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Itl IOND`BAR
CITY OF DIAMOND BAR
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.cityofdiaunondbarcom building@diamondbarca.gov
JOB SITE ADDRESS
APN LOT TRACT
OWNER Ol 1111i
ADDRESS 'A alsk������ f-
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CITY t ZIP 1IZ40 TEL -
APPLICANT Al,,k D,011L TEL. ,® II
CONTRACTOR
ADDRESS
CITYZIflpsliiiP 9A7L 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 items) [Section 7031.5, Business and
Professions Code: Any city or county that requires a permit in 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 Ilcensed pursuantto the provisions of the Contractor's State License Law tGhaptsr 9) Commencing with Section
7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from lcensure 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 properly, or my employees with wages as their sole compensation, will do U all of or U portions
of the work, and the structure is not intended or offered fur sale (Section 7044, Business and Professions Code: The
Contractors' Slate License Law does not applyto an owner of property who, through enr ioyees' or personal effort, builds
or Improves the property, provided that the improvements are not Intended or offered tar sale. K however, the building or
improvement is sold within one year of completion, the Owner-Bullder will have the burden o -f proving that It was not built
or Improved for the purpose of sale.).
U 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 bcansed Contractor pursuanttothe Contractors' State
License Law.).
U I am exerri lrom licensure under the Contractor's State License law for the following reason(s):
Date: Sign:
By my signature below I acknowledge that, except -for my personal resldence in which I must have resided for at least one
year pricrto completion of the improvements covered by this permit,] cannot legally sell a structure that I have bull€ as an
owner -builder if it has not been constructed In Its entirely by licensed contractors. I understand That a copy of the
applicable law, Section 7044 of the Business and Professions Code Is availahle upon request when this application Is
submitted or attire following Web site: http/www.leginfo.ca.gov/calaw.htmi.
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 IV
Professions Code, andel my license is In full force and effect.
LICENSE CLASS: IV LIE. NO,:
EXP. DATE: CDNTRACTOR:
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
�d Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
/1 I have and will maintain Worker's Compensatlon insurance, as required by Section 3700 of the Labor Code, for
the performance ofthe work for which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER 7--;1
POLICY NUMBER ® D
(CHIS SECTION NEED NOT RE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS).
I certify that in the performance of the workfor which this permit Is Issued, I shall not employ any person in any manner so as to
become subject to the Worker's Compensation Laws of CaHfornlaAnd agree that if I should become subject to the Worker's
Compensation provisions of Section 3700 of the Labor Cade. I shall forthwith comply with those provisions.
DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
penaltles and civil fines up to one hundred thousand dollars (51 00,000), in addilion to the cost of the compensation,
damages as provided far in section 3700 ofthe 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
which this permit is issued (Sec. 3097, Civ. C.).
LENOEli'S NAME:
LENDER'S AUDRESS:
i
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 inspection purposes
i
� PERMITTEE NAME (PRTN�
r
SIGNATURE OF PERMITTEE DATE
APPLICATION DATE 1 • 11 P�/gC�f PRL —71-6
ISSUE DATE: PERMITIt
TYPE CONST. OCC GROUP:
Scope of Work O 446U.4 7V
3,bAll
# DWEL. UNITS # STORIES
�-, /r
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w
Patio/Deck
w
LL
PooVSpa
ZRe
-Roof
Commercial
m
Valuations:
Adj. Area:
QUANTITY DESCRIPTION
FEE
!o® 4i
U
EE
U
w
w
z
z
m
J
rL
U
Z
x
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
Si
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: 55 VAI PAID ElYA,/_11Q3 P9
+Z VALIDATION: Vo
RECEIPT# �5� P `[ PAID BY: Iy?03il VALIDATION,
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
'71TY OF DIAMOND
BAA
INSPECTION
R
TRACT AND LEDGER
!7FOOTfiGSS
SWfTCH GEAR
COMMERCIAL HOOD
UG. PLUMBING
T -BAR
UG. ELECTRICAL
INTERCEPTER
LIFER GROUND
HOT MOP/SHOWFRPAN
SEWER LATERAL
SEPTIC/CESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVID
SiWFR CLEANOUT
DEMOLITION
R{]0f SHEATHING
ROOF DRAINS
f 1.008 )fIFATHJNG
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
P{70LiSPA
SHEAR WALLS iNTERIOR
. ....
