HomeMy WebLinkAboutPR20190000719PERMIT #: PR20190000719
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
1.4 21810 Copley Drive, Diamond Bar, CA 9176S
(909) 839-7020 Fax: (909) 861-3117 Budding Inspection Hotline (909) 839-7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS 164 PROSPECTORS RD 5, DIAMOND BAR, CA 9176S
APN 8718010020 LOT# TRACT#
OWNER NAME KANG SANG S
ADDRESS 164 S PROSPECTORS RD
CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME
ADDRESS
CITY STATE ZIP TEL
ARCH/ENG/DES NAME
ADDRESS
CITY STATE ZIP TEL
P/C DATE P/C#
ISSUE DATE 01 May2019 PRO PR20190000719
TYPE CONSTRUCTION OCC GROUP
SCOPE OF WORK, RE -ROOF OF COMPOSITION ROOF - COMPLETE TEAR OFF EXCEPT FOR SHEATHING
#DWELL UNITS 0 #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SO. FT
FACTOR PSF
AD1 AR£A/VALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
2,30000
$10,327 00
COMMERCIAL
TOTAL VALUATION*
TOTAL
$10,3270000
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
$305 73
PLAN REVIEW
ELECTRICAL
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
$134
ENERGY
RETENTION FEE
$15 29
PRE/ALT FEE
BASF
5100
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
$250 00
PERMIT SYSTEM REPLACMENT FEE
$12 23
TOTAL FEES.
$630 61
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT# 44391 PAY METHOD CK,#1161 VALIDATION
RC
PERMIT #: OR20190000719 10
CITY OF DIAMOND BAR
INSPECTION RECORD
INSPECTION
SETBACK / LETTER
..
TRACK AND LEDGER
.•INSPECTOR:
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
POOL/SPA
UFER GROUND
GAS TEST, EL, PL, ME
SEWER LATERAL
PRE GUNITE
SEWER CLEANOUT
POOL PRE DECK BONDING
MAIN WATER LINE
P_TRAP
ROOFSHEATHING
r `
J OG
FENCE/GATE/ALARM
FLOOR SHEATHING
FINAL POOL
SHEAR WALLS EXTERIOR
WALLS
SHEAR WALLS INTERIOR
WALL FOOTING/STEEL
FRAMING/VENTING
WALL STEEL 1ST( ) 2ND( ) 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 PW ENGINEERING
LATH EXTERIOR
FINAL PW MAINTENANCE
LATH INTERIOR
FINALHEALTHDEPT
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
L
7
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
CERT OF OCCUPANCY
COMMENTS
0
PERMIT M PRZO19OM719
OWNER-61 DER DECLARATION
1 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 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 (J 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 )
(J 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 )
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 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 httpjwww Ieginfo ca goy/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 (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-39 LICENSE NUMBER 771DO8
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 STATE COMPENSATION POLICY # EXPIRATION DATE
INSURANCE FUND
NAME OF AGENT 9213810 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
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 prope inspection purposes
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT
DATE
I� tit � uti�► �c�tl:ll
Building
r Copley
Diamond
t ri r
/tJobaddrem MS' To' rgce,,� s Poi Nmolyb BAP 9� 4i , it
Dear Property Owner
An application for a building penmd has been submitted on your name stating yourself as the budder 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 it 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 d 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 -budder' budding
permit, erroneously implying that the property owner is providing his or her own labor and materials personally
Budding 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 csib 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
III_ia,� ND IIAU.'
i
' Ti,
G
Building & Safety Division
21825 Copley Drive
Diamond Bar, California 91765
(909) 839-7020 Fax (909) 861-3117
Attention Property Owner
An "Owner -Builder" 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 building permit No budding permit will be issued until this verification is received by us
el I personally pla provide the major labor and materials for construction of the proposed property
improvement(Qes or no)
J2 1 (have/have not) a signed an application for a building permit for the proposed work
I have contracted with the following person (firm) to provide the proposed construction
Name Address City
Phone
Contractors License No
I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and
provide the major work
Name Address City
Phone
Contractors License No
5 1 will provide some of the work but I have contracted (hired) the following persons to provide the work
indicated
Name
&igned
Date
Address Phone
Type of Work
i5• 0 tole . i 1. s L. i. i.
Dear Property Owner
An application for a budding permit has been submitted in your name listing yourself as the builder of the property
improvements specrfiedvit kh CA)b ef4 PIV d_;f-
T - a • ♦ • • • • •- • -•t - t • - • T- • • • • -
the property owner, obtain the prior approval of the permitting authority
OWNER'S ACKNOWLEDGEMENT AND VERIFICATION
DIRECTIONS Read and initial each statement below to signify you understand or verify this information
__!;�f I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Budder" building 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 I am willfully acting as an Owner -Budder and am aware of the limits of my
insurance coverage for injuries to workers on my property
�_2 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
�3 1 understand as an "Owner -Builder' 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 I understand Contractors are required by law to be licensed and bonded in California and to list their license
T numbers on permits and contracts
5 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tail value of my construction is at least five hundred dollars ($500), including labor and matenals, I may be considered
an "employer' under state and federal law
6 I understand if I am considered an "employer' under state and federal law, 1 must register with the state and
feleral 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 taws may subject
me to serious financial risk
7 1 understand under California Contractors' State Licanse Law, an Owner -Builder who builds single-family
r idential structures cannot legally build them with the intent to offer there 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
8 1 understand as an Owner -Budder if I sell the property for which this permit is issued, I may be held liable for
ny financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects
in the workmanship or materials
9 I 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 Caldomia Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www cslb ca aov for more information about licensed contractors
5 10 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the following address
11 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by ill applicable laws and requirements that govern Owner -Builders as well as employers
7
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 property licensed and the status of their workers' compensation insurance coverage
Before a building permit can be issued, this forth 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 verify the property owner's signature
Signature of Property Owner Date 1