HomeMy WebLinkAboutPR20190000120PERMIT M
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.citvofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS: 21930 BIRDS EYE OR, DIAMOND BAR, CA 9176S
APN 8293039015 LOT# TRACT#
OWNER NAME LEE BRYAN
ADDRESS 21930 BIRDS EYE DR
CJTY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME AFFORDABLE WATER HEATERS
ADDRESS 28372 Constellation Road
CITY Valencia STATE CA ZIP 9135S TEL 1661) 259.7131
ARCH/ENG/DES NAME
ADDRESS
CITY STATE CA ZIP TEL
P/C DATE P/C#
ISSUE DATE 23 Jan 2019 PR# PR20190000120
TYPE CONSTRUCTION OCCGROUP
SCOPE OF WORK REPLACEMENT OF WATER HEATER IN GARAGE. SAME LOCATION.
#DWELL UNITS #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SQ FT
FACTOR PSF
ADJ AREAIVALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
ROOF
COMMERCIAL
TOTAL VALUATION
TOTAL:
Plumbing
TYPE
QUANTITY
AMOUNT
TOTAL
Water Heater (Changeout Same Location)
1
$19 82
$19 82
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
PLUMBING
$55 76
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
TENTION FEE
$2 79
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
TOTAL FEES.
$103 57
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT # PAY METHOD VALIDATION
PERMIT #: PR2019ET000120
i 1 - • 1 _..G..i.
• i 1
INSPECTION•.INSPECTOR:
SETBACK / LETTER
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
100040A
GROUND
GAS TEST, EL, PL, ME
SEWER LATERAL
PRE GUNITE
SEW ER CLEANOUT
POOL PRE DECK BONDING
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 LST(} 2ND( 1 LIFT
MECHANICAL
WALL DRAIN/SEAL.......
RO ELECTRICAL W () C t I
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
ILATION WALL
ROUGH FIR€APPROVAL
INSULATION CEILING
FINAL FIND DEPARTMENT
HOT MOP/SHOWERPAN
FINAL PLANNING
DRYWALL
FINAL PIN ENG04MING
LATH EXTERIOR
F(R AL PW MAINTENANCE
LATH INTERIOR
FINAL HEALTH DEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL $URDING
ELECTRIC METER RELEASE
FINAL. MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
Lin
SPECIAL INSPECTION
FINAL MUMBING
kA IA --
SMOKE & CARBON
MONOXIDE DETECTORS
TC OF OCCUPANCY
CERT OFOCCUPAIN
PERMIT #: PR20190000120
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 the applicable item(s) (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 basis 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 (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, 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 -Budder will have the burden of proving that it was not built or improved for
the purpose of sale )
(J 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 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 I must have resided for at least one
year prior to completion of the improvements covered by this permit, 1 cannot legally sell a structure that I have built as an
owner -budder 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.gov/calaw.htmi
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT, DATE
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.
LICENSE CLASS: C-36 LICENSE NUMBER 627368
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 ($500,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 INSURANCE COMPANY OF THE POLICY # EXPIRATION DATE
WEST
NAME OF AGENT- WSA503249703 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 taws of California, and agree that, if I should become subject to the workers' compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions
SIGNATURE OF APPUCANT 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 action 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