HomeMy WebLinkAboutPR17-12924CITY OF DIAMOND BARS
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
(949) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarea.gov
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JOB SITE ADDRESS 1-eraj L) w
APN LOT TRACT
OWNER k\
ADDRESS -e- rr a C C
CITY `'yafl'YW,'Vk.,._5�.a zIP�'fEL. �-79 il�
APPLICANT ' ,ay -f_ L -i TEL.7tLi ADZ Ji s3 .-
CONTRACTOR
ADDRESS 1 L 14-1
CITY1y� ZIP_qTEL
ARCH/ENG/
DESIGNER J7 V !' Of -ii
ADDRESS U5 z_ 1tTA
CITY ^ !s_ ZIP TEL. 7i' S
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 ahmkmark(s), I have placed next to the applicable items) {Section 70al.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 statement that he or she
Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section
7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from Ilcensufe 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},
(_)1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or I 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 properly 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-Ruiider will have the burden of proving that It was not built
or Improved for the purpose of sale.).
U I, as owner of the property, am exclus vely 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 tothe Contractors' State
License Law.),
L) I am exempt from 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 residence in which I must have resided for at least one
year priorto completion of the improvements covered by this permll cannot Iegaily sell a structure that I have built as an
owner -builder if it has not been constructed in its entirety by llcensed 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 atthe following Web site: htfplwww.Ieginfo.ca.govlcalaw.html.
LICENSED CONTRACTOR'S DECLARATION
i hereby affirm under penally 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 Linn full�fyorce and effect.
LICENSE CLASS: �-""d LIC, NO.: lot t q 46 �d
EXP. DATE:L•-`--�y'^-%4i 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 -Insure for Worker's Compensation, as provided by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued,
I have and wNl maintain Worker's Compensation 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 N -ti_
POLICY NUMBER 017 E7 12_4�i
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}.
I cerhiy that in the performance of the work forwhich this permit is Issued, I shall not employany person In any manner so as to
become subject to the Worker's Compensation Laws of Callfornla. And agree that if I should become suhJect to the Worker's
Compensation provisions of Section 3700 of the Labor Code, 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
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 work for
which this permit is issued (Sec. 3097, Clv. C.).
LENDER'S NAME:
LENDER'S ADDRESS.
I cerdfy 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 pr arty for inspection purposes.
- � -
PERMITTEENAME(PRIN �-
SIGNATURE OF PERMITT - DATE
PRESS
FIRMLY
APPLICATION DATE:IS
ISSUE DATE: If PERMIT# :
TYPE CONST.
P/C#^�' — I In l
„" ! Z 1
OCC GROUP:
s
yds e
Scope of Work ,,ZiT a il
l: Gtr /I • y g _
# DWEL. UNITS # STORIE=S # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADDI
Garage/Carport
Patic/DeoK
LL
�
Pool/Spa
ZRe
-Roof
Commeroia€
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Valuation:
kdj. Area:
QUANT€TY DESCRIPTION FEE
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m
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CONSTRUCTION:
PLAN REVIEW:
2-1
ELECTRIC:
5q _3 6
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
17— 2-L4
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P1C: � PAID BY: VALIDATION:
RECEIPT#.4_51 4 PAID BY:'- 3 VALIDATION:
WHITE — Department Copy, YELLOW --- Finance Copy, PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECTION D
71RACTANDGER
COMMERCIAL HOOD
T -BAR
INTERCEPTHI
HOT MOPISHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOIP ION
ROOF DRAINS
ROUGH CONDUIT
POOLISPA
ROUGHPLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GONITE
POOL PRE DECK BONDING
P TRAP
FENCE 1 GATE/ ALARM
FINAL POOL
WALLS:
WAI 1. I DOTING/STEEL.
WAI I STEEL 1'T( ) 2N°( } LIFT
........... _.
WALL. BOND BEAM
WALL DRAIN/ SEAL
WALL. FINAL
RG FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL. PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
SETBACK/LETTER
FOOTINGS FORMS
SLAB
UG. PLUMBING
UG. ELECTRICAL
LIFER GRCUND
SEWER LATEHAL
MAIN WATER LINE
SEWER GL..FANOUT
ROOF SHEATHING
FLOOR iff ATHING
SHEAR WALLS EXTERIOR
SHEAR WALLS INTERIOR
FRAMINGIVENTING
ROUGH MLCHANICAL
_ .........
ROUGH ELECTRICAL W( ) C ( )
ROUGH PLUMBING
INSULATION WALL
INSULMION CEILING
DRYWAI 1.
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
--
GAS'.1 LST
SC IAICH COAT
ELECTRIC METER RELEASE
CA5 METER RELEASE
SPECIAL INSPECTION
00
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
1C. of OCCUPANCY
CERT. of OCCUPANCY
71RACTANDGER
COMMERCIAL HOOD
T -BAR
INTERCEPTHI
HOT MOPISHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOIP ION
ROOF DRAINS
ROUGH CONDUIT
POOLISPA
ROUGHPLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GONITE
POOL PRE DECK BONDING
P TRAP
FENCE 1 GATE/ ALARM
FINAL POOL
WALLS:
WAI 1. I DOTING/STEEL.
WAI I STEEL 1'T( ) 2N°( } LIFT
........... _.
WALL. BOND BEAM
WALL DRAIN/ SEAL
WALL. FINAL
RG FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL. PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
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CITY OF DIAMOND BAR
DEPARTMENT OF CONIMUNITY & 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 vi'ww cityofdiamondbancom building(?,diamondbarea.gov
JOB SITE ADDRESS I CA r 6e I- Al iAJ
APN LOT TRACT
OWNER i t s)
ADDRESS Vi er4r ,. G
CITY Prig _4r: ZIP e-TEL?�J,
APPLICANT u L it— TEL. "7i'd-F 7
CONTRACTOR"
Al I
CITY �� L= �9 � '"'' ZIP '3: �iJTEL.:7dvf Iw' '
ARCH/ENG/
DESIGNER €i�tkfw rte°
ADDRESS I �,') V4 t'&,.
