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PERMIT M PR201800347 CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 DIAMOND BAR BUILDING PERMIT APPLICATION www cltvofdiamondbar com building@dlamondbarca.gov JOB SITE ADDRESS: 21439 BROKEN ARROW DR, DIAMOND BAR, CA 9276S APN 8292017026 LOT#, TRACT#' OWNER NAME WONG BENAVIDEZ REBECCA ADDRESS 21439 BROKEN ARROW DR CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE> APPLICANT NAME TEL CONTRACTOR NAME We Care Plumbing Heating and Air Conditioning ADDRESS 41085 Golden Gate Cir CITY Murrieta STATE CA ZIP 92562 TEL (951) 600-0700 ARCH/ENG/DES NAME ADDRESS CITY STATE CA ZIP TEL P/C DATE P/C# ISSUE DATE 03 Dec 2018 PR# PR20180034738 TYPE CONSTRUCTION OCCGROUP SCOPE OF WORK Change out A/C, FAU and (12) Ducts #DWELL UNITS #STORIES #BEDROOMS BUILDING FEES DESCRIPTION SO FT FACTOR PSF ADJ AREA/VALUATION SFR/ADD/REM GARAGE/CARPORT PATIO/DECK POOL/SPA RE -ROOF COMMERCIAL TOTAL VALUATION: TOTAL Mechanical TYPE QUANTITY AMOUNT TOTAL A/C Residential (< 100,001 BTU) 1 $32 42 $32 42 Furnace F A U , Floor (< 100,001 BTU) 1 $32 4Z $32 42 Alterations of Duct System 12 $156 69 $156 69 PLAN CHECK FEES PERMIT FEES CONSTRUCTION PLAN REVIEW ELECTRICAL PLUMBING MECHANICAL $221 53 INSPECTION FEE ISSUANCE $45 02 SMIP ENERGY RETENTION FEE $19 94 PRE/ALT FEE BASF PLOT PLAN ZONING CLEARANCE RECYCLING AND WASTE DEPOSIT TOTAL FEES, $286 49 COMMENTS P/C RECEIPT # PAY METHOD VALIDATION PERMIT RECEIPT # PAY METHOD VALIDATION PERMIT #: PR2018003473o - CITY OF DIAMOND BAR INSPECTION RECORD SETBACK / LETTER 6. .• TRACK AND LEDGER .• .• FOOTINGS FORMS T-BAR SLAB POOL DEMOLITION UG PLUMBING ROOF DRAINS UG ELECTRICAL POOL/SPA LIFERGROUND GAS TEST, EL, PL, ME SEWER LATERAL PRE GUNITE SEWER CLEANOUT POOL PRE DECK BONDING MAIN WATER LINE P TRAP ROOF SHEATHING FENCE / GATE / ALARM FLOOR SHEATHING FINAL POOL SHEAR WALLS EXTERIOR WALLS SHEAR WALLS INTERIOR WALL FOOTING/STEEL FRAMING/VENTING WALL STEEL 1ST( )?ND( ) LIFT RD MECHANICAL WALL DRAIN/SEAL RO ELECTRICAL W O C O WALL FINAL RO PLUMBING RO FRAMING PLANNING APPROVAL ULATION WALL ROUGH FIRE APPROVAL INSULATION CEILING FINAL FIRE DEPARTMENT HOT MOP/SHOW ERPAN FINAL PLANNING DRYWALL FINAL PIN ENGINEERING LATH EXTERIOR FINAL PIN MAINTENANCE LATH INTERIOR FINAL HEALTH DEPT GAS TEST FINAL INDUSTRIAL WASTE SCRATCH COAT FINAL BUILDING ELECTRIC METER RELEASE FINAL MECHANICAL S Q 1 GAS METER RELEASE FINAL ELECTRICAL SPECIAL INSPECTION FINAL PLUMBING SMOKE & CARBON MONOXIDE DETECTORS TC OF OCCUPANCY CERT OF OCCUPANCY COMMENTS t :tt OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason($) indicated below by the checkmark(s) I have placed next to the applicable items) [Section 70315, 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 Contractors' 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 licensure and the bans for the alleged exemption Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil 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 U 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 budding or improvement is sold within one year of completion, the Owner -Budder will have the burden of proving that it was not built or improved for the purpose of sale ) U 1, 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 for the projects with a licensed Contractor pursuant to the Contractors' State License Law ) (_) I am exempt from licensure under the Contractor's State License law for the following reason(s) By my signature below I acknowledge that, except for my personal residence in which 1 must have resided for at least one year prior to completion of the improvements covered by this permit, I 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 site http/www leginfo ca govfcalaw html SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT DATE LICENSED CONTRACTOR'S DECLARATION i hereby affirm under penalty of perjury that 1 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 LICENSE CLASS C20 LICENSE NUMBER 779604 EXPIRATION DATE CONTRACTOR SIGNATURE WORKERS' COMPENSATION DECLARATION: WARNING FAILURE TO SECURE WORKERS' 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES 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 workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My workers' compensation insurance carrier and policy number are' CARRIER Cypress Insurance Co POLICY If EXPIRATION DATE NAME OF AGENT WCWC907S93 PHONE # I certify that, 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 subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the tabor Code, I shall forthwith comply with those provisions SIGNATURE OF APPLICANT DATE DECLARATION REGARDING 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 (Section 8172, Civil Code) LENDER'S NAME LENDER'S ADDRESS, By my signature below, I certify to each of the following I am the property owner or authorized to act on the property owner's behalf I have read this application and the information I have provided is correct I agree to comply with all applicable city and county ordinances and state laws relating to budding construction I authorize representatives of the City of Diamond Bar to enter the above -identified property for inspection purposes SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT DATE