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HomeMy WebLinkAboutPR17-2276i w z 0 0 M J m a a 0 m m 0 0 LU z 0 M z a m 0 CD fZl 0 z a rq rr 0 U z a U H 0 z Y CC 0 ILL Z 0 a w 0 i U LiM 0 0 w H a 0 w z CJ U CITY OF DIAMOND BAR�� DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS r v, (909) 839-7020 Fax: (909) 86I-3117 Building Inspection Hotline (909) 839-7027 FIRMLY y9g" BUILDING PERMIT APPLICATION www.cityofdiaroondbar.com building@diamondbarca.gov ' APPLICATION DATE: N 1 �� PIC#'�2 JOB SITE ADDRESS ­0.#���"- �Iu}' r f,'' ISSUE DATE: PERMIT# : APIA g LOT TRAG€ OWNER( 7 ADD SS to 6' CITY , "I ZIP TEL, ' 7 APPLICANT,_ TEL. CONTRACTOR 1 11C1 y J yv ADDRESS/ L`A�±I�Ku CITY TEL. ARCH/ENC/ DESIGNER ADDRESS CITY ZIP TFL. OWNER -BUILDER 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 tyle applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to conslmct, alter, improve, demolish, or repair, any structure, print to 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 Stale License Law (Chapter J) Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exemptfrom licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicantto a civil penalty of not more than five hundred dollars ($500). (_)1, as owner of the property, or my employees with wages as thetr sole compensation, will do (_) all of or (-) 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, 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 R was not built or Improved for the purpose of sale.). O 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 am owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuant tothe Contractors' State License Law,), U I am exemptfrom licensure under the Contractor's State License taw forthe following reasons) By my signature below I acknowledge that, exceptfor 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 an owner -builder if it has not been constructed in its entirely 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 attire following Web site: httplwww.laginfo.ca.gov/calaw.htTil, 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. ENSE CLASS: _ LIC. NO.: d ^ P. DATE: (-,17 '' CONTRACTOR: ' WORKER'S COMPENSATION DECLA TION 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 forwhich this permit is Issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the wmrkfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: ,![� yCARRIERLsriW.YIL"i pp / POLICY NUMBER � f` %a- (WIS SECTION NEE) NOT RECOMPLL7E0IFTHE PERMIT I5 FCR ONE RUNJRED DOLLARS $100 OR LESS'. I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person ire any manner so as 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 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 fEnes op to one hundred thousand dollars ($10),000}, in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and atlorney's tees. 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, ON. Q. LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this applicatlon and state thatthe above information is corned. 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 roperty, for inspection purposes. '71) f PERMITTEE NAME (PAINT) SIGNATURE OF PERMITTEE �I -` y DATE l TYPE CONST OCC GROUP: Scope of Work 1'Z=-4 p # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREMALUATION SFR/ADD/REM Garag VCarpert ;'atiolDeck Pool/Spa Re -Roof Commercial Valuation: Adj. Area: CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ICCI 16NC'.P. ._ SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTALFEES® COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT #� �Q &a PAID BY. � VALIDATION: J, WHITE Department Copy, YELLOW — Finance Copy, PI NK —Assessor Copy QUANTITY DESCRIPTION FEE J U U w uJ z m z a U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ICCI 16NC'.P. ._ SMTP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTALFEES® COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT #� �Q &a PAID BY. � VALIDATION: J, WHITE Department Copy, YELLOW — Finance Copy, PI NK —Assessor Copy [4161iIMI:Iilk ISO ins{a e�tie�n.INC OFFICE (909) 592-4153 229 W. BONITA AVE„ SUITE 2E FAX (909) 592-6248 SAN DIMAS, CA 91773 Registered Deputy inspector's Report Date , l . Reinforced Concrete ❑ H.S. Bolts ❑ Sprayed Applied Fireproofing [:i Post Tensioned Concrete ❑Welding ❑Quality Control ❑ Reinforced Masonry ❑ Shop f Drilled 1n Anchors city Job Address 3 q® , 5 P etcp t p —f r C.