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HomeMy WebLinkAboutPR13-1819CITY OF DIAMOND 13AR U`VARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond liar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027FIRMLY BUILDING PERMIT APPLICATION pl�l JOB SITE ADDRESS X �� f 8 OAS k �O�-l- D(L• Cil /ali��altn APN LOT TRACT OWNER X 'SaANON A S N t N ADDRESS 9::,br Gw'- 6& A 120 V e CITY ZIP TEL. APPLICANT TEL. CONTRACTOR iCenc ADDRESS CITY ZIP TEL. ARCH/ENG/DESIGNERq K M ILI tX0- oGIh4YTf1, ADDRESS '12 1.U7U r PrL, CITY /aLNu'� ZIP LA -41 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons) 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. It 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' Slate License Law does not apply to an owner o1 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: tt Avww.I info.ca.gov/calaw.htnil. DATE: SIGN: LICE ED CO RACTOR'S DECLARATION I hereby affirm under penalty of perjury th I a ensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession de, 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 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 POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (Sl 00) OR LESS). I certify that in the performance of the work for which This permit is i tied, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws o1 Califor 'a'And agree that if I should nv subject o Ore rker's Compensation provi ie s o Section 3700 of}�I�bQr Code all forthwith comply wit ose pr io sr' DATLV/..2 PPUCANT: �/ \ WARNING: Failure to secure Worker's,(' pe on coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hum housand dollars ($100,000), in addition to the cost o1 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 u the above-mentioned property for inspectio urpo es. Ef? � E PRINT) � IGNATUR F PERMITTEE DATE APPLICATION DATE: ,tl \ ISSUE DATE: �� t TYPE CONST. P/C# 0Cz PERMIT#- t] P9 OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW ❑ ❑ RW ❑ ❑ PROPOSED US 'e, l f t (-IL 01V k t L G'SI PL~hLC - t. V-)LtSTfnch }- CUSL- 1041-&W 6J+-4 Q1cCWy'�Lt�IC,� 2. nAL"A-(Y A.Voi r%�:i If DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/AD EM •Z_o 0 Garage/Carport c� LU Patio/Deck LL Pool/Spa (} Z Re -Roof Commercial C0 6,PrLCA>ASr 1400 Valuation O Adj. Area: QUANTITY DESCRIPTIOV FEE a D � t V f - U w w v z 'm J J a U Z a w 2 r CONSTRUCTION:Jf"3 PLAN REVIEW: S25 ELECTRIC: \a Sc PLUMBING: S�eI MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: TOTAL FEES %,021 COMMENTS: [`� J "� PI c \t,og �+ 36th RECEIPT # i? r? PAID BY: 77 VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy. GOLDENROD — File Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SKI LETTER ROUGH PLUMBING ` , . _ , , L o TRACT AND LEDGER _ 16S FORMS SWITCH GEAR LATH (PRE) COMMERCIAL HOOD MING2A1;i tit ': T -BAR GAS TEST INTERCEPTER (ROUND i HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT LLS EXTERIOR . POOL/SPA LLS INTERIOR" ROUGH PLUMBING' TENTING - ROUGH ELECTRICAL CHANICAL . . p j ROUGH MECHANICAL . CTRICAL W(' .) C O lU' GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP `tr(,4 te/ �I1711466� Y//J''a&4 M&r r°G��I "a POrbiLll - 0C.4 -i jC&.m zApJ�A J'Aw'1k C �(AQQ num re Asf aff m ROUGH PLUMBING ` , . _ , , L o INSULATION WALL 40 INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR is GAS TEST SCRATCH COAT D j ELECTRIC METER RELEASE 4 /� GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL M ECHANICAL FINAL ELECTRICAL FINAL PLUMBING T,C'=of OCCUPANCY ...; CERT. of'OCCUPANCY� `tr(,4 