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(S) PERMIT #: PR20190000881
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21910 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 961-3117 Building Inspection Hotline (909) 839-7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com budding@dlamondbarca.gov
JOB SITE ADDRESS. 21215 CHIRPING SPARROW RD, DIAMOND BAR, CA 9176S
APN 8714020043 LOT#
OWNER NAME MITCHELTREE MICHAELJ
TRACT#
ADDRESS 21215 CHIRPING SPARROW RD
CITY DIAMOND BAR ZIP 91765
APPLICANT NAME
TEL <NO PRIMARY PHONE>
TEL
CONTRACTOR NAME Eta -Tech Electrical Services Inc
ADDRESS 2634 E Coolidge Ave
CITY Orange STATE CA
ZIP 92867 TEL (714) S14-S722
ARCH(ENGJDES NAME
-
ADDRESS
CITY STATE CA
ZIP TEL
P/C DATE
PfC#
ISSUE DATE 28 May2019
PAN PR20190000891
TYPE CONSTRUCTION
OCCGROUP
SCOPE OF WORK. 200 AMP PANEL UPGRADE
#DWELL UNITS #STORIES
#BEDROOM$
BUILDING FEES
DESCRIPTION
SQ FT
FACTOR PSF
ADJ AREA/VALUATION
SFRJADD%REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION:
TOTAL.
Electrical
TYPE
QUANTITY
AMOUNT
TOTAL
Panel Upgrade (200-1000 amps)
1
$72 28
$72 28
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
$72 28
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
rENTION FEE
$3 61
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
PERMIT SYSTEM REPLACMENT FEE
$2 89
TOTAL FEES:
$123 80
COMMENTS
P/C RECEIPT #
PAY METHOD VALIDATION
PERMIT RECEIPT # 44779
PAY METHOD VALIDATION EM
CITY OF DIAMOND BAR
r=�
' • • '
INSPECTION•
SETBACK / LETTER
•INSPECTOR:
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
POOVSPA
LIFER GROUND
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 15TI I ZND( 7 LIFT
RO MECHANICAL
WALL DRAIN/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 PIN ENGH7EERI"
LATH EXTERIOR
FINAL PW MAINTENANCE
LATH INTERIOR
FINAL HEALTH DEFT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FMWL BUILDING
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
d
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
CERT-OF OCCUPANCY
COMMENTS
PERMIT #: PR20190000881
01111NER•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 Items) (Section 7031.5, 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 (Chapter9, Commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he or she is exempt from hcensure 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 (_) 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 budding or improvement is
sold within one year of completion, the Owner -Builder will have the burden of provingthat 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 )
(J I am exempt from ice nsure 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 bulk 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 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 C10 LICENSE NUMBER 900705
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 C05T 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 workfor which this permit is issued My workers' compensation insurance carrier and
policy number are
CARRIER SECURITY NATIONAL POLICY # EXPIRATION DATE
INSURANCE COMPANY
NAME OF AGENT SWC123190 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 i echon purposes
SIGNATURE OF OPERTY OWNER OR AUTHORIZED AGENT AnthonyDjaz
DATE. P 2 -1/ g'/