� ® Issue By C'�n� Job Name (� a Mix Design or Material Used Architect Engineer/e®r e— f Contractor r �v Subcontractor TIME IN TIME OUT REG. HOURS O.T. HOURS CYLINDERS All inspections based on a minimum of 4 hours and over 4 hours - B hours minimurn. 12101 1' Arm M �,`f iy0. PAGE % OF ERTIFICATION OF OMPLIANCE 1 HEREBY CERTIFY HAT I HAVE INSPECTS TO THE BEST OF MY KNOWLEDGE ALL OF THE ABO REPORTED WORK U SS OTHER WISE NOTED. I HAVE FOUND THIS, RK TO COMPLY WIT GOVERNING BUILDING NG LAWS.CIFICRTIONS. AND APPUC LE SECTIONS In addition, any inspection extending past noon hour will be an 8 hour minimum. _- — IGNATURE OF REGISTERED INSPECTOR ®�_ `e . Approved by —. ------ - SPECIALTY NO AGENCY Project Superintendent WHITE • OFFICE COPY CANARY • CITY INSPECTOR PINK • JOB SITE County"of Los Angeles o y� PUBLICWDFRCS „ DEPAR.Tmr=NT OF PUBLIC WORKS BUILDING & SAFETY DIVISIONAt Field Office Address: "� Se-vfce"Ct'$ STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, at significant construction stages and at completion of the structural system- Structural observation does not include or waive the responsibility forthe inspections required by Sections 106, 1701 or othersections of the Los Angeles County Bullding Code. (Sections 106.4.5, 1702) Report No. a *--finn.uinrk thrnTlryh 1.11.. i�dav of P ' .20 1 7 Page No_ o'f . - 1-{IJ:i IZ✓}7llrt ur�.iuuca aii .t.viiaa, a.,uv}... .. .._. zra•r - _-.- - - FLOOR PORTION OBSERVED, IF NOT WHOLE Pro}ect Address- )) � fa' f f �� f® Structural Observer of Record (5OR): DR Phone No-: d 13 Concrete Bulhdin,qPermItNo.: Structural bservationperf ed by: bserverP sionaiLic ;erverPhone No.: 0 Steel Deck Caisson, Piles, GraM-Bearrts 0 Wood 17 Concrete Moment Frame rrra r_iir.kituNVIN=0= 1111201t.MAOIRAMRINMEJ010rmiuitE FOUNDATION WALL FLAMES FLOOR PORTION OBSERVED, IF NOT WHOLE Footing, Stern Walls, 0 Concrete II Steel MamentFrante 13 Concrete 0 Mat Foundation I:] Masonry © Steel Braced Frame 0 Steel Deck Caisson, Piles, GraM-Bearrts 0 Wood 17 Concrete Moment Frame D Wood 13 Retaining Foundation Millsift Special Anchors E3 Others: IO other: 0 MasonryWali Frame 0 Others: 0 Others: I h' r•.r-�r+r rn rrr� rCC[f+1��i1�ICC• �y I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE: 1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANGE WITH THE REQUIREMENTS ��Ml £l OF THE CI YICOUNTY OF 2. 1, ORANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH s� � 26693 C/2? SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; vx 3, ALL DEFICIENCIES WHICH REMAIN To 13F CORRECTED HAVE BEEN INDICATED ABOVE; �`sr 4. 1 REC15MMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CIT couNTY F CA OF BE WITHHELD UNTIL OBSERVED DEFICIENCIES ARI- CORRECTED. STAMP STRUCTUM siGNATURE f ATE 013 -SER R OF RECORD 1 of I sortdor,- LARUCP Structural Observation Report Fob m (V9.Q 512DQQ} Page County "of Los Angeles eeE9JC*oA>6 DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION LAR D Field Office Address: -STRUCTURAL OBSERVATION REPORT FORM sTRUcTURAL OBSERVATJON means the visual observation of the structural systemst, for genera! co»forma to the approved plans and specifications, of significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required by Sections 108, 1701 or othersecfiDnS of the Los Angeles County Building Code. (Sections 106.4.6, 1702) Report No. !, 20_Pa a No. of This report includes all .ronsiruction work.thrnugh -_ � day of _.C_. PrajectAd cess structural Observer of Record (SOR}: OR Phone NO.: % . Building Permit No.: v 5tru ral Observation perforSAAA ed l,y. L server P essianal Li g. No.: Observer Phone No rlRc:PFRVFD STRUCTO ELEMENTS AND THEIR CONNE TIONS FOUNDATION WALL El Footing, Stern Walls, D Concrete 0 Mat Foundation fl Masonry t { M Caisson, Piles, Grad'e•Bearq-!. OI Retaining Foundation #iillside Special Anchors 1Nood E3 other. 0 others. � f. OBSERVED DEFICIENCIES: M FRAMES Fuuvw C3 Steel Moment Frame 0 Concrete © Steel Braced Frame 0 Steel Deck © concrete lViament Frame Wood E3 Masonry Wall Frame 113 Others: Others: , i PORTION OBSERVED. IF NOT WHOLE surf doe- LpRUCi' Structural Ot:servabon Report Faun N1.Q; 32000} City of Diamond Bar Building & Safety Division 21810Copley Drive Diamond Bar, CA 91765 Building Division (909) 839-7020 / Inspection Request Hotline (909) 839-7027 PERMIT # P K.