HomeMy WebLinkAboutPR17-5483_.._-:_:.:.... 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.cityofdiamondbar.com building@diamoudbarca.gov
JOB SITE ADDRESS 2-1-112— _3 I /,ie),, 2r,L-
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APPLICANT Cw t3 �! TEL. ::?14 t0i'C� il
CONTRACTOR err i
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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 far the reason{s)
indicated below by the checkmark(s), I have placed next to the appiicable iterl (Section 701 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 appliaantfor the permit to file a signed statemontthal 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 Cade] orthat he or she is exempt from 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 civi I penalty
of not more than five hundred dollars ($500).
() I, as owner of the property, or my employees with wages as their sole compensation, will do [j all of or i porlions
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, 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 w111 have the burden of provlrg that it was not built
or Improved for the purpose of sale).
() 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 iorthe projects with a licensed Contractor pursmntto the Contractors' State
License Law.).
U 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 prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as ar
owner -builder if if 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 i5
submitled or at the following Web site: http/www.leginfc.ca.gov/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 Profsssiens Code, and my license is in full force and ffect.
LICENSE EXP. DATE 'S CONTRACTOR'S
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 Se11-[nsure 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 wild maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the werkfor which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Nu CARRIER ARRIER
POLICY NUMBER06
[PHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS).
I certify that in the performance of to work for which this permit is issued, I shall Tat employ any person in any manner seas to
become subject to the Worker`s Compensation Laws of California. And agree that If I should become subject to the Worker's
Compensation provisions of Section 3700 of the Labor Code, I shalt 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 ($1 DO,DOO), 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 parmit Is issued (Seo. 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. I agree to comply with all city and
county ordinances and state laws relating to building construatlon, and hereby authorize representatives of this county to
enter upon the abo-menIII pro arty for Inspection purposes:
PERMITTEE NAME (PRINT)
SIGNATURE OF PERMITTEE UATE
APPLICATION DATE: r i `" P/C# T "51 V
ISSUE DATE: A PERMIT# : ����� � g4 3_
TYPE CONST. OCC GROUP:
Scope of Work
inti :]a
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
Lu
Patio/Deck
Lij
L'-
Pool
ZRe
-Roof
Commercial
CD
VajUaftll Adj. Area:
QUANTITY DESCRIPTION
FEE
V
F
v
J
co
Es
Es
a
J
a
U_
x
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
L6 4, (J
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
!
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:.
PRE -ALT FEE:
r;
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
z
P/C: _ PAID BY: VALIDATION:
RECEIPT # ,. F''4 PAIL) BY: " '^ t 7— VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK--- Assessor Copy
.. RECORD
.......... .... ......
_ _ _
POMONA UNIFIED SCHOOL DISTRICT
CAPITAL PACILITlES PROGRAM MANAGEMENT Form Number
800 SOUTH GAREY AVENUE • POMONA • CALIFORNIA 91766
Certification of Compliance
qL
44akicant's N e Applicant's ane No.
�ppl,- aili Add s __ ✓ �� �s
Applicant's Signature Date of Signa ire
The applicant executing this declaration certifies under penalty of perjury that: (1) they are the Owner and/or Developer or they are authorized to sign on behalf of the
Owner and/or Developer, (2) that the information provided is true and accurate to the best of the Owner's andlor Developer's knowledge, (3) the Owner and/or
Developer will file an amended certification of compliance and pay the additional amounts due if Owner and/or Developer increases the number of dwelling units
andlor square footage after the building permit is issued or if the initial determination of units and/or square footage is found to be incorrect, and (4) they have read
and fully understand this side and the reverse side of this document including the 90 -day protest period posted an the reverse side of this document.
Namg
Phone No.
r ik Li�?
Development Type and Fee Schedule Check appropriate box(es), fl! in the fee per sq. ft. and circle the fee level in effect.
Residential $ Isq. ft. (Level 1 - Level 2 - Level 3)
New_Addition I Single Family I Single Family attached_I Multi Family 1 Other
❑ Manufactured/Mobile Homes $ Isq, ft. (Level 1 - Level 2 - Level 3)
❑ Commercial/industrial $ /sq. fL Exempt status justification I notes:
❑ Senior Citizen Housing $ Is . ft. (See reverse side of sheet_) .y— 5 00 sq - '"
Exempt $ -fl- /sq. ft. (Provide justification.)
Fee Ct1t
a}lc�ulations Each Certification of Compliance form is for five (5) projects maxim` num. Use additional fforms for additionalprojects. f
1. " "1 � 1 ��E 0 -D�Ll$ ' .0 _ pU 13 sq. ft. $ -"
Tract No_ I Lot No. 1 Address Plan Check Na Fee per sq. ft. Area Fee
Tract No. l Lot No. / Address
Plan Check No.
3_
Tract No. I Lot No. I Address Pian Check No,
4.
Tract No_ I Lot No. I Address Plan Check No.
5.
Tract No. I Lot No. / Address Plan Check No.
$
Fee per sq. fL Area
$ h.
Fee per sq. ft. Area
$ sq. ft.
Fee per sq. ff. Area
$ sq. ft.
Fee per sq. ft. Area
TOTAL FEES DUE
(This form only.)
Fee
Fee
Fee
Fee
Receipt of Fees This is to certify that ali fees due to the Pomona Unified School District under applicable provisions of the Government Code and the
Education Code, as prerequisite to the issuance of a Building Permit by the City/County, have been received. Based on the information
presented above, this Certification of Compliance is hereby executed.
