Loading...
HomeMy WebLinkAboutPR17-437 (14)0 F— Q n a z a G LL c: or CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES k 21810 Copley Drive, Diamond Bar CA 91765 PRESS (909) 839-7020 Fax: (909) 861-31:7 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APS i ICATIr)N www.cityofdiamondbancom building@dia'mondbarca.gov i JOB SITE ADDRESSk APN ~ 0 r T TRACT OWNER ADDRESS ➢ r .. ;.�«" $f. °' f, CITY ZIP TEL APPLICANT eTEL. 7 CONTRACTOR ADDRESS CITY ZIP TEL. ARCH y� �,.- DESIGNER f ( $-i L`��, ADDRESS /-� . , v�tl�� CITY O" : 'Ill Ck—ZIP QTEL. 2 . ­ OWNER- UILDER 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 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 in its issuance, also requires Bre applicant for the permit to file a signed statement that he of she is licensed pursuant to the provisions of Bre Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of Ure Business and Professions Cade] orthat he or she is exemptfrom licensors 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 property, or my employees with wages as their sole compensation, will do (a all of orU 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 apply to an owner of property who, through employees' cr personal effort, builds or improves the property, provided chat the Improvements are not intended or offered for sate. If however, the bullding or Improvement Is sold within one year of completion, the Owner-Bulider will have the burden of proving that it was not built ar 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 properly who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). LJ I am exempt from licensure under the Contractor's State License law for the following reason(s): Data: Sign: By my signature below I acknowledge that, oxoapt for 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 its entirety by licensed contractors. I understand that a copy of the applicable law. Section 7044 of the Business and Professions Cade Is available upon request when this application is submitted or at the following Wet site: http/wvvw.logintc.ca.gov/calaw.himf, 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 and Professions Code, and my license Is in full force and effect. z LICENSE CLASS t LIC. NO.. EXP. DATE: e` +^,..:.» 3'0 `^ OINITR.4CTOR: ixalC 1i WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION& I have and will maintain a Certliicaie of Consent to Self -Insure for Worker's Compensafion, as provided by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compansatlan Insurance, as required by Section 3700 of the 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 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS S1 OO OR LESS). I certifythat Into performance cf the workfor which this permit Is issued, I shat€ not employ any person In any manner so as to become subject to the Worker's Compensation Laws of Callfamla. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 otfhe Labor Code, I shall forthwith comply with thoss provisions, i DATE'. APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall 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 - 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, Clv. C.). LEN DER'S NAME: LENDER'S ADDRESS: i 1 certify that I have read this application and state that the above information is carred. I agree to comply with all city and I 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 PERMITTE NAME (PRINT , SIGNATUREOPPERNOi7 DATE APPLICATION DATE: �10� �l�—� P/C#{�� �7J ISSUE DATE: k ° PERMIT# :a T '7 a TYPE CONST. OCC GROUP: Scope of Work � _' � p 7 p�yrf✓.� �awL��,�a€' �€._� �S�` # DWEL. UNITS ROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio eck"�+,; LL ri Pool/Spa ZRe -Roof Commercial m lfaluaiiar7: Adj. Area: QUANTITY DESCRIPTION FEE w m m U_ CONSTRUCTION: PLAN REVIEW: �� + SS ELECTRIC: f" PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: 4-S TOTAL FEES COMMENTS: PIC: PAID 8Y: VALIDATION: %1+� RECEIPT # :- PAID BY: i VALIDATION: WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy ELITE SPECIAL INSPECTIONS INC. 8616 Cleta St. Downey, CA, 90241 Business Cell/ Vbicel Text: (562) 413-8159 Elite.Safe@mail.com SPECIAL INSPECTORS TIME SHEET & REPORT Date: 7114117 Building Permit # PR 17-437 .lob Identification Romero Residence Contractor: General LDP: Architect ,lob #: 7.14.17 Pert -nit Date Jurisdiction Address 1 143 CIearCreek Can Sub - Reinforced Concrete ❑ ACI Grade I -Tech 0 Epoxy❑ Engineer Diamond Bar n Diamond Bar C Prestressed Concrete L Masonry ❑ Other ❑ VOTE: Contractor assumes responsibilty for any and all work that is performed outside of stamped/approved plans )earing the seal of the applicable enforcing agency of record. Contractor is informed that any and all work performed 3rior to Building Department approval is performed at contractors own risk pending proper approval by the Building Dfficial. !-roviaea v,'suai insDecrlon ror. Flans Date: Provided Special Inspection of (2) 314" dia. holes 6" deep into (E) Footings T&B @ each Location for #5 Dowels @ 12" OC & 518" dia. holes 6" deep into (E) Conc. SOG for #4 Dowels @ 24" OC. -All holes brushed & blown w180 psi compressed air - Epoxy used Simpson Set- XP Exp. Date 9129118 Product in good condition - Observed injection of epoxy into holes & insertion of dowels No Violations Observed l DAILY HOURS WORKED Certificate of Compliance itraight Tim — I hereby certify that I have observed to the best of my knowledge all of the above reported work Finn & Ilalf unless otherwise noted. I have found this work to be in compliance with the Approved Plans, Double Time Specifications, and applicable sections of the Governing Building Codes. All inspection is based on a 4 hour minimum., over4 hours is an S hours minimum. Atter S is time and a half, respectively. All lab work necessary to complete inspections will be paid by owner, engineer or contractor. Registered Special Inspector (Please Print): Steve Montgomery Registered Special Inspector (Please Sign): Ste�vP.Movtt�aevtesy Owners Rep: Company: ICC #: 80198-41 City #: Phone Special Inspectors Name City zip Address — Type of Inspection `Continuous © Periodic ,lob Site Ac Job Name Type of Pr( Attach work experience and educational qualifications to this application. The above named person will be employed to inspect and/or test and will be responsible for the following inspections (Please circle number and provide description of work): 1, Concrete Placement 2. Reinforcing and/or prestressed steel 3. Structural Welding, — 4. High -Strength Bolting ---- 5. Structural C.3 7. Duties and responsibilities of the Special lnspectorLL 1. The special inspector shall observe the work assigned for conformance with the approved design drawings and specifications. 2. Thespecialinspectorshatifurn ishinspectionreports tothe buiIdingoff icial,the engineer orarch itectof 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. --+- Owner's Signature Contractor's Sr ure Fee$ 2 Receipt No. a S c'. 6S 10012 6D Approved: wilding Official Date OISTpIBUTION. white —Re Canary — Inspector Pink — Special Inspector