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PERMIT #: 00 CITY Of DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21810 Copley Drive, Diamond Bar, CA 4171 (909) 839 7020 Fax: (909) 881-3117 Building Inspection Hotline (909) 839-7027 DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com budding@diamondbarca.gov JOB SITE ADDRESS, S78 TOPSIDE PL, DIAMOND BAR, CA 91765 APN 8281035097 LOT# TRACT# OWNER NAME WALKER HOLLOWAY ADDRESS 578 TOPSIDE PL _ CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE> APPLICANT NAME TEL CONTRACTOR NAME Tesla Energy Opembons, Inc ADDRESS 6800 Dumbarton Cr, CITY Fremont STATE CA ZIP 94555 TEL 944 837.5201 ARCH/ENG/DES NAME _ ADDRESS CITY STATE CA ZIP TEL P/C DATE P/C# ISSUE DATE 26 Nov 2019 PR# PR20180034586 TYPE CONSTRUCTION OCC GROUP SCOPE OF WORK, PV System Roof Mount, 91 kW,128) modules, (2) iiwerters, (1) 125 amp load center ,WELLUNITS 0 #STORIES #BEDROOMS BUILDING FEES DESCRIPTION SO FT FACTOR P5F ADIAREA/VALUATION SFR/ADD/REM GARAGE/CARPORT PATIO/DECK___-- POOL/SPA RE -ROOF COMMERCIAL TOTAL VALUATION TOTAL $13,468 0000 Electrical TYPE QUANTITY AMOUNT TOTAL Photovoltaic Systems 1 $7199 $7199 Panel Upgrade (less than 200 amps) 1 $46 64 $46 64 PLAN CHECK FEES PERMIT FEES CONSTRUCTION PLAN REVIEW $50 00 $102 40 ELECTRICAL $118 63 PLUMBING MECHANICAL INSPECTION FEE ISSUANCE $78 69 SMIP $175 ENERGY RETENTION FEE $1100 PRE/ALT FEE BASF $100 PLOT PLAN ZONING CLEARANCE RECYCLING AND WASTE DEPOSIT TOTAL FEES: $363 47 COMMENTS P/C RECEIPT # PAY METHOD VALIDATION PERMIT RECEIPT # 42328 PAY METHOD hark A 2M26n VALIDATION EM 1:747iTiiiElmo IN031141*11liTd INSPECTION SETBACK j LETTER DATE� INSPECTOR: INSPECTION TRACK AND LEDGER DATE: INSPECTOR: FOOTINGS FORMS T-BAR SLAB POOL DEMOLITION UG PLUMBING ROOF DRAINS UG ELECTRICAL P004/SAA LIFER GROUND GAS TEST, EL, PL, ME SEWER LATERAL PRE GUNITE SEWER CLEANOUT POOL PRE DECK BONDING MAIN WATER LINE P-TRAP ROOF SHEATHING FENCE f GATE J ALARM FLOOR SHEATHING ANALPOOL i, SHEAR WALLS EXTERIOR WALLS SHEAR WALLS INTERIOR WALL FOOTING/STEEL FRAMING/VENTING WALL STEEL SST( ) 2ND( I LIFT RO MECHANICAL WALL DRAIN/SEAL RO ELECTRICAL W ( I C (j WALL FINAL RO PLUMBING RO FRAMING PLANNING APPROVAL INSULATION WALL ROUGH FIRE APPROVAL INSULATION CEILING FINAL FIREOEPARTMENT HOT MOP(SHOWERPAN FINAL PLANNING DRYWALL FINAL PW ENGINEERING LATH EXTERIOR FINAL PW MAINTENANCE LATH INTERIOR FINAL HEALTH PART GAS TEST FINAL INDUSTRIAL WASTE SCRATCH COAT FINAL BUILDING Ilk - ELECTRIC METER RELEASE FINAL MECHANICAL GAS METER RELEASE FINAL ELECTRICAL } SPECIAL INSPECTION FINAL PLUMBING SMOKE & CARBON MONOXIDE DETECTORS TC OF OCCUPANCY CERT OF OCCUPANCY COMMENTS )F . 'rM21Hcrtzi�:i� 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 Cade) 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) j (_)1 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 ) (_) 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 forthe protects 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 -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 govfcalaw 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 C46 LICENSE NUMBER 888104 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 performanceof 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 Zurich American POLICY # EXPIRATION DATE NAME OF AGENT EWS107458501 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, Ovil 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 f in ec n pure s SIGNATURE ff PROP TY OWNER OR AUTHORIZED AGENT Adela Melendrez DAT ! 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