Receipt No.
DistrictlFiscal Services (Signature and Printed Last NamelTifle)
Check No.
Date
See reverse side for General Information, Senior Citizen Housing, Payment of Fees, Notice - Protest Period and Appeals Praeess.
Distribution of Copies: White - CitylCounty, Yeiiow- District/UPM; Pink -District/Fiscal Services; Goldenrod - Owner/Developer. Revised 1/05
GENERAL INFORMATION
On November 4, 1998, SB 50 became effective. This bill grants California school districts the authority to levy fees in excess of those authorized by
Government Code Section 65995 (bevel 1 Fees), if the district meets certain specified tests and approves a School Facilities Needs Analysis.
Alternative Level 2 fees may be levied when state bond funds are available for school construction projects, and Alternative Level 3 fees may only be
levied when the State allocation Board certifies that it is no longer approving apportionments for new construction due to lack of available funding.
The Board of Education approved the School Facilities Needs Analysis and adopted a resolution levying the alternative fees under SB 50 and has
approved the fees on commercial/industrial development by separate resolution. Copies of the resolutions and the School Facilities Needs Analysis
are available for viewing in the Capital Facilities Program Management office.
SENIOR CITIZEN HOUSING
Per Government Code Section 65995.1(c), if a senior citizen housing project is later converted to non -restricted use, the applicant/developer who is
seeking the change in use will have to pay the difference between the current residential fee and what was paid for the senior citizen housing.
�7_�► i�i�tLi1;�-3L�1�C�
State law prohibits a city or county from issuing a building permit unless the local school district has certified that the application is in compliance
with the District's collection program for fees assessed developers_ The procedure for obtaining the required certification follows:
Project Plans - A set of project plans stamped by the governing city or county building department, and valuation receipt indicating calculated square
footage and plan check number, must be reviewed by the District. The address follows:
Capital Facilities Program Management, Pomona Unified School District, 800 South Garey Avenue, Pomona, CA 91766.
Calculating Area for Residential Projects - The District levies fees on existing residential construction only if the resulting increase in assessable
space exceeds 500 square feet after deducting any loss of assessable space in the same residential structure as a result of the same reconstruction. All
assessable square footage in new residential structures is subject to the fee levy. "Assessable space" means all square footage within the perimeter of
a residential structure, not including any carport, walkway, garage, overhang, patio, enclosed patio, detached accessory structure, or similar area.
Residential projects also include the initial location, installation or occupancy of a manufactured home or mobile home.
Calculating Area for Commercial/Industrial Projects - The chargeable covered and enclosed space of commercial or industrial construction shall not
be deemed to include the square footage of any structure existing on the site of that construction as of the date the first building permit is issued for
any portion of that construction_ "Chargeable covered and enclosed space" means the covered and enclosed space determined to be within the
perimeter of a commercial or industrial structure, not including any storage areas incidental to the principal use of the construction, garage, parking
structure, unenclosed walkway, or utility or disposal area.
Available Hours for Verification - CFPM staff will verify project development type and square footage and complete the Certification of Compliance
,during available hours. Availablehours are from 8:30 A.M. - 12:00 P.M. and 1:00 P.M. - 4:00 P.M., Monday through Friday, except District
holidays. Other times are available by appointment by calling (909) 397-4800, ext_ 3920.
Available Hours for Payment - Fees due are paid to the District during available hours. Available hours are from 8:30 A.M. - 12:00 P.M. and 1:00
P.M. - 4:00 P.M., Monday through Friday, except District holidays. Copies of the completed Certification of Compliance will be given to the
applicant for use in obtaining the building permit(s) and for the applicant's records.
NOTICE - PROTEST PERIOD
Section 6620 of the Government Code requires that Pomona Unified School District provide a written notice to the project applicant, at the time of
payment of school development fees, mitigation payments or other exactions ("Fees"), of the 90-dayperiod to protest the imposition of these Fees.
Therefore, in accordance with Section 66020 of the Government Code and other applicable law, this Notice shall serve to advise the applicant that
the 90 -day protest period in regard to such Fees or the validity thereof, commences with such payment or performance of any other requirement as
described in Section 66020 of the Government Code.
APPEALS PROCESS
Any claim by an applicant that their project should be exempt from assessment.of fees, or that the fees levied are incorrect, must be made in writing
and filed with the Pomona Unified School District. The claim must specify the factual and legal grounds supporting the claim. In addition, the claim
must contain a statement specifying the nature of the project and the date the project building permit application was filed.
The District's Superintendent, or his designee, shall respond in writing to a claim within fourteen (14) days from receipt of the claim. The response
shalt contain the Superintendent's decision on time claim and a statement of the reasons supporting the decision.
Any claimant who is dissatisfied with the decision may request review by the District's Board of .Education. A request for review must be written and
filed with the Superintendent's or designee's office not later than ten (10) days from the date of the decision. The request must contain a statement of
all factual and legal grounds in support of the continuing claim.
The Board of Education shall consider and act upon a request for review at a public meeting not later than thirty (30) days from the date of filing of
the request. A claimant may appear and address the Board in regard to the claim. The Board shall provide written notice of its decision, to be mailed
to the claimant, within fourteen (14) days atter public meeting at which the Board acted upon the claim.
Correspondence shall be addressed to:
Assistant to the Superintendent, .business Services -Facilities, Pomona Unified School District, 800 South Garey Avenue, Pomona, CA 91766