-
HOUGH PLUMBING
..._ .... .......
FRAMING/VENTING
_.
ROUGH ELECTRICAL
_.
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C ()
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSU I A110 WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL.
FENCE / GATE/ ALARM
LATH (PRE)
FINAL. POOL
LATH EXTERIOR
WALLS:
LATH INTERIOR
WALL FOOTINGISTEEL
GAS TEST
WALL STFFI IST( )2%0( )LIFT
..........
SCRATCH COAT
WALL BOND REAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
R0, FRAMING PLANNING APPROVAL
FINAL BUILDING .
ROUGH FIRE APPROVAL
FINAL MECHANICAL
........ ,. _—
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
OWE
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
......
T.C. of OCCUPANCY
_.. _ _..._
FINAL COMMUNITY SERVICES
CERT, of OCCUPANCY
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
_ _
CITYO.FDIAMOND BAR
BUILDING & SAFET.YDIVISION
21810 Copley Drive
Diamond Bar, CA 91765
(909) 839-7020
In order to help assure the life and safety within existing dwellings, the 2013 California Residential Code (CRC) Section
R314 and R315, along with the Callfomia Building Code Section 420.5 and 420.6 requires existing dwellings to have
smoke alarms and carbon monoxide alarms installed within the upper 12" of the ceiling when a building permit is issued
for, worked on, or in a building that is valued at $1,000 or more. Alarms may be solely battery operated where repairs or
alterations do not result in the removal of wail and ceiling finishes or there is no access by means of aftic, basement or
crawl space.
Starting July 1, 2014 all smoke alarms including combination smoke alarms, that are solely battery powered
shall contain a non -replaceable, non -removable battery that is capable of powering the smoke alarm for at least
10 years.
'REQUIRED IN EXISTING DWELLINGS
-
• Where a permit is required for alterations, repairs or additions exceeding $1,000,
• Existing dwellings or sleeping units that have attached garages or fuel burning appliances.
Carbon monoxide alarms shall be installed:
• Outside of each separate dwelling unit sleeping area in the immediate vicinity of the bedroom(s).
• On every level of a dwelling unit including basements.
REQUIRED IN NEW DWELLINGS:
Carbon monoxide alarms shall be installed:
• Outside of each separate dwelling unit sleeping area in the immediate vicinity of the bedrooms(s).
• On every level of a dwelling unit-includfng basements.
Alarms shall receive their primary power from the permanent building wiring without a disconnecting switch other than as
required for overcurrent protection. Battery backup is required.
NOTE:
Multiple purpose alarms.
• Listed and labeled combination carbon monoxide /smoke alarms are acceptable in new and existing
dwellings.
Carbon Monoxide Alarms is a requirement that is in addition to required Smoke Alarms.
The alarms are required to be installed in the following locations:
-.+ Smoke alarms in all sleeping rooms.
❖ CO alarms in all sleeping rooms where fuel burning appliances are installed.
❖ Smoke alarm and CO alarm in hallways preceding sleeping rooms.
❖ Smoke alarm and CO alarms on each dwelling level including basements and habitable attic rooms.
The smoke and CO alarms are required to comply with the above when requesting a final inspection. Please make sure
an adult is present to allow the inspector access to the home to verify compliance with the above requirements. If no one
Will be available, you may opt to complete the Installation Certification below and leave it with the job card.
(Please rill out and tear off this ,portion to leave with the yob card if no one will be available to
allow the ,inspector inside the house.)
INSTALLATION CERTIFICATION
For the property located at 't i -Z I S - �� �c. � � ^, 1 hereby certify that the required
smoke alarms and carbon monoxide alarms have been installed as listed above.
Signature Print Name Date
Relationship to project (please check one):
n Owner o Agent for Owner ❑ Licensed Contractor ❑ Agent for Licensed Contractor
If "Licensed Contractor" or "Agent for Licensed Contractor" is checked, please complete the following:
Contractor Contractor's State License Number