HomeMy WebLinkAboutPR201900007171
PERMIT #: PR20190000717
Aw CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 91765
(909) 939-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com budding@diamondbarca.gov
JOB SITE ADDRESS: 227 NAVAJO SPRINGS RD, DIAMOND 6AR, CA 91765
APN 8703001002 LOT#
OWNER NAME FREGOSO CHRISTINA
TRACT#
ADDRESS 227 NAVAJO SPRINGS RD
CITY DI NO BAR ZIP 91765
APPLICANT NAME
TEL <NO PRIMARY PHONE>
TEL
CONTRACTORNAME
ADDRESS
CITY STATE
ZIP TEL
ARCH/ENG/DES NAME
ADDRESS
CITY STATE
ZIP TEL
P/C DATE
ISSUE DATE 01 May 2019
P/C#
PR# PR20190000717
TYPE CONSTRUCTION
OCC GROUP
SCOPE OF WORK water line re-route
#DWELL UNITS #STORIES
#BEDROOMS
BUILDING FEES
DESCRIPTION
SQ FT
FACTOR ESE
AD.I AREA/VALUATION
SFRJADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION:
TOTAL
Plumbing
TYPE
QUANTITY
AMOUNT
TOTAL
Plumbing Fixture / Trap or Set of Fixtures
1
$19 82
$19 82
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
PLUMBING
$55 76
MECHANICAL
INSPECTION FEE
15SUANCE
$45 02
SMIP
ENERGY
RETENTION FEE
$2 79
PRE/ALT FEE -
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
PERMIT SYSTEM REPtACMENT FEE
$2 23
TOTAL FEES:
1 $105 80
COMMENTS
P/C RECEIPT# PAY METHOD VALIDATION
PERMIT RECEIPT# 44,382 PAY METHOD Ca$h VALIDATION EM
PERMIT M PR20190000717 .
INSPECTION RECORD
SETBACK/LETTER
DATE:INSPECTION
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING t''�"j
••.•7 �I
q
!
ROOF DRAINS
UG ELECTRICAL
PDOVSPA
.
LITER GROUND
GAS TEST, EL, Pt, ME
SEWER LATERAL
PRE GUNITE
SEWER CLEANOUT
POOL PRE DECK BONDING
MAIN WATER LINE
P-TRAP
ROOF SHEATHING
FENCE I GATE/ALARM
FLOOR SHEATHING
FINAL POOL
SHEAR WALLS EXTERIOR
WALLS
SHEAR WALLS INTERIOR
WALL FOOTING/STEEL
FRAMINGIVENTING
WALL STEEL SST(E 2ND() LIFT
RO MECHANICAL
WALLORAIN/SEAL
RO ELECTRICAL W () C IT
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGH FIREAPPROVAL
INSULATION CEILING
FINAL FIRE DEPARTMENT
HOT MOP/SHO WERPAN
FINAL PLANNING
DRYWALL
FINAL PIN EN61NEERING
LATH EXTERIOR
FINAL PWMAINTENANCE
LATH INTERIOR
FINAL HEALTH DEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
CERt F OCCU2bt=
L0 i IT ll L
t
PERMIT #: PR20190000717
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 7031 S, 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 hcensure and the basis for the alleged exemption Any violation of Section 7031 S by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($S00) ]
U 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 -Budder 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 hcensure 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 permrt, I cannot legally sell a structure that I have built 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 html ^�
Ql �1
SIGNATURE OF PROP TY OWNER OR AUTHORIZED AGENT DATE
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjurythat 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 <Enter License Classy LICENSE NUMBER.
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 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 work for which this permit is issued My workers' compensation insurance carrier and
policy number are
CARRIER <Enter Workers Comp> POLICY # EXPIRATION DATE
NAME OF AGENT 0 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 OFAPPLICANT DATE
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency forthe performance of the workfor 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
1 have read this application and the information I have provided is correct
I agree to complywith 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 ChnsvaFregoso
DATE Q
V 0
Job Address
II1 T)n,7ii�i�T14 11,UdIII
Building & Safety Division
21810 Copley Drive
Diamond Bar, California 91765
(909) 839-7020 Fax (909) 861-3117
z27 Nq-✓r.
