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It PERMIT III: CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 961-3117 Building Inspection Hotline (909) 839-7027 an+ar DIAMOND BAR BUILDING PERMIT APPLICATION www citvoidiamondbar.com budding@diamondbarca.gov JOB SITE ADDRESS' 21680 Gateway Center Dr # 268 APN 8293050002 LOT# TRACT# OWNER NAME D8 GATEWAY CORPORATE INC ADDRESS 18819 TELLER AVE #277 CITY IRVINE ZIP 92612 TEL <NO PRIMARY PHONE> APPLICANT NAME TEL CONTRACTOR NAME CAUSER CONSTRUCTION ADDRESS 240 N ORANGE AVE CITY BREA STATE CA ZIP 92821 TEL 714)255.2700 ARCH/ENG/OES NAME Hattm Design Group, LLC ADDRESS 319S-C Airport Loop Or, Studio 2 CITY Costa Mesa STATE CA ZIP 92626 TEL 949) 399-1112 P/C DATE P/C# ISSUE DATE 1S Apr 2019 PR# PR20190000366 TYPE CONSTRUCTION OCCGROUP SCOPE OF WORK Tenant Improvement Work DEMOLISHING DEMISING WALL, NEW PARTITIONS, NEW TFTLE 24, LED LIGHTING, NEW ELECTRICAL AND NEW FINISHES (2,377 Ft-) SUITE #268 #DWELLUNITS #STORIES #BEDROOMS BUILDING FEES DESCRIPTION SO FT FACTOR PSF ADJ AREAIVALUATION SFR/ADD/REM GARAGE/CARPORT PATIO/DECK POOL/SPA RE -ROOF COMMERCIAL TOTAL VALUATION, TOTAL Electrical TYPE QUANTITY AMOUNT TOTAL Lighting Fixtures, Sockets, or Other Lamp Holding Devices 50 $162 $95 60 PLAN CHECK FEES PERMIT FEES CONSTRUCTION $1,720 38 $1,608 55 PLAN REVIEW ELECTRICAL $95 60 PLUMBING MECHANICAL INSPECTION FEE ISSUANCE $78 69 SMIP $29 12 ENERGY $17204 RETENTION FEE $163 92 PRE/ALT FEE BASF PLOT PLAN ZONING CLEARANCE RECYCLING AND WASTE DEPOSIT PERMITSYSTEM REPLACMENT FEE $13113 TOTAL FEES. $3,999 43 COMMENTS P/C RECEIPT # PAY METHOD VALIDATION PERMIT RECEIPT# PAY METHOD (;heCk X 1311 VALIDATION EM a A . PERMIT #: RR20190000366 • I• TUN • • :.'.. i. INSPECTION•' SETBACK / LETTER TRACK AND LEDGER •INSPECTOR: FOOTINGS FORMS T BAR SLAB PDOL DEMOLITION UG PLUMBING ROOF DRAINS UG ELECTRICAL P0041SPA UFER GROUND GAS TEST, EL, PL, ME SEWER LATERAL PRE GUNITE SEWER CLEANOUT POOL PRE DECK BONDING MAIN WATER UNE P-TRAP ROOFSHEATHING FENCE/GATE/ALARM FLOOR SHEATHING FINAL POOL SHEAR WALLS EXTERIOR WALLS SHEAR WALLS INTERIOR WALL FOOTING/STEEL FRAMINONENTING ,r" •? WALL STEEL 1ST{ j 2NDI j LIFT RO MECHANICAL WALLDRAIN%SEAL RO ELECTRICAL W (I C I) WALL FINAL RO PLUMBING RO FRAMING PLANNING APPROVAL INSULATION WALL ROUGH FIRBAPPROVAL INSULATION CEILING FINAL FIRE DEPARTMENT HOT MOP/SHOWERPAN FINAL PLANNING DRYWALL FINAL PWENGINEERING LATH EXTERIOR -- FINAL PW MAINTENANCE LATH INTERIOR FINAL HEALTH DEPT GAS TEST FINAL INDUSTRIAL WASTE SCRATCH COAT FINAL BUILDING ELECTRIC METER RELEASE FINAL MECHANICAL GAS METER RELEASE FINAL ELECTRICAL SPECIAL INSPECTION FINAL PLUMBING SMOKE &CARBON MONOXIDE DETECTORS -^ TC OF OCCUPANCY ' C,,�RT OF OCCUPANCY COMMENTS PERMIT M PR20190000366 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons) 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 ($Soo) ] (J 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 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 -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 635842 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 Travelers Property POLICY # EXPIRATION DATE NAME OF AGENT UBOK19760619 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 constructio I authorize representatives of the City of Diamond Bar to enter the abov - entified prop for inspection pur ose SIGNATURE Of PR PERTY OWNER OR AUTHORIZED AGENT DATE