HomeMy WebLinkAbout16-0658CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES FNIA`
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 :?
APN � L L LOT TRACT
OWNER
ADDRESS
CITY N4M Ilid j3Grt- ZI _JLUT TEL.
APPLICANT K I&r� TEL.
CONTRACTOR ',% il ?! Sn + CO'
ADDRESS V IZ
CITY 1,41?wl ZIP1 /7 YWTEL.
ARCH/ENG/
DESIGNER rrH etSp
ADDRESS d/A Sloiny Gvtc
CITY17jYiGl 2vik- ZIP 7- TEL. 907-
OWNER-BUILDER
O '—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
shructuro, 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.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
dd}my license is in full force and effect.
C. -t
LICENS CLASS: O 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 qlx� 6a QI I
POLICY NUMBER [ ' 4 7/ !t
(IRIS SECTION NEED NOT BE COMPLETED IF PERMff 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: 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 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 -,n property for inspection purposes.
W/h/
PERMI NAME (PRINT)
SIGNATWINIF PERMITTEE DATE
APPLICATION DATE: �7- f� ] —��� P/C# pk 4-qare
ISSUE DATE: J �V PERMIT# : - 0 s r
TYPE CONST. OCC/GROUP:
Scope of Work �ltl� L Y�S O/1
• lL � �luv �' .
42 >cb A
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
WL
Patio/Deck
LU
LL
Pool/Spa
ZRe
-Roof
0
Commercial
5
C3
Valuation: Adj. Area:
QUANTITY DESCRIPTION FEE
ccU
U
w
w
c7
z
m
J
rL
ZU_
Q
x
U
CONSTRUCTION:
PLAN REVIEW:
`
ELECTRIC: C
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE: I' _
SMIP:
ENERGY P/C:
ENERGY PERMIT: L,
RETENTION FEE: "Z•�%
PRE -ALT FEE:
BASF: Gd
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
V
COMMENTS:
P/C: 4 10PAID BY: 7
y VALIDATION: f .
RECEIPT # PAID BY: ,�%� J'A VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF -DIAMOND BAR
INSFECTI10N 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:
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 r
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
DI�L�IOA'D BAR �
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT 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 V 11 /x
APN .(LOT TRACT
OWNER X A441 {e ( t✓ r I
ADDRESS
CITY ZIP TEL.
APPLICANT TEL.
CONTRACTOR %T w
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
7044,1 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
Licene 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, andel my license is
in (full force and effect.
ICENSE CLASS:— LIC. NO.:
ATE: CONTRACTOR: r
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 Carder and
Policy Number are:
CARRIER--VITWV"
X POLICY NUMBER I ( 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 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 ($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.
(a.
PERMITTEE N (PRINT)
of
SIGNATURE OF RMITTEE DATE
APPLICATION DATE: 1 a t I I"
ISSUE DATE: , /d�/'1 VI PERMIT# :
V
TYPE CONST.
P/C# /�Q'�
4-
OCC GROUP:
Scope of Work
# DWEL. UNITS # STORIES
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w
Patio/Deck
UJ
LL
Pool/Spa
ZRe
-Roof
0
Commercial
5
co
Valuation:
Adj. Area:
QUANTITY DESCRIPTION FEE
r.+: -4r to �o 55L
J
w
co
z
m
J
a
J
Q
U
Z
Q
x
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
�,l • ,�f
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS: RPcf �iFIPCf
%—/ka — e �o� �dfG►w
diF�'PrP_.✓I�_ OrC
P��n��cdC
P/C: PAID BY: VALIDATION:
RECEIPT # PAID BY: VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECT'IGN RECORD
INSPECTIONDATE
INSPECTOR
INSPECTOR
SETBACK/LETTER
COMMERCIAL HOOD
FOOTINGS FORMS
INTERCEPTER
SLAB
SEPTIC/CESSPOOL
UG. PLUMBING
DEMOLITION
UG. ELECTRICAL
ROUGH CONDUIT
LIFER GROUND
ROUGH PLUMBING
SEWER LATERAL
ROUGH MECHANICAL
MAIN WATER LINE
PRE GUNITE
SEWER CLEANOUT
P -TRAP
ROOF SHEATHING
FINAL POOL
FLOOR SHEATHING
WALL FOOTING/STEEL
SHEAR WALLS EXTERIOR
WALL BOND BEAM
SHEAR WALLS INTERIOR
WALL FINAL
FRAMINGNENTING
ROUGH FIRE APPROVAL
ROUGH MECHANICAL
FINAL PLANNING
ROUGH ELECTRICAL W( ) C
ROUGH PLUMBING
FINAL COMMUNITY SERVICES
INSULATION WALL
FINAL INDUSTRIAL WASTE
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
,T /
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( )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