CITY ZIP A " TEL. s� l � .)
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, alter, improve, demolish, or repair, any
structure, prior to its issuance, also requires the applicant for the permit to file a signed statementthat he or she
is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9) Commencing with Section
7GOO of Division 3 of the Business and Professions Code] or chat he or she is exempifrom licensure and the basis for
the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a Cil penalty
of not more than five hundred dollars (8500).
(-) 1, as owner of the property, or my employees with wages as their sole compensation, will do (-) all of or ( j 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' or personal effort, hufids
or Improves the property, provided that the improvements are not Intended or offered for sale. If however, the building or
Improvement 1s sold within one year of complstion, the Owner-Rullder w1i have the burdor of proving that h 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 (Secticn
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who
builds or improves (hereon, and who contracts for the projects with a ilceneed Contractor pursuant to the Contractors' State
License Law,},
(-) I am exemptfrom licensure under the Contractor's State License law for the fallowing reason(s):
Date: Sigrr.
By my signature below 1 acknowledge that, except for my personal residence in whioh 1 must have resided for at least one
year prier to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an
owner-trullder if it has not been constructed in Its entirety by licensed contractors. I understand that a copy of the
apphcabie law, Section 7044 of the Business and Professions Code is available upon request when this application is
submitted or at the following Web site: httpMrvvw.leglnfocagov/calaw.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 lull force and effect.
LICENSE CLASS:
EXP. DATE a_u'.r CONTRACTOR:���..r'
WORKER'S COMPENSATION DECLARATION
I HEHEBY 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 ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Code, ter
the performance ori work for which this permit Is Issued My Worker's Compensation Insurance Carrier and
Policy Number are:
a y"
CARRIER
POLICY NUMBER.---L:�_ T2.
(THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS 8100 OR LESS).
I certifythat In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to
become subs to the Worker's Compensation Laws of California And agree ihai if I should become subject to the Worker's
Compensation provisions of Section 3700 of the Labor Code, 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
penalties and civil tines up to one hundred thousand dollars (S100,000), 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 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. 1 agree to comply with all city and
county ordinances and state laws relating to building construction, and hereby authorize representatives of this county Is
enter upon the abov -men Toned p party for inspection purposes.
PERMITTEE,. ,RINT)
a
SIGNATUl PERINI DATE
APPLICATION DATE:
ISSUE DATE:
TYPE CONST.
d ' ') .
`! I `HERMIT#:
P/C# z 0.— 7 6
Ii �J -
OCC GROUP:
Scope of Worktjv
# DWEL. UNITS
,V & i
# STORIES
# BEDROOMS
DESCRIPTION
SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w
Patio/Deck
W
LL
Pool/Spa
ZRe
-Roof
0
Commercial
in
Valuation:3
Adj. Area:
QUANTITY
DESCRIPTION FEE
a
U
s
U
LSJ
m
z
m
b
4
z
LD
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
0a Fee
P/C:
RECEIPT #
PAID BY:
PAID I
VALIDATION:
VALIDATION:
WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
CITY OF DIAMOND BAR
INSPECTION ,IIT
SETBACK/ LETTER
FOOTINGS FORMS
SLAB
UG. PLUMBING
UG. ELECTRICAL
LIFER GROUND
SEWER LATERAL
ROUGHMECHANICAL
..._._ ..... __.
ROUGH ELECTRICAL W( ) C ( )
ROUGH PLUMBING
........
INSIRATION WALL
INSUI ATION CEILING
DRYWAI 1
LA -Ir{ (PRr:)
I.AT[ i IXIENOR
I ATI1 INTERIOR
CAS .I Li I -
SC RA I CH
iI-
SCRAICH COAT
ELL(;IRIC METER RELEASE
r(=ASI METER RELEASE
SPLGIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
'FINAL PLUMBING
T.O, of OCCUPANCY
CUT. of OCCUPANCY
RACE AND LEDGER
SWI I Cl I GEAR
COMMI:HCIAL HOOD
I fiRli
IN i I IICEPTER
HO -T MOWSHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
--
PRE GUNITE
.- —
POOL PRE DECK BONDING
P -TRAP
FENCE 1 GATE/ ALARM
FINAL POOL
WALLS:
WALL FOOTING/STEFI
WALL STEEL 18( ) 2"0( ) LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
RO. FRAMING PLANNING APPROVAL .
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY S RVWES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
CITY OF DIAMOND BAR
BUILDING & SAFETY DIVISION
21810 Copley Drive
Diamond Bar, CA 91765
(909) 839-7010
�a F F ' - ,•� i "' �_� «;f. � ��S E-,� y i i i!� l'.t �� � � g ms's "r '.! ' w � c - .'. y . i a�; r' , - ylr� '-r- # r-" <'""`� ��� S � �
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 California Building Code Section 4.20.5 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 wall and ceiling finishes or there is no access by means of attic, 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.
CARBON MONOXIDE ALARMS
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:
a 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 including 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:
0 Listed and labeled combination carbon monoxide I 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 fill out and tear off this portion to leave with the job card if no one will be available to
ailow the inspector inside the !souse.)
INSTALLATION CERTIFICATION
For the prop cated pt:LL r° I hereby certify that the required
smoke alar 1116h monoxide alarms have been irAstalled as listed above.
oo
ignature Print Name ate
Relationship to project (please check one):
Owner n 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