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PERMIT #: PR20190000982
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 9176S
(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: 2221S CHIRPING SPARROW RD, DIAMOND BAR, CA 91765
APN 8714020043 LOT# TRACT#
OWNER NAME MITCHELTREE MICHAELJ
ADDRESS 21215 CHIRPING SPARROW RD
CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME Eco-Tech Electrical Services Inc
ADDRESS 2634 E Coolidge Ave
CITY Orange STATE CA ZIP 92867 TEL 714 514-5722
ARCH/ENG/DES NAME
ADDRESS
CITY STATE CA ZIP TEL
P/C DATE PIC#
ISSUE DATE 04 Jun 2019 PR# PR20190000882
TYPE CONSTRUCTION OCC GROUP
SCOPE OF WORK, Ev Charger
#DWELL UNITS #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SO, FT
FACTOR PSF
AD1 AREA/VALUATION
SFRIADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION
TOTAL.
Electrical
TYPE
QUANTITY
AMOUNT
TOTAL
Receptacle, Switch, Lighting or other Outlets
1
$2 35
$2 35
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
$50 00
$55 76
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
RETENTION FEE
$2 79
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
PERMIT SYSTEM REPLACMENT FEE
$2 23
TOTAL FEES:
$155 80
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT # 448t5f PAY METHOD (;heck#UU1114 VALIDATION EM
r IN
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTIONt=
SETBACK f LETTER
t
fINSPECTOR:
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
POOOFA
UFER GROUND
GAS TEST, £L, PL, ME
SEWER LATERAL
PRE GUNITE
SEWER CLEANOUT
POOL PRE DECK BONDING
MAIN WATER LINE
P-TRAP
ROOFSHEATHING
FENCE / GATE I ALARM
FLOOR SHEATHING
FINAL POOL
SHEAR WALLS EXTERIOR
WALLS
SHEAR WALLS INTERIOR
WALL FOOTINGISTEEL
FRAMING/VENTING
WALL STEEL 1ST{) 2NDj I LIFT
RO MECHANICAL
WALLORAfN/SEAL
RO ELECTRICAL W () C { j
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGH FIRE APPROVAL
INSUL.ATIONCEIUNG
FINAL FIRE DEPARTMENT
'
HOT MOP/SHOWERPAN
FINAL PLANNING
DRYWALL
TIMM ~ENGINEERING
LATH EXTERIOR
FINAL PW MAINTENANCE
LATH INTERIOR
FINAL HEALTH DEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
ELECTRIC METER RELEASE
FINALMECHANK'AL
GAS METER RELEASE
FINAL ELECTRICAL
'J
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE B CARBON
MONOXIDE DETECTORS
TC OF OCCUPANCY
CERT OF OCCUPANCY
COMMENTS
PERMIT M PR20190000882
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 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 ($S00) j
(_) 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 proving that it was not built or improved for
the purpose of sale )
(, 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 }
U 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 1 have built as ,
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
1 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 COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES
1 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 Security National Insurance POLICY # EXPIRATION DATE
NAME OF AGENT• SWC123180 PHONE #
1 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, 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 building construction
I authorize representatives of the City of Diamond Bar to enter the above -identified property for inspection purposes
SIGNATURE QF PR PERTY OWNER OR AUTHORIZED AGENT TSVEA/ rtj . OrM L
DATE L j oll