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HomeMy WebLinkAboutPR17-305UJ CD 0 0 LUa rr 0 r 0 0 m cc CD CITY OF DIAMOND BAR u � ✓� 11 t Fully% I . ti,• DEPARTMEr OF COMMUNITY & DEVELOPMENT SERVICES " ' 21810 Copley Ii ►�fainond Sar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building diamondbarca.gov JOB SITE ADDRESS_�� 1j APN _ _OT TRACT OWNER ADDRESS �` �s CITY ZIPTELi� :r APPLIC NT _ TEL. CONTRACTOR - ADDRESS 1--"L e,, r f CITY V" v f; -ZIP EF ARCH/l DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contraelor'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 Cade: 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 pursuant to the provisions of the Contractor's State License Law {Chapter 9) Commencing with Section 70DU of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicardfor a permit subjects the app€icantto a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages asthed sole componsaten, will do U all of or U portions of the work, and the structure is rot 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' 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 forthe 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 Cade: The Contractors' State License Law does not apply to an owner of property who I or improves thereon, and who contracts for the projects with a licensed Contractor pursuantto the Contractam' State License Law-), () I am exempt from licensure under the Contractor's Stale License law for the following reason(s): Cate: Sign: 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 Tis permlt,l cannot legally sell a structure that i have built as an owner-bu1ltler If it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Si 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: httplwwwfeginfo.cfl.gcvlcalaw.html, 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 forc�,and effect. LICENSE CLASS: f LIC, NO.: f� EXP.DATEt_-4_'-.�+�,�.-/'<"--CONTRACTOR: a'� - . 1 WORKER'S COMPEN TION DECLARATION I HEREBYX+MM UNDER PENALTY OF PERJJPY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by �Seecction 3700 of the Labor Code, for the performance of the work for which this permit is issued, w I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the Performance of the rk for which this permit is issued. My Worker's Compensation Irsurance Canierand Policy Number are: CARRIER POLICY NUMBER z� e - ( (THIS SECTION NEED NOT BE COMPLETED IF THE PERMITS FOA ONE Hi DO $100 OR LESS). E ceriifythat into performance of the work for which this permit is issued, I shall not employ any person it any manner so as to became subject to the Worker's Compensation L of Caf}#p a. Aliid agree that it] should become suh}ect to the Worker's Compensation Srovisio s on 37CC of G.tabor Ef a af�forthwith comp]y ' lhoseprovis€ons,,,,_,"" DATE: LICANT::"'.:�7 L�. .>� nth '•'" , �` WARNING: Failure to secure Worker's Compo coverage is unlawful, and shall subject an employer to criminal penalties and civil floes 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 Caere is a Construction Lending Agency for the performance of the work for which this permit is issued {Sec. 3097, ON. C.). LENDER'S NAME: LENDER'S ADDRESS: i I certify that I have read this application and state that the above Informatlor is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, arrecreby authorize representatives of this county to enter in the Albove,4noritioned property for Inspectition puirpasos. Pi AME{PAl t ! l SIGNATJF OF PER ITTEE , DATE APPLICATION DATE: 1 .7 ISSUE DATE: \ ' PERMIT# : TYPE CONST. PIC# PEI + s -M 17 — OCC GROUP: j Scope of Work% DWEL. UNITS # STORIES r AA# # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFFJADI)IHLMI Garage/Carport LO L Patio/Deck W L,_ PoollSpa ZRe -Roof O Commercial r0 Valuation: Adj. Area: QUANTITY DESCRIPTION FEE fJC-... V z z v ME CONSTRUCTION: PLAN REVIEW: -a ELECTRIC: PLUMBING: MFCHANIC16 /+, � - ' Iq I , 01i INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: a BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: VALIDATION: RECEIPTft SS_PAIDBY:� G VALIDATION: WHITE—Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy CIT-T OF DIAMOND BAR INSPECTION RECORD COMMENTS: I TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD IT -BAR INTERCEPTER HOT MOPISHOWERPAN SEMOXESSPOOL BIERS REPORT RECEIVED DEMOLITION j ROOF DRAINS ROUGH CONDUIT I ��Wwf Horizontal Application Unit Installed on Platform Line contact is permissible but not preferr See the unit nameplate for clearances. N GAS . ENTRY 3ERVIC PLATF(JRf(t 0 k"11111 1 -9 . ", TVA;. N VENA - PIPE 4i q 21)(� Fo a N&i Cm � �?I Amcw r c L e 0 C u r u `c C `v c c C Z Lti on on to CO LU C3 U 0 Y LC 0 C5 H I— U Lu M on CD zd 0 0 7 0 z JOB SITE ADDRESS _,:. IL� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861'_3117 Building Inspection Hotline (909) 839-7027 PRESS BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov FIRMLY APN LOT TRACT OWNER -� ADDRESS CIN ZIP I 6 EL. 31 APPLICANT TEL, CONTRACTOR ADDRESS CITY ZIP DESIGNER ADDRESS CITY Zilf TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Coptractor's State Llcense 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 P Code: Any suecity c , county that requires a permit to construct, after, improve, demolish, ar repair, any structure, prier W 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 Ohlisien 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars (5501 f, as owner of the property, or my employees with wages as their sale compensation, will do {� all of or L 1 portions f the work, and the structure is not intended or offered for sale (Section 7044, On, and Professions Code: ons Contractors' State License Law does not apply to an owner of property who, through a siness an or personal effort, builds or improves the property, provided that the improvements are not Intended 0tr offered for sale. If however, the building or lmpravemerd is sold within ane year of completion, the Owner -Builder will have the burden of proving that It was not built or improved for the purpose of sale.). C } I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner oI property who builds or Improves thereon, and who contraclsforihe projects with a licensed Contractor pursuantto the Contractors' State License law,), U 1 am exempt from licensure under the Contractor's State License law for the following reason(s}: Date: AfY1 -),,n 1_7 1_ By my signature below I acknowledge that, exmistfor my porsonaf msldenc2-in-rVhlch I must have resided for at least one year prier 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 Code is available upon request when this application is submitted or at the following Web sife: httpAvww.feginfo.ca,govlcafaw.html. I hereby affirm under penalty of perjury that I am licensed under proulsions of Chapter 9 (commencing with Section 7000) Of Division 3 ofthe Buslness and Professions Cade, and my license is In full force and effect. (-ICENSE CLASS: LIC. NO.: EXP, DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS; I have and will maintain a Certlfoate of Consent to Self-lnsure for Worker's Compensation, as provided by Suction 3700 of the Lobar Code, for tine performance of the work far which this permit is issued. — I have and will maintain of the Labor Code a the performance ofihe work for whichtlt'sspepermit Ision ssued, My Workerance. 2s requireds Compensatloy Section o Insurance Career Policy Number are: and CARRIER POLICY NUMBER APPLICATION DATE: PIC# ISSUE DATE; '� � PERMIT# : R f T — �l j TYPE CONST. OCC GROUP: Scope of Work 00� # DWEL, UNITS # STORIES # BEDROOMS DESCRIPTION SQ, FT. FACTOR PSF ADJ. AREA/VALUATiON SFR/ADD E 2 1 Garage/Carport w Patio/Deck LL Pocl/Spa zRe -Roof O Commercial M M , „" - I'Adf. Area: QUANTfTY DESCRIPTfON FEE ptk>-1 t U c7 TDi �P�i z m z CONSTRUCTION: ' Y' # PLAN REVIEW:• , ELECTRIC: PLUMBING: .D_ d_Z MECHANICAL: INSPECTION FEE: ISSUANCE: 1 SMIP: 'I" I-- wU i UL GUMF'Lt f Lu IF THE PERMIT IS FOR ONE HUNDRED DCLIARS $100 OR LESS , — I certify that In the performance of the work forwhich this permit is issued, shalt not employ any person In any manner so as to ENERGY P/C: become subject to the Worker's Compensation Laws of California. And agree that if i should became subject to the Worker's ENERGY PERMIT; Compensation provisions Of Sector 3700 of the Labor Code, f shall forthwith comply with those provlsiens. RETENTION FEE: DATE: APPLICANT; Ty, WARNING, Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal PRE ALT FEE; ponaltles and civil fines up to one hundred thousand dollars ($100,000j, in addition to the cast of the compensation, BASF: damages as pravlded for In section 3708 ofthe labor code, interest, and attorney's fees, CONSTRUCTION LENDING AGENCY PLOT PLAN: 1 hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for ZONING CLEARANCE: which this permit Is issued (sec. 3097, Civ. C), LENDER'S NAME: LENDER'S ADDRESS: 1 certify that I have read 7appllastate that the ahove information is correct. I agree to comply with all city and TOTAL FEES �Y county Ordinances and sbullding construction, and hereby authorize representatives ofthis counTy to "t""Y�enter upon the above-me1r inspection purposes. COMMENTS:PER ITTEE NAVE (PRINPlc: a,% Zy �`i _ PAID BY:, VALIDATION:, S A E OF PER EE DATE i