($ ZZ -4'(p DATE ISSUED; i/ ('0z I } ._„_ ADDRESS: 1340 Sims PL. DESCRIPTION:- ddition- &RZSGr� Patio cover- q ck 8qS' POST IN SAFE, CONSPICUOUS PLACE AT FRONT OFJOB. PROVIDE PERMIT NUMBER WHEN CALLING FOR INSPECTION, HAVE APPROVED PLANS ON JOBSITE ATTIME OF INSPECTION. INSPECTION REQUESTS SHALL BE MADE 24 HOURS IN ADVANCE, YOU MAY CALLUS THE DAY OF YOUR INSPECTION AT 9:00 AM AT (909) 839-7020 TO OBTAIN AN APPROXIMATE TIMEFRAME, INSPECTION DATE: SIGN: j INSPECTION DATE; SIGN: SETBACK / LETTER. TRACT AND LEDGER FOOTINGS FORMS SWITCH GEAR SLAB COMMERCIAL HOOD UG.PLUMBING % O] T -BAR UG„ ELECTRICAL INTERCEPTER UFER GROUND HOT MOP/SHOWERPAN SEWER LATERAL SEPTICICESSPOOL SEWER CLEANOUT HERS REPORT RECEIVED MAIN WATER LINE DEMOLITION ROOF SHEATHING C % ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT 511EAR WALLS EXTERIOR POOLLSPA: SHEAR WALLS INTERIOR ROUGH PLUMBING FRAMING/VEN71NG � ROUGH ELECTRICAL . Roo MECHANICAL i7 ROUGH _MECHANICAL RO. ELECTRICAL W() C () GAS TEST RD. PLUMBING 7.e t'7 PRE GUNITIE INSULATION WALL POOL PRE DECK BONDING INSULATION CEILING P -TRAP DRYWALL FENCE / GATE / ALARM LATH (PRE) FINAL POOL LATH EXTERIOR 24 WALLS LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1ST( ) 2ND() LIFT SCRATCH COAT j WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN / SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RD. FRAMING PLANNING APPROVAL FINAL BUILDING r ROU PTREAPPROVAL 7) VA MECHANICAL NAL FERE FINAL ELECTRICAL HNAL PLANNING 41 FINAL PLUMBING i7AIAL ENGINEERING/PW T.C. of OCCUPANCY FINAL COMMUNITY SERVICES CER,T.OF OCCUPANY FINAL HEA LTHDEP T. INDUSTRIAL WASTEHNAL COMMENTS: NEW CONSTRUCTION PROJECT LOT ADDRESS BUILDING USE City Residential/ Commercial/Industrial HOME IMPROVEMENT OR REMODELING PROJECT ADDRESS DESCRIPTION Diamond Bar Walnut (Bedroom, Family Rm., Kitchen , etc.) Other City NO TOTAL SQ. FT. TOTAL SQ. FT. ;ADO Signature of Superintendent of Buildings--&� Date '7 151 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 $ c'r'. S,4 Are (EFF. 12/1/08) Residential Development $2.97/sq. ft. Receipt # Commercial/Industrial $0.471sq. ft. Date 2. :3 t 6 Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet (eliminating garage or uncovered patio). NXThis is to certify that all fees are due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. C This is to certify that the above described development has been determined to be EXEMPT from the development fees of Government Code Section 65 99 5 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET )SC, Coli-a-Sloynihan Director, Fiscal Services 1187 Rev. 2188; 6/88; 8/89; 1190; 8190; 10190; 8192; 6193; 11193; 8194; 6196; 1197; 8198; 7104; 6106; 2/08; 12108; 1/13; 6/16 S$ RECE o RECEIVEDf FROM DATE __,;ADDRESS - o r CERTIFICATE OF COP A'yFOR VC With Fee Provisions of Government Code Section. DEVELOPER/OWNER_ � !fr ACCCCN7 accaur HOW p AfD ADDRESS ' V ! if f AMT. PAID CASH CITYIZIP '`�7f�mw'x TELEPHONE_ BALANCE oUE CHECK MONEY ORDER NEW CONSTRUCTION PROJECT LOT ADDRESS BUILDING USE City Residential/ Commercial/Industrial HOME IMPROVEMENT OR REMODELING PROJECT ADDRESS DESCRIPTION Diamond Bar Walnut (Bedroom, Family Rm., Kitchen , etc.) Other City NO TOTAL SQ. FT. TOTAL SQ. FT. ;ADO Signature of Superintendent of Buildings--&� Date '7 151 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 $ c'r'. S,4 Are (EFF. 12/1/08) Residential Development $2.97/sq. ft. Receipt # Commercial/Industrial $0.471sq. ft. Date 2. :3 t 6 Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet (eliminating garage or uncovered patio). NXThis is to certify that all fees are due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. C This is to certify that the above described development has been determined to be EXEMPT from the development fees of Government Code Section 65 99 5 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET )SC, Coli-a-Sloynihan Director, Fiscal Services 1187 Rev. 2188; 6/88; 8/89; 1190; 8190; 10190; 8192; 6193; 11193; 8194; 6196; 1197; 8198; 7104; 6106; 2/08; 12108; 1/13; 6/16 S$