Dear Property Owner
jai- � Oil"
—1 i 6SS
An application for a building permit has been submitted in your name stating yourself as the builder of the
property improvements specified
For your protection, you should be aware that as "owner -builder" you are the responsible party of record on
such a permit Building permits are not required to be signed by property owners unless they are personally
performing their own work If your work is being performed by someone other than yourself, you may protect yourself
from possible liability if that person applies for the proper permit in his or her name
Contractors are required by law to be licensed and bonded by the State of California and to have a business
license from the City of County They are also required bylaw to put their license number on all permits for which they
apply
If you employ or otherwise engage any persons other than your immediate family, and the work (including
materials and other costs) is $500 00 or more for the entire project, and such persons are not licensed as contractors
or subcontractors, then you may be an employer
If you are an employer, you must register with the state and federal government as an employer and you are
subject to several obligations including state and federal income tax withholding, federal social security taxes, workers
compensation insurance, disability insurance costs, and unemployment compensation contributions
There may be financial risks for you if you do not carry out these obligations, and these risks are especially
serious with respect to workers compensation insurance
For more specific information about your obligations under the federal law, contact the Internal Review Service
(and if you wish, the U S Small Business Administration) For more specific information about your obligations under
State law, contact the Department of Benefit -Payments and the Division of Industrial Accidents
If the structure is intended for sale, the property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or subcontractor, only
under limited conditions
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building
permit, erroneously implying that the property owner is providing his or her own labor and materials personally
Building permits are not required to be signed by the property owners unless they are performing their own work
personally
Information about licensed contractors may be obtained by contacting the Contractors State License Board at
9821 Business Park Drive, Sacramento, CA 95827, www cslb ca aov or at (800) 321-CSLB (2752)
Please complete and return the enclosed "Owner -Builder" verification form so that we can confirm that you are
aware of these matters The budding permit will not be issued until the verification is returned
0
Attention Property Owner
An "Owner -Budder" budding permit has been applied for in your name and bearing your signature
Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and
issuing your budding permit No budding permit will be issued until this verification is received by us
I personally pl,a� to ' provide the major labor and materials for construction of the proposed property
improvement ee or no)
V I(RYlave not) signed an application for a budding permit for the proposed work
Contractor; License No
0 4 plan to provide portions of the work, but I have hired the following person to �Mrqdmate, supervise and
Name All- fi Address,5bli
Phone M i
5 1 will provide some of the work but I have contracted (hired) the following persons to provide the r
indicated
Name
M
Address Phone
Datey V I' 19-t -
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
OWNER'S ACKNOWLEDGEMENT AND VERIFICATION
DIRECTIONS Read and initial each statement below to signify, you understand or verity this information
t I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Budder' budding permit that erroneously implies that the property owner is providing his or her own labor and material
personally 1, as an Owner -Budder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property My homeowners insurance may not
provide coverage for those injuries 1 am willfully acting as an Owner -Budder and am aware of the limits of my
insurance coverage for injuries to workers on my property
d2 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility
W3 1 understand as an "Owner -Budder' I am the responsible party of record on the permit I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead of my own
�.
4 1 understand Contractors are required by taw to be licensed and bonded in California and to list their license
/Jnuumbers on permits and contracts
`'_5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including tabor and materials, I may be considered
an "employer" under state and federal law
CC 6 I understand if i am considered an "employer' under state and federal taw, i must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee " I also understand my failure to abide by these laws may subject
me to serious financial risk
cj 7 1 understand under California Contractors' State License Law, an Owner -Budder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor
Cc 8 1 understand as an Owner -Budder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects
in the workmanship or materials
l.Eg 1 understand I may obtain more information regarding my obligations as an "employer" from the internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www csib ca gov for more information about licensed contractors
10 1 am aware of and consent to an Owner -Budder budding permit applied for in my name, and understand that
am the party legally and financially responsible for proposed construction activity at the following address
[k 11 I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers
12 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form Licensed contractors are regulated by laws designed to protect the public if
you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist
you with any financial loss you may sustain as a result of a complaint Your only remedy against unlicensed
Contractors may be in civil court it is also important for you to understand that if an unlicensed Contractor or employee
of that individual or firm is injured while working on your property, you may be held liable for damages If you obtain a
permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those
Contractors are properly licensed and the status of their workers' compensation insurance coverage
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit
Note A copy of the property owner's driver's license, form notarization, or other venfication acceptable to the agency is
required to be presented when the permit is issued to verity the property owner's signature
Signature of Property Owner Date `"fsl r' cz