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Home My WebLink AboutPR15-2485�•► r.�». CITY OF DIAMOND BAR - 7 • • DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES j 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@ m arca.gov JOB SITE ADDRESS bbl ` �'+ c vh6 v I APN LOT TRACT OWNER 1 K AfkDIr:lie Z ADDRESS CITYa4-Vntau/ ZIP_64_7 S TEL. APPLICANTd�►?n.� TEL. Jf 352.33ic�1 CONTRACTOR J, 6 S ADDRESS CITY�7✓ (l hva, Q 1111. jIP a1fi41 TEL. �•- d 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, atter, 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 LJ 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.). L) 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.). (-) 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 Cade, and my cense's in f 11 ice and effect. pp LICENSE C S y (-3%Cl(0 1LI)C. NO.: DATE: CONTRACTOR: LQ WORKER'S C PENSATION DECLARATION I HEREBY AFFIRM UND R 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 Nu�ar \ CARRIER A.\- 1 W W FN�jV WAGER BER (THIS SECTION NEED NOT BE COM D IF A PEhMfr IS R) NE HUNDRED S ($100) OR LESS). I certify that in the performance of the work for which this permit is i d, I sh 1 mploy any pe n in any manner so a to become su ject to the Worker's Compim of California. d agre if I should b me subject to the Worker's Camp on provi �On of Section 37 abor sha torthw' ovisions. DATE: I APPLICANT: WARNING: Failure to secure Worker's -&0,nnd verage wful, and shall s ct an employer to criminal penalties a d civil fines up to one hun redollars ($100,000), in addition to of the corn ensation, damages as provided for in section 3708 of e, 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 or ances and state laws relating to building construction, and hereby authorize representatives of this county to en the above-mentioned prope nspection pur P A \ INT) (x I J SIG RE C• APPLICATION DATE:, II��Z 7,1 P/C# Pa Ns - a4 s �/ � ISSUE DATE: fERMIT# TYPE CONST. OCC GROUP: 1 Scope of Work 2 I�r7• tU" ��-t �WGr Rt�bG # DWEL. UNITS # STORIES 2 IAF S b( - # BEDROOMS_ DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport UL) w Patio/Deck W W Pool/Spa ZRe -Roof 0_ Commercial m Y�y' CGS i E e Vailuation:�q. `S Adj. Area: QUANTITY DESCRIPTION FEE U U W J W co z m J a U_ U CONSTRUCTION: PLAN REVIEW: A to S • C:o ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: _ �'�- dl y SMIP: A r ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: %f PLOT PLAN: ZONING CLEARANCE: TOTAL FEES ��. S • d COMMENTS: 3�, 3, P/C: 6S PAID BY: ., S3 RECEIPT k/ J PAID BY: VALIDATION: S_\ VALIDATION: V ' WHITE'-' Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF`'t °O TND BAR INSPECTION ION RECORD IhSPECTIQN SETBACK/ LETTER DATE INSPECTOR FOOTINGS FORMS / SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND _ SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING //-7 CO ^P /f-/ FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR 7,/ A. LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE - GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING S T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: INSPECTIONDATE INSPECTOR 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 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 ` 0 w Q a 0 0 UJ cs W DI ►9d11'D B�1R See Zr,speck ions CITY OF DIAMOND BAR °= or)R 5 Z q(96DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 RESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027(}^ ) / P FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS �� ' S U--3 a --Z, Cs{ >d . APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT S.1-:1 CONTRACTOR �G'a'1t /L�cc-t p1i►-,r r J ADDRESS —1 2 2� �•4-,� r� wy, n !1r v. CITY�rr•cranoJ L -K -I -ZIP _r7V_! A TEL. `I t Y— -7 L �j- 41 V- ; 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): 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 Gode 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.: - Ir dO(a U q S DATE: !C CONTRACTOR: Sii «J-+- (-2 Y A3,tA---t -.— WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I ve 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 Cade, 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 0 O -r -1 2 1 L. O 1 (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 CompenZol proviions of Section 3700 of th her Code, I shall forthwith comply with those provisions. DATE: APPLICANT:�� WARNING: Failure to secure Worker's Compe tion 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. ., 101E a /} PE I E NAME (PRINT) G URE OF PERMITTEE DATE APPLICATION DATE: 1O -dr- IJ PP//C# ISSUE DATE: U PERMIT# : 10415-- r TYPE CONST.(/ T OCC GROUP: �y Scope of Work /l.cPJ►.�_ ►��yw h,�_ # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport CO Patio/Deck LU LL Pool/Spa ZRe -Roof Commercial ca 00 Valuation: 0 r, r, Adj. Area: QUANTITY DESCRIPTION FEE CJ h1 1 U J I[S �-�-�• 1 a� S � z m a 7=1 Psi ` 1 � o A-,2 x.,41 s ax . 2�fY.s 435 � _ CONSTRUCTION: PLAN REVIEW: p SSBI li / ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 1 ii}a-.SL SMTP: L p1 19 ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: /0.0.6 BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES / COMMENTS: 7 ° , a 7 P/C: PAID BY: VALIDATION: RECEIPT # PAID BY:I,1 VALIDATION: /Y V WHITE - Department Copy, YELLOW - Finance Copy, PINK - Assessor Copy CITY OF DJAti'"rl^,N:Dl ' BAR INSPECTION RECORD - - INSPECTIONDATE INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) 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 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 SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA 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( ) 2No( ) 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 IIM0IND 11AR '* */AST6 M!}N�}Eaetrtt3�r- CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 1S 21065 RESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 11� I� FIRMLY BUILDING PERMIT APPLICATION � i) 1 JOB SITE ADDRESS APN LOT TRACT NJ OWNER ADDRESS Z (o Sb n Dir• CITY ZIP TEL. aOe?)rj �15rIVO� k�APPLICANT & TEL. CONTRACTOR ADDRE0 n CITY Q ZIP C,11A TEL. 710 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 Cade: 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 70M 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 fora permit subjects the applicant to a civil penalty of n t more than five hundred dollars ($500). as owner of the property, or my employees with wages as their sole compensation, will do 1 all of or (_) portions e 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): 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 a ilable upon request when this application is submitted or at the followi eb si tt /www.leginfo.ca.gov/calaw. DATE:r SIGN: LICENSED CONTRACTMIS 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.: DATE: CONTRACTOR: 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: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMrr IS FOR ONE HUNDRED DOLLARS (S1 00) 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 (5100,000), 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 certity 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 -mention d property for inspection purposes. C ! PERMITTEE NAM (PRIM SIGNATURE Ol"PERIVIlREe DATE APPLICATION DATE: -s- P/C# ISSUE DATE: o'4 !r PERMIT# PRI Jr- - 16 TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE ❑ ❑ ❑ ❑ PROPOSED U C11< �C r C W # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport 0 w Patio/Deck L Pool/ Re -Roof 0 0 —� Z Commercial [0 F� Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U J w co m J a a U Q w -------------- CONSTRUCTION: >ty PLAN REVIEW: I T 2-24 ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ,`� ISSUANCE: 0b / S S. 6 LI SMTP: C) . R Z ENERGY P/C: ENERGY PERMIT: RETENTION FEE: ti PRE -ALT FEE: Z . U o BSAF: 1%i 40 TOTAL FEES COMMENTS: RECEIPT # 21552- I PAID BY: _ �_}} VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy l CITY OF DIAMOND RAR INSPECTION RECORD ` SETBACK/°LETT°ER E r "` "°� '"""` `'�° ' ° I TRACTAND LEDGER :FOOTINGS FORMS' , ..- .,,.,....a. SHEAR WALLS INTERIOR°3 SWITCH GEAR glg6 ROUGH PLUMBING I I FINAL POOL COMMERCIAL HOOD 'UG. PLUMBING°�= "' 'T -BAR ELECTRIGAL_�`'''� �� '`'.°" ROUGH MECHANICAL INTERCEPTER UFER,GROUND _ _.�` , -' e . ^i I ; WALL BOND BEAM 'HOT MOP/SFiOWERPAN SEWER LATERAL ) , „` s SEPTIC/CESSPOOL MAIN WATER LINE ROUGHPLUMBING�',"PRE _ HERS REPORT RECEIVED SEWER CLEANOUT GUNITE.�, ,:�• m, ,,,.,<� . DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING FIRE DEPARTINENT ROUGH CONDUIT SHEAR WALL EXTERIQR� ", .. :te,i0. PUOU$PA �' a ' ° , ..- .,,.,....a. SHEAR WALLS INTERIOR°3 I FENCE / GATE/ ALARM. _ ROUGH PLUMBING I I FINAL POOL FRAMING/VENTING ' "' TROUGH ELECTR16A:C WALL FOOTING/STEEL ROUGH MECHANICAL WALL STEEL 1S'( ) 2"°( )LIFT ROUGH MECHANICAL., I ; WALL BOND BEAM ROUGH ELECTRICAL"W( ) C ( ) , „` s i GAS TEST WALL FINAL ROUGHPLUMBING�',"PRE r w GUNITE.�, ,:�• m, ,,,.,<� . . INSULATION WALL ,.n. POOL'PRE DECK B4ONDING"� FINAL,MEbHANICAL(FINAL FIRE DEPARTINENT INSULATION CEILING ° I DRYWALL I FENCE / GATE/ ALARM. _ LATH (PRE) I I FINAL POOL LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST_ WALL STEEL 1S'( ) 2"°( )LIFT _ SCRATCH COAT I ; WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL GAS METER RELEASE WALL FINAL SPECIAL INSPECTION RO.FRAMING PLANNINGAPPROVAL w FINALBUILDIN-Q ,,&, r. ,° . n _ TROUGH FIRE APPR V—, , FINAL,MEbHANICAL(FINAL FIRE DEPARTINENT WN'ALELECTRICAL !=FINAL PLANNING,,, FINAL PLUMBING • , �, TC. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: ° °.' _» ° ' FINAL ENGINEERING/ -PW FINAL COMMUNITY -:SERVICES FINAL HEALTH DEPT, ."; FINAL INDUSTRIAL WASTE' 7 4i° 47- 4 _; w IIM I I 'lyColiPURA.T�9 Building & Safety Division 21810 Copley Drive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Job Address: 7% I A Sin�2cqkV 0i. l i amo NA g a r Dear Property Owner: An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified. For your protection, you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City of County. They are also required by law to put their license number on all permits for which they apply. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under the federal law, contact the Internal Review Service (and if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State law, contact the Department of Benefit -Payments and the Division of Industrial Accidents. If the structure is intended for sale, the property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and materials personally. Building permits are not required to be signed by the property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board at 9821 Business Park Drive, Sacramento, CA 95827, www.cslb.ca.aov or at (800) 321-CSLB (2752). Please complete and return the enclosed "Owner -Builder' verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Ago, Building & Safety Division 21825 Copley Drive Diamond Bar, California 91765 (909) 839-7020 Fax (909) 861-3117 Attention Property Owner: An "Owner -Builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received by us. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no). t►�c5 2. 1 (have/have not) r -G signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone NA Contractors License No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone M Contractors License No. 5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated.- Name ndicated:Name NI Address Phone Type of Work Signed Property Owner Date �� -7-L4 —15- f NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at Q f. j + i4coo n CA C We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGEMENT AND VERIFICATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. (-E 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. l 7'/5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), includinglabor and materials, I may be considered an "employer" under state and federal law. 6 I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. &7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. W8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. &/10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: V11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 4V__12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or an changes to of the 9 Y information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is. required to be presented when the permit is issued to verify the property owner's signature. �( —1 Signature of Property Owner: Date: ✓ \ I CALIFORNIA• • •D _c�f�� .cwt .a .cat_ .'ACc�Cs�, sa•.a .M•!n�t�...�t�•si� ..��•.c� ..�<si..� .c�<�<�<�.•�,�.�.�.-�. ^�<!�<!�<!�<s�<.:�<.� .c�<!�<�<. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of � OJ �� ►�l�i�J ) ` `` I On ` before me, 1i1��J1 �'IU111'Aj (1e�2, 1�'C�T�IY� pJ IG Date wHjeeInsertName and Tit e of the Officer personally appeared "ViO, V n 01f:& Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person,(Sj whose namewis/fie subscribed to the within instrument and acknowledged to me that 1;6/she/tt3ey executed the same in Fya/her/tho authorized capacity(iA, and that by Wi!57her/thfir signatureVon the instrument the personw, or the entity upon. behalf of which the person* acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. BELINDA MARL It Z Commission # 2066897 xlnncLa Z , Notary PuWic - California = Si natur Z Los Angeles County 9. g Comm. f ires Ma 3,2018t Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Doc u ent:� Ve�e� Document Date - Number Number of Pages: Signer(s) Other Than Named Above: _ -�'C> Pk5 T 'Skjl-) i'�Z2 Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: El Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee Cl Guardian or Conservator ❑ Other: Signer Is Representing: "i4�•✓ '✓4�4�y,4\✓dA�."✓4�✓4� '✓4� ' '••� '`i%�✓4�✓, SL '✓SL4�4�✓. S�.L4�✓4�✓4�✓4�✓4N✓4S✓4S K✓4�✓4\ Diamond Bar City Hall Building and Safety Unit 21810 Copley Drive Diamond Bar, CA 91765 To Whom It May Concern: I am the homeowner of 2616 Sunbright Drive in Diamond Bar and would like to get an owner builder permit to re -roof my home. Please allow Andy Williams Chavez to pull the owner builder permit on my behalf, as I work in Downtown Los Angeles and I am unable to get to City Hall during working hours. Please contact me at 909-576-7905 should you have any questions or concerns. Bettina Rodriguez, Homeowner RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: BETTINA H. RODRIGUEZ 805 SUNRIVER DRIVE DIAMOND BAR, CA. 91765-1889 I�II�'�fl�IIRAI'�I�!�iMIN'lll� *20140047848* SPACE ABOVE THIS LINE FOR RECORDER'S MAIL TAX STATEMENTS TO: DOCUMENTARY TRANSFER TAX $NONE/NO CONSIDERATION$ ... Computed on the consideration or value of property conveyed or ...Computed on the consideration or value less liens or encumbrances remaining at time of sale SAME AS ABOVE THIS CONVEYANCE TRANSFERS GRANTOR(S) INTEREST INTO OR OUT OF HISMER/THEIR REVOCABLE TRUST R&T 11930 Signature of Declarant or Agent determining tax — Firm Name THE UNDERSIGNED GRANTOR(S) HEREBYDECLARE GRANT DEED Preparedly: �Jnite Est la 'ng, Inc. FOR A VALUABLE CONSIDERATION, Receipt of. which is hereby acknowledged, BETTIINNAA�aH., RODRIGUEZ AND RONDA LYNN RAMSEYER, AS CO -TRUSTEES OF THE SONJA BLACK REVOCABLE TRUST DATED NOV 3 2010 do hereby Grant(s) to ARTURO RODRIGUEZ AND BETTINA H. RODRIGUEZ, AS TRUSTEES OF THE ARTURO RODRIGUEZ AND BETTTINA RODRIGUEZ FAMILY TRUST DATED FEBRUARY 11 2013, A ONE HALF UNDIVIDED INTEREST in the real property in the City of Diamond Bar, County of Los Angeles, State of California, described as follows: LOT 41 OF TRACTfN"o. 25986, AS PER MAP RECORDED IN BOOK 689 PAGES 40 THROUGH 44 INCLUSIVE OF MISCELLANEObY9 MAPS, AS PER THE OFFICIAL RECORDS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. - APN: 8285-016-013 COMMONLY KNOWN AS: 2616 SUNBRIGHT DRIVE, DIAMOND BAR, CA. 91765 Dated: October 8, 2013 �RD/AA, BETTINA H. RODRIGUEZ, TRUS STATE OF CALIFORNIA ) )SS COUNTY OF ORANGE ) 67�• I1"S Tt��. ON OCTOBER 8. 2013, BEFORE ME TRACY GREER . A NOTARY PUBLIC PERSONALLY APPEARED BETTINA H. RODRIGUEZ AND RONDA LYNN RAMSEYER WHO PROVED TO ME ON THE BASIS OF SATISFACTORY EVIDENCE TO BE THE PERSON(S) WHOSE NAME(S),W*ARE SUBSCRIBED TO THE WITHIN INSTRUMENT AND ACKNOWLEDGED TO ME THATX/5ie/fHEY EXECUTED THE SAME IN 4-H3 FBit/THEIR AUTHORIZED CAPACITY(IES) AND THAT BY4i1S 3ER/THEIR SIGNATURE(S) ON THE INSTRUMENT THE PERSON(S), OR THE ENTITY UPON BEHALF OF WHICH THE PERSON(S) ACTED, EXECUTED THE INSTRUMENT. I CERTIFY UNDER PENALTY OF PERJURY PARAGRAPH IS TRUE AND CORRECT. WITNESS MY D OFFICIAL SEAL, NOTARY IC UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING m '[RACY GREER Commission # 1878700 Notary Public - California z z 4", , w ` Orange County n My Comm. Expires Jan 31, 2014