te/ �I1711466� Y//J''a&4 M&r r°G��I "a POrbiLll - 0C.4 -i jC&.m zApJ�A J'Aw'1k C �(AQQ num re Asf aff m REGISTERED DEPUTY BUILDING I'NSPECTOR'S CERTIFICATE Of COMPLIANCE oeeurert etiit»srcaro'trsET Address of Buiah,p � Off -Site DATE OF THIS CERTIFICATE FatuicatDr J Permit'-,! •� d/ Number Year TO THE SUPERINTENDENT OF BUILDING: CITY INSPECTOR: I hereby certifythatahe.following portions of the work at the above address•which required continuous inspection, and which I was employed to inspect, were inspected by me and comply with the provisions of the Building Code applicable thereto: Type of inspection: [ ] Masonry [ ] ReBar Placement j ] Concrete or Mixer [ ] Welding [ ] Concrete Placement j ] Gunite [ ] Hi -Ten Bolts ( ] Tendon Placement (X ] Other�1,�2T.����O�s Description and location of :work completed: CPi/i/ o - e7 m r GoiyN L�T��C, /1ir3r5/J/1.��e.�'� -' /,�,t�m7,✓/ Ga�/./✓�=G'1io,�� BF " C Size of Structure Time Arrived No. of Stories Time Left Job Conc. Mix Design No. Psi Swimming Pool I had sufficient time to inspect all materials used and placed. I was not employed by the contractor, suboontractor or material vendor. ,G /1 Gdv�yy o� Registration No Employed By: Lab SignatuNe - Registered Dreplutgi Building Inspectpf Independent T/ Print Full Name DO NOT AMEND, ALTER, CHANGE, DELETE, OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL RENDER IT NULL AND VOID. IN.Form:07 (Rev. 6112005) www.ladbs.org s INSPECTOR S DAILYSREPORT OF COMPACTED FILL Job Name y �� ► - i Nth► �� . Job Location ��e � hA12111�. z1 � Job No S x-07 Pa ' 6f /� General Contractor Grading Contractor Dat Day of, Week' Grading Shift Hrs. Contractor's Supt. of Foreman & Signature ` Field Tech. /�} �%�,/ Hrs on Site w Y' �f From"��`r — To/w; Source and Descriptions of Fill Materials -,,APProximate Fill Yade e Total Req'd Placed thls'shift ° Total to date Weather Report Se uence No. .`, •,. Test 'Test Elevation Soil Fill Test Dry % of Max Remark No. Location or Depth Type Moisture % Density Ibs/cu.ft. Dry Density a Remarks (Describe equipment used hauling, spreading, watering, condition and compacting; also report thickness N lifts, removal of poor soil insufficiently compacted, and comment in unusual events.) 17+r CA)JAt<), fe v+ -6t PIA64 1' t�'>��j»��-�. ��IS© t,P 4% C11SA ' �-'ccc,I pp N 2/4" Of"O ,wi & QVNN5iviY�14T'_er(41.�ho0 r4 p; ib m vtvl , 5vii+A4e -e,)r �l✓ifs- <iinnll' I jose Goch W 5-WISfix l(s ifo 'eco w,,!A't(s Pmav4, A; ` t� fes. P'A\4 oiC�Cli i*,Ac I VS�i li l . Sketch ;J `— b,. O L) Copy to Client ( ) Copy to OCI ( ) Company Policy: Four (a) hours minimum Charge tincludin 9 travel lime) CAL LAND ENGINEERING,: , INC. ...ir Quartech Consultants,:inc. by: y{ VBSDEPARTMENT OF BUILDING ANO SAFETY Los Angeles Regional Uniform Code Program STRUCTURAL OBSERVATION REPORT FORM ELES RFC�ONq�` (LARUCP STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, at significant construction stages and at completion of the structurai system. Structural observation does not include or waive the responsibility for the inspections reCILWed by Section 108, 1701 or otfler sections of the code. 11444 p (� Report No. _ i, ,,A-- .,n �,tr� � ti -n rernrh thrni inh �� � riav of JPerJ� 20 I/— Page No. � of —L Project Address: z�6S J�jivll fir. Structural Observer of Record (SOR): Phone No. of SOR: ic,/Reg. No. of Observer: Phone No. of Obsery Building Permit No.. Structural Observation periormec Y i3 —1 45 I CAwei. Professional C G" PP '/ 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.) t '.1L-4 D ., L, ✓' 1;_ 1 Jn ) w L eL. of +/J -e4- WL, s Al k -e— D. I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST' OF MY KNOWLEDGE: 1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FORTHE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY OF LOS ANGELES, 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I 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 THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY OF LOS ANGELES BE WITHHELD UNTIL ALL OB;Z DEFICIENCIES ARE CORRECTED. SIGNATURE C)F S1RUC Hcj�, t at-rt`v'EF. a7E uEN coo I NO.0 68688 I � CIVIL 0 ST AMP OF S; I RUC. I Uli t- OBSERVER ) IN/Form.08(Pait 1)(Rev 111/2007) www.Iadbs.org utsonnvou airtu�i ELEMENTS/ CONNECTION FOUNDATION WALL FRAMES FLOOR OBSERVATION LOCATION • Footing, Stem Wralls, CI Concrete ] Steel Moment Frarne ❑ Concrete ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck ❑ Caisson, Piles, Grade U Wood Concrete Moment Wood Beams Frame ❑ Retaining Foundation ❑ Others. I 1 Masonry Wall Frame ❑ Others: Hillside SPeclal Anchors ❑ Others: ❑ Uthers: 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.) t '.1L-4 D ., L, ✓' 1;_ 1 Jn ) w L eL. of +/J -e4- WL, s Al k -e— D. I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST' OF MY KNOWLEDGE: 1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE CHARGE FORTHE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY OF LOS ANGELES, 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I 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 THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY OF LOS ANGELES BE WITHHELD UNTIL ALL OB;Z DEFICIENCIES ARE CORRECTED. SIGNATURE C)F S1RUC Hcj�, t at-rt`v'EF. a7E uEN coo I NO.0 68688 I � CIVIL 0 ST AMP OF S; I RUC. I Uli t- OBSERVER ) IN/Form.08(Pait 1)(Rev 111/2007) www.Iadbs.org Los Angeles Regional Uniform Code Program Committee 1-3: Structural Observation STRUCTURAL OBSERVATION REPORT FORM IfLARUCP STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, 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 Section 108, 1701 or other sections of the code. _Q Report N0. 1 This report inciudes all construction work through 6 day of �Y 20 t L Page No. --Lof L Project Address: O Structural Obs ver of Record (SOR): C, 4e,,, Cts rill" 2 a c �� PORTION OBSERVED, IF NOT WHOLE 1 Los Angeles Regional Uniform Code Program Committee 1-3: Structural Observation STRUCTURAL OBSERVATION REPORT FORM IfLARUCP STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the approved plans and specifications, 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 Section 108, 1701 or other sections of the code. _Q Report N0. 1 This report inciudes all construction work through 6 day of �Y 20 t L Page No. --Lof L Project Address: O Structural Obs ver of Record (SOR): C, 4e,,, Cts Phone No. of SOR: . qo 2 a c �� PORTION OBSERVED, IF NOT WHOLE ❑ Footing, Stem Walls Building Permit No.: Structural Observation performed by: dtiwc- C�a-o Professional Lie./Reg. No. of Observer: 66-6 k9- Phone No. of Observer. /i 1_1 Mat Foundation -+4 ,C ❑Steel Deck nRSFRvFn STRI IrTI IRAI FI FMFNTS AND THEIR CONNECTIONS FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED, IF NOT WHOLE ❑ Footing, Stem Walls ❑ Concrete ❑ Steel Moment Frame ❑ Concrete 1_1 Mat Foundation 11 Masonry ❑Steel Braced Frame ❑Steel Deck Caisson, Piles, Grade Beams ❑ Wood ❑ Concrete Moment Frame CI Wood ❑ Retaining Foundation Hillside Special Anchors ❑ Other: ❑ Masonry Wall Frame ❑ Others: FJ Others- L.1 Others: -- , 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 IN ACCORDANCE WITH THE REQUIREMENTS TY OR COUNTY HAVING JURISDICTION. 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER ESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT TRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL CONFORMANCE WITH OVED 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 JURISDICTION IBE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED. gnature d,-- 9�� a '�3 /4 /' / Date c ised E N0.0 OF CN�'� �M STAMP OF STRUCTURAL OBSERVER OF RECORD (Revised 10/29/2002) County Of LOS Angeles SAFETY DIVISION DEPARTMENT OF PUBLIC WORKS BUILDING Los Angeles Regional Uniform Code Program STRUCTURAL OBSERVATION REPORT FORM m ^o rtha t STRUCTURAL OBSERVATION smeans the Z.1 obser ti stages and atof the strucomplletion of the structural system. o approved plans and spec at significant y Section 108, 1704 or Structural observation does not include r waive ng Code. (sibilus r the 4inspecti ns required by „f thn I n.c Angeles County olner Report No. -61" No. of— da ` ,20�Page This report includes all construction work through y of SOR Phone No.: Structural Observer of Reco d (SOR): Project Address: i uY' JI��,ucM � g O CV%"4.H C � No.: Observer Phone o.: Building Permit No.: V 909 , Structural observation Observr Pro�����ic./Reg. by6L^ G performed 4401,V AND THEIR CI O OBSERVED STRU TURAL ELEMENTS ELEMENTS/CONNECTION FRAMES FLOOR OBSERVATION LOCATION FOUNDATION WALL ❑ Footing, Stem Walls ❑ Concrete ❑ Steel Moment Frame ❑ Concrete ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck ❑ Wood ❑ Caisson, Piles, ❑ Wood ❑ Concrete Moment Frame Grade Beams ❑ Masonry Wall [I Others: ❑ Retaining Foundation ❑ Others: y Hillside Special Anchors Frame ❑ Others: ❑ Others: ral NOTED DEFICIENCIES with the prlans ordinohe load path: rresponding corrective fenalvreport by the lstrucspalcobsereerewhich states that conformance with the approved p all observed deficiencies have been resolved is required before acceptance of the work by the building officials. 1 "r'__ i_ :" 0_'1- 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 IN ACCORDANCE WITH THE REQUIREMENTS OF THE COUNTY OF LOS ANGELES. 2. 1, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY 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; THE MS BY THE 4 OFE LOS ANGELES BECEPTANCE WITHHELDF UNTIL STRUCTURAL OBSERVED DEFICIENCIES COUNTY DE ICIENCIES ARE CORRECTED. C{nNATI IRF OF STRL Version 1.0 (2009 oAl nRCF'R\/FR DATE /�Q�GHUEN c't�y\` t40•C 686$8 \� OF CP��F (STAMP OF STRUCTURAL. OBSERVER) jail. IV LVVV (AWNay�A mr MA&prfts REGISTERED DEPUTY BUILDING INSPECTOR'S GERTIFICATE OF.GOMPLLANGE Address of ')--Sts 001V, Kvtotl Dr. ialr"-'OV\A Off -Sao Fabricator peffr".-. Number Year TO THE SUPERINTENDENT OF-BUIWING: CITY INSPECTOR: DATE OF THIS CERTIFICATE I hereby cedify-,thatthe: following portions of the work atthe above, addresswhich: required continuous inspection, and which I was employed to inspect were inspected by me and comply with the provisions of the Building Cod6'applicable thereto, - Type of inspection: Masonry ReBar Placement Welding Concrete Plaeement Hi -Ten Bolts Tendon Placement 4;�- Description and location, of -work completed: Concrete or Mixer Gunite Other De -W4 6k-c6C5 VC"v V>J-k-, LAA, C k "A'\'r ks' \k Size " ( C J*-VA�' cv'r ' Aeay'A%. V'-Css Ckv e - Size of Structure Time Arrived No. of Stories Time Left Job Conc. Mix Design No. Psi Swimming Pool I had sufficient time to inspect all materials used and -placed. I was not employed by the contractor, subcontractor or material vendor - Registration No Employed By: Lab. 4A LA n -(V 019414 I -IC( Z2I5W7* &ature - Regis'"uty Building Inspector Independent 7T41— K—A Print FulAame DO NOT AMEND, ALTER, CHANGE, DELETE, OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL RENDER IT NULL AND voib. IN-Form.07 (Rev. 6/1/2005) www.ladbs.org .h a�rv�ohc�l ej or ("S., DEPUTY INSPECTOR'S CERTIFICATE OF COMPLIANCE DEPARTMENT OF BUILDING AND SAFETY Address 2_'6\6 dwk V Yeo t1 T)'r • Date of Certificate $ 15 2' 0 Fabricator o Permit ? R TO THE SUPERINTENDENT OF BUILDING: CITY INSPECTOR: I hereby certify that the following portion of the work at the above job address which required continuous and/or periodic inspection, and which I was employed to inspect, was inspected and approved by me and complies with provisions of the building Codes applicable thereto: Type of inspection: [ ] Steel Construction [ ] Sprayed Fire -Resistant Materials [ ] Prestressed Concrete [ ] Concrete Construction [ ] Smoke Control Drilled -in Anchor [ ] Masonry Construction [ ] Methane [ ] Gunite / Shotcrete [ ] Wood Construction [ ] Exterior Insulation & Finish System [ ] Seismic Resistance [ ] Soils [ ] Wind Resistance [ ] Other: Location and Description of work completed �oV��t�+naAGtw� �V�,�� �iov� o'�.�'�,rcwr�e� y-or�, ��S-Ea �`A.� c►v� i Vv40 e X. S- % xb� C0IA !C t[g--(!C W � 4\ e Po X&yv�� Ra ke- 5 t Ze le �e�o-t�� aKJ' c�e cky\k C'.S SS a a4SCp-fct��C' T Size of Structure Time Arrived No. of Stories Time Left Job Conc. Mix Design No. P.S.I. Registration Number N Coto it� � � � / Z C L -9 Zt 5 (A-7 Employed by: Lab: Independent [ } Signature: Registered Deputy ding Inspector: Print Full Name: rw-A e Cell phone number: 20 — %ZZ — 2 © PK E -Mail Address: DO NOT AMEND, ALTER, CHANCE, DELETE OR APPEND ANY PRINTED PORTION OF THIS CERTIFICATE AS IT WILL RENDER IT NULL AND VOID. INFORM 07 (Rev. 01/04/12) www.ladbs.org CITY OF DIAMOND BAR tI 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 OWNERJX_1H ADDRESS ei^kAro �►S A�ay� CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/DESIGNERX KCo {2'dSOGfb•TZ� 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). (_) 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.). 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.). L) 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 lice sed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is av able upon request when this application is submitjed at the foII0JWg Web site: http/ w.leginfc.ca. alaw.ht nI. DATE: SIGN: /J LICENSED ACTOR'S DECLARATION hereby affirm under penalty of perjury t� at I am li sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes ons C , 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 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: 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 lifomia. And agree that if I should become subject to the Vorker's Co on 3700 of the Lobo de, I shall forthwith comply unfit t e�ryouDATE:LICANMo�ehun, Co nsation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to o d thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in secti 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 ant upon the above-mentioned property for inspec n pur oses. PER E fTAME (P l Si VTUR011p"'ITTEE DATE Mw PRESS FIRMLY APPLICATION DATE: ISSUE DATE: TYPE CONST. P/C# f'Q V3' �� 9 PERMIT# OCC GROUP: ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ r PROPOSED USE tw '2 3 # DWEL. UNITS T -J �S� o!\ %� rl V c 6A --T N ROOMS • 'Tw 0 (-x)ALIC - IA J (-o a•P-t's . aEA oVE c-m#1L.a1&YnF C -IT lroVe c # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport rA LU Patio/Deck LL Pool/Spa ZRe -Roof D Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE CC I U w co M rL U CONSTRUCTION: PLAN REVIEW:_ ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: TOTAL FEES '1�q COMMENTS: Pk-- a o 43 J 4-3s RECEIPT # PAID BY: VALIDATION: WHITE— Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD ;SETBACKt LETTER ' `�`' d€t g (r - TRACT AND LEDGER — ---- -- I -- ---- -- FOQTINGS FORMS , °;' SWITCH GEAR SLAB ; a A: . , UG.:PLUMBINGo� $) ` COMMERCIAL HOOD T -BAR UG,:�ELECTRICAL` - l' �y. INTERCEPTER UFERGROi1ND a HOT MOP/SHOWERPAN I SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED _ SEWER CLEANOUT DEMOLITION j ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT SHEARWALLS EXTERIOR. , �� Edi _� �:i �,i POOL/SPA SHEAR WALLS INTERIOR„ . ROUGH PLUMBING FRAMINGtVENT(NG _ ROUGHELECTRICAL (ROUGH MECHANICAL,,,v ROUGH.MECHANICAL .. ROUGH,ELEGTRICAL)hi(� ,ROUGH PLUMBING ...� µ' N PRE GUNITE POOLgPRE DECK BONDING INSULATION WALL INSULATION CEILING P -TRAP DRYWALL FENCf",Vj ATUALARM` _ LATH (PRE) FINAL POOL ' A LATH EXTERIOR WALLS: LATH INTERIOR WALL FOOTING/STEEL GAS TEST _ WALL STEEL 1 S'( )2 ND( ) LIFT SCRATCH COAT WALL BOND BEAM ELECTRIC METER RELEASE WALL DRAIN/ SEAL ' GAS METER RELEASE WALL FINAL SPECIAL INSPECTION R0, FRAMING PLANNINGAPPROVALV FINAL BUILDING ROUGHFIRE APPROVAL= ' - EINAIMECHANICAL; -� ,. FINAL -FIRE DEPARTMENT ,� ;FINAL ELECTRICAL `' � � �� �� � FINAL PLANNING ' ,�.r, k� �a FINAL PLUMBING �- �- :. FINAL EN6INEERING7 PW T.C.'' of OCCUPANCY a FINAL COMMUNITY SERVICES CERT. of OCCUPANPY;,k-,,K_ FINAL HEALTH DEPT. _ , < LL LL ccCL C a LL n z F- 2 cc LL CL cc z c ao- Dli �`D ARS CITY OF DIAMOND BAR ` DEPARTMENT OF COMMUNITY & DUVEL i MENT 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 JOB SITE ADDRESS 281g041-g,"'Iff APN LOT� TRACT OWNER ctnnvL -.4ih ADDRESS 2ff1g, Vqtf A6140// CITY AdCI-1— ZIP 417,6J- TEL. 90 9 7- /S APPLICANT *411/7 &Ayr TEL. CONTRACTOR 0a;We,#— ADDRESS 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 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 Code is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.htmi. 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 farce 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 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: r 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 cast of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. F 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. PERM E P ] J^ J// SIGEE DATE APPLICATION DATE: �Z 16 ISSUE DATE: PERMIT# : TYPE CONST. 45~6WOCC uP/C# r (P-13—/sl q GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport rn LO Patio/Deck LU LL Pool/Spa ZRe -Roof i Commercial 7 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U c r U w w co z m J a ZU_ Q x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: - TOTAL FEES COMMENTS: P/C:�9 PAID BY: RECEIPT # dr l rg PAID BY: 7(1' ^� VALIDATION: / � VALIDATION WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY O IANrO-ND"'BAR _ INSPE.,.IOON RECORD INSPECTION DATE INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL LIFER 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 rLECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: INSPECTION DATE INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN 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