HomeMy WebLinkAboutPR13-1004E
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REPS
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov
JOBSITEADDRESS 1gt2- Ro"146- Ci'a (vt4
APN LOT TRACT
OWNERS I F11 e Crl N OC j,44, A -
ADDRESS ialy MD -1,1146- CA-Wy0)1(
CITY D , & ZIP TEL. 'ql)-1 - 2-Z8 •- 3'q3
APPLICANT OM K-2 Ati 5' 4.eL" TEL.
CONTRACTOR
ADDRESS 12-2-23 /i-✓!', tt job -5'69
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
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, 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 Codel 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 peril 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
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 purpose of sale.).
U 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 to an owner of property who
builds or improves thereon, and who contracts forthe 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):
Date: Sign:
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 permiLl 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.
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, aan'l n�d my license is in full force and effect.
LICENSE CLASS: rCJ LIC. NO.: % D (0 6
EXP. DATE: -Z Z. CONTRACTOR: gV,4 7—Aly- Co
T� WORKER'S 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 Worker's Compensation, as provided by
ection 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 S` Ll A.1• Q
POLICY NUMBER aY
(PHIS SECTION NEED NOT BE COMPLETED IF THE 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 them 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.
PER NAME (PRIN
�d�11,
SIGNATURE OF PERMITTEE DATE
APPLICATION DATE: �( ar7 / 1 t. P/C#
ISSUE DATE: "/26_7 A (we PERMIT# : *�a \ -S —. .._ \ Qll�,
TYPE CONST. OCC GROUP:
Scope of Work ?Q'�O GCIV�V
�1F� �Y1S�Cl��a'Y1'crl'�'
# DWEL. UNITS # STORIES
o -F GJIoF` \ 1i
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w T!Rk..k act
w
LL Pool/Sipa
ZRe -Roof
Commercial
m
Valuation:
Adj. Area:
QUANTITY DESCRIPTION
FEE
a
U
U
w
w
z
m
J
a
_ZU
Q
x
U
w
CONSTRUCTION:
PLAN REVIEW:
$ $9
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
\
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
••��
al • OQ
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY: VALIDATION: G
RECEIPT # 323-1 PAID BY: Y CJS VALIDATION: T
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
COMMENTS:
_W_ C
Age •`
Building Division (909) 839-7020 / Inspection Request Hotline (909) 839-7027
C qty of Diimond fiaf "
Building & Safety Division
21810 Copley Drive
Diamond Bar, CA 91765
PERMIT # I?g= �?j o ��(��{ DATE ISSUED: S
ADDRESS: / l Z- XIOY///rig (�4vnU//r\ DESCRIPTION. Gf/��`+P✓�of �G� �J
POST IN SAFE, CONSPICUOUS PLACE AT FRONT OF JOB. PROVIDE PERMIT NUMBER WHEN CALLING FOR INSPECTION. HAVE APPROVED PLANS
ON JOBSITE AT TIME OF INSPECTION. INSPECTION REQUESTS SHALL BE MADE 24 HOURS IN
�y rA 11 1C TUC nnV nC Vn is INSPE !ON AT 9.00 AM AT (909) 839-7020 TO OBTAIN AN APPROXIMATE TIMEFRAME.
HUVHIVLC. lllV IVIH1 l.r\LL v �� vr.. ...... -... ........ _.__ .......
INSPECTION DATE: SIGN:
_ __ _ -
INSPECTION DATE: SIGN:
SETBACK / LETTER
I
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG. PLUMBING
T -BAR
UG. ELECTRICAL
INTERCEPTER
UFER GROUND j
HOT MOP/SHOWERPAN
SEWER LATERAL f
SEPTIC/CESSPOOL
SEWER CLEANOUT
HERS REPORT RECEIVED
MAIN WATER LINE
DEMOLITION
ROOF SHEATHING 0
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOL/SPA:
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMING/VENTING `] B'7
ROUGH ELECTRICAL
R0. MECHANICAL
ROUGH MECHANICAL r
R0. ELECTRICAL W( ) C O
GAS TEST
RO. PLUMBING
PRE GUNITIE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE / GATE / ALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS:
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 1ST( ) 2ND( ) LIFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN / SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO. FRAMING PLANNING APPROVAL
FINAL BUILDING D� (�I ,
ROUGH FIRE A PPRO VA L.
FINAL MECHANICAL
FINAL FIRE
FINAL ELECTRICAL
FINAL PLANNING
•
FINAL PLUMBING
FINAL ENGINEERING/ PW
T.C. of OCCUPANCY
FINAL COMMUNITYSERVICES
CERT.OF OCCUPANY
FINAL HEALTH DEPT.
INDUSTRIAL WASTE FINAL
,6ti�. � .. ^,,,;..,. a. ,. � ...
.. .. ..r � - . .,.. - _...- �. ..
DI�1t�IIND 6�R
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS l Z Mb G C
APN LOT TRACT
OWNER S''MVC (tAt4OFFL4-kt9
ADDRESS 1'91Z- MOONrNG C"V A
CITY 171d'MoND riti2 ZIP°►1?tr TEL. `CA -29P -3W3
APPLICANT C7H *, M,(3A-41AAA TEL. (J - Z3t-40!TI :2
CONTRACTOR A-V 4 Tt} C 00 M S 7 K C77 04
ADDRESS IZZ23 N16 -KLA -N1> A -Vi!_:, b.)06-56
CITY 9- CuChMuld ZIP 9t?3,LTEL.9f-731-/Sl']
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
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, 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 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).
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
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 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):
Date: Sign:
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,l 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. 1 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.
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.
LICENSE CLASS: LIC. NO.: q b 4 CP �r
EXP. DATE: CONTRACTOR: 0kJ_A- Z r. c, -o _r -re c -n od
WORKER'S 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 Worker's Compensation, as provided by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
tl� 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 IF THE 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. Q.
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.
0 i of_ ✓Bwp-a4r
PER AME (PRINT)S PE I y6A�LL D TEF O/2i
PRESS
FIRMLY
APPLICATION DATE: lb I Z1 2 614 P/C#
ISSUE DATE: lC/Zi Ise PERMIT#:•�i�"i-
TYPE CONST. OCC GROUP:
Scope of Work
If DWEL. UNITS If STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
W
Patio/Deck
W
u-
Pool/Spa
ZRe
-Roof
Commercial
m
Valuation: Adj. Area:
QUANTITY DESCRIPTION FEE
a
U
U
w
w
co
z
in
a
ZU_
Q
x
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING: Q $�
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP: r
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES `3_I • d 1
COMMENTS:
P/C: PAID BY: VALIDATION:
RECEIPT # S 2� PAID BY: 4Q1aSA VALIDATION: Ohm_
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
COMMENTS: