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HomeMy WebLinkAboutNo Permit Numberz z Y z i )L� . OND IitU • �'n�, l�.t... pub W''" 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 JOB SITE ADDRESS APN LOT TRACT OWNER ADDRESS III ov, CITY ZIPS TEL. APPLICANT TEL. CONTRACTOR a&ld �&I-e ADDR S LN CITY //�� r:y�'ZIP9►7il TEL. -W� ?47- i52_ 3 po ARCH/ENG/DESIGNER 4q%l 1/L 7. ADDRESS I i 5'st CITY ZIP 'vf 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). C1 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. 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.). (-) 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,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. 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. LICENSE CLASS: U LIC. NO.:Ru Li S�S DATE: `..� [�� CONTRACTOR: 43k" f'P WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE 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 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- _ c 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 the above-Mted property for inspection purposes. f — PE N INT) 1 Li- s TORE OF PERMITT DATE ®r -__ PRESS FIRMLY APPLICATION DATE: 1 \ I Z'� I 1 t26 P/C# P12 \J-1-" Soop ISSUE DATE: 1/7 1PERMIT# TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW ❑ ❑ RW ❑ ❑ PROPOSED USE QJn # DWEL. UNITS # STORIES 610 (e 2- If BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport ct) LU Patio/Deck LL Pool/Spa ZRe -Roof J Commercial m Valuation1 fl-14.6ii fl-1Adj. Area: QUANTITY DESCRIPTION FEE �j E U J w c� m rL U Q w CONSTRUCTION: PLAN REVIEW: \a 1. ELECTRIC: _ C. S %% Slo PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: �. 1 SMIP: ads ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �� • 3� BSAF: PP Sbg .CO TOTAL FEES \ C:\ S \ • �6� COMMENTS: Or RECEIPT# or� PAID BY: '� i l3� VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy SLAB ,UG. PLUMBING UG. ELECTRICAL ;LIFER GROUND A SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING ;SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR 6R INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL1BUILDING e FINAL MECHl1NiCAL '' �, " FINAL ELECTRICAO ;FINAL PLUMBING dft LC. of OCCUPANCY " CERT. of OCCUPANCY! COMMENTS: CITY OF DIAMOND BAR INSPECTION RECORD TRACT AND LEDGER " POOL/SPA SWITCH GEAR COMMERCIAL HOOD ROUGH PLUMBING .. T -BAR ROUGH ELECTRICAL, . X 14, .: INTERCEPTER _. , GAS TEST HOT MOP/SHOWERPAN ,b PRE GUNITE'' SEPTIC/CESSPOOL _ POOL PRE DECK BONDING HERS REPORT RECEIVED FENCE / GATE! ALARM DEMOLITION FINAL POOL ,'f'_ ROOF DRAINS WALL FOOTING,'STEEL ROUGH CONDUIT POOL/SPA r _ ROUGH PLUMBING ROUGH ELECTRICAL, . X 14, .: ROUGH,ME ANICAL _. , GAS TEST ,b PRE GUNITE'' POOL PRE DECK BONDING P -TRAP FENCE / GATE! ALARM FINAL POOL ,'f'_ WALLS: WALL FOOTING,'STEEL WALL STEEL 1ST( ) 2"e( j LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL RO. FRAMING PL'/aWINGAPPROVAL wva r. BOUGH FIRE APPROVAL ;® r �+ FINAL FIRE DEPARTMENT <,. r FINALPLANNING��"'"�' x , . FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES x ; FINAL HEALTH,DEPT, FINAL INDUSTRIALWASTE CITY OF DIAMOND BAR Department of Building and Safety REQUEST FOR APPROVAL OF SPECIAL INSPECTOR Special Inspectors Name N 'E� Is,L cow Phone No. G 2G - I 0 ,oaq Address 5.bl &qq- City -Zip qC94 7 -- Type of Inspection ❑ Continuous ❑ Periodic Job Site Address `ZZ50 Job Name Type of Project u cqg .at L'q Attach work experience and educational qualifications to this application. The above named person will be employed to inspect and/or test and will be responsible for the following inspections (Please circle number and provide description of work): 1. Concrete Plac 2. Reinforcing and/or prestressed steel 3. Structural Welding 4. High -Strength Bolting 5. Structural Masonry 6. �a X `1 —. D R (-If 0 1 N A f9e )-I OFF 7. a -M t ii G1 Duties and responsibilities of the Special Inspector: 1. The special inspector shall observe the work assigned for conformance with the approved design drawings and specifications. 2. The special inspector shall furnish inspection reports to the building official, the engineer or architect of record, and other designated persons. All discrepancies shall be brought to the immediate attention of the contractor for correction; then, if uncorrected, to the proper design authority and to the building official. 3. The special inspector shall submit a final signed report stating whether the work requiring special inspection was, to the best of his knowledge, in conformance with.the.approved plans and specifications and the applicable workmanship provision of the codes. Date vwnen 4 p,yr'afu v ........ �......., .,.y..,..,,.., Fee$ 4S 1. 5Approved: a --i � S Date Building Official Receipt No.- j �4i.1S 10012 BD DISTRIBUTION. White —File Canary — Inspector Pink — Special Inspector P Il'. ONe People Helping People Build a Safer World'" I IINNNTTEISRNa�TIIOONAI C"EMUNCIr MEMBER I Kenneth Balcom Certified Member Member #: 0849653 Exp: 5/31/2015 i ►��a International Code Council 500 New Jersey Avenue, NW Washington, DC 20001 The individual na ed hereon is CERTIFIED in the categories shown, h ving been so certified ursuant to successful com etion of th rescribe written i examin TS4- L—N, Not valid unless signed by certificate holder. ICC Certification attests to competent knowledge of codes and 4 Balcom, Ken 501 Marie Avenue Los Angeles CA 90042 (626)390-0896 COUNTY OF.LOS'ANGELES DEPARTMENT:OF PUBLIORKS BUILD ING'AND C.WSAFETY DMSION CERTIFICATE OF REGISTRA 6k SPECIAL INSPECTOR snDNo . 01605 Expiration: Date: 06/30/2016 SPECIALITY. W C R P RIM © W No. U - IS IS TIfiO C�TIFY TH o IS A LICENSED IN PECTOR IN THE CITY OF RIVE EXPIRES DAN CHUDY BUILDING OFFICIAL • , s LM FACH DM~ SMS s •, f•. THIS IS TO CERTIFY THAT: No. 6129 KEN L. BALCOM • • Is a REGISTERED INSPECTOR for the CITY OF LONG BEACH, CALIFORNIA CERTIFICATION No. D1075 MASONRY ® REINFORCED CONCRETE ® GRADING ❑ STRUCTURAL STEEL & WELDING ® WOOD SHEAR ❑ PRESTRESS ❑ FIREPROOFING.® DRIVEN PILE ❑ EPDXY DATE: 6-06-14 EXPIRES: 6-06-15 _ 7?uoxa #us..,. eL350 BUILDING OFFI IAL p,ALI';Ic:oncrete t-Ileld 7 esting t echmcian_- Grade a MR KENNETH .L BALCOM' Certificatton ID'#00986247- _-Expire"son 03/27/,2015 " certification Verify at CheckAuorg International Code Council 500 New Jersey Avenue, NW 3=01i ` Washington, DC 20001 INTERNATIONAL CODE COUNCIr The individual named hereon is CERTIFIED in .'the categories sho having been so ce ' ed pursuant to successful co pletion of the press bed written .1jeX77 ns. Not valid unless signed by certificate holder. ICC Certification attests to competent knowledge of codes ant standards. Training:Partilcipation Card This is to Certify that: KEN <BALCOM Showed proficiency in the specialized techniques taught in the training class described below. Type of Training: Fall Protection Training Date: April 24th 2010 Training Sitc: Twinin Inc Instructor/s: Dan Ward City of Orange Special Inspection Certification card Certification 014019 Issued. To: Ken Balcom ecus 6oI1dm6 o�J%/! c,t._5�•� Va M Nrou6p December 31st, 2016 ' IL I �. Go Straight to `My ICC' - Scan with your mobile device. Toll Free: 1 -888 -ICC -SAFE (422-7233) www.iccsafe.org Thank you foryoursupportand participation. Signature of Member v 3 .. � T -r '� a– a •-` a _ � t .. .., �;; I -programs; or to verify the vandlty of'thfs card, contact:, t a � ` " `' ,The American Conaebe Insti6ute'° i - n45 7 Farmington Hills Ml4g333.9094 j a /848-37,§ •, xi �� - 848-3793 ,x� _,�.".�=_�` a. M'� ���iw�,:=.`aim :.:• _. ._ .. .. Baa�Unauthor�rzedreprodycUon or#misuse�ofthis �,� � �card4inay result�tmlegal action �= Mr. Kenneth L Balcom, Master of Special Inspection - 849653 - _ Wf,, Kenneth L Balcom, Master of Special Inspection - 849653 Structural Steel& Welding Special inspector - Exp. 021102012 :Master of Special Inspection - Exp. 06/062014 Rifori�ed Concrete Special Inspector- Exp. 01/092015 `. eiplied SpraY=ap Fireproofing Special Inspector - Exp. 01/092015 Structural Masonry Special Inspector - Exp. 01/092015 _ !Structural Steel and Bolting Special Inspector- Exp. 01109/2015 Structural Welding Special Inspector- Exp. 01/092015 i DISTRICT OFFICES (661) 524-2390 - RG11ifored Concrete ❑ Pile & Pits Fouration Antelope Valley ❑ Pre -stressed Concrete o Mastic & Inturn t Fire Proofing Calabasas / Malibu (81%800-4150 , -1766 vemery—���II&i (316)952 o CarsonE 323 881J030 dr�aucnnal stat and Bolting ❑ special Case East Los Angeles ( ?. �� La Puente , {626) 961-9611 d W 5rrucngal welding ❑ Smoke Control Lomita pusLr– WORKS (323) 534-3760 (626) 574-0941 r "tiny Fir` Resistance Material ❑ special Inspections—Lateral Resisting San Gabriel Valley �- (r1) 222<2940 a wants Systems Santa Glarita (562)- 946-1390 $ i ❑soils ❑ Structural Tearing—Lateral Resisting South Whittier i Southwest (323) 820-6500 Universal (818) 762-6284 Re9ieterea use 77 FOR .EVERY .JOB PLEASE CALL 714-7447200 DAILY CALL44 NUMBER 562-570-6826 Faz- N umber: 562=570-6271 r To STOR WORK - Call one of the following inspectors: 1. Ray: Woolhether 562=670-6287 2.. -.,r -.van Zeisel - 562-570-6165 3. Loren: Patten 562=570-6451 - I �r- y l i 1 1 �3 r -- i THE CITY OF SAN DIEGO SPECIAL INSPECTOR CERTIFICATE KEN BALC,OM 1128 tettificate No:: r # I <�. Signature: a e(s) of waik-urdcated,u(tclar the prmislons of Qt apter 14 _ r No. P A L M D A L E Building and Safety r� • • h. ,CIAL INSPECTION REGISTRATION SP5Name Type oflnspecuon ` •' I pector' Signature Building Official's A$proyal Date Expires Register No. Expires: Issuance Fee: 379 7/1/2014 $80.00 i Inspection Administrator I The bearer of this Certificate is authorized to act in the•City, of Ir S; _ as a Special Inspector of. ';; Reinforced Concrete I Masonry I Structural ;i SteelMelding I Fireproofing{ OF rq, I � Kenneth Balcom o �i 501 Marie Ave ul Los Angeles CA 90042 DEPUTY INSPECTION REGISTRATION CITY OF DOWNEY e BUILDING AND SAFETY 11111 Brookshire Avenue �3 r Downey, CA 90241 (562) 9047142 (www.downevca.ore) 3-035 REGISTRATIONNUMBERY. NAME: COM A COMPANY: ISSUE DATE: ( a Building anti Safety SPECIAL INSPECTOR N01 AN WIPLOYEE Cf CIIY0f S.'VWCLARti.4 iy KENNETH L. BALCOM Certification No. 10-00m ISSUED: MARCH 12;,2014 (SUBJECT' FOR RENEWAL N`ONE,Y'EAR) STL-SB STL W CONC MASONRY SFRM ANCHORS 0 E 71141S CARD IS THE PROPERTY OF THE CITY OF SANTA CLARITA AND MUST BE`USED FOR j PURPOSES OF CITY VERIFICATION OF SPECIAL INSPECTOR STATUS ONLY If found return to: 23920 Valencia Blvd. Ste 140, Santa Clarita CA 91355 DEVELOPMENT SERVICES DEPAF DIVISION OF,BUILDINqSAFEfY• INSPECTION SERVICES; Tel.�(858) 4925070 Fit ,(858) 492=! ,a r1 Shuctural Masonry ❑�Stuctttrai Steel and�V(lelding ' ❑ SPray appligd Fireproofing � Pile Drning4 , �� DS?306(Rav a=o) �rCH1EF Bi I hereby affirm that all the information given is true and complete to the best of my knowledge. I understand that ani false information will disqualify my registration. I understand that registration is valid for the duration of the fiscal year, ending on Jun 30th, and I ust reapply for jobs done after this a#e. SIGNATURE: