HomeMy WebLinkAboutPlumbing permit (Gas Line).pdfPERMIT #: PR20190002179
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.cit ofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS: 23647 GOLDEN SPRINGS
APN:
OWNER NAME:
ADDRESS:
LOT#:
TRACTM
CITY:
APPLICANT NAME:
ZIP:
TEL:
TEL:
CONTRACTOR MAXIMUM MECHANICAL PLUMBING dba EDWARD BARRAGAN
NAME:
ADDRESS: 346 CENTINARY DR
CITY: WALNUT
STATE: CA
ZIP: 91789 TEL: 1424) 391-2611
ARCH/ENG/DES.
NAME:
ADDRESS.
CITY:
STATE: CA
ZIP: TEL:
P/C DATE: P/C#:
ISSUE DATE: 16 Dec 2019 PR#: PR20190002178
T Y P E
CONSTRUCTION:
OCC GROUP:
SCOPE OF WORK. 90 FEET OF GAS LINE REPAIR
#DWELL UNITS:
#STORIES:
#BEDROOMS:
BUILDING FEES
DESCRIPTION
SO, FT.
FACTOR PSF
ADJ AREA/VALUATION
SFR/ADD/R E M
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE -ROOF
COMMERCIAL
TOTAL VALUATION:
TOTAL:
Plumbing
TYPE
QUANTITY
AMOUNT
TOTAL
Gas Piping System
1
$101.80
$101.80
PLAN CHECK FEES
PERMIT FEES
CONSTRUCTION:
PLAN REVIEW:
ELECTRICAL:
PLUMBING
$101.80
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
$46.23
SMIP:
ENERGY:
RETENTION FEE:
$5.09
PRE/ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE.
RECYCLING AND WASTE DEPOSIT:
PERMIT SYSTEM REPLACMENT FEE:
$4.07
TOTAL FEES:
$157.19
COMMENTS:
P/C RECEIPT M PAY METHOD: VALIDATION:
PERMIT RECEIPT 47786 PAY METHOD: CASH VALIDATION: CR
M
PERMIT #: PR20190002178
OWNER -BUILDER DECLARATION
I hereby affirm -under penalty of perjury that I am exempt from the Contractor's State License Law forthe reason(sy indicated
below bythe. checkma.rk(s) I have placed nextto the.applicable. item(s) [Section 703i.5, Business and Professions Code: Arty
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, priorto its issuance, also
requires the applicant forthe permit to file a signed statement that he or she is licensed.pursuant to the provisionsof. the
Contractors' State License.Law.(Chapter Si, Commencing with Section 7`000 of Division 3.of the Business and Professions Code)
or that he or she is exernpt.frorri licensure and the basis forthe.alleged exemption: Any violation of Section 7031,.5 by any
applicant fora. 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.inten.ded or offered fors.ale. (Sectlon..7044, Business a.rid Professions Code: The Contractors'
State License Law does notapplyto an owner.of property who, through employees' or personal effort, builds or improves the..
pro perty,.provided that the'improve m.ents are not intended or offered for sale. If however,. the building or improvement:is
sold .within one year of completion, the Owner -Builder wilt have the.burden of proving that it was not built or improved forthe
purpose.ofsal.e.)
(_} 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 an.owner of property who builds or.
improves thereon, and. who contracts forthe projects: with a Iicensed:Contra.ctor pursuant to the Contractors` State License
Law.)
(_) I am exempt from Iicensure.underthe Contractor's.State License law forthe 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 cannotlegally 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 704.4 of the Business.:and.Professions Code. is available upon request: when this: application. is submitted or at the
following Webs ite: httpJwww,leginfo.ca.gov/ca.law.html.
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT- DATE:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I.a.m 11censed'under provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the. Business and Professions Code, and my license is in full farce: and effect.
LICENSE CLASS`. C36 LICENSE NUMBER: 1051.536
EXPIRATION DATE: CONTRACTOR SIGNATURE:
WORKERS' COMPENSATION DECLARATION:
WARNING -.FAILURE TO SECURE WORKERS' CDMPENSATION.COVERAGE.I..S UNLAWFUL, AND SHALL.SUBIECTAN'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.t
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIQNS:
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 bySection.3700 of the Labor Code, forthe performance of the work for
which this permit is issued:.
I have.and will maintain workers' compensation insurance, as.require d by Section. 3700 of the Labor Code; for
the pedorrpance of the work for which this permit is issued. My workers' compensation insurance carrier and
policy numberare.:
.CARRIER: < Enter Workers Comp? POLICY #:. EXPIRATIONDATE:
NAME OF AGENT: 0 PHONE..#:
I certify.that, 1n the performance of the work for which this permit is issued; I shalt not employ any person 1n ally manner so:as10 become
subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensation
provisions of Section 3700:of the Labor Code, I shall forthwith comply with those provisions.
51GNATURE 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 thework for which this
permit is issued JSection 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 1 have. provided is correct.
1 agree to comply with. all..app[icab le city and county ordlnances and state Paws relating to building construction.
):authorize representatives af.the. City of Diamond Bar to enter the above=identi "e rop ty for inspection purposes.
SIGNATURE: OF PROPERTY OWNER OR AUTHORIZED AGENT: r
DATE:
PERMIT #: PR20190002178
CITY OF DIAMOND BAR
INSPECTION RECORD
RNOVUM M