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Home My WebLink About18708 �" '� �I�---� :'��.� �,--.—�"" '; �!r... . �% �,� CITY OF DIAMOND BAR ` � �� DEPARTME7�1T OF COIvIIvIUNTfY Kt bEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS �� BUILDING PERMIT APPLICATIUN FIRMLY } JOBSITE /�/� � Q APPUCATION PERMIT P/C � o ADDRESS_`L �S /r �_S� DATE � � �z NUMBER � � �� g O � o I OCC °T APN LO'i TRACT_ __ DA EE � ��CONST. GROUP p OWNER � ADDRESS 22 7 ZONING SETBACKS 0 z CITY O�� ZIP TEL FRONT _ _ RW � � APPLICANT �, TEL. REAR Q� SIDE SIDE STREET Ryy J CONTRACTOR� �I-�CTR� i _ � ADDRESS L'��l� � TK q � CITY L� I�A'C',yQ_� ZIP 7E (7 -�( PROPOSED USE o - — w ARCH/ENG! z DESIGNER A O Ely3�d�- AS�(;. w — NO.DWEL. NO. a ADDRESS' _��r �'U'�a., NO. cn ,,p,�� ) UNITS STORIES _�_ BEDROOMS� � CI7Y�(J l ��_ Zlr �� TE 'T i � DESCRIPTION SQ.FT. FACTOR PSF DJ. RE ALUATION Q OWNER-BUILDER DECLARATION p SF D /REM Q p I HERLBV AFFlRM UNOER PENALTV OF PEFJURV THAT i AM EXEMPT FROM THE GONTRACTORS LI� G8f8J0/CBfPOK W CENSEUWFORTHEfOLIOWINGREASON(SEC.'/031.SBUSMESSAN�F90fE5510N5CODE:ANVGITYOR (n U GOUNTVWHICMREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROYE.UEMOLISH.CFREPAIRANYS'RUC� w ^� W TURE,PRIOR TO ITS ISSUANCF.,ALSD REOUIRES THE APPLICANT FOP SUCH PERMIT TO FILE A SIGNED w a�i DBGk v � � STATEMENT THAT HE OR SHE 5 LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTORS LI- � � GENSE LAW(CHAPTER 9(COMIAENCING W'�TH SECrION 7oao)OF DIVISION 3�F THE BUSINESS AND PRo� POOUSpB � � FESSIONSCO�E!ORTHATHEORSHEISE%EMPTTN�REFROMAN�THFAASiSFORTHEALLEGEDEXEMP- (3 . � TION.ANVVIOLATIONOFSECTI��N1031.SBYANYAGFLICAN�GORAPERM��TSi19JEC�5 fHFAPpLICANTTO Z Re-Poof ,I r AqVIL PENALTV OF NOT MORF THAN FIVE HUNDRED DO�L4R5(S5o0�.j�. � Q ❑I.ASOWNEROFTHEPROPERfY,ORMVEMPLOVEESWiTHWAGESA57HEIRSO�ECOMPENSATiON, � Commercial �. Z WILL DO THE WORK,AND THE S7RUCTURE i5 NOT INTEND[J ON OFFERED FOH SALE;SEC.�006,BU�.I- J � NE55 PND PROFESSIONS CODL:THE GONTRACTOaSIICENSE LAW JOcS NO�APPiV TO AN OWNER OF = PROPERTV NTiD BU IL�S OR IMI'FOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OP HERSELF OR � � THROUGHHISORHEROWNENPLOVEES,PPOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � W pFFEREDFORSPIE.IF,HOWEVi:R,THEBUILDINGORIMPFOVEMENTiSSOLDWITHINONEYEAROFCOMPLE- I � T�ON,THE OWNER BUILOER WILL MAVE THE BURDEN OF PROVING'HAT HE OR SHE�IO NOT BUILD OH I Z IMPROVE FOR 7HE PURVOSE OF SALE). ' _ ��I,ASOWNEROFTHEPROPERTY,AMEXCWSIVELYCONTRACTINGWI�HLICENSE�CONTRACTORS W � 70 CANSTRUCT 7HE PFOJECT(SEC.]oad,BIISINESS AND PROFESSIUNS CODE:THE CONIRACTORS LI- Vall12[IOfI � ADJ.AREA W CENSELAWDOESNOTAPPLVIOANOWNEROFAPROPERTYWHOd'JII.DSORIMPROVESTHEREON,AND - � YMOCONTRACTSFOqSUCHGi70JECTSWITHACqNTRACTOR(5)LICENSEDPURSUANT?OTHECON�'RqG QUANTITY DESCRIPTION FEE Y TORSLICENSELAw.). _ � - J I FM E%EMPT UNDER SEC. 8.8 P.C.FORTHIS REASON Q � U ¢ � pATE � �.� Ci•�___ OWNER _ —�_ U � LICENSED CONTAACTORS DECLARATION W ¢ � 1 HC11[BV AfFIRM�N�ER PENA_TY OF PERJURY TNAT IAM LICENSE�UNOER PRGVi510N5 OF CHAPTER � d 9(COMMENCING WIT4 SECT10�I7o00)OF DIVIS'.ON 3 VF THE BUSINESSANO PF'.OFESSiJNS CO;JE,AND Z X MY IIGENSE'S IN FULL FORCE�iND EFFECT. �W �{ (`' Y' m UCENSE CLASS y 4 �G__ LIC.NO. S _ru t��,� � U DATE_�__��CY�_ CONTRACTOR C CT C�ii V d �, W � WORI<ERS'COMPENSATION DECLARATION a � I NEREBV AFFIRM UNDEF PENA_TV OF PERJURY ONE OF THE FOLLOWING�ECIARATIONS: Z � Z __INAVFANDWILLMAINT4INACERTIFICATEOFCONSEN'iOSEIF�INSUPEFOPVlORKERS' ¢ _ Q COMPENSATION,ASPROVIDEOBYSECTION��Oo�JFTHELAeORCODE.FORTHEPERFORMANCE U OFTHE WORK�OR WHICH(HIS PERMI'IS i55UE�. W —� � � w I HAVE AND WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE.AS REQUIRE�BV SEC710N ^, Q3]OOOF THE_AAOR CODF.FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS �� — ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POUCY NUMBER ARE: CONSTRUCTION Q � - ] cnaaiea PLAN REVIEW l __ Z coucvr�uMSEa_ ELECTRIC ,0 � a r � � ('HISSECTKXJNEmN0T8EO;Y�ARETEDOF?HEPERIMIS�CiFONEHUPDREDWIIARS(510010FLESS). PLUMBING ,, , W Z I CERTIFV THAT IN THE I�ERFORMANCE OF THE VJORK FOR WHICH THIS PEFMiT IS ISSUEO,I MECHANICAL -- (' �r�f�I I LJ SHALL VOT EMPLOV ANV PERSON IN ANV MAN�ER SOAS TO BECOM[SUBJEf,T TO THE — � � WORKERS'COMPENSA'lON IAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOULD BECOME WSi�ECTION FEE j� SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3]UO OF THE IABOR U\ r A` -� � � (:Wt,ISHAiIFOFTNN'ITHGOMFIYWITHTHOSEPROVISIGNS. ISSUANCE �.� � �J`J;-� l L�, � O - � p DATE:.__ APPLICANT: SMIP _ J WARNING:FAIL'JRETOSECUflEWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHPLLBE ENERGVP�C _ � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UPTO JNE HUNDRED THOUSFNG ENERGV PERMIT 1 y OOLLARS(f100.000�,IN ADDITIONTO THE GOSTOF COMP�fJ5AT10N.�AMA(iE5 FS PROVIpE�FOq IN —� _ J SECTION 3708 OF THE LA90R CODE,INTEREST,ANO ATTORNEV'S FEES. � RETENTION FEE � 7� OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ Q 1 HEFEBYAFFiRM UNDER PENA TV OF PERJUFY'HAT TH=RE IS ACONSTFUCTION LENDING AGENCY � FOR iNE PEPFOqMANCE OF THE K'OFK FOR WHICH iMIS PERMIT IS ISSU=�(SEC 1091,CIV.C.). -�------��- -- Z w j LENOEH'SNAME _ ` y F- LENOER'SADDRESS � TOTAL FEES � �a L'I.J , � I CERTIFY THAT I HAV=aEA�TFIS APf'�ICATIONAND STATE THAT TI�E ADOVE INFOftMATION IS CORRECT w I AGt1Cf 10 COMPLY WITH AL�.(:ItY AND COUNTYORDINANCESANp STATE lAWS RELATING TO AUILDING ��f � L � CONSTRUCTION.ANp MEREBV i1UTHORIZE FEPRESENTATIVES OF THIS GOUNTV TO ENTER UPU4 TFE �/�("�v �� z ABOYE�MENTIONED PROPERTY FOF INSPECTION P�RPOSES. COMMENTS 1 v � / 1� ��O�// -- - -__. _-.- J � - — m PFRMITT- N (PRINT� Q � ,�O� ——_'— � SIGNATI/H OFPERMITTEE �ATF -- = RECPT NO. PAID BY ��)� VALIDATION ~ WHITE-De artment Co VELLOW-Finance Co PINK-Assessor Co GOLDENRO�File Co GREEN-A licant's Co P PY. PY� PY, PY� PP PY ,x„- ,... .. .... ... .� . - ��,.. ��..�� sa�, .€� ��. ,� � �. �, �, � #�� ;a� It � „ n�� . a , m��. v �' �� , �, . 1�� _ � ��.�G-�� .A _ . � � �s � �4 ,� — ; , � : _ _ � . � � , � , � _ _ . _ ° ��;�j f�-�, , � . �' _ - �'�f t " � ... ... ...... . ..... . � . .. .. / . `..` : . .. .. .. ��:. � � .. .. . ��r��U3 : � /�-/� a _ . : , � � - � _ _. � � ��'� : _ r° __ _ �a,��:��c-�.s=�� _ . �� `�` ..�„ ��°"`. ,,,, ,� � � ae , �J�--. . � ,� ,( _ �lZ !.'1/�"(<'.-::3� 1•`y�_ ��/�.5��''r,- [.�.��7�'l'�?�_/�`+_�_'_.��__.l�'�T�.��!�� ' �' ' _ _._ .___._ ._ -��03 ¢� � '�'1 �� _ -.� _ .._.. - . � � /� �}-a�-,�l:�,f,.n��eE�4. _ _ _ _ ' �� p`3 f a��S.�C.1}�� .�.� � �L- '�^-� � � �`7 �''''1 _ _ . ,. � �� _ __ __ _�,__ _�___ _ � �� a ��,� ��6 ,n�� ---. . . � � � ��1 � i,. — — — — _ — — _ �'� �^'� �.�� .�< ��,� -++� _ ___ � ; �` 1�� ,� ' _ �;,, __ _ —— , � � �'� � �� _ � '� �,I. ... ... _. . . .. .... . . .. _ .. . .. .. . . I , � POMONA UNIFIED SCHOOL DISTRICT ; CAPITAL FACILITIES PROGRAM MANAGEMENT porm Number 800 SOUTH GAREY AVENUE • POMONA • CALIFORNIA 91766 Certi�cation of Compliance a� ��r�►� �'l � ��l • �� z-- A licant s Nar�e ApplicanYs P one No. ' `� !-��t� �r � ��N � 17►Pst. �� f�a�--��' � � �� ApplicanYs Mailing Addri3ss ✓ ✓ ApplicanYs Signature Date of Signature The upplicunt executing this declurution cer[ifies under penulry of perjury thut:(1)they ure the Owner und/i�r Develnper or they ure uuthnrized to si�n on behul f nf the Owner und/nr Developer, (2)thut the infnrmution prnvided is true und uccurute to the best of the Owner's und/nr Developer's knowledge, (3) the Owner and/or Developer will file un�lmended cenificatinn nf compliunce and puy the udditionul umnunts due if Owner und/nr Developer increuses the number of dwellinx units und/or syuure fi�otuge nfter the building permit is issued or if the initial determinution nf units artd/i�r syuure footage is found to be incorrect,und(4)they Iwve reud nndJu[ly undersrand this side and rhe reverse side nf this document including the 90-duy protesr period posted on the reverse side of rhi.r document. �i��'�11 �J�c� �`�� 8 C� I - (07 C�2 Owners/Deve�p s Nam Owners/De elopers Phone No. 1�� I��..F.�3� � l�u��e �i�,� �-�'S °Ir71�� Owner's/Developers Mailing Ad ress Development Type and Fee Schedule Check apprnpriate bnx(es),fill in the fee pe�sy.ft.und circle the fee level in eJfect. � � Residential $�jt�2 /sq.ft. (Level 1 evel 2- vel 3) Exempt status justification/notes: ❑ Manufactured/Mlobile Homes$ /sq.ft. (Level 1 -Level 2-Level 3) ❑ Commercial/Industrial $ /sq.ft. ❑ Senior Citizen Flousing $ /sq.ft. (See reverse side of sheet.) ❑ Exempt $ -0- /sq.ft. (Providejustification.) Fee Calculations Euch Certificution of Compliunce fiirm is for five(5)projects muximum. Use additinnu!fornu for udditionul projects. � t� � " p2 —'��Z $ 3 c�Z �r�'�L�iZ�q.n. $ �`[3Z�G� Tract No.I Lot No.�Address Plan Chack No. Fee per�sq.tt. Area � Fee 2. $ s4.k. $ Tract No.1 Lot No.!Address Plan Check No. Fee per sq.ft. Area Fee 3. $ sG.n. $ Tract No./Lot No.!Address Plan Check No. Fee per sq.ft. Area Fee 4. $ sq.ft. $ Tract No./Lot No.!Address Plan Check No. Fee per sq.ft. Area Fee 5. $ s4.ft. $ Tract No./Lot No.!Address Plan Check No. Fee per sq.ft. Area Fee TOTAL UNITS: � � TOTAL FEES{DUE $ i�Z—�_�� (This form only.) (This Form ordy.) �_�� U ^ � �� '�l` DisMct/CFPM (Name and Title/Signature an I Da , Receipt of Fees Thi.r is to certify thut ull fees due to the Pomnna Unified Sr.hnnl District under prnvisinn oj'Gnvernment Cnde Sectinns 65995, 65995.5 und 65995J und Educution Code Section 17620,us prereyuisi[e ro the issuunce nf a Building Perntit by the Ciry/Counry, huve been received.Based on the infornuition presented ubove,this Certification of Compliunce is hereby executed. j1 U Recei . Check No. Date Submitted � c� = I �i �� DistricV scal ervices (Name and Title) Date See rev_erse side 1 or General Information,Senior Citizen Housin�2.Pavment of Fees, Notice-Protest Period and Anpeals Process. Distribution of Copies: White-City/County; Yellow-DistricUCFPM; Pink-DistricUFiscal Services; Goldenrod•OwnedDaveloper. Revised 12/Ot GENERAL INFORMATION On November 4, 1998,SB 50 became effective.This bill grants Califomia school districts the authority to levy fees in excess of those authorized by Government Code Section 65995 (Level 1 Fees), if the district meets ceRain specified tests and approves a School Facilities Needs Analysis. Alternative Level 2 fees may be levied when state bond funds are available for school construction projects,and Alternative Level 3 fees may only be levied when[he State allocation Board certifies that it is no longer approving apportionments for new construction due to lack of available funding. The 8oard of Educatinn approved the School Facilities Needs Analysis and advpted a resolution levying the altemative fees under SB 50 on March 27,2001.On March 13,2001,the Board also approved a resolution authorizing the levy of statutory fees on commerciai/industrial development. SENIOR CITIZEN HOUSING - Per Govemment Code Section 65995.1(c), if a senior ci[izen housing project is later converted to non-restricted use,the applicanddeveloper who is seeking the change in usc will have to pay the difference between the current residential fee and what was paid for the senior citizen housing. PAYMENT OF FEES State 4aw prohibits a city or county from issuing a building perrtti[unless the locai school district has certified that the application is in compliance with the DistricYs collection program for fees assessed developers.The procedure for obtaining the reyuired certification follows: Proiect Plans-A set of project plans stamped by the governing city or counry building department,and valuation receipt indicating calculated square footage and plan check number,must be reviewed by the District.The address follows: Capital Facilities Program Management,Pomona Unified Schoal District,800 South Garey Avenue,Pomoria,CA 91766. CalculatinQ Area for Residential Proiects - The Dis[rict levies fces on residential construction only if the resulting increase in assessable space exceeds 500 square feet.This minimum of 500 square feet is net of decreased assessable space in the same residential structure which also results from tha[ cons[ruction. "Assessable space" means all square footage within the perimeter of a residential structure, not including any carpoR, walkway,garage,overhang,patio,enclosed patio,detached accessory structure,or similar area.Residential projects also include the initial location, installation or occupancy of a manufactured fiome or mobile home. Calculating Area for CommerciaVIndustrial Proiects-The chargeable covered and enclosed space of commercial or industrial construction shall not be deemed to include the square footage of any structure existing on the site of that construction as of the date the first building pernut is issued for any portiorr of that construction. "Chargeable covered and enclosed space" means the covered and enclosed space de[ermined to be within the perimeter of a commercial or industrial structure,not including any storage areas incidental to the principal use of the construetion,garage,parking structure,unenclosed walkway,or utility or disposal area. Available Hours for Verification-CFPM staff wi11 verify project development type and square footage and complete the Certification of Compliance during available hours. Available hours are from 8:30 A.M. - 12:00 P.M. and 1:00 P.M. - 4:00 P.M., Monday through Friday, except District holidays.Other times are available by appointment by calling(909)397-4800,ext.3920. Available Hours for Pavment-Fees due are paid to the District during available hours.Available hours are from 8:30 A.M.- 12:00 P.M.and 1:00 P.M.-4:00 P.M.,Monday through Friday,except District holidays.Copies of the completed Certification of Compliance will be given the applicant for use in obtaining the building permit(s)and for the applicant's records. P10TICF.-PROTEST PERIOD Section 6620 of the Government Code requires that Pomona Unified School Dis[rict provide a writ[en notice to the project applicant,at the time of payment of school development fees, mitigation payments or other exactions ("Fees"),of the 90-day period to protest the imposition of these Fees. Therefore, in accordance with Section 66020 of the Government Code and other applicable law, this Notice shall serve to advise the applicant that thc 90-day protest period in regard to such Fees or the validity thereof,commences with such payment or performance of any other requiremen[as described in Section 66020 of the Government Code. APPEALS PROCESS Any claim by an applicant that their project should be exempt from assessment of fees,or that the fees levied are incorrect,must be made in writing and filed with the Pomona Unified School District.The claim must specify the factual and legal grounds supporting the claim.In addition,the claim must contain a statement specifying the nature of the project and[he date the project building pertnit application was filed. The District's Superintendent,or his designee,shall respond in writing to a claim within Yourteen(14)days from receipt of the claim.The response shall contain the Superintendent's decision on the claim and a statement of the reasons supporting the decision. Any claimant who is dissatisfied with the decision may request review by the District's Board of Education.A request for review must be written and filed with the Superintendent's or designee's office not tater than ten(10)days from the date of the decision.The request must contain a statement of all factual and lega]grounds in support of the continuing claim. The Board of Education shall consider and act upon a request for review at a public meeting not later than thirty(30)days from the date of filing of the request.A claimant may appear and address the Board in regard to the claim.The Board shall provide written notice of its decision,to be mailed to the claimant,within fourteen(]4)days after public meeting at which the Board acted upon the claim. Correspondence shall be addressed to: Assistant Superintendent of Business Services,Pomona Unified Schaol District,800 South Garey Avenue,Pomona,CA 91766. �v�7 Jy r" =i r 9�1 Y.i'_ic.'%�W � vou POIUtONA Uhl1�lED SCHG�QL DISTRICT � Fac!!ttles PlanntnQ,arowth �Devetapmen#Ospartmerit R••rM•�•:� . � 8at}South t38rey Avenue Pomana,Calltornta 91766 CertHication at Co�npitance wiri iM pravl�lonr d Oava�mmsnt Cad�9�cdon 53oeo�Bb9�5.3 _ ___ ___. _ a'w`'°o"w"'� Ho llow "�`'""' 22757 HaPPY � comw�lr wm..na Pl�w,.nt�rn0.r Diamond Bar CA 91765 � {9 0 9) 8 61—6 2 b 2 TM,p�rson�ipnir+p�sprswmh ttut hdstM is aulFwriz�d tarrpn�c» �� brhali a!th�owrwddewlop�r and tlut IF�ir�€armaEia�+pnoviC�d is krt�Md socurat�e to tl1t b�st ot hieJtur krwwi�dpt. �EE SGN�DUl.E: T1rt d�vNopm�nt Mfs isvied by Bis Pamcns Unified$ckaoi�iatdct(PUSD)under p�ovision o!See6on 5309U 8&S9s5.3 ot 1h� t3avrmmsnt C:c�de ar+r. Raaid�ntial Aavebprtrorit �t.84/aq.tt. Coa+m��cial Dwaiopim�nt i0.30Ysq.R. GBvelopm�t�t Type: Cj�w C«+�tructian �,►a�aon ❑c�a,�r 22757 Happy Hallow t�w«wm.�. (�Y�s ❑No tnnar at biieryhl�P�ejree ?uw CMaL Nwnbr(aI �p*��^^+r � 1. � �.�i4es... u..er a.. .c�} F.. i• �atfAiYtw Miiiii+4 An+�M l FM 3. La��ad�«r a w�e�y ti..ts�. t} F.. +�. la/W6w� ot SuiMq �is4 F4 F» 5. ca r u..« ,u..sv. ) c» Buitding Receipt of Sub#o#ai US@ �Rsaidential F@@S('`�this is to cortity ihwt aII fass dus b tM �"°aP Q Ca+rsmsieist �a.i Pa»cma Unified Schoat 13ishie!u�er ptrvvrsion of tiovsrrxn�nt Cade S�clion �C3tl�s� 53090 8�85495.3 as a pt��4uiaite to O�� !M isuiar�ot a 9uikfu�p Pa+rnit by tl� D�parhm�nt oi Pubiic Wotks trrvs b�sn receiv�+d. Bas�d on tlt�It�totmatian Total Square A�s�s�ted above,this Gttiu�tion d FOOtB 8 Camptadon is Mmby eucaauted. I �v+�+� Tota!Fees Due i Dab Oata P'US�FadtAiss P1a�xsinp.Growth 3 PUSD�scal Srnricus Deparimeni DevMopms�l Dapartrn�rrt �w/ Nw.ylMwyw Q151'Al9UTIONi:�:��IINrtF PW�ifllnp Plnk•MJSO PMCri 3w+Aa� t'"`s fielOrtR4d•Own�r 1 Wr�iap�► `�.3" CITY OF DIAMOND BAR DEPARTMENT OF COMMLRIITY !� DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS_�L�/r�IOLLy/1/ST. APN LO'i TRACT OWNER ADDRESS CITY G ZIP TEL. APPLICANT�,TEL. CONTRACTOR�;1"t� L'_c0 �I-�GTR- i ADDRESS I'T�-t�I��d S�- N CITY L��I�q'I?�Q�ZIP C�,'i TE�.Z(��( ARCH/ENG/ DESIGNER C/�A F1J//'��cc d-AS�,'1(,- ADDRESS'AW- !I!$ RS T"'V'F CITY V L��_ZIp��TE ly'-� OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� CENSE UW FOR THE FOLLOWRIG REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIR ANY STRUC� TORE, PRIOR TO ITS ISSUANCE:,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 5 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT Si18JECr5 THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500). ): ^ I.AS OWNER OF THE PROPER iV,OR MV EMPLOYEES WITH WAGES ASTHEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7046,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES N0;APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SI1CH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EM PLOVEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOW EVER,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING SHAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). ��I,AS 0 WNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING W I LH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7066, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S)t.ICENsED PURSUANT T 0 THE CONTRAC- TORS LICENSE LAW.). -J I AM E%EMPT UNDER SEC.0.8 P.C. FOR THIS REASON DATE�.�Ci•�„�-_OWNER- LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTlOh17000)OF DIVISION 30F THE BUSINESS AND PROFESS�JNS CODE,AND MY LICENSE IS IN FU L L FOR C E AND EFFECT. { � �� LICENSE CLASS y 4 LIC. N0. 'J �f lc/��,� DATE �_ ��CY� CONTRACTOR C CT G�ii � WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENA N OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE OOMRETED OF THE PERMIT IS FOF ONE HONORED DOLIAF7,S(f100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSA'-ION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: ,_APPLICANT WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,ANO ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY 1 HEREBY AFFIRM UNDER PENA N OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ TF IS 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 ED PROPE RN FOR INSPECTION PURPOSES. A�,�1 OGNf3- PFRMITT N (PRINT SIGNATI/H OF PERMITTEE--DATE�,(-0� WHITE-Department Copy,YELL-OW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy U1,1�911XD 13,18 i PRESS FIRMLY .6-1/le DIZI VVA;�, .1 lln ��14�52io POMONA UNIFIED SCHOOL DISTRICT CAPITAL FACILITIES PROGRAM MANAGEMENT 800 SOUTH GAREY AVENUE• POMONA•CALIFORNIA 91766 Certification of Compliance Aoolicant's P one No. A licant sNar�e Applicant's Mailing Address I-iI Form Number Applicant's Signature Date of Signature The applicant executing this declaration certifies under penalty of perjury that: (1)they are the Owner and/or Developer or they are authorized to sign on behalf of the Owner and/or Developer, (2)that the information provided is true and accurate to the best of the Owner's and/or Developer's knowledge, (3)the Owner and/or Developer will file an amended certification of compliance and pay the additional amounts due if Owner and/or Developer increases the number of dwelling units and/or square footage after the building permit is issued or if the initial determination of units and/or square footage is found to be incorrect,and(4)they have read and fully understand this side and the reverse side of this document including the 90-day protest period posted on the reverse side of this document. De to ers Phone No. Owners/Develo s Nam Owners/ Owners/Developees Mailing Address Development Type and Fee Schedule $-0-/sq. ft. (Provide justification.) Residential $30�_/sq. ft. (Level 1 evil 2-vel 3) 13 Manufactured/Mobile Homes$/sq.ft. (Level 1 -Level 2- Level 3) ^ Commercial/Industrial $/sq.ft. 11 Senior Citizen Housing $/sq. ft. (See reverse side of sheet.) 11 Exempt II,Z c G Exempt status justification/notes: Fee Calculations Each Certification of Compliance form is for five(5)projects maximum. Use additional forms for additional projects. 2. 3. 4. 5. Tract No./Lot No.! Address Tract No./Lot No. 1 Address Tract No./Lot No. ! Address Tract No./Lot No.! Address TOTAL UNITS: (This form only.) �/,-^' �q Check appropriate box(es),fill in the fee per sq.ft. and circle the fee level in effect. D2$ 3 t�Z�i 0+2 g. ft. $ Plan Check No. Fee per sq. It. Area $ Plan Check No. Fee per sq.ft. Area $ Plan Check No. Fee per sq.ft. Area $ Plan Check No. Fee per sq.ft. Area $ Plan Check No. Fee per sq.ft. Area $ III�' DalleT District/CFPM (Name and Title/Signature an Receipt of Fees This is to certify that all fees due to the Pomona Unified School District under provision of Government Code Sections 65995, 65995.5 and 65995.7 and Education Code Section 17620,as prerequisite to the issuance of a Building Permit by the City/County, B d h i i d b hi i i C li i h b d h b i d C ave een rece ve ase on t e nformat on presente a ove,t s ert ficat on of omp ance ere y execute s Recei Check No. Date Submitted District/scat Services(Name and Title)Date See reverse side for General Information,Senior Citizen HousinQ, Payment of Fees, Notice- Protest Period and Appeals Process. Fee sq. ft. $ Fee sq. ft. $ Fee sq. ft. $ Fee sq. ft. $ Fee TOTAL FEES DUE (This form only.)Iti Distribution of Copies:White-City/County; Yellow-Distdct/CFPM; Pink-District/Fiscal Services;Goldenrod-Owner/Developer. Revised 12101 GENERALINFORMATION On November 4, 1998,SB 50 became effective.This bill grants California school districts the authority to levy fees in excess of those authorized by Government Code Section 65995(Level 1 Fees), if the district meets certain specified tests and approves a School Facilities Needs Analysis. Alternative Level 2 fees may be levied when state bond funds are available for school construction projects,and Alternative Level 3 fees may only be levied when the State allocation Board certifies that it is no longer approving apportionments for new construction due to lack of available funding. The Board of Education approved the School Facilities Needs Analysis and adopted a resolution levying the alternative fees under SB 50 on March 27, 2001.On March 13,2001,the Board also approved a resolution authorizing the levy of statutory fees on commercial/industrial development. SENIOR CITIZEN HOUSING Per Government Code Section 65995.1(c),if a senior citizen housing project is later converted to non-restricted use,the applicant/developer who is seeking the change in use will have to pay the difference between the current residential fee and what was paid for the senior citizen housing. PAYMENT OF FEES State law prohibits a city or county from issuing a building permit unless the local school district has certified that the application is in compliance with the District's collection program for fees assessed developers.The procedure for obtaining the required certification follows: Project Plans-A set of project plans stamped by the governing city or county building department,and valuation receipt indicating calculated square footage and plan check number, must be reviewed by the District.The address follows: Capital Facilities Program Management, Pomona Unified School District,800 South Garey Avenue, Pomona,CA 91766. Calculating Area for Residential Projects-The District levies fees on residential construction only if the resulting increase in assessable space exceeds 500 square feet.This minimum of 500 square feet is net of decreased assessable space in the same residential structure which also results from that construction. "Assessable space" means all square footage within the perimeter of a residential structure,not including any carport, walkway,garage,overhang,patio,enclosed patio,detached accessory structure,or similar area. Residential projects also include the initial location, installation or occupancy of a manufactured home or mobile home. Calculating Area for Commercial/Industrial Projects-The chargeable covered and enclosed space of commercial or industrial construction shall not be deemed to include the square footage of any structure existing on the site of that construction as of the date the first building permit is issued for any portion of that construction. "Chargeable covered and enclosed space" means the covered and enclosed space determined to be within the perimeter of a commercial or industrial structure, not including any storage areas incidental to the principal use of the construction, garage, parking structure, unenclosed walkway,or utility or disposal area. Available Hours for Verification-CFPM staff will verify project development type and square footage and complete the Certification of Compliance during available hours.Available hours are from 8:30 A.M.- 12:00 P.M.and 1:00 P.M.-4:00 P.M.,Monday through Friday,except District holidays. Other times are available by appointment by calling (909)397-4800,ext. 3920. Available Hours for Payment-Fees due are paid to the District during available hours.Available hours are from 8:30 A.M.- 12:00 P.M.and 1:00 P.M. -4:00 P.M., Monday through Friday,except District holidays. Copies of the completed Certification of Compliance will be given the applicant for use in obtaining the building permit(s)and for the applicant's records. NOTICE-PROTEST PERIOD Section 6620 of the Government Code requires that Pomona Unified School District provide a written notice to the project applicant, at the time of payment of school development fees, mitigation payments or other exactions("Fees"),of the 90-day period to protest the imposition of these Fees. Therefore, in accordance with Section 66020 of the Government Code and other applicable law,this Notice shall serve to advise the applicant that the 90-day protest period in regard to such Fees or the validity thereof,commences with such payment or performance of any other requirement as described in Section 66020 of the Government Code. APPEALS PROCESS Any claim by an applicant that their project should be exempt from assessment of fees,or that the fees levied are incorrect, must be made in writing and filed with the Pomona Unified School District.The claim must specify the factual and legal grounds supporting the claim.In addition,the claim must contain a statement specifying the nature of the project and the date the project building permit application was filed. The District's Superintendent,or his designee,shall respond in writing to a claim within fourteen (14)days from receipt of the claim.The response shall contain the Superintendent's decision on the claim and a statement of the reasons supporting the decision. Any claimant who is dissatisfied with the decision may request review by the District's Board of Education.A request for review must be written and filed with the Superintendent's or designee's office not later than ten (10)days from the date of the decision.The request must contain a statement of all factual and legal grounds in support of the continuing claim. The Board of Education shall consider and act upon a request for review at a public meeting not later than thirty(30)days from the date of filing of the request.A claimant may appear and address the Board in regard to the claim.The Board shall provide written notice of its decision,to be mailed to the claimant,within fourteen (14)days after public meeting at which the Board acted upon the claim. Correspondence shall be addressed to: Assistant Superintendent of Business Services,Pomona Unified School District,800 South Garey Avenue, Pomona,CA 91766. �V.7L 7/J7J7f"' � � � POIUIONA UNIFIED SCHOOL DISTRICT Factltties Planning,Qrowth �Development Department 800 South Garey Avenue Pomona,Caltiornta Si 766 CertHicatlon of Compliance wiMt fN previsions at Qovemment Cody Section 53080 665595.3 Oww(oPu (wnw sa.a nabs. wP 22757 Happy Hollow IIiamond .Bar CA 91.765 (909)861-6262 Pun en.d� r+.wr'..hl FEE SCHEDULE: The development Peas levied by the Pomona Unified School OlsMct(PUSD)under provision of Sec6an 53080 b 65995.3 of Iha Goverment Cods are: Residential Dsvebpment Appicart comv.nr Hunw and Anon. NkrnGn s... MA+.. 3�pnan iur�aA-vow The pen.on siprrnp represents that hdahe is a(�horizad toe�t on behel! of the ownar/dewloper and that the infomsation provided is trot and eocurab to tM best of hiefier Immowfedpe. il.tl4/aq. ft. Commercial Dwabpmsnt i0.30/aq. R, Ts�dr+rrq�ar A�ai.w Mwau a I a P�aja< 1. Lrr�Add�ws Z. La11WbM, 3. Lai I A08�w 4. is f Adaw� 5. La��ranw. Butldtng Use�Residential Q Cornmereial other [JExempbd Total Square Footage Q Ysrilied hats PUSD Facilities Planrvnp,Granlh � Development Oepartrr-ant [�t7lhet u..a �v.-Fy a s,rirw�� (s+ FiT IY-Mifiy Awe(Sy. FCJ Lh�a WvMw� (sa FLI uw at MaT9q.fit) Receipt of Fees This is to certify(hat all fees dos b the Pomona Urtibad Scholl Distric! (r>dar pnv(siort of Govemment Code Section 53080 Zk 65995.3 u a pnraquiaib to the lesusr(ce of a t3uilrFnp Permit by the Deparbnent of Public Works haw been received t3ased on the IMormation presented above.thin GrtificaGon of Comp{stion is Mreby executed. Dab PUSD Fiscal Services Department Subtotal Total Fees Oue (Yea �fYo Garw�nrdonDwykpinw swwy Fi r FN FM NM�1 IlwnNr DISTRIBUTION; YMhNs-C11ylt:ottlYy YMow• r1JB0 FacNINS PY�It•PUSD F'ygl SNVkr