HomeMy WebLinkAboutPR20190000633PERMIT #: PR20190000633
ra CITY OF DIAMOND BAR
' COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 91765
(909)839-7020 Fax: (909) 861-3217 Building Inspection Hotline (909)939.7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com building@Idiamondbarca.gov
JOB SITE ADDRESS: 24120 WILLOW CREEK RD, DIAMOND BAR, CA 9176S
APN 8703005037 LOT# TRACT#
OWNER NAME ESCOBEDO MONIOOJ & IRMA
ADDRESS 24120 WILLOW CREEK RD
CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME Sierra Roof Inc
ADDRESS P 0 Box 3189
CITY Anaheim STATE CA ZIP 92803 TEL (714)63S-5071
ARCH/ENGJDES NAME
ADDRESS
CITY STATE CA ZIP TEL
P/C DATE P(C#
ISSUE DATE 18 Apr 2019 PR# PR20190000633
TYPE CONSTRUCTION OCCGROUP
SCOPE OF WORK REMOVE EXISTING ROOF AND RE -ROOF Wj A NEW 30 YEAR COMP SHINGLE, 30 LB UNDERLAYMENT
#DWELL UNITS 0 #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SO FT
FACTOR PSF
ADJ AREAIVALUATION
SFRfADDJREM
GARAGE/CARPORT
PATIO/DECK
POOLJSPA
RE -ROOF
2120000
$6,000 00
COMMERCIAL
TOTAL VALUATION-
TOTAL-
$6,000 0000
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
$195 53
PLAN REVIEW
ELECTRICAL
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
$0 78
ENERGY
RETENTION FEE
$977
PRE%ALT FEE
BASF
$1 OD
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
$250 00
PERMIT SYSTEM REPLACMENT FEE
$782
TOTAL FEES:
$509 92
COMMENTS
PIC RECEIPT# PAY METHOD VAUDATION
PERMIT RECEIPT # PAY METHOD VALIDATION
PERMIT #: PR241400691
w
SETBACK / LETTER
DATE:
INSPECTOR:INSPECTION
TRARK AND LEDGER
DATE:
INSPECTOR:
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
POO4/5PA
LIFER GROUND
GAS TEST, Eb PL, ME
SEWER LATERAL
PRE GUNITE
SEWER CLEANOUT
POOL PRE DECK BONDING
MAIN WATER LINE
P•TRAP
ROOgSHEATHING
j�
/
FENCE / GATE / ALARM
FLO
FINAL POOL
SHEOR
WALLS
SHER
WALL FOOTING/STEEL
FRAMINGIVENTING
WALL STEEL ISTII 2NO(I LIFT
RO MECHANICAL
WALL DRAIN/SEAL
RO ELECTRICAL W 0 C I I
WALL FINAL
NO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGHFIREAPPROVAL
INSULATION CEILING
FINAL FIRE DEPARTMENT
HOT MOP/SHOWERPAN
FRPALPLANNING
DRYWALL
FINAL PWENGINEERING
LATH EXTERIOR
FINAL PW MAWTENANCE
LATH INTERIOR
FINAL HEALTH DEPT
GAS TEST
FINAL EVOUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
ELECTRIC METER RELEASE
FMWLMECHANICAL
GAS METER RELEASE
RNALELECJRICAL
SPECIAL INSPECTION
FIX" PLUMBING
SMOKE & CARBON
MONOXIDE DETECTORS
T C OF OCCUPANCY
_...
CERT. OF OCCUPANCY
COMMENTS
it
PERMIT M
CVWNER-BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated
below by the checkmark(s) I have placed next to the applicable item(s) [Section 7031 S, Business and Professions Code Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he or she is exempt from licensure and the basis forthe alleged exemption Any violation of Section 70315 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($S00) )
(_) I as owner of the property, or my employees with wages as their sole compensation, will do (J 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 )
U 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 Iicensure 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 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 B LICENSE NUMBER 967971
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. STATE COMPENSATION POLICY#' EXPIRATION DATE
INSURANCE FUND
NAME OF AGENT 9018656 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 6172, Civil Code)
LENDER'S NAME _
LENDER'S ADDRESS
By my signature below, I certify to each of the following
1 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-idenph irl pe o inspection purposes
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT
DATE
A