RECEIPT #_' $ ' PAID BY:g � VALIDATION:=(_ WHITE Department Copy, YELLOW Finance Copy, PINK—Assessor Copy In HIM, M� COMMENTS:- Building & Safety Division 21810 Copley Dive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Job Address: 11"I Cowie ��, thujas 4Dt, .i ]�Ium ,y k %ai- Dear Property Owner: 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 bylaw 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 unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board at 9821 Business Park Drive, Sacramento, CA 95827, www.csib.ca.gov 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, Attention Property Owner: An "Owner-Buiider" 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. 1. 1 personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no). Yec' 2. 1 (havethave not) kQ2e- . signed an application for a building permit for the proposed work. 3, [have contracted with the following person (firm) to provide the proposed construction: Name 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 work indicated: Name Address Phone Signed Prdoerty Owner Date 6 1 -�-G t Type of Work NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at M We are providing you with an Owner -Builder Acknowledgment and Information Verification Form 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 until 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 I Li. 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. l; 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. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �LZ I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. jQJ— 3. 1 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 miring a licensed Contractor and having the permit filed in his or her name instead of my own. \41— 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. I� L 5. 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" understate and federal law. 6. I 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. 1LL 7. 1 understand under California 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 all 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. U". 1 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. V9. 1 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 1-500-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. A&IL1 D. I 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: �)L11_ I 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. IA,L-12. I 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 will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit 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; Date: %iwGURlNNG REQUESTED Y: SNFC,, MMZONAL. T;TI,E COMPANY RECORDING REQUESTED BSI: R,4: I:�;ci'oth Order No. 720746,2 Escrow No. Parcel No. ^ ff2mmi ^�r AND WHEN RLCORDED MAIL TO T, --.A N CiA 0 23467 C'0Y0"E f' SP IM -j5 DRIVE ,)DAMO't Tip BA1=�., CA. 91765 SPACE ABOVE THIS LINE FOR RECORDER'S USE THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $8114.00 computed on full value of property conveyed, or computed on full valueless liens or encumbrances remaining at the time of sale. 1 unincorporated area: Z 10'nFMOD4 BAT, and FOR A ifALUA1BLE CONSIDERATION, receipt of which is hereby acknowledged, Roger L. Gripe and Margaret D. Gripe, trustee(s) or SUCceSOr trnstee(s) of The Gripe Family living Trust dated September 11, 2002 hereby GRANT(S) to ":.urr G,ao and `°,Vehtin- I<ianlg, huisbpoad a?W wife as Joint 7enarnts the following described real property in the County of L,?.,,, AnpMes, State of California: Lot '',19 rFr Tract 1410. 25096, as der nnap recorded in bool< 868, page(s) 43 to 54 inclusive of nnaps, in the office of floe Comity R --corder of said County. More commonly lalo ya', g2"467 Coyote ` rin2gs EFr s ° , J1 u �mopn�N Ilan 9 CA tS1 7�r :- Date 1\4,a}� :?..�'_0-r,7 The Gripe Family Living Trust dated Roger L. Gripe,2- xu steee September 11, 2002 Margret D. Gripe, Y' rus to eV/ A notary public or other officer completing this certificate verifies only the identity of the individual who signed the docutnent to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA `:OUNTTYOP 1S.S. rl r On (–) � ..._ "--) I , before me, personally appearedLy� c; i �Y G G LLP, wbokoved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNl'SS my hand and official seal. l _ KYRA L. ESTRADA Signature (Seal) Notary Public - California Riverside County Commission, # 2188450 My Comm. Expires Mar 26, 2021 Mail Tax Statement to: SAME AS ABOVE or Address Noted Below Ac- > Cc? M m � = :� §j�\ x Z m 0 \XM \10 -4 �n 2ZM M LD > \7 w C) %M C M X 71 \ > Cc? 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