU z 0 CITY OF DIAMOND BAR m 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 www.cityofdiamondbar.com building@di "dbarca.gov JOB SITE ADDRESS, €I Poii,Iiii Kflokj__ APN LOT TRACT OWNEF G rIt- 'i ADDRy�SS �L L_ I t 're CtTYSrI ZIP (_7 VJTEL. APPLICANT Ti CONTRACTOR ADDRESS 2_� �2 d w • - CITY ff L. orti - -ZIP a. TFL , '_7S514 ARCHI 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 reasons) indicated below by the checkmark(s), € have placed next to the applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, all improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to fife 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 hasls for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicantto a civil penalty of not more than five hundred dollars ($500). O I, as owner of the propeRy, or my employees with wages as their sole compensation, will do U all of or `)portions Di 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 1s sold within one year of compietion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale,), (_)1, 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 exemptfrom licensure underthe Contractor's State License law forlho following reason(s): Date: Sign: By my signature helow I acknowledge that, exception 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 ris entirety by iii coni I understand that a copy of the j applicable law, Section 7044 of the Business and Professions Code is avallable upon request when this application is submitted or at the following Wet site: http/wwwJaginfc.ca,govlcalawThrel. LICENSED CONTRACTOR'S DECLARATION iI hereby affirm under penalty of perjury that 1 an licensed under provisions of Chapter 9 (commencing with Section 7000) r of Division 3 of the Business and Professions Code, and my license is in full force and effect. 1 r ICENSECLASS: —1' — LIC.I aC�A7 _ P. DATE Ia d %CONTRACTOR: _.�Oi rut 4 - WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECIARATiONS: 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 forwhich 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 workfor which this permit is issocd. My Worker's Compensation Insurance Cartier and i Policy Number are: ? CARRIER 3 POLICY NUMBER i (THIS SECTON NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). 1 cedifythat in the performance ofthe work for which this Permit is issued, I shall not employ any person in any manner so as to became subject to the Worker's Compensation Laws of California. And agree that if I should become subjectto the Werker's a Compensation provisions of Section S70C of the Labor e, I shall 114w0h comply with those provisions. : DATE: APPLICANT -J WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shat€ subject an employer to criminal B penalties and civil fines up to one hundred thousand dollars (5100,00), In addition to the cost of the compensation, j damages as provided for in section 3700 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 r which this por nit is issued (Sec. 3097, Clv, G.) LENDER'S NAME: LENDER'S ADDRESS'. J 1 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 5 enter upon the above-merrionedproperty for inspectionpurposes. J d_ PERMITTEE NAMWPRIN' �... SIGNATi1RE OF PERM DATE APPLICATION DATEt: 5 /q /I ' PIC# P' RI_° _ 1 009 ISSUE DATE: { PERMIT# : IM \71 - %C � TYPE CONST. 000GROUP: Scope cf Work & # DWEL. UNITS # STORIES Pa, # BEDROOMS DESCRIPTI SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD EM Garage/Carpert 21 w Patio/Deck LL Pool/Spa ZRe -Roof of Commercial Valuation. * ,) Adj. Area: r QUANTITY DESCRIPTION FEE 1�r' CC $$ �^ r cu 20 9y'4k^F� -w '�Vr OJ C U , d U � ua CONSTRUCTION: PLAN REVIEW: 7 ��jj . ag ELECTRIC: • 1 - 'i PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: \ • dS ` SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BAS F: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C:,�Ll ® PAID BY: cL3gggq VALIDATION: L RECEIPT It @ -__ PAID BY:VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD SEWER LATERAL MAA WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERVR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE ;AS MIETER RELEASE SPECIAL INSPECTION COMMENTS: MENTS: U __ it- 2� TRACT AND LEDGER j SWITCH GEAR GOMMERCIAL HOOD T -BAR INTERCEPTER HOT MOPISHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT WALLS; WALL FOOTING/STEEL WALL STEEL l5`( )2m')( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL i WALL FINAL