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PERMIT II: PR20180034075
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21910 Copley Drive, Diamond Bar, CA 9176S
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-T027
DIAMOND BAR BUILDING PERMIT APPLICATION www.cityofdiamondbar.cam budding@diamondbarca.gov
JOB SITE ADDRE55+23504 RIDGE LINE RD, DIAMOND BAR, CA 91765
APN LOT#
OWNER NAME
TRACT#
ADDRESS
CITY ZIP
APPLICANT NAME
TEL
TEL
CONTRACTOR NAME Service Champions
ADDRESS 3150 E Birch St
CITY Brea STATE CA
ZIP 92821 TEL (714)777-7777
ARCH/ENG/DES NAME
ADDRESS
CITY STATE CA
ZIP TEL
P/C DATE
P/C#
ISSUE DATE 23 Aug 2018
PR# PR20180034075
TYPE CONSTRUCTION
OCC GROUP
SCOPE OF WORK- Attic insulation
#DWELL UNITS 0 #STORIES
#BEDROOMS
BUILDING FEES
DESCRIPTION
SO FT
FACTOR PSF
ADIAREA/VALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
ROOF
COMMERCIAL
TOTAL VALUATION:
TOTAL.
$43 6300
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
$48205
PLAN REVIEW
ELECTRICAL
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SM I P
$2 47
ENERGY
TENTION FEE
$2410
PRE/ALT FEE
BASF
$1 00
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
-COMMENTS
TOTAL FEES.
$554 64
P/C RECEIPT #
PAY METHOD VALIDATION
PERMIT RECEIPT# a
PAY METHOD f $.'y^. VALIDATION 'tii
+_,
PERMIT #: PR20180034075
111 r 1 ! ki• r 1.
INSPECTION
SETBACK / LETTER
DATE:
INSPECTOR�
INSPECTION
TRACK AND LEDGER
DATE:
INSPECTOR:
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
P00415PA
UFER 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 IST(j 3N0{) LIFT
RO MECHANICAL
WALLDRAIN/SEAL
RO ELECTRICAL W 3 j C{ j
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGHFIREAPPROVAL
INSULATION CEILING
FINAL FIREDEPARTMENT
HOT MOP/SHOW ERPAN
FINAL PLANNING
DRYWALL
RNAL PW ENGINEERING
LATH EXTERIOR
FINAL PW MAINTENANCE
LATH INTERIOR
FINAL HEALTNDEPT:
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
G'1
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
GERT OF OCCUPANCY
COMMENTS
A 1%
PERMIT #: PR20180034075
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)
orthat he or she is exempt from licensure and the basis forthe 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 U all of or (J 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 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 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 leglnfo 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 <Enter License Class> LICENSE NUMBER 799170
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
1 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, (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 buildinge6nstruction
I authorize representatives of the City of Diamond Bar to enter the above -identified property f i on purposes
SIGNATURE OF PROPERTY OWNER OR UT ORlZED AGENT
DATE .Q>