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Home My WebLink AboutPR16-2175a eE . CITY OF DIAMOND BAR DEPARTMENT OF COMNiJNIT 1(& DEVELOPMENT SERVICES 21810CopleyDrive, Diamond Bar, CA91765�PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7021 FIRMLY BUILDING PERMIT APPLICATION www.ci ofdiamondbar.com buildin ty gr,►amondbarca.gov Z. JOB SITE ADDRESS `�`�f o-: ' �'' Scope of Work e ` � IG' 0,l' E' fllS,a44` # DWEL. UNITS # STORIES APN q, LY e_'`.� Cl LOT TRACT OWNER `z-1, a 7V ' ADDRESS 13.0'8 CITY ZIP TI APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER Ouav I ADDRE$$G— CITY ZIP 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), I have placed next to the applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, 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 taw (Chapter 9) Commencingwith Section 7000 of Division 3 of the Business and Professions Gods] artist he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Sector 7031.5 by any applicant for a pernitsuhjects the applicantto a civil penalty of not more than five hundred dollars ($500). 11, as owner of the property, or my employees with wages as theirsole compensation, will do {_) all of or U portions of the work, and the structure Is not intended or offered for said (Section 7044, Business and Pmfessiens 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.). L) 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 contractsforthe projectswith a licensed Contractor pursuanttothe Contractors' State License Law.). L) I am exempt from licensure under t e Contractor's State Licause law forthe fallowing reason(s): Date: Sign: .e - By my signature below I acknowledge that, exceptfor my per s'ra!lresldeho In which I mustve resided for at least one year prior to completion of the improvements covered by this pernii cannot legally sell a sl uncture 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 availaits upon request when this application Is submitted or at the following Web site: httplwwwJrrghfo-ca,govlcalaw,html. LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NG.: EXP. DATF: 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 -Ensure for Worker's Compensation, as provided by Section 3700 of to Labor Code, forthe performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER UHIS SECTION NEED NOT BE COMPLETED IF THE PERMITS FOR ONE HUNDRED DOLLARS $100 CR LESS}. I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so a; to become subject to the Worker's Compensation Laws of California. And agree that if I should became subject to the Worker's Compensation provisions of Section 3700 ofthe Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shelf subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, damages as provided for in section 3708 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 workfor which this permit is issued (Sec. 3997, 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 slate laws relating to building construction, and hereby aultnrize representatives ofthis county to enter upon the above-mentioned properly for inspection purposes. PERM E;ENA (PAINT) SIGNATURE OF PERMITTEE DATE APPLICATION DATE: �� P Li/ 10 P/C# i` ri! tS ISSUE DATE: A F7RMIT#: TYPE CONST. 1 2/2g1 l OCC GROUP: Scope of Work e ` � IG' 0,l' E' fllS,a44` # DWEL. UNITS # STORIES v . 6d is 9BEDROOMS g V DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SF D RFM IS Garage/Carport w PattolDeck Lu LL Pool/Spa zRe -Roof � Commercial LL3 Valuation: 1 Adj. Area: QUANTITY DESCRIPTION FEE J a t/L a W W, c� 1 v1 II yf f zh z x CONSTRUCTION: PLAN REVIEW :'• 2.2 2�2 02 ELECTRIC: 2 PLUMBING: 3 t .� MECHANICAL:�_�._ INSPECTION FEE: ISSUANCE: 144.4g SMIP: 10• til i� ENERGY P/C:lb" ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: Z' CFO BASF:- PLOT PLAN:"• .ZONING CLEARANCE: TOTAL_ FEES �,) �' � COMMENTS: A4 $ 2-fo i PIC: < J8 .7 PAID BY: lqow ,r Q 61 1 ALIDATION: RECEIPT PAID BY. 2•VALIDATION:_,__, WHITE —Department Copy, YELLOW —Finance Copy, PINK— Assessor Copy COTNTS: !Z 1J7 !1 ELITE SPECIAL INSPECTIONS INC. 861.6 Cleta St Downey, CA, 90241 Bus. Cell / Message / Text (5621413-8159 Elite.Safe@nail.com SPECIAL INSPECTORS TIME SHEET & REPORT Date: 3/14/17 Building Permit ## P R 16-2175 Job Identification Zhong Residence Contractor: General Owner / Builder LDP: Architect Gary Ma Permit Date 9/14/16 ,lob #: 3/14/17 Jurisdiction Diamond Bar B&S Address 21339 Hidden Pines ®r,_Damond_Bar, CA Sub - Engineer R. Zhong Reinforced Concrete ❑ ACI Grade 1 -Tech ❑ Prestressed Concrete ❑ ' Masonry ❑ Epoayp post Set Dowels Other p Tension Force Proof Load Testing NOTE: Contractor assumes responsibilty for any and all work that is performed outside of stamped/approved plans bearing the seal of the applicable enforcing agency of record. Contractor is informed that any and alfwork performed prior to Building Department approval is performed at contractors own risk pending proper approval by the Building Official. Provided Visual Inspection fora � Plans Date: 2/27/16 Provided tension force 'Pull' testing application for 112" diameter (#4) Re -Bar Dowels post set into epoxy adhesive holes to rear addition per plans A-6. All anchors received tension proof load force of (17.792psi), 4,000 Lbs measured on calibrated gauge 11116116, Cert. #47201-001 and held for 30 seconds per. (5) bars tested. Approximately 10% of total. All load force applied using 'Enerpac P-39 10K w/ 12 ton capacity load cell. SIN #RC -10T No displacements observed. All testing deemed as 'Passed'. All force loads pending proper approval by RDP of record and Building Inspector. Hours Billed # 4 Certificate of Compliance Paid Check # 52701 hereby certify that 1 have observed to the best of my knowledge all of the above reported work INVOICE # 3/14/17 _ unless otherwise noted. I have found this work to be in compliance with the Approved Plans, BALANCE. PAID Specifications, and applicable sections of the Governing Building Codes. All inspection is based on a 4 hour minimum, over 4 hours is an 8 hours minimum. After 8 is time and a halt respectively. In addition, any inspection extending past noon bout will be an 8 hour minimum. All lab worts necessary to complete inspections will he paid by owner, engineer or contractor. Certified Special Inspector (Please Print): RandClil A. Martinez ICC #: 8064363 Certified Special Inspector (Please Sign): City # Registered Owners Representative: Company: CITY OF DIAMOND BAR 111 P.11 [RiIj i Department of Building and Safety ' REQUEST FOR APPROVAL OF SPECIAL INSPECTOR Special Inspectors Name �zg lowl"4 Z7";7,t-- Phone No. 2 r r 3 Dov Address q6W City Zip Type of Inspection ❑ Continuous Q Periodic Job Site Address Job Name Type of Project Attach work experience and educational qualifications to this application. The above named person will be employed to inspect and/ortest and will be responsible forthe following inspections (Please circle number and provide description of work): �oncrete Placement einforcing and/or prestressed steel 3, Structural Welding 4. High -Strength Bolting �TPstructural Masonry - 6. e'!!�&z -22 7. Duties and responsibilities of the Special Inspector. 1. The special inspector shall observe the work assigned for conformance with the approved design drawings and specifications. 2. The special inspector shall furnish inspection reports to the building official, the engineer orarchitectof record, and other designated persons. All discrepancies shall be brought to the immediate attention of the contractor for correction; then, if uncorrected, to the proper design authority and to the building official. 3. The special inspector shall submit a final signed report stating whether the work requiring special inspection was, to the best of his knowledge, in conformance with the approved plans and specifications and the applicable workmanship provision of the codes. Date Owner's Si§rlature Contractor's Signature Fee $ fl 2- ® Approved: Building Official Receipt No. Date - - I 1 DISTRIBUTION. White — File Canary — Inspector 10012 130 Pink — Special inspector WALNUT VALLEY UNIFIED SCHOOL DISTRICT 880 SOUTH LEMON AVENUE, WALNUT CA 91789 CERTIFICATE OF COMPLIANCE With Fee Provisions of Government Code Section 65996 I--- 1 0 DEVELOPER/OWNER 0A ADDRESS h B C1TY/ZlP 6 TELEPHONE ?� NEW CONSTRUCTION PROJECT LOT ADDRESS City BUILDING USE SignaVre of A plicant The person signing represents at he/she is authorized to sign on behalf of the owner/developer and that the Information provided is true and accurate to the best of his/her knowledge. Residential/ Commercial/industrial HOME IMPROVEMENT OR REMODELING PROJECT TOTAL SQ. FT. ADDRESS DESCRIPTION TOTAL SQ. FT. .Gk\SS,R s Diamond Bar � Walnut (Bedroom, Family Rm., Kitchen, etc.) Other City Signature of Superintendent of Buildings Date u 90 1 TO BE COMPLETED BY SCHOOL DISTRICT FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE School District under provision of Government Code §65995 $ Are (EFF. I2/I/08) Residential Development $2.97/sq. ft. Receipt # Commercial/Industrial $0.47/sq. ft. Date Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet eliminating garage or uncovered patio). This is to certify that all fees are due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. L This is to certify that the above described development has been determined to be EXEMPT from the development fees of Government Code Section 65995 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET -V OTHER Celia Moynihan Director, Fiscal Services 1187 Rev. 2/88; 6/88; 8189; 1190--8/90; 10190; 8192; 6193; 11193; 8194; 6196; 1/97; 8/98; 7104; 6/06; 2108; 12108; 1/13; 6/16 Jab Address: 2 1 Dear'Property Owner. Building & Safety Division 21810 Copley Drive Dimond Bar, California 91765 (909) 8397020 Fax (909) 861-3117 eh An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their.own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City of County. They are also required by law to put their license number on all permits for which they apply. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under.the federal law, contact the Internal Review Service (and if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State law, contact the Department of Benefit -Payments and the Division of Industrial Accidents. If the structure is intended for sale, the property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder'" building permit, erroneously implying that the property owner is providing his or her own labor and materials personally. Building permits are not required to be signed by the property owners un less they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board at 8829 Business Park Drive, Sacramento, CA 95827, www.csib.ca,aov or at (800) 321-CSLB (2752). Please complete and return the enclosed "Owner -Builder" verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. �a^ Building & Safety Division 21825 Copley Drive Diamond Bar, CaHfonda 91765 (909) 8397020 Fax (909) 8613117 Attention Property Owner° An "Owrier_ Builder" building permit has been: applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received by us. I . I personally plan to provide the major labor and 'materials for construction of the proposed property improvement (yes'or no).S 2. 1(havethave not) arV Qi signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Dame Address City Phone Contractors License No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address city Phone Contractors License No. 5. 1 will provide some of the work. but I have contracted (hired) the following persons to provide the worts indicated: Name Signed Prope/ er Date Address Phone Type of Work NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit Lias be submitted in your name listing o rseIf as the builder of the property improvements specified at -2,1 r� Pn 2",vi.A�S f��A bar We are: providing you with an Owner -Builder Acknowledgment and Information Verification N=orm to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We. will not issue a building permit untie you have read, initialed your understanding, of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property'':owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGEMENT AND VERIFICATION DIRECTIONS:. Read and initial each statement below to signify you understand or verify this information. 3,2L1. I understand a frequent practice of unlicensed persons is. to' have the property owner obtain an "Owner- Builder' -building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner=Builder, may be held liable and subject to serious financial risk for any Injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. 1 am. willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by propertyowners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. `c2i-3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. Ic 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 'j ti & i understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. r 6.' 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I. also understand my failure to abide by these laws may subject me to serious financial risk. -127. 1 understand under Califomia Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally Build them with the intent to offer them for sale, unless ail work is performed by licensed subcontractors and the number.of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. it 8& I understand as an Owner. -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain 'more information regarding my obligations as an. "employer' from the Internal Revenue Service, the United States 'Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www,cslb.ca. ov for more information about licensed contractors. r am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: �11. 1 agree that, as the. party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form, Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you wilt be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building pen -nit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of Property Owner: 2� Date: I