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Home My WebLink About14993 (663)J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION. FIRMLY ADDRESS �% l S S'aur�l Li/�//S/�llF1/J�DA OlZ. APN LOT TRACT - OWNER -_154- t' %N.v ADDRESS � / I S. WYNN L /' 00,0 ;01/ CITY .AiZIP TEL. APPLICANT TEL CONTRACTO D ADDRESS ! 1Y J E-s1t./✓ Eat yo CITYNv� 7N IPj2gd TEL%t1 - ARCRENG/ DESIGNER �AMMf^ /lS AiBi9%�t ADDRESS CRY ZIP TEL. OWNER -BUILDER DECLARATION I HERESY AFFIRM UNDER PENALTY OF PERAMY THAT 1 AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW &THE FOLLOWING REASON (SEC 7031.9 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOURESA PERMRTO CCNSTRUCr,ALTER MPROVE DEMOLISK OR REPAIRAW 9TRUG TURF PRIOR TO RS ISSUANCE. ALSO REOUIRES THE APPL= FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE U LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTERS (COMMENCING WITH SECTION 7000) OF DIVISIONS OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOA THE ALLEGED EXEMP- TION. 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 (9500) ): 0 L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WADE SAS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUS I. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AHD WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE F, HOWEVER THE BUILDING OR SAPROVEMENT IS SOLD WITHN MEYEAR OF COUPLE- 'TION. OUPLE•'TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE1. O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS 70 CONSTRUCT THE PROJECT ISEC. 70". BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U• CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WRTHA CONTRACTOR(S) LICENSED PURSUANTTO THE COHTRAG TORS LICENSE LAW) D I AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PER LAITY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCSKL WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS D PROFESSIONS OODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. � n LICENSE CLASS LIC. NO. DATE �D -a.!%" 7A2L+li CONTRACTOR WORKERS' COMPENSATION DECLARATION 1lf\�J I HEREBY AFFIRM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLA _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INS FOR ERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR FOR THE PERFORMANCE OF THE WORK FOR WHICH THISPERAWTIS ISSUED. I HAVE ANDWIL MAINTAIN WORKERS' COMPENSATION NSU CE, AS RECUIRED BY 37000ETHE LABOR CODE, FORTHE PERFORMANCE OF THE FOR WHICH ERMIT IS ISSUED. MY WORKERS COAAPEN511710N INSURANCE CARRIER BERARE: CARRIER POL)CY NI/ANER (TlssEcrloNNEED7 3 L ) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOM ECT 7 E WORKERS'COMPENSATON LAWS OF CALIFORNIA AND AGREE IS HOU COM SUBJECT TO THE WORKERS COMPENSATION PROVIS SOF .t THE LABOR 1 SHALL FORTHWITH COMPLY WITHIN ISI n Fy�� DATE: 7-, `+APPLICANT: WARNING: FAILURE TO SECURE WORKERS' ENSATIN ERA. UN.AVIFUL AND SHALL BE SURIECTANEMPLOYER TOCRIMINALPENAL ES MDC FINES OONEMNDRED THOUSAND DOLLARS IS 100,000). IN ADDITION TO THE COST OF COMP . DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. NTE REST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED (SEC. 3097. CIV C.). LENDER'SNAME -/%' L/,•1,6 LENDERSADORESS 1CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATNQ TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MEN710NED PROPERTY FOR INSPECTION PURPOSES. TD.�s G A4 •Y' M� PERMITTEENAME(P I I aN.NA OF ERMRTEE DATE APPLICA DATE ZO PERMIT, •� IL NUMBER �P/C ISSUE /�7� TYPE OCC DATE CONST. GROUP ZONING S ACKS FRONT RW ❑ REAR p SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE 4(7 NO. OWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT I FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM N Garage/Carport W Patio/Dock 9sNv LL PooVSPa ZRe -Roof Commercial 5 m U Valuation ADJ.ARFJ1 DUAN -n DESCRIPTION FEE J Q V Cr l' - LU J W 0 2 m U Z Q S C�O��}p�p�UC ION V W 110-T7O IL ECT PLU ING HANICAL NSPECTION FEE L ISSUANCE 90 SMIP " ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE- T CM CIF rn AmmD BAR -Pi YTT jNya P.N gAFPTY TOTAL FE i,- (�) COMMEN RECPT. NO. PAID BY VALIDATION WFIITE—Department Copy YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD} -File Copy. GREEN—ApPlicom's Copy