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Home My WebLink AboutPR20210000100PERMIT #: PR20210000100 CITY OF DIAMOND BAR COMMUNITY DEVETOPMENT DEPARTMENT 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building tnspection Hotline (909) B3g-7027 BUILDING PERMIT APPLICATIoN www.citvofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS: 536 Navajo Springs APN:LOT#:TRACT#: OWNER NAME: ADDRESS: _ CITY:ZlPl TEL: TEL:APPLICANT NAME: CONTRACTOR NAME, mn ADDRESS: 17120 M. a,*, to, ARCH/ENG/DES, NAME: ADDRESSI CIry: STATE: CA ZIP:TEL: P/C DATE: ISSUE DATE: P/C#: PRS: OCC GROUP: SCOPE OF WORK: Pex repipe flDWELL UNITS:flsToRrEs:SBEDROOMS: BL,TLDTNG FEES - DESCRI PTION SQ. FI.FACTOR PSF ADJ AREA/VALUATION sFR/ADD/RE [,4 GARAG E/CARPORT PATIO/DE CK POO L/SPA RE-ROOF COMMERCIAL TOTAL VALUATION:TOTAL: Plumbing TYPE QUANTITY AMOUNT TOTAL Re-Pipe PEX 5 s20.80 s104.00 Water Heater (Changeout Same Location)L s20.80 s20.80 PLAN CHECK FEES PERMIT FEES CONSTRUCTION: PLAN REVIEW: ELECTRICAL: PLUMBING s124.80 MECHAN ICAL: INSPECTION FEE: ISSUANCE: s41.24SMIP EN E RGY: RETENTION FEE:s6.24PRE/ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: RECYCLING AND WASTE DEPOSIT: EROSION CONTROL PLAN CHECK FEE: PERMIT SYSTFM REPLACMEN'] I,EE: s4.9e TOTAL FEES:5L83.27 CON4 M E NTS: P/C RECEIPT Cl PERMIT RECEIPT #: PAY METHOD: PAY METHOD: VALIDATION: VALIDATION: PERMIT #: PR20210000100 CITY OF DIAMOND BAR INSPECTION RECORD SETEACK / LETTER TRACK AND LEDGER FOOTINGS FORMS T.BAR S LAB POOL DEMOLITION UG. PLUMBING ROOF DRAINS UC. ELECTRICAL POOL/SPA: UFER GROUND GAS TEST, EL, PL, ME SEWER LATERAL PRE GUNITE SEWER CLEANOI]T 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 FRAM ING/^r'ENIING wnLl srerL rsr( ) zND( ) lrrr RO, MECHANICAL WALL DRAIN / SEAL Ro.ELEcrRrcArwoco RO. PLUMBING RO, FRAMING PTANNING APPROVAL INSULATION WALL ROUGH FIRE APPROVAL NSUIATION CEILING FINAL FIRE DEPARTMENT HOT MOP/SHOWERPAN FINAL PL],.NNING DRYWALL FINAL PW ENGINEERING LATH EXTERIOR FINAL PW MAINTENANCE LATH INTERIOR FINAL HEALTH DEPT. GAS TEST FINAL INDUSTRIALWASTE SCRATCH COAT fINAL BUILDING ETECTRIC IVIETER RELEASE FINAL MECHANICAL GAS METER RELEASE FINAL ELECTRICAL SPEC At INSPECTION FINAL PLUMBING SMOKE & CARBON I\,lONOXIDE DETECTORS T,C, OF OCCUPANCY CERT. OF OCCUPANCY COMMENTS: 2/23/21 2/23/21 PERMIT #: PR20210000100 OWNER-BUI LDER 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) fsection 7031.5, 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 iicensure and the basis for the alleged exemption. 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 (S5OO).1: (-) 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. lf however, the building or improvement is sold within one year of completion, the Owner-Buiider will have the burden of proving that it was not built or improved for the purpose of sale.) (-) l, as owner ofthe 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 llcensure 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-builder ifit has not been constructed in its entirety by licensed contractors. I understand that a copy ofthe applicable law, Section 7044 of the Buslness and Professions Code is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.htm l. SIGNATURE OF PROPERTY OWNER OR AUTHORIZED AGENT:DATE: .4. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secti Division 3 ofthe Business and Professions Code, and my license is in full force and effect.,-r LICENSE CLASS: C36 LICENSE NUMBER: ,4ds{ EXPIRATIoN DATE: CSNTRACTORSTGNATUREy' l,// lA ,t n WoRKERS'COMPENSAT|ONDECLARAT|QD|y'/ / vw / l/!. WARNING: FAILURE TO SECURE WORKERS, COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUsJECT AN EMPL0YER To CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DoLLARS (S1OO,OOO), IN ADDITION To THE COST oF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COI]E, 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-lnsure for workers' compensation, issued by the Director of lndustrial 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 ofthe Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: CARRIER: Pacific Compensation POLICY #: EXptRATtON DATE: lnsurance NAME OF AGENT: WA001"60705 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 sub.ject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provlsions. SIGNATURFoFAPPLICANT: DEcLAmffio,*oAGENcy 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 (5ection 8172, Civil Code). LENDER'5 NAME: LENDER'S ADDRESS: By r1'ly signature below, I certily to each of the following: I anr tlre property owlrer or authorized to act on the property owner's behalt. I have read this application and tfle information I have provided is correct. i agree to comply with all applicable city and county ordinances and state laws relating to bui I arrthorize representatives of the City of Diarnond Bar to enter thejbdv\iderrtifred propcrty SIGNATURE OF PROPERTY O)/fNER OR AUTHORIZED AGENTl ChTid SOUSAp^rE, / lA^ - ( lding construction. -/ /w // -/- 9/ Ad