The URL can be used to link to this page

Home My WebLink AboutPR17-0853CITY OF DIAMOND BAR rr I I € DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES I F_ 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 wwtiv.cityoidiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS -377 V ea W a ) APN LOT TRACT OWNER V ADDRESS Cwv�e4 v, n CIN N vlti ZIP'RI EL. �� - gZ17 APPLICANT 45 TEL. 56Z '950� % CONTRACTOR CDU V C, k ne. r 'W ADDRESS CITY h ZiP Q TEL.'. P? ARCH/ENG/ IF DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penally 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 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 slatementthal he or she Is licensed pursuantto the provisions of the Contractor's State License Law (Chapterg) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from Ilcensure and the basis for the al failed 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). (-)1, as owner of the property, or my employees with wages as thetrsole compensation, will do V all of or (-) portions of the work, and the structure is not Intended or offered for sate {Secgon 7044, Business and Professions We: The Cc [motors' State License Levi does not apply to an owner of properly Who, through employees' or personal effort, builds or improves the properly, 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 harden of proving that it was not hall[ or Improved for the purpose of sate.). (_) 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 forthe projects with a licensed Contractor pursuant to the Contractors' State License Levi.). (-) I am examptfrom licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my algnature below I acknowledge that, except for my personal residence in which I must have resided forst leastone year prior be completion of the Improvements covered by this permit,[ cannot legally sell a structure that I have built as an owaer-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: httphvvnv.Ieglnio.ca.govlcalavr.html. LICENSED CONTRACTOR'S DECLARATION I herebyaiftrm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlons Code, and mylicIs In full force and effect. len�see C2 LIC. NO.: _lr?{1 6 LICENSE CLASS: h EXP. DATEC CONTRACTOR: _'tl6 7 ��JFi G Ni CP 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 3700 of the Labor Code, for the performance of the work far which this permit Is issued. Or I have and will maintain Worker's Compensation Insurance, as required by Secton 3700 of the Labor Cade, for the performance of the work for which this permit Is Issued. My Workar's Compensation Insurance Carrier and �- q `9 Policy Number re: qy ', CO%MPGR CARRIER 1+rl-,.% f A V I CAV1C�. POLICY NUMBER 1'I6b %5 ' i 10 _ (ITIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DDL[AAS $100 OR LESS). I certifythal in the performance of the vmrkforwbich thispermltfs Issued, I shall notemployany person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that If I should become subject to the Worker's Compe ,11 pro ' Ions of Section 3700 o borCads, I s I fodhhh eompiy wity thma provlslons. DATE: S I APPLICANT: 1!'/f+l [i3'17e;� WARNING: Failure to secure Worker's Componsa8an coverage Is unlawful, and shall suhjec[ an employer to cdminal penalties and civ11 fines up to one hundred thousand dollars ($100,000), in addition to the cast of the compensation, damages as provided for In section 3708 of the labor code, Interest, and attorney's fees. CONSTRUCTIDN LENDING AGENCY I hereby affirm under penally 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 bullding construction, and hereby authorize representatives of this county to enter upon theabove-m tionedpropertytornspectlonpurposes. #it/ L3Y PFRMiTT RIN SIGNATURE OF PERMITTEE DATE APPLICATION DATE: x P/C# - r ISSUE DATE: PERMIT# TYPE CONST. OCC GROUP: Scope of Work U e � � t # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Poovspa Z_ Re -Roof 9 Commercial D1 Valuation: Adj. Area: QUANTITY DESCRIPTION FEE 41 UU my ri c� z il 17 11 on J 0. z U g CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:' SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES Ps- y: 05, COMMENTS: PIC: PAID BY: � VALIDATION: RECEIPT ff (a 2 PAID BY: 15-q: T VALIDATION: WHITE — Department Copy, YELLOW --- Finance Copy, PINK —Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK/ LETTER FOOTINGS FORMS __. .......... TRACT AND LEDGER SWITCH GEAR SLAB COMMERCIAL HOOD UG. PLUMING T -BAR UG- ELECTRICAL INTERCEPTER UFFR GROUND HOT MOP/SHOWFRPAN SEWER LATFRAL MAIN WATER LINT SEWER CLEANOUT SEPTIC/CESSPOOL HERS REPORT REGEIVEQ DEMOLITION ROOF DRAINS ROOF SHEATHING FLOOR SHEATHING ROUGH CONDUIT SHEAR WALLS EXTERIOR POOL/SPA SHEAR WALLS INTERIOR _ ROUGH PLUMBING FRAMINGAIENTING ROUGH ELECTRICAL ROUGH MECHANICAL _ ROUGH_ MECHANICAL ROUGH ELECTRICAL W(m) C { } GAS TEST ROUGH PLUMBING PRE GUNITE POOL PRE DECK BONDING INSULATION WALL INSULATION GFILING P -TRAP DRYWALL LATH {PRE} FENCE /GATE/ ALARM - - - FINAL POOL LATH EXTERIOR WALLS: l -ATH INTERIOR GAS TEST ...... _ WALL FOOTING/STEEL WALL STEEL 1�f{ } 2N°( } LIFT SCRAI CH COAT - ... _. WALL BOND BEAM _.. ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PLANNING APPROVAL FINAL BUILDING ROUGH FIRE APPROVAL FINAL MECHANICAL FINAL FIRE DEPARTMENT FINAL ELECTRICAL ` FINAL PLANNING FINAL PLUMBING _ FINAL ENGINEERING/ PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CERT. o4 OCCUPANCY FINAL HEALTH DEPT, F1NAL INDUSTRIAL WASTE COMMENTS: .�__ CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 4 of 4) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Maura Cardenas Company: Date Signed: We Green, Inc. 2017-06-07 Address: CEA/HERS Certification identification (if applicable): 3E45 Ruffin Road #330 RCN13195 City/State/Zip: Phone: San Diego CA 92123 888-991-4377 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the appllaable reculrements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved'by the Qnforcement agency. 4. The information reported on applicable sections of the (CE211) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirementsspecified.,gn the Certificate(s) of Compliance (CE1R) approved by the enforcement agency. S. I will ensure that a registered copy of this Certificate of Verlficatlon shalt be posted, or made available with the building permit(s) Issued for the building, and made available to the enforcement agency for all applica6le`inspectlons. I understand that a registered copy of this Certificate of Verification is required to be included with the documentation the.b4(ilder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Cpntractor, or, i3uilder/Owner): Southwest ;MVAC Responsible Builder or installer Name:CSLB License: Julio Hernandez - --' 932164 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A HERS Rater Information HERS hater Company Name: We Green, Inc. Responsible Rater Name: Responsible Rater Signature: Maura Cardenas ResponsiblelRater Certification Number w/ this HERS Provider: Date Signed: RCN 13195 2017-06-07 Digitally signed by CHEE'R5T'". This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: Registration Date/Time: 2017-06-07 16:27:48 HERS Provider: CHEERS 417-A020090942A-002-000-M25000A-M25A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-06-07 16:27:49 2016 Residential Compliance Schema Version: rev 10/16