HomeMy WebLinkAboutPR20210000715PERMIT #:PR20210000715
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 BUILDINGPERMITAPPLICATION www.cityofdiamondbar.com
JOB SITEADDRESS:1067 ADEL AVE,DIAMOND BAR,CA91765
APN:8763002013
OWNER NAME:TYLERDAISY A
ADDRESS:1211 MESSINAPL
CITY:POMONA
APPLICANTNAME:
CONTRACTOR NAME:AVA INC dbaRELIABLEROOFING
ADDRESS:12441 CHANDLERBLVD.
CITY:VALLEYVILLAGE
ARCH/ENG/DES.NAME:
ADDRESS:
CITY:
P/C DATE:
ISSUE DATE:
TYPE CONSTRUCTION:
SCOPE OF WORK:Composition Re-roof
building@diamondbarca.gov
LOT#TRACTA:
<NO PRIMARYPHONE>ZIP:91766 TEL:
TEL:
TEL:(818)646-0458ZIP:91607STATE:CA
TEL:STATE:CA ZIP:
P/CH
PR#
occGROUP:
#DWELL UNITS:0 #STORIES:#BEDROOMS:
BUILDING FEES
ADIAREAVALUATIONDESCRIPTIONSQ.FT.FACTOR PSF
SFR/ADD/REM
GARAGE/CARPORT
PATIO/DECK
POOL/SPA
RE-ROOF
COMMERCIAL
TOTAL VALUATION:
$15,180.003,300.00
$15,180.0000TOTAL:
PLAN CHECK FEES PERMIT FEES
CONSTRUCTION:
PLAN REVIEW:
ELECTRICAL:
PLUMBING
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY:
RETENTION FEE:
PRE/ALT FEE:
BASF:
PLOT PLAN:
zONINGCLEARANCE:
RECYCLINGAND WASTE DEPOSIT:
EROSION CONTROL PLAN CHECKFEE:
BUILDING ADMIN SPECIAL REVOLVING
FUND:
$436.48
$47.24
$1.97
$21.82
$1.00
$250.00
$174
PERMIT SYSTEM REPLACMENT FEE:
TOTAL FEES:|$775.97
COMMENTS:
P/CRECEIPT#:
PERMITRECEIPT#:
PAYMETHOD:
PAYMETHOD:
VALIDATION:
VALIDATION:
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PERMIT #:PR20210000715
CITY OF DIAMOND BAR
INSPECTION RECORD
DATE:INSPECTOR:INSPECTION DATE:INSPECTOR:INSPECTION
SETBACK/LETTER
FOOTINGS FORMS
SLAB
UG.PLUMBING
UG.ELECTRICAL
UFER GROUND
SEWER LATERAL
SEWERCLEANOUT
MAIN WATERLINE
TRACK AND LEDGER
T-BAR
POOL DEMOUITION
ROOF DRAINS
POOYSPA:
GAS TEST,EL,PL,ME
PRE GUNITE
POOL PRE DECK BONDING
P-TRAP
ROOF SHEATHING FENCE/GATE /ALARM
FINAL POOL
WALLS
FLOORSHEATHING
SHEAR WALSEXTERIOR
SHEAR WALLSINTERIOR
FRAMING/VENTING
RO.MECHANICAL
RO.ELECTRICALW ()C(0
RO.PLUMBING
INSULATION WALL
INSULATION CEILING
WALFOOTING/STEEL
WAL STEEL 1sT()2ND()LIFT
WALL DRAIN/SEAL
WALL FINAL
RO.FRAMING PLANNING
APPROVAL
ROUGH FIRE APPROVAL
FINAL FIREDEPARTMENT
HOT MOP/SHOWERPAN
DRYWALL
LATH EXTERIOR
LATH INTERIOR
GASTTEST
SCAATCHCOAT
ELECTRIC METERRELEASE
GAS METERRELEASE
SPECIAL INSPECTION
FINAL PLANNING
FINAL PW ENGINEERING
FiINAL PWMAINTENANCE
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
SMOKE&CARBON
MONOXIDE DETECTORS
T.C.OFOCCUPANCY
CERT.OFOCCUPANCY
COMMENTS:
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5/25/21
6/1/21
PERMIT #:PR20210000715
OWNER-BUILDER 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)(Section 7031.5,Businessand ProfessionsCode: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 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).]:
las owner of the property,or myemployeeswith wagesas their solecompensation,will do (all of or (U portionsof 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-Builder will have the burden of proving that it was not built or improved for
the purposeofsale.)
L)1,asowner of theproperty n 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.)
L)Iam exempt from licensure under the Contractor'sStateLicense law for the followingreason(s):
By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one
vear prior to completion of the improvements covered by this permit,I cannot legally 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 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 OFPROPERTYOWNER ORAUTHORIZEDAGENT: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.
LICENSECLASS:
EXPIRATION DATE:
LICENSENUMBER:1035546C39
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:
Ihave 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.
Ihave 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:
State Compensation Insurance POLICY #:CARRIER:EXPIRATION DATE:
Fund
NAME OF AGENT:9216023
Icertify 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:
PHONE#
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.
agree to comply with al applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of the City of Diamond Bar to enter the above-identified property for inspection purposes.
SIGNATURE OFPRPPERTYPWNER OR AUTHORIZED AGENT:Zohrab Ter-Karapetyan
DATE:O5/24/3
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