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HomeMy WebLinkAboutPR14-4440M LU 2 CD z C3 on H I 1111r l . %iiii•>; CITY OF DIAMOND BAL" 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 10 FIRMLY BUILDING PERMIT APPLICATION JOB SITE ADDRESS APN -6 OT TRACT OWNER7C ADDRESS CITY ZIP TEL. PPLICANT + TEL CONTRACTORX • Tt— G1- ADDRESS 6 r CITY ZI Obi TEL. ARCH/ENG/DESIGNERY A"_e_� i�s, lhA . ADDRESS V. O CITY �hl/') 6A ZIP TEL. r O� 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). (-) I, as owner of the property, or my employees with wages as their sale 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 Cade: 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.). (_j 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,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. 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.htmi. w.leginfo.ca.gov/calaw.htmi. 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 Code, and my license is in full force and effect.` K_LICENSE CLASS: LI 0.: v T E:Z ONTRACTO ' i WORKS 'S COMPENSATION TION 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. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 o1 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 X POLICY NUMBER/zL�--�� (f HIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100) 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 o1 the Labor Cale, 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 AMELENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. l 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 u th b ve•menti off" 'for inspection purposes. PERMITTEE ME (PRINT) G AT E OF PERMITTEE D4TE APPLICATION DATE: D— a fI l P/C# /"'l - y'No ISSUE DATE: " I 41Z t 14' PERMIT# f R \A-- g'o TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE ❑ ❑ ❑ ❑ 'PROPOSED USE .;2"_,'.4_, t�' -pin # DWEL. UNITS �_ # STORIES _�_ # BEDROOMS_ DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SF ADD EM Garage/Carport rn w Patio/Deck LL Pool/Spa Z Re -Roof O Commercial Valuation: Adj. Area: QUANTITY 4 DESCRIPTION FEE a J - -� C Cti Z z m Tvf!'C J Q z a sf�y U y CONSTRUCTION: PLAN REVIEW: \to -q -a SS ELECTRIC: \Z.�� • A4•0 PLUMBING: \-IO • IQ 1 MECHANICAL: E - • SS INSPECTION FEE: ISSUANCE: \4'� • a SMIP: ENERGY P/C: A411716. 8�I ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: '©'� • O� BSAF: 1 • OO TOTAL FEES \ Fs a , S�- COMMENTS: a54a . 4_b RECEIPT #- 211,0211b `P PAID BY: V_ VALIDATION: J ;x�q WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAIR INSPECTION RECORD SETBACK/ LETTER: FOOTINGS FORMS SLAB UG. PLUMBINGUG. ELECTRICAL _ LIFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT �1 ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIORVy FRAM INGNENTING ,' ' ROUGH MECHANICAL' j ROUGH ELECTRICAL,. W(.) C O \� ROUGH' PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL -BUILDING FINAL MECHANICAL, ->r FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY.' COMMENTS: TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING �ROUGH;ELECTRICAL , ROUGH MECHANICAL rti GAS TEST PRE GUNITE POOL PRE DECK BONDING; RAP ,FENCE ,FENCE /--GATE/ALARM, FINAL:00OL WALLS: WALL FOOTING/STEEL WALL STEEL 1ST( )2 ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL r-rr:-raT.: County of Los Angeles DEPARTMENT OF PUBLIC WORKS BUILDING & SAFFETY DIVISION LAR USP Field Office Address: STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and spermcations, at significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required by Sections 108, 1701 or other sections of the Los Angeles County Building Code. (Sections 106.4.5, 1702) 1> Report No. st This report includes all construction work through / day of 20 Page No. of Project Address: Structural Observer of Record ($OR): SOR Phone No.: Building Kermit No.: I Structural Observation performed by: I Observer Professional LIcJReg. No.: I Observer Phone No.: nnnFRVFn STRt1CTt1RAL ELEMENTS AND THEIR CONNECTIONS FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED, IF NOT WHOLE Doting, Stem Walls, ❑ Concrete ❑ Steel Moment Frame ❑ Concrete ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck ❑ Caisson, Plies, Grade Beams ❑ Wood ❑ Concrete Moment Frame ❑ Wood ❑ Retaining Foundation Hillstle Special Anchors ❑ Other: ❑ Masonry Wall Frame ❑ Others: ❑ Others: ❑ Others: NOTES: 3 I)VA10-16 3`�0.C. FIA .e OBSERVED DEFICIENCIES: I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE: 1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION W ACCORDANCE WITH THE REQUIREMENTS OF THE CITY/COUNTY OF 2. 1, OR ANOTHER ENGINEER OR ARCHITECT WHO 1 HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 3. ALL DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE; 4. 1 RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITYICOUNTY OF BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED. DATE QAOFESS�pp,,,, C 63432 ' i W - T CA Sp L j�1 /I� T OF STAMP OF STRUCTURAL OBSERVER OF RECORD sorf.doc - LARU P Structural Observation Report Fonn (V1.0 - 5/2000) Page 1 of 1 ueputy- inspection Services DEPT OF BLDG. & SAFETY (213) 281-2417 �t OTY OF &AMW COUNTY OF REGISTERED INSPECTOR'S DAILY -REPORT OF Reinforced Concrete _ H.S. Bott Assembly _ Drilled In Anchors _ Grading P T - Concrete _ Welding >GEpoxy J Injection Other Reinforced Masonry _ Fireproofing _ Quality Control 07• ' W.;12 w� / ! DATE OF INSPECTION DESCRIPTION OF WORK INSPECTED: HOURS SAMPLES All inspections based on a minimum of 4 hours & over 4 hours - 8 hour minimum. In addition, over 8 hours and Saturday will be billed at time and a half. ATTORNEY'S FEES - If any action at law or in equity is brought to enforce or interpret the terms of this Contract, the prevailing party shall be entitled to reasonable attorney's fees. costs and necessary disbursements in addition to any other relief to which such party mai• he entitled. CERTIFICATE OF COMPLIANCE Registered Deputy Building Inspector's certificate Signed by Inspector 1. D. NO. has been filed and it states that the above work was inspected by him and complies with the provisions of the Building Code applicable thereto. Respectfully Submitted Approved �y: By perintcndent eputy InSpecUdn1 S vices Deputy InspeLtion SOrW,ces DEPT OF BLDG. & SAFETY (23) 2281-2417 CI TY OFf;Q �1 COUNTY OF REGISTERED INSPECT'OR'S DAILY REPORT OF Reinforced Concrete _ H.S. Bott Assembly _ Drilled In Anchors _ Grading P T - Concrete _ Welding XEpoxy / Injection Other Reinforced Masonry _ Fireproofing Quality Control DATE OF INSPECTION DESCRIPTION OF WORK INSPECTED: ♦t r.r � �f J� la.c is DATE OF INSPECTION DESCRIPTION OF WORK INSPECTED: �f J� la.c HOURS SAMPLES Grout Mortar Concrete Block Prisms Density All inspections based on a minimum of 4 hours & over 4 hours - 8 hour minimum. In addition. over 8 hours and Saturday will be billed at time and a half. ATTORNEY'S FEES - if any action at law or to equity is brought to enforce or interpret the terms of this Contract, the prevailing party shall be entitled to reasonable attorney's fees. costs and necessary disbursements in addition to any other relief to which such party may he entitled. CERTIFICATE OF COMPLIANCE Registered De ut Building inspector's certificate Signed by Inspector_ l �!. I.D. NO. �/ has been filed and it states that the above work—was inspected by him and complies with the provisions of the Building Code applicable thereto. Respectfully Submitted Approved V: — _By Project Superintendent Dep(liy InspectiongerviteE