HomeMy WebLinkAboutPR15-2707CITY OF DIAMOND BAR Rill
I I i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
c 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 'Building Inspection Hotline (909) 8 -7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com b ing@di a.gov
JOB SITE ADDRESS
APN LOT TRACT
OWNER K�4
ADDRESS TAnn-Q_ a 5 qb 6,1P
CITY 1 ZIP� TEL.
APPLICANTTE . 3I
CONTRACTOR `� G
ADDRESS
CITY a ZI O TEL.
ARCH/ENG%
DESIGNER
ADDRESS
CITY ZIP EL.
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 (_ 1 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,) 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 Cade, and my license is in full force and effect.
LICENSE CLASS: SID LIC. NO.: ae" t
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: Z U 1
CARRIER
If
POLICY NUMBER V xo ` R
(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 ection 3700 of the labor Code, I s �I forth,w�ith comply with those�p�7gvisions.
DATE: APPLICANT: 1 i`ritr&O'f�l,E�Z
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 upon the above-mentioned property for inspection purposes.
PERMITTEE NAME (PRINT) — AL&U` dl /
SIGNATURE OF PERMITTEE TE
APPLICATION DATE`: P/C#
ISSUE DATE: J �1�L� PERMIT# : f � J -4-71.017
TYPE CONST. OCC GROUP:
Scope of Work
k
# DWEL. UNITS
-4 6 (IT A
# STORIES # BEDROOMS
DESCRIPTION SQ. FT.
FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w
Patio/Deck
w
LL
Pool/Spa
zRe
-Roof
F3
Commercial
10
Valuation:
Adj. Area:
QUANTITY
DESCRIPTION FEE
U
iL
U
w
w
cv
z
M
J
a
zi
L)
Q
x
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
I.t'w CSI
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMIP:
%. r
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
.(
BASF:
�r d
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY: VALIDATION:
RECEIPT # PAID BY: 7 7 VALIDATION:
WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy
CITY OF DIAIVIO-ND 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 4
FINAL MECHANICAL
FINAL ELECTRICAL S
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
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
CITY OF DIAMOND BAR
BUILDING & SAFE77DIVISION
21810 Copley Drive
Diamond Bar, CA 91765
(909) 839-7020
SMOKE ALARM AND CARBON MONOXIDE CERTIFICATION
In order to help assure the life and safety within existing dwellings, the 2013 California Residential Code (CRC) Section
R314 and R315, along with the California Building Code Section 420.5 and 420.6 requires existing dwellings to have
smoke alarms and carbon monoxide alarms installed within the upper 12" of the ceiling when a building permit is issued
for, worked on, or in a building that is valued at $1,000 or more. Alarms may be solely battery operated where repairs or
alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or
crawl space.
Starting July 1, 2014 all smoke alarms including combination smoke alarms, that are solely battery powered
shall contain a non -replaceable, non -removable battery that is capable of powering the smoke alarm for at least
10 years.
CARBON MONOXIDE ALARMS
REQUIRED IN EXISTING DWELLINGS:
• Where a permit is required for alterations, repairs or additions exceeding $1,000.
• Existing dwellings or sleeping units that have attached garages or fuel burning appliances.
Carbon monoxide alarms shall be installed:
• Outside of each separate dwelling unit sleeping area in the immediate vicinity of the bedroom(s).
• On every level of a dwelling unit including basements.
REQUIRED IN NEW DWELLINGS:
Carbon monoxide alarms shall be installed:
• Outside of ea��,gep. radwelling unit sleeping area in the immediate vicinity of the bedrooms(s).
• On every level of a dwelling unit including basements.
Alarms shall receive their primary power from the permanent building wiring without a disconnecting switch other than as
required for overcurrent protection. Battery backup is required.
NOTE:
Multiple purpose alarms.
• Listed and labeled combination carbon monoxide /smoke alarms are acceptable in new and existing.
dwellings.
Carbon Monoxide Alarms is a requirement that is in addition to required Smoke Alarms.
The alarms are required to be installed in the following locations:
•3 Smoke alarms in all sleeping rooms.
❖ CO alarms in all sleeping rooms where fuel burning appliances are installed.
❖ Smoke alarm and CO alarm in hallways preceding sleeping rooms.
❖ Smoke alarm and CO alarms on each dwelling level including basements and habitable attic rooms.
The smoke and CO alarms are required to comply with the above when requesting a final inspection. Please make sure
an adult is present to allow the Inspector access to the home to verify compliance with the above requirements. If no one
will be available, you may opt to complete the Installation Certification below and leave it with the job card.
(Please fill out and tear off this portion to leave with the job card if no one will be available to
allow the inspector inside the house.)
INSTALLATION CERTIFICATION
For the property located at _ _,'M ?Off" �/M I hereby certify that the required
smo a alarms and arbon monoxide alarms have been installed as above.
--l-AlwAs Atav th1d
t r Print Name D to
Relationship to project (please check one):
❑ Owner ❑ Agent for Owner *,p.L-icensed Contractor ❑ Agent for Licensed Contractor
If "Licensed Contractor" or "Agent for Licensed Contractor" is checked, please complete the following:
ContractoF Contractor's Sta a License Number