Loading...
HomeMy WebLinkAboutPR15-385f 1 �. CITX OF DIAMOND BAR �t I 'DEPARTMENT OF COMMUNITY &,DEV,ELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOB SITE ADDRESSK APN LOT TRACT OWNER P, G 1I I ADDRESS)Of-?- K o it CITY Ori ZIPIJt�TEL. APPLICANT /� I TEL. CONTRACTOR l�U� (.`=r(lO(/1 &Af,Ir Yr. ADDRESS / IicA.•Gf J CITY 0PLI-'Hi RS Z``IP 9J2 TEL. 1919 A-31 ARCH/ENG/DESIGNERX AD'JRESS p CITY ZIP TEL. OWNER-BUILDER DECLARATION I ht reby 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, 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 Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Cade] or that he or she is exempt from licensure and the basis for thealleged 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). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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 o',,mproves the property, provided that the improvements are not intended or offered for sale. If however, the building or i;iprovement 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 purpose of sale.). U I, 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.). U 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,[ 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. DATE: SIGN: 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 Cade, and my license is in full force and effect. jp LICENSE CLASS: r LIC. NO.: / / 7 �a DATE: c f A �S• CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 have and will maintain a Certificate of Consent to Self -Insure for Worker's 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 Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) 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 so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's 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 the 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: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I 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. "LNO PERMITTEE NAME (PRINT) , 'r I SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION DATE:: \ i \ S P/C# ISSUE DATE: 0 T101 i17, PERMIT# pIZiS--3 TYPE CONST. OCC GROUP: $ S li 13sr ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE ❑ ❑ ❑ ❑ PROPOSED USE• A I 1 N f ',in, /2 ' 9 v✓ C IL- J 2 J hldf-.. k- t JCt if # DWEL. UNITS # STORIES If BEDROOMS - DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SF ADD REM p Garage/Carport Co w Patio/Deck LL Pool/Spa _Z Re -Roof —� Commercial m ValuationV 01000 Adj. Area: QUANTITY DESCRIPTION FEE Q150 r'e_f- -, `c6 2 1 "�/J • U J I uKc-� I CONSTRUCTION: (c��Ss PLAN REVIEW: S0.'J • G\ • gg ELECTRIC: �1�'I • 4 O PLUMBING: MECHANICAL: 28 6, S Z. INSPECTION FEE: ISSUANCE: ��JJ SMIP: ENERGY P/C: S g • �_�o ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �i1 34 BSAF: Lt. 54. �� . 59_ L ami TOTAL FEES �( �j$ • is COMMENTS: ag-\ Q560 . SSI `!J Bl - 1 flc 3 -/ s,& en. RECEIPT # LS33 (, PAID BY: 163 4S' VALIDATION:F WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy >K/LETTER IGS FORMS ,UFER GROUND SEWER LATERAL _ MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING INSULATION WALL TRACT AND LEDGER INSULATION CEILING 1; DRYWALL j LATH (PRE) ROUGH. ELECTRICAL LATH EXTERIOR '' '. LATH INTERIOR GAS TEST GAS"TEST � SCRATCH COAT iI j % ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING 0 -TRAP FINAL MECHANICAL FENCE / GATE/ ALARM FINAL PLUMBIN64 =TC.kof`OCCUPANCY "' . CERT OfOCCUPANCY, c ;, COMMENTS:,",t,rr/tdS AGa WALL FOOTING/STEEL 3 9*wm(0 NI A. CK' 'Y OF, DIAMOND BAR INSPEICTIOWRECORD s vqtt . WALL DRAIN/ SEAL WALL FINAL JGAPPROVAL OVAL I'MENT ' TRACT AND LEDGER SWITCH GEAR _ COMMERCIAL HOOD T -BAR ' F INTERCEPTER ROUGH. ELECTRICAL HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED GAS"TEST � DEMOLITION ROOF DRAINS PRE GUNITE ROUGH CONDUIT s vqtt . WALL DRAIN/ SEAL WALL FINAL JGAPPROVAL OVAL I'MENT ' PUULISPA ROUGH,PLUMBING ROUGH. ELECTRICAL ROUGH MECHANICAL`ft sow,, GAS"TEST � PRE GUNITE POOL PRE DECK BONDING;, 0 -TRAP FENCE / GATE/ ALARM FINAL POOL s '- WALLS: WALL FOOTING/STEEL WALL STEEL 1sT( ) 2NO( ) LIFT WALL BOND BEAM s vqtt . WALL DRAIN/ SEAL WALL FINAL JGAPPROVAL OVAL I'MENT ' •POMONA UNIFIED SCHOOL DISTRICT 1584 CAPITAL FACILITIES PROGRAM MANAGEMENT Form Number 800 SOUTH GAREY AVENUE 0 POMONA • CALIFORNIA 91766 Certification of Compliance Applirant's Name Applicant's Phone No. ✓ ✓ �t2� rl5 Applicant's Signature Date of Signature The applicant executing this declaration certifies under penalty ofperjury that: (1) they are the Owner and/or Developer or they are authorized to sign on behalf of the Owner and/or Developer, (z) that the information provided is true and accurate to the best of the Owner's and/or Developer's knowledge, (3) the Owner and/or Developer will file an amended certification of compliance and pay the additional amounts due if Owner and/or Developer increases the number of dwelling units and/or square footage after the building permit is issued or if the initial determination of units and/or square footage is found to be incorrect, and (4) they have read end fully understand this side and the reverse side of this document including the 90 -day protest period posted on the reverse side of this document. 0tA-0 k --LX- G�GG ,ner's/Developer s Mailing Address i- Ownees/Developer s Phone No. ,vin Development Type and Fee Schedule Check appropriate box(es), fill in the fee per sq. ft. and circle the fee level in effect. Residential $ `�4' /sq. ft. (Level 1 - Level 2 - Level 3) New—Addition/ Single Family_ / Single Family attached_ / Multi Family_ ! Other. ❑ Manufactured/Mobile Homes $ /sq. ft. (Level 1 - Level 2 - Level 3) ❑ Commercial/Industrial $ /sq. ft. Exempt status justification / notes: ❑ Senior Citizen Housing $ /sq. ft. (See reverse side of sheet.) ri 9,0D 5 c . Fr ,KExempt $ -0- /sq. ft. (Provide justification.) Fee Calculations Each Certification of Compliance form is for five (S) projects maximum. Use additional forms for additional projects. ,.1c� N��rgl4ss �iuc� �fL-15- 3$� Tract No. / Lot No. / Addtess Plan Check No. 2. / Lot No. / Address 0 Tract No. / Lot No./ Address 4. Tract No. / Lot No. / Address 5. Tract No. / Lot No. / Address TOTAL UNITS: I (this form only.) r Plan Check No. Plan Check No. Plan Check No. Plan Check No. Last $ 3:3% Fee per sq. ft. Fee per sq. ft. $ Fee persq.ft- Fee per sq. fL Fee per sq.fL *3 o "'1 so. ft Area sq. ft. Area sq. ft. Area sq. ft. Area sq. ft. Area TOTAL FEES DUE $ - (this form only.) $ Fee $ Fee Fee Fee Fee L-0- -1. /- Date Receipt of Fees This is to certify that all fees due to the Pomona Unified School District under applicable provisions of the Government Code and the Education Code, as prerequisite to the issuance ofa Building Permit by the City/County, have been received. Based on the information presented above, this Certification of Compliance is hereby executed. Receipt No. Check No. District/Fiscal Services (Signature and Printed Last Namerritle) Date See reverse side for General Information, Senior Citizen Housing, Payment of Fees, Notice - Protest Period and Appeals Process. Distribution of Copies: White - City/County; Yellow - District/CFPM; Pink - District/Fiscal Services; Goldenrod - Owner/Developer. Revised 1/05 GENERAL INFORMATION On November 4, 1998, SB 50 became effective. This bill grants California school districts the authority to levy fees in excess of those authorized by ? Government Code Section 65995 (Level 1 Fees), if the district meets certain specified tests and approves a School Facilities Needs Analysis. Alternative Level 2 fees may be levied when state bond funds are available for school construction projects, and Alternative Level 3 fees may only be levied when the State allocation Board certifies that it is no longer approving apportionments for new construction due to lack of available funding. The Board of Education approved the School Facilities Needs An and adopted resolution levying the alternative fees under SB 50 and has approved the fees on commercial/industrial development by separate resolution. Copies of the resolutions and the School Facilities Needs Analysis are available for viewing in the Capital Facilities Program Management office. SENIOR CITIZEN HOUSING Per Government Code Section 65995.1(c), if a senior citizen housing project is later converted to non -restricted use, the applicant/developer who is seeking the change in use will have to pay the difference between the current residential fee and what was paid for the senior citizen housing. PAYMENT OF FEES State law prohibits a city or county from issuing a building permit unless the local school district has certified that the application is in compliance with the District's collection program for fees assessed developers. The procedure for obtaining the required certification follows: ,-- Project Plans - A set of project plans stamped by the governing city or county building department, and valuation receipt indicating calculated square footage and plan check number, must be reviewed by the District. The address follows: , Capital Facilities Program Management, Pomona Unified School District, 800 South Garey Avenue, Pomona, CA 91766. Calculating Area for Residential Projects - The District levies fees on existing residential construction only if the resulting increase in assessable space exceeds 500 square feet after deducting any loss of assessable space in the same residential structure as a result of the same reconstruction.^All assessable square footage in new residential structures is subject to the fee levy. "Assessable space" means all square footage within the perimete'r of a residential structure, not including any carport, walkway, garage, overhang, patio, enclosed patio, detached accessory structure, or similar area. Residential projects also include the initial location, installation or occupancy of a manufactured home or mobile home. Calculating Area for Commercial/Industrial Projects - The chargeable covered and enclosed space of commercial or industrial construction shall not be deemed to include the square footage of any structure existing on the site of that construction as of the date the first building permit is issued for any portion of that construction. "Chargeable covered and enclosed space" means the covered and enclosed space determined to be within the perimeter of a commercial or industrial structure, not including any storage areas incidental to the principal use of the construction, garage, parking structure, unenclosed walkway, or utility or disposal area. Available Hours for Verification - CFPM staff will verify project development type and square footage and complete the Certification of Compliance 1 during available hours. Available hours are from 8:30 A.M. - 12:00 P.M. and 1:00 P.M. - 4:00 P.M., Monday through Friday, except District holidays. Other times are available by appointment by calling (909) 397-4800, ext. 3920. Available Hours for Payment - Fees due are paid to the District during available hours. Available hours are from 8:30 A.M. - 12:00 P.M. and 1:00 P.M. - 4:00 P.M., Monday through Friday, except District holidays. Copies -of the completed Certification of Compliance will be given to the applicant for use in obtaining the building permit(s) and for the applicant's records. NOTICE - PROTEST PERIOD Section 6620 of the Government Code requires that Pomona Unified School District provide a written notice to the project applicant, at the time of payment of school development fees, mitigation payments or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees. Therefore, in accordance with Section 66020 of the Government Code and other applicable law, this Notice shall serve to advise the applicant that the 90 -day protest period in regard to such Fees or the validity thereof, commences with such payment or performance of any other requirement as described in Section 66020 of the Government Code. APPEALS PROCESS Any -claim by an applicant that their project should be exempt from assessment.of fees, or that the fees levied are incorrect, must be made in writing and filed with the Pomona Unified School District. The claim must specify the factual and legal grounds supporting the claim. In addition, the claim must contain a statement specifying the nature of the project and the date the project building permit application was filed. The District's Superintendent, or his designee, shall respond in writing to a claim within fourteen (14) days from receipt of the claim. The response shall contain the Superintendent's decision on the claim and a statement of the reasons supporting the decision. Any claimant who is dissatisfied with the decision may request review by the District's Board of Education. A request for review must be written and filed with the Superintendent's or designee's office not later than ten (10) days from the date of the decision. The request must contain a statement of all factual and legal grounds in support of the continuing claim. The Board of Education shall consider and act upon a request for review at a public meeting not later than thirty (30) days from the date of filing of the request. A claimant may appear and address the Board in regard to the claim. The Board shall provide written notice of its decision, to be mailed to the claimant, within fourteen (14) days after public meeting at which the Board acted upon the claim. Correspondence shall be addressed to: Assistant to the Superintendent, Business Services -Facilities, Pomona Unified School District, 800 South Garey Avenue, Pomona, CA 91766 I SPECIAL INSPECTORS CERTIFICATE OF COMPLIANCE SPECIAL INSPECTOR REPORT Each inspector must complete this report and mail it to the Community, Economic & Development Services Department, Building -and Safety Division., PLAN CHECK/PERMIT NO.: Daily K Weekly ❑ Final ❑ 'JOB ADDRESS: /O'2'z-���� SS T>�/mac %`fes , GENERAL -CONTRACTOR: TYPE OF WORK INSPECTED _01 Reinforced Concrete ✓ Mason Hi -Tensile Bolting Prestressed Concrete Gradin /Fill Spray -Applied Gypsum Concrete Welding Fireproofing Other: Specify: DESCRIPTION OF WORK INSPECTED: ��af! S' sem- / `f' # G�Q>!rl � .I ��OG '�SO o� 3 )G'S LOCATION IN STRUCTURE: All work on this job to date, to the best of my knowledge, has been satisfactorily completed and conforms to the approved plans and applicable building code . DATE SSP CIAL IN PEC , R CERTIFICATION/REGISTRATION NO. R; PLANNING 3 ©L1ILOING\BLOG1,FORPASISPEC INSPECTION REPORT.000 (/