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HomeMy WebLinkAboutPR14-5117CIT'Y'OT DL4P tl�ND BAR`. ` DEPARTMENT OF COIVAUNITY 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 JOB SITE ADDRESS 7 � � PN `��l-Qrl f TRACT OWNER J 05 -EE P.14 ADDRESS 25 b QA Zi CITY I l h h n,✓D f3AR ZIP '71-76S TEL. APPLICANT Ebu,AA D R [a+lr(-a 0 4. C -A TEL. CONTRACTOR ADDRESS CITY i - L- ' _ 4 ZIP a- '_�_iEL. ARCH/ENG/DESIGNER ADDRESS CITY ZIP Ti OWNEn-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason($) Indicated below by the checkmark(s), I have placed next to the applicable Ite(n(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from Ticersuro and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S60% (_) I, as owner of the property, or my employees with wages as their sole compensation, will do (H at of or O portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not applyto an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or Improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that It was not built or improved for the purpose of sale.). (J I, as owner of the property, am exclusively contracting with licensed Contfactms to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of property who builds or improvestherecn, and who contracts forthe projects with a licensed Contractor pu rsuanf tothe Contractors' State License Law.), �) I an exemptirom licensure under the Contractor's State License law forthe following reason($); 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 permlt,l 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: httpMww.leglnfo.ca.govlcalaw.html. DATE: ....— SIGN:: LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I are licensed under provisions of Chapter 9 {commencing with Section 7000) u* nlvision 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CI..ASS GATE i 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 Section 370D of the Labor Code, for the performance of the work for which firs s permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued, My Workers Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1 DO) CRI I certify that in the performance of the work for which this pe(mit is issued, I shall not employ any person In any mareerso as to became subject to the Workers Compensation Laws of California. And agree that if I should become subject to the Workers Compensation previsions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. iF DATE: APPLICANT: i WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal i penalties and civil fines up to one hundred thousand dollars ($100,000), in addldon to the cost of the compensation, i damages as provided for in section 3708 of the labor code, Interest, and attorney's fees. CONSTRUCTION LENDING AGENCY j 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.). LENDES'S NAI ...... LENDER'S ADDRESS: .... i I cer4fy that I have read this application and state thatthe above information is coned. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofthis county to y enter upon the above-mentloned property for inspection purposes. i ' PERMITTEE NAME PRINT) 3ICNATUREOFPERMITTE�� DATE -� APPLICATION DATE: PIC# ISSUE DATE: PERMIT#® 7 TYPE CONST. F: i apz_ J& - oh— OCC GROUP: -5 ZONING SETBACKS FRONT RW REAR SIDF/SIDE STREET RW SIDE ❑ ❑ ❑ PROPOSED US # DWEL. UNITS l.0 A17 f T1 ! 77 F f R e7 D fAr l A CaC tFtl # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SF D /REM —7 Garage/Carport 07 LU fbaHeck �' r.. LL Pool/spa ZRe -Roof D -j Commercial t7C� Valuatio Adj. Area: a ' QUANTITY DESCRIPTION FEE u � P i.,' is 's, ✓ , o �r�_ i r L CONSTRUCTION: PLAN REVIEW: ELECTRIC:-? ! / aell y PLUMBING: MECHANICAL.: INSPECTION FEE: ISSUANCE: 4 I SMTP: ENERGY P/C: 1 br ENERGY PERMIT: RETENTION FEE:=`t PRE -ALT FEE: Z TOTAL FEES Ila, , 7, COMMENTS: 6 RECEIPT# ,_._ PAID BY: .:. @ ` VALIDATION;.._ WHITE — Departmarrt Copy, YELLOW — Finance Copy, PINK—Assessor Copy, GOLDENROD —File Copy, GREEN --Applicant's Copy CITY F 1�. -,.D BAR INSPECTION dud'Vth v€ t#i9 kU#J i ROOF -SHEATHIM'.. FLOOR SHEATHING aWtU[Alf. IIV Nti I WN COMMENT,c02'el Ciity, of Los Angeles'Uniform Code Program Uniform Procedure I-7: Special Inspections Special Inspection Report • DISCREPANCY ---CONFORMANCE 1 AI; discrepartcigs shall be brought to the immediate attention of if work conforms to appmvad design and code raqulrerr�nts, submit the Canlractor for carrecHon, if corr$c#arts are notmade in a this report to Building Department and copies to Contractor, Engineer! timely manner, this report Shap be used as a discrepancy noflce. Architect of record and Owner no later char► the business day fofloti, ing Submit the original to 80ding Depar[rnent and copies to the conclusion of the special Inspection, For inspectforrs greater than 5 Conffador, Engineer/Architect of record and Owner_ 14.,.,a _.-L—u _ This is a: " Pro ress Report Final Re rt Re rt No. 1 pName 4 NFt i of Praa ��.`Ar� �S �- �iE glrtper or Re E:��cial IrtsPactlor►: C1ty Repisl�atton Naunber: Comany: t. P013049 VanBul Inspection TYPe of Inspection: * Reinforced Concrete c Structural Masonry o Prestressed/Posttensloned o Solis In ConovWpiasonry * Shotcrete/Gunite o Sb uMral welding o Insulating Concrete/Gypaete o High Sbvngt:h BMng Time Time D to Paa No. 714-345-8266 o Pilfng,'Plers & Caissons 4 Examtfon and Pills o spray-Appiled Fire Proofing 1, miter * Smoke Central o Energy Compliance Testing Reports a Arr#veo Departed Description and L,ocathm Of Work Inspected 239 .; o I HEREBY DECLARE THAT THE FOLLOWING IS TRUE TO THE SM OF MY KNOWLEDGE: 2- 1 A.%% 2— Au, OR MY COMPANY IS, RETAINED BY THE OWNER OR THE ARCHITECTMNGINEER OF R1~CORD TO PROVIDE SPECIAL INSPECTION FOR THE WORK COVERED IN THIS REPORT, Z i HAVE PERFORMED THE REQUIRED INSPECTION DURING THE 77M E PERIOD AS STATED ABOVE. 3. THE WORK COVERED IN TI`!tS REPORTIS IN CONFOR1WtKE TO THE APPROVED PLANS, SPECIFICATIONS AND APPLICA',7C,14 WORKMANSHIP PROVISIONS OF THE CODi;, EXCEPTAS INDICATED OTHERWISE. Signature:..; �— Date' Huan Van Buf, Deputy Inspector STRUCTURAL OBSERVATION REPORT FbRM STRUCTURAL OBSERVATION means the visual observation of the structural system, forgeneral conformance to the approved plans and specifications, at significant construction stages and at completion of the structural system. S Report No. 14-091.1 This report includes all construction work through Ge day of FF-BRUARY 20 16 Page No. 1 of 1 Project Address: Structural Observer of Record (SOR): SOR Phone No.: EDUARDO J CARRILLO 562 708-3586 Building Permit No.; Structural Observatmn Observr Professional Lic./Reg. ND.: Observer Phone No.: performed by: EC C77737 562 708-3586 OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS ELEMENTSICONNECTION WALL FRAMES FLOOR OBSERVATION LOCATION D Concrete ❑ Steel Moment Frame Ll Concrete " ,yam ❑ Mat Foundation ❑ Masonry❑ Steel Braced Frame ❑Steel Deck D Caisson, Piles, D Wood ❑ Concrete Moment ©Woad Grade Beams Frame ❑ Retaining Foundation ❑ Others: © Masonry Wall ❑ Others: Hillside Special Anchors Frame ❑ Others: D Others: FOUNDATION Footing, Stem Walls NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance with the approved plans or in the load path: (A final report by the structural observer which states that all observed deficiencies have been resolved is required before acceptance of the work by the building officials.) e- OL DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE: 1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE, AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE l3 IN GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 3. ALL NOTED DEFICIENCIES WHICH REMAIN To BE CORRECTED HAVE BEEN INDICATED ABOVE; 4. 1 RECOMMEND THAT ACCEF fANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE R£ OF STRUCTURAL OBSERVER - . 4` - C, f DATE C; ' 7 s' �,: 9 (STAMP OF STRUCTURAL OBSERVER) 960 6th St. Ste. 101-A-163 Norco, CA 92560 (951) 415-4341 Www. Dal tonIn spection.com Jerry@Daltonlnspection.com CMnMC,M OF GOhff%MNCF I== M I in THffIffYBRt9PECMM'IOTHIBiWW-W) WiBMMOW TBS A VR REMWW Wli$E;1Ra= O't iiORM I WAVZ FOUM M= TO coUmywrmTMLUTgovmpLAN&SrBcwlcAnMAMAPPLWA=SECrMOF TJAiFRTiYFO$ C1$.i�IMS�TR�7TSThEf:,' j�ji�. 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