The URL can be used to link to this page

Home My WebLink AboutPR15-2730Cr CL 0 a I_ rn J cc 0 C:) DL1:�I0�`D B�1R CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMEN`f SERV.CES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-702FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building mondbarca.gov JOB SITE ADDRESS Q 3 4 0—,,. \�1 APN LOT TRACT OWNER 124-11 int ADDRESS 2110.1 nebco CITY biahh..,ZIPT1e, TEL. Z - APPLICANT Mi -C- EL. CONTRACTOR I CO •f ' I,h. C I 11`6+11 Li ADDRESS 25 3 A/ Wh;fes Norse c i r CITY 1r✓abli wt ZIP CA- TEL. 9 / 91 ARCH/ENG/ _ DESIGNER ADDRESS Al -,7; --teff, +4- y e Zy 5 CITY Mvyrt,2- 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, after, 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). V 1, 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 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: hftp/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 liry-/ c�ense is in (full force and effect. nd LICENSE CLASS: a LIC. NO.: l Z bo DATE: CONTRACTOR: /4 L C LUIZSVYLLUTC n rr ,% f1�c.� 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. 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: ,y 1 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 subjaef to the Worker's Compensation provisions of Section 3700 of theLabor e, I shall forthwith it comply with those provisions. DATE:-(!—/ % APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawfu , 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. 1 qAn I) all- i c! PERMITTEE NAME (PRINT),", SIGNATURE OF PERMITTEE r DATE� O APPLICATION DATE: �� / ISSUE DATE: a a1 1 (.o PERMIT# TYPE CONST. P/C# •� 'c►7 OCC GROUP: Scope of Work Re�no��eC 1, o u s e # DWEL. UNITS If STORIES 2 A 2 Ae w ha�luv�n # BEDROOMS 4_ DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/E '.2977 99 ! -A ' Garage/Carport 1"'d ' w Patio/Deck W LL Pool/Spa ZRe -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE 0 2o- S w: f'GA✓-S U + w 7oi Les � m �f Twh 154f1 a � �X�t�uGC ri x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: vi i ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: �y O/ V BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: A-7 QPAID BY: � 6'7 VALIDATION: RECEIPT # PAID BY: VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy mq CITY OF "AiMND'BAR INSPECTION RECORD INSPECTIONDA ...INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING y, UG. ELECTRICAL 1 UFER GROUND SEWER LATERAL ; MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING �4 ROUGH MECHANICAL ROUGH ELECTRICAL W( )C( ti ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL L/ LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING CP FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: INSPECTIONDATE INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD. T -BAR INTERCEPTER HOT MOP/SHOWERPAN WIWI SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE/GATE/ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1ST( )2 ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE _" k.1W: . LA:DR:UJC�Ff STRUCTURAL OBSERVATION REPORT FORM STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specificatlons, at significant construction stages and at completion of the structural system. Structural observation does not include or waive the responsibility for the inspections required U Section 108, 1704 or other sections of the code. Report No. This report includes all construction work through ZH day of , 20 (o Page No. 1 of I Project Ad cess: Structural Observer of Record (SOR): Phone No. of OR: 2 02 v- MAH o e 1 Budding Permit No.: Structural Observation performed by: Professional Lic./Reg. No. of Observer: Phone No. of Observer. FOUNDATION WALL FRAMES FLOOR ELEMENTS/ CONNECTION OBSERVATION LOCATION ❑ Footing, Stem Walls, ❑ Concrete ❑ Steel Moment Frame ❑ Concrete COIC44 C t t;'C� W *4.,TVeo- %JG*, tasmwl hIB�►ST�e WIa;�..y ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck ❑ Caisson, Piles. Grade Rood ❑ Concrete Moment ❑ Wood Beams Frame �llGlleN-ft�i� r ❑ Retaining Foundation ❑ Others: ❑ Masonry Wall Frame ❑ Others: Hillside Special Anchors ❑ Others: 53'Others: NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance with the approved plans or in the load path: (A final report by the structural observer which states that all observed deficiencies have been resolved is required before acceptance of the work by the building officials.) �al,t.c.Ii4�.i.F �at�t� I'��o�►�t�o p�e� �1,a�14 • _ � .. 1 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 IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY OF LOS ANGELES. 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 NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE; 4. 1 RECOMMEND T ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY OF LOS ANGELES B ELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED. a q-• 20 t 6► OF SED ARC,y -A �r C-26061 \J.� ^RENEWAL / DATE STAMP OF I WForm.08 (Pert 1) (Rev. IPI1YO14) wwwJadb.org