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Home My WebLink AboutPR17-984CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 4 1 I 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 wwwcityofdiamondbar.com build ing@diam ondbarca.gov JOB SITE ADDRESS IX40 ce APN LOT TRACT OWNER �Ia ft, L!'ti ADDRESS )00 ;'ntp, Drill -7-"2-O3 CITY ZIP �TEL. 16 _ -R1y - 4PLICAe APPLICANT/9 f &M 641eit-TEL. CONTRACTOR ADDRESS T CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS D .S CITY r ZIP TEL. 4 OWNER- BUILDER DECLARATIO I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for fire reason(s) indicated below by the checkmark{s), I have placed next to the applicable items) [Section 70315, 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 7600 of Division 3 of the Business and Pmfessinns Cade] or that he or she is exempttram licensure and the basis for the alleged exempfion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicantto a civil penalty of not more than live hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will de 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 appfyto an owner of property who, through employees' er personal effort builds or improves the property, provided thatthe 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 cf proving that it was not built or improved for the purpose of sale.), Ca 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 contraclsfor the projects with a Ilcensed Contractor pursuantto the Contractors' State License Law.). O I am exempt from licensure under the Contractor's State License law forthe following ramon(s): Date: Sign: By my signature below I acknowledge that, exceptfor my personaf residence In which I must have resided for at leastone year prior to completion ofthe 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 Cade is available upon request when this application is submitted or atthe following Web site: