HomeMy WebLinkAboutPR20180034740OFPERMIT #: PR201SM34740
CITY OF OIAMOND R
COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 91765
(909) $39-7020 Fax: (909) 961-3117 Building Inspection Hotline (909) 839-7027
DIAINC}ND BAR BUILDING PERMIT APPLICATION www.citvofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS: 20124 Walnut Drive South
APN 8762029002
OWNER NAME
ADDRESS
LOT#
TRACT#
CITY
APPLICANT NAME
ZIP
TEL
TEL
CONTRACTOR NAME LIFETIME SOLUTIONS INC
ADDRESS 154COVILLAGEDR
CITY VICTORVILLE
STATE CA
ZIP 92394 TEL (760) 951-7605
ARCH/ENG/DES NAME
ADDRESS
CITY
STATE CA
ZIP TEL
P/C DATE
ISSUE DATE
P/C# ......................
PR#
TYPE CONSTRUCTION
OCC GROUP
SCOPE OF WORK Water Softer
#DWELL UNITS
#STORIES
#BEDROOMS
BUILDING FEES
DESCRIPTION
SQ. FT
FACTOR PSF
ADJ ARWVALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOLISPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION.
TOTAL.
Plumbing
TYPE
QUANTITY
AMOUNT TOTAL
Water Softener
1
$19 82 $19 82
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
PLUMBING
$55 76
MECHANICAL
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
RETENTION FEE
$5 02
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
TOTAL FEES:
$105 80
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT PAY METHOD Check#3251 VALIDATION EM
PERMIT M PR20190034740
INSPECTION
SETBACK/LETTER
D+
i'
•
TRACKANDLEDGER
kINSPECTOR:
FOOTINGS FORMS
T-RAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
P0011SPA
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 / GATE /ALARM
FLOOR SHEATHING
FINAL POOL
SHEAR WALLS EXTERIOR
WALLS
SHEAR WALLS INTERIOR
WALL FOOTING/STEEL
FRAMING/VENTING
WALL STEEL 1ST() 2NDO LIFT
RO MECHANICAL
WALLDRAIN/SEAL
RO ELECTRICAL W () C ()
WALL FINAL
BIT PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGHFIREAPPROVAL
INSULATION CEILING
FINAL FIRE DEPARTMENT
HOT MOP/SHO WERPAN
FINAL PLANNING
DRYWALL
FINAL PW ENGINEERING
LATH EXTERIOR
FINAL PW MAINTENANCE
LATH INTERIOR
FRNALHEALTNDVIF
GAS TEST
FINAL INDUSTRIAL WASTE
SCRATCH COAT
FINAL BUILDING
ELECTRIC METER RELEASE
FINAL MECHANICAL
GAS METER RELEASE
FINAL ELECTRICAL
SPKMALINSPECTION
FINAL PLUMBING
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SMOKE SMOKE & CARBON
MONOXIDE DETECTORS
TC OFOCCUPANCY
CERT OF OCCUPANCY
COMMENTS
PERMIT #: PR20180034740
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)
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) ]-
(_) 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 -Builder will have the burden of proving that it was not built or improved for
the purpose of sale )
(_) 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 )
(_) I am exempt from Iicensure under the Contractor's State License law for the following reasons)
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 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. C36 LICENSE NUMBER 588619
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 HDIGZordl POLICY# EXPIRATION DATE
NAME OF AGENT ENGCC0002177 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 owners 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 for inspection purposes
SIGNATURE F ROPERTY OWNER OR AUTHORIZED AGENT FredSalazar
DATER I ]L- 3 - I le