HomeMy WebLinkAboutPR20190001009l
(Z� PERMIT #:
CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
DIAMOND BAR BUILDING PERMIT APPLICATION www.citvofdlamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS: 2103 MORNING CANYON RD, DIAMOND BAR, CA 91765
APN 8292010026 LOT# TRACT#
OWNER NAME WAGNER RANDY S & LOU A
ADDRESS 2103 MORNING CANYON RD
CITY DIAMOND BAR ZIP 91765 TEL <NO PRIMARY PHONE>
APPLICANT NAME TEL
CONTRACTOR NAME ARS-Amencan Residential SVs dba Rightime Home Services
ADDRESS 96S RIDGE LAKE BLVD SUITE 201
CITY Memphis STATE TN ZIP 38120 TEL (951) 276-9744
ARCH/ENG/DES NAME
ADDRESS
CITY STATE TN ZIP TEL
P/C DATE P/C#
ISSUE DATE PR#
TYPE CONSTRUCTION OCC GROUP
SCOPE OF WORK INSTALLATION A/C UNIT S-TON COMPLETE SPLIT SYSTEM REPLACEMENT NO DUCT WORK
#DWELL UNITS #STORIES #BEDROOMS
BUILDING FEES
DESCRIPTION
SO, FT
FACTOR PSF
ADJ AREA/VALUATION
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION:
TOTAL
Mechanical
TYPE
QUANTITY
AMOUNT
TOTAL
A/C Residential (< 100,001 BTU)
1
$32 42
$32 42
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION
PLAN REVIEW
ELECTRICAL
PLUMBING
MECHANICAL
$77 15
INSPECTION FEE
ISSUANCE
$45 02
SMIP
ENERGY
RETENTION FEE
$3 86
PRE/ALT FEE
BASF
PLOT PLAN
ZONING CLEARANCE
RECYCLING AND WASTE DEPOSIT
PERMIT SYSTEM REPLACMENT FEE
$3 81
TOTAL FEES:
$129 84
COMMENTS
P/C RECEIPT # PAY METHOD VALIDATION
PERMIT RECEIPT # 45071 PAY METHOD 8120007247 VALIDATION RC
r
PERMIT 8: PR20190001009
INSPECTION RECORD
SETBACK LETTER
DATE:INSPECTION
TRACK AND LEDGER
FOOTINGS FORMS
T-BAR
SLAB
POOL DEMOLITION
UG PLUMBING
ROOF DRAINS
UG ELECTRICAL
POOI,ISPA
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
WADS
SHEAR WALLS INTERIOR
WALL FOOTING/STEEL
FRAMING/VENTING
WALL STEEL SST(} 2ND() UFT
RO MECHANICAL
WALL DRAIN/SEAL
RO ELECTRICAL W () C I }
WALL FINAL
RO PLUMBING
RO FRAMING PLANNING
APPROVAL
INSULATION WALL
ROUGH FIREAPPROVAL
INSULATION CEILING
FINAL FIREOEPARTMENT
HOT MOPISHO W ERPAN
FINAL PLANNING
DRYWALL
FINAL PW ENGINEERING
LATH EXTERIOR
NNALPWMAINTENANCE
LATH INTERIOR
FAYAL HEALTHOEPT
GAS TEST
FINAL INOUSIRML WASTE
SCRATCH COAT
FINAL BUILDING
ELECTRIC METER RELEASE
FINALMECHAN=
L r�rfq
f J
GAS METER RELEASE
FINAL ELECTRICAL
SPECIAL INSPECTION
FINAL PLUMBING
SMOKE & CARBON
MONOXIDE pETECTORS
T C OF OCCUPANCY
Cy
OF OCCUPANCY
3
PERMIT M PR20190001009
OWNER -BUILDER DECLARATION
i hereby affirm under penalty of perjurythat I am exempt from the Contractor's State License Law far 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 repairany 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 (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 building or improvement is
sold within one year of completion, the Owner -Budder 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 for the projects with a licensed Contractor pursuant to the Contractors' State License
Law )
(_) 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 <Enter License Class> LICENSE NUMBER 765074
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 try 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 LIBERTY INSURANCE POLICY If EXPIRATION DATE
CORPORATION
NAME OF AGENT WA763DS08631018 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 became
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 budding construction
I authorize representatives of the City of Diamond Bar to enter the abo e- dentified prope for ns ct n purpo 7
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT CA -
DATE