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HomeMy WebLinkAbout18447J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) (909) 860-3195 Fax (909) 861-3117 PRESS ; BUILDING PERMIT APPLICATION FIRMLY DDREE ASS__ 21865 COPLEY DRIVE ADDRE APN LLOT TRACT OWNER ou h OCOaSt—Air ud 1 y Yigmt ISTRICT ADDRESS 21865 Copley Drive CITY Diamond Bar Zip 91765FEL. ( 396-2238 APPLICANT P i n n a r IF, C N G TEL. - CONTRACTOR _pZ LNAJZ_ ,$ CNC. C 0 M y A N V ADDRESS 300 N. Mari Fanfel d. Slip l 1-on CITY 24 i 31 a nY d ZIP TX TEL. (91 S ARCH/ENG/ 7 9701 701 DESIGNER Pinnacle CNG S stems LLC ADDRESS 4915 W. In ustria BlAq. CITY Midland ZIP TEL. ( 91 5) ti94— OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.513USIN ESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER. IMPROVE, DEMOLISH, OR REPAIR ANY STRUC TORE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF SENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION T031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HJNDRED DOLLARS (S5DO).). ❑ I, AS OWNER OF TH: PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND --HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER CF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ 1, AS OWNER OF TH'.= PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPFLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ I AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70.) OF D'NISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FOFCE AND EFFECT LICENSE CLASS A LIC. NO 795786 DATE 5 3-1 / 01 CONTRACTOR PINNACLE CN WORKERSCOMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONEOF THE FOLLOWING DECLARATIONS. _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERSCOMPENSATION INSURANCE. AS REQURED BY SECTION 3700 OF THE LABOP CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND PCLICY NUMBER ARE: CARRIER AMERICA HOZIE ASSURANCE POLICY NUMBER __- -7 2 0 6482 (THIS SECTION NEE) NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (E1o0) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS 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 37DO CF THE LABOR CODE, I SHALL FOFF HWITH COMPLY WITH THOSE PROVISIONS. DATE: _ APPLICANT _ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL TINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI W,000), IN ADD'. TION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN I SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1 CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRMUNDER OF THE OFPERJU RYTHATTHERE LSACONSTRUCTION . LENDING AGENCY FOR THE PERFORMANCE Or THE WORK FOR WHICI{THIS PERMIT IS ISSUED (SEC. 3097, C(V. C.). LENDER'S NAME �Yl ON E LENDER'S ADDRESS -- — 1 CERTIFY THAT I HAVE REAC THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY OPD'NANCES AND STATE LAWS RELATING TO BUILDING j CONSTRUCTION, AND HEFIE13YAUTIIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. Bob Yung.inger P BE AME P T) siGMTUREbF PE MI EE OAT APPLICATION PERMIT P/C DATE C' NUMBER U� 1 # 0nl -r640 ISSUE e U TYPE OCC DATE it CONSL GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE Replace existing Compressed naturai gas fue ing equip ent- with n®w Qgejbpment NO. DWEL. NO. NO. N /A N/A N /A U ITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM to Garage/Carport WPatio/Deck LL PooUSpa V Z Re -Root Commercial D m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE G U cc H U w J w iry Z_ m CL Q U_ Z Q 2 U w CONSTRUCTION �+ v PLAN REVIEW SO ._ ELECTRIC PLUMBING .� D MECHANICAL _ INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT _. RETENTION FEE: PRE-ALT FEE: V J TOTAL FEES S�3.i3 Vl CIS COMMENTS RECPT NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDLNHULIL­Hue copy, UKt-LN—P,ppllcanTs copy DIAUIOXD BAR i Lii w CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EE DDR A 21865 COPLEY DRIVE ADDR ESS APN fPT CT t Ou oC ast Air a I y I ag . OWNER DISTRICT ADDRESS 21865 Copley Drive CITY Diamond Bar ZIP 91765rEL. (39 6-2238 APPLICANT Pinnacl CNG TEL. CONTRACTOR _PISJNACLE CNG COMPANY ADDRESS 300 N. MariPnfPld, q f-,--1100 CITY I d Ddidla ZIP T X TEL. ( c) 1 5) 6— 4- ARCH/ENG/ 797010 TO DESIGNER Pinnacle CNG Systems LLC ADDRESS 4915 W. Industrial B CITY Midland ZIP TX TEL.(915)694- OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER. IMPROVE. DEMOLISH, OR REPAIR ANY STRUC TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): U I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND --HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). U 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U I AM EXEMPT UNDE R SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS 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 FOECE AND EFFECT 795786 A LICENSE CLASS LIC. NO. DATE 5/ 31 / 0 1 CONTRACTOR PINNACLE C N COMPANY WORKERS' COMPENSATION DECLARATION 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. AS PROVIDED 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 AMERICA HOME ASSURANCE POLICY NUMBER _ 7 2 Q 64$2 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I CERTIFY THAT IN TIE 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. DATE: APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 (SEC. 3097, CIV. C.), LENDER'S NAME NONE LENDER'S ADDRESS CERTIFY THAT I HAVE REAC THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. Bob Yunginger P EE AME P T) 04 24/02 SIG LIRE OF PE MI EE DATE PRESS FIRMLY APPLICATION Y_ RMIT P/C DATE W G- 8 i C—,, l PE ISSUE c TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ E SIDE/SIDE STREET RW ^ SIDE ^ PROPOSEDUSE Replace existing compressed natural gas fue ing equipment with new a ruipment NO. DWEL. N /A NO. N/A NO N/A nU44 ITS STORIES BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Cl) Garage/Carport W Patio/Deck LL PooVSpa z Re -Roof 0 Commercial 5 co W W CD z In a U_ z U W Valuation AD).AREA QUANTITY DESCRIPTION FEE CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT 1 r� RETENTION FEE: 00 PRE-ALT FEE: TOTAL FEES —3- i3 '—'I 1 f COMMENTS ,tn RECPT NO. PAID BY VALIDATION —I V 2 WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy COUNTY OF LOS ANGELES FIRE DEPARTMENT PERMIT Permission is hereby granted to the permittee listed below in accordance with Article 74 of the Los Angeles County Fire Code for the following: COMPRESSED GASES This permit is non -transferable and granted until revoked. It is subject to revocation for proper cause and for violation of LACC Title 32 (Fire Code). Non-compliance of any provision of this permit constitutes a violation of the Fire Code. Permitee Name: South Coast Air Quality Phone: 909.396-2238 Address: 21865 Copely Dr. City: Diamond Bar Zip Code: 91765 Date Issued: October 10, 2002 Station: 120 Bn: 19 Permitee Signature: Inspector Signature: Inspector Name: Mike Pacheco See attached requirement sheet. Additional Requirements: