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Home My WebLink AboutPR16-2666a 0 0 U) J i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES [y, 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 Z\K Itj ex-.7�� APN LOT TRACT OWNER V-J-^, ADDRESS 2-1'-"b 91=16f - U CITYQ'11- 1d V-0'r ZIPO'417 TEL U-IL •tGr�O�f.'3"7-1 APPLICANTA %A-- t./�a n�E{�$St TEL65tPZ '' ASS CO`Z CONTRACTOR Lik Sb%,:m- ADDRESS %k V2,S a S E' • CITY �� Ny'( $� ZIP L. ARCH/ENG/ DESIGNER ADDRESS2Yjl0 w • 7 3�I tti t� CITY' 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 70DO 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): Date: Sign: 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 Cade is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. C to/ C-t( 0 LICENSE CLASS: LIC. NO.: --A `l \' I EXP. DATE:' 0 ' t 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. 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 Numbe 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 Cade, I shall forthwith comply with Nose 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---%f-e 11 � i LA PERMITTEE NAME'P SIGNATURE O�ITTEE DATE APPLICATION DATE: 1` %to P/C#M I L, - 2 6 43 ISSUE DATE: �a'I $ �1to PERMIT#: P�)� TYPE CONST. OCC GROUP: Scope of Work9_C' —__" e8 So\�t`• \-* ti.00j,K # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck W LL Pool/Spa ZRe -Roof � Commercial Z) 00 Valuation Adj. Area: QUANTITY DESCRIPTION FEE U U w L7 z m J a c� �d x U CONSTRUCTION: 2, r i0 PLAN REVIEW: qR. 89 ELECTRIC: 130. O 3 PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: 1 2 . 2.L'I SMIP: 2- 76 ENERGY P/C: ENERGY PERMIT: RETENTION FEE: 261 OO PRE-ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES 4 7' •38 COMMENTS: P/C , PAID BY: VALIDATION: AJ RECEIPT p —4 k `CPAID BY: <;.0;.6 VALIDATION: Q WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: FFIDAVIT SELF -CERTIFICATION FOR COMPLIANCE OF SMOKE DETECTORS AND CARBON MONOXIDE ALARMS When the valuation of additions, alterations,or repairs to dwelling units exceeds $1,000.00 smoke detectors shall be installed in each sleeping room, and outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements and habitable attics as required by Section R314, of the 2013 California Residential Code (CRC). For dwellings or sleeping units containing fuel burning appliances or having attached garages, carbon monoxide detectors shall be installed outside each separate sleeping'area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements as required by Section R315 of the 2013 CRC. All alarms shall comply with requirements for listing and approval by the Office of the State Fire Marshal. Property Address: 21515 Round Rock Drive, Diamond Bar, CA 91765 Building Permit Number: BLD20 Total # of Bedrooms: 5 Total # of Floors: ' (Including Habitable Basements and Attic Spaces) TOTAL Number of Smoke Alarms in Dwelling Unit: 7 TOTAL Number of Carbon Monoxide Alarms in Dwelling Unit: As owner of the above -referenced property, I hereby certify that I have installed the smoke detectors and carbon monoxide detectors in accordance with the manufacturer's instructions and in compliance with the above sections of the California Residential Code, California Building Code and California Health and Safety Code. I declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on (Date) Owner's Name (printed/typed): Jian Wu Signature of Owner: BSD-III Farm . Affidavit Self-C'ertif—fian f n- Compliance of Smah and Carban Alo—ide Dvtactarx Updated: 06126114 (gar RESIDENTIAL SMOKE AND CARBON MONOXIDE ALARM REQUIREMENTS Effective January 1, 2011, all residential permit exceeding $1,000 in valuation shall be required to install smoke and carbon monoxide detectors throughout the residence. Smoke and carbon monoxide detectors shall be installed in accordance with the 2013 California Residential Code (CRC) and shall be verified at the permit final. Smoke alarms shall be tested and maintained in accordance with the manufacturer's instructions. Smoke alarms shall be replaced after 10 years from the date of manufacture marked on the unit, or if the date of manufacture cannot be determined. Smoke alarms shall be installed in the following locations: 1. In each sleeping room. 2. Outside each separate sleeping area in the immediate vicinity of the bedrooms. 3. On each additional story of the dwelling, including basements ad habitable attics but not including crawl spaces and uninhabitable attics. Carbon monoxide alarms shall be installed in the following locations: 1. Outside of each separate dwelling unit sleeping area in the immediate vicinity of the bedroom(s). 2. On every level of a dwelling unit including basements. Smoke & Carbon Monoxide Alarm Locations 1mr i rinside alarm,{ i eachSmoke &carbon g I, monoxide alarm n outside each Sleeping location Smoke alarms at each floor level, habitable attic & basement .... .. •;:gat?� (4rJp (�wcs esa 111 ro— - Affdar-ir Seq=C'errgicari— for Cnmp(i-- of Smoke and Ca, h A10-ide Ueractore Updare& 06/26/14 rgar -Smoke Detect •rS and Carbon onoxide Alarms Adobe Sign Document History 11/14/2016 .Created::-_-; 11/14/2016 By:. LA Solar Group (Admin@lasolargroup.com) .. Status: Signed Transaction ID: CBJCHBCAABAAMTkCHa1KgYwN2Vdu4k1WHiETSzy9sFlf "Smoke Detectors and Carbon Monoxide Alarms" History Document created by LA Solar Group (Admin@lasolargroup.com) 11/14/2016 - 2:23:19 PM PST- IP address: 76.174.148.188 �► Document emailed to Jian Wu (88.jian.wu@gmail.com) for signature 11/14/2016 - 2:23:21 PM PST Document viewed by Jian Wu (88.jian.wu@gmail.com) 11/14/2016 - 4:39:26 PM PST- IP address: 64.233.172.146 &a Document e-signed by Jian Wu (88.jian.wu@gmail.com) Signature Date: 11/14/2016 - 9:29:41 PM PST - Time Source: server- IP address: 47.150.195.87 Signed document emailed to diane@lasolargroup.com, Jian Wu (88.jian.wu@gmail.com) and LA Solar Group (Admin@lasolargroup.com) 11/14/2016 - 9:29:41 PM PST Adobe Sign