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PERMIT M PR20180034213
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) 639-7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com bullding@diamondbarca.gov
10B SITE ADDRESS. 22MO HILTON HEAD DR, Unit.122, DIAMOND BAR, CA 9176522840 HILTON HEAD DR, Unit:123, DIAMOND BAR, CA
9176522840 HILTON HEAD DR, Unn:124, DIAMOND BAR, CA 9176S22840 HILTON HEAD DR, Unit 125, DIAMOND BAR, CA 9176S22840
HILTON HEAD DR, Unit:127, DIAMOND BAR, CA 9176522840 HILTON HEAD DR, Unn:128, DIAMOND BAR, CA 9176522840 HILTON HEAD
DR, Unn.129, DIAMOND BAR, CA 9176522940 HILTON HEAD DR, Unit:130, DIAMOND BAR, CA 9176S22840 HILTON HEAD DR, Unft•9131,
DIAMOND BAR, CA 9176522840 HILTON HEAD DR, UnIt.132, DIAMOND BAR, CA 9176S22840 HILTON HEAD DR, Unit:133, DIAMOND
BAR, CA 917652284E HILTON HEAD DR, Unit.134, DIAMOND BAR, CA 9176522840 HILTON HEAD DR, Unit:135, DIAMOND BAR, CA
917652284E HILTON HEAD DR, Unn*136, DIAMOND BAR, CA 9176522940 HILTON HEAD DR, Unit'121, DIAMOND BAR, CA 91765
APN 871702312S8717023126 LOT# TRACT#
87170231278717023128
87170231298717023131
87170231328717023133
87170231348717023135
87170231368717023137
87170231388717023139
OWNER NAME OSBORN AARON 1CASTELLAN05 ESTER V & MICHAEL PIARAMILLO JORGELUNDY CHARLES F & VALERIE ALOPEZ BERNAROCHAU
CATHYWYNN ANGELAViLLAMIL MIGUEL AREINA DERRICK & TRISNAWATI SHEE BONG CHOSHEE CHENG LIEN CSIU KITTY KXU
NAIXINACOSTA JACQUELINE T
ADDRESS 2290 HILTON HEAD DR #12122840 HILTON HEAD DR #12222840 HILTON HEAD DR #12312 EL DURADO CT22840 HILTON HEAD DR #1252801
GLENHURST PL22840 HILTON HEAD DR #12822840 HILTON HEAD DR #13122840 HILTON HEAD DR #12922840 HILTON HEAD DR #13019745
COLIMA RD #1-267136 S FIRCROFT ST22840 HILTON HEAD DR #13422840 HILTON HEAD DR #13S
CITY DIAMOND BAR ZIP 9176S9176591765917669176S917 TEL <NO PRIMARY PHONE><NO PRIMARY PHONExNO PRIMARY
DIAMOND BAR 92917659176S9176591765917489 PHONExNO PRIMARY PHONE><NO PRIMARY PHONExNO
DIAMOND BAR POMONA 17919176591765 PRIMARY PHONExNO PRIMARY PHONExNO PRIMARY
DIAMOND BAR WEST PHONExNO PRIMARY PHONES<NO PRIMARY PHONE><NO
COVINA DIAMOND BAR PRIMARY PHONE><NO PRIMARY PHONExNO PRIMARY
DIAMOND BAR PHONEa NO PRIMARY PHONE>
DIAMOND BAR
DIAMOND BAR ROWLANp HEIGHTS
WEST COVINA DIAMOND
BAR DIAMOND BAR
APPLICANT NAME TEL
CONTRACTOR NAME
ADDRESS
CITY STATE ZIP TEL
ARCH/ENG/OES NAME
ADDRESS
CITY STATE ZIP TEL
P/C DATE P/C#
ISSUE DATE 25Sep 2018 PR# PR20180034213 -
TYPE CONSTRUCTION OCC GROUP
SCOPE OF WORK PEX RE -PIPE ENTIRE HOME- UPENOR PEx SYSTEM (160) FIXTURES
#DWELL UNITS #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SO FT
FACTOR PSF
ACJ AREAIVALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION
TOTAL
Plumbing
TYPE
T QUANTITY
AMOUNT
TOTAL
Plumbing Fixture/ Trap or Set of fixtures
1 160
$1982
$3,17120
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
PLUMBING
$3,17120
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
RETENTION FEE
$158 56
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
0
RECYCLING AND WASTE DEPOSIT
TOTAL FEES
$3,37478
COMMENTS
'C RECL"T PAY METHOD VALIDATION
PER �IT RECEIPT 0 PAY METHOD VALIDATION
PERMIT #. PR20180034213
INSPECTIONr•
SETBACK / LETTER
•
a
TRACK AND LEDGER
r"
s"
FOOTINGS FORMS ''..
T-BAR
SLAB
POOL DEMOLITION
UG. PLUMBING
ROOF DRAINS
UG ELECTRICAL
POOOPA
LIFER 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 WADS INTERIOR
WALL FOOTING/STEEL
FRAMINGNENTFNG
WALL STEEL SST( j 2ND(I LIFT
RO MECHANICAL
WALLORAIN / SEAL
TO ELECTRICAL W ( I C (}
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGH FIREAPPROVAL
INSULATION CEIUNG
FLNALFLREDEPARTMENT
HOT MOP/SHOWERPAN
FINAL PLANNING
DRYWALL
FINAL PWENGIHEERIN6
LATH EXTERIOR
FINALPW ATAINTENANCE
LATH INTERIOR
FINAL HEALTH DEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUBDLNO
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
I
SPECIAL INSPECTION
FINAL PLUMBING
fA
'1
j
t
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
CERT OF OCCUPANCY
COMMENTS
PERMIT #: PR20180034213
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 (_) 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 building 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 )
(_) 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
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 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 C-36 LICENSE NUMBER C-36
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 TECHNOLOGY INSURANCE POLICY # EXPIRATION DATE
COMPANY INC
NAME OF AGENT TWC3675469 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, 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
1 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 OF PROPERTY OWNER OR AUTHORIZED AGENT.
DATE