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Cff) PERMIT #: PR20190000349
PIP 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, 21711 BIRCH HILL DR, DIAMOND BAR, CA 91765
APN 8285007002 LOT# TRACT#
OWNER NAME INFANTI PATRICIAA
ADDRESS 21711 BIRCH HILL DR
CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME GM Construction
ADDRESS 7729 Cypress Ave
CITY Fontana STATE CA ZIP 92336- TEL (503) 510-4426
ARCH/ENG/DES NAME
ADDRESS
CITY STATE CA ZIP TEL
P/C DATE P/C#
ISSUE DATE 11 Mar 2019 PR# PR20190000349
TYPE CONSTRUCTION OCCGROUP
SCOPE OF WORK Re -roof by adding second layer of composition, hose bib and (1) flood light
#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:
$3,800 0000
Electrical
TYPE
QUANTITY
AMOUNT
TOTAL
Lighting Fixtures, Sockets, or Other Lamp Holding Devices
1
$2 35
$2 35
Plumbing
TYPE
QUANTITY
AMOUNT
TOTAL
Plumbing Facture/ Trap or Set of Fixtures
1
$1982
$1982
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
$15145
PLAN REVIEW
ELECTRICAL
$55 76
PLUMBING
$55 76
MECHANICAL
INSPECTION FEE
ISSUANCE
$112
SMIP
$0 50
ENERGY
RETENTION FEE
$1315
PRE/ALT FEE
BASF
$100
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
TOTAL FEES-
$389
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT # 43689 PAY METHOD Gash VALIDATION
PERMIT #: PR2019060349-.
INSPECTIONs•
SETBACK/LETTER
•
•INSPECTOR:
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOFDRAINS
UG ELECTRICAL
POOLJSPA
LEER GROUND
GAS TEST, EL, PL, ME
SEWER LATERAL
PRE GUNITE
SEWER CLEANOUT
POOL PRE DECK BONDING
MAIN WATER LINE
P-TRAP
ROOFSHEATHING
FENCE/GATE/ALARM
FLOOR SHEATHING
FINAL POOL
SHEAR WALLS EXTERIOR
WALLS
SHEAR WALLS INTERIOR
WALL FOOTING/STEEL
FRAMINGIVENTING
WALL STEEL SST[) LND() LIFT
RO MECHANICAL
WALLORAIN/SEAL
RO ELECTRICAL W() C(}
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGH FIREAPPROVAL
INSULATION CEILING
'..
FINAL FIRE DEPARTMENT
HOT MOP/SHOWERPAN
FINAL PLANNING
DRYWALL
FINAL PW ENGINEERING
LATH EXTERIOR
FRYAL PW MARYTENANCE
LATH INTERIOR
FINALHEALTNDEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINALSUILDING
Ir{(I
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
RMLELECTRICAL
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE S CARBON
MONOXIDE DETECTORS
---
TO OFOCCUPANCY
DEBT OF OCCUPANCY
COMMENTS
PERMIT #:
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 item(s) [Section 70315, Business and Professions Code Arty
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) )
(J I as owner of the property, or my employees with wages as their sole compensation, will do(_) 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 -Builder will have the burden of proving that it was not built or improved for
the purpose of sale )
`)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 )
(J 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, I 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 html
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 B LICENSE NUMBER 1033221
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 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 Accredited and Surety & POLICY # EXPIRATION DATE
Casualty Co
NAME OF AGENT 1WTCCA1701235156 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 Labor Code, t 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 ins on pur ses
SIGNATURE Of PROP TY OWNER OtA AUTHORIZED AGENT Gonzalo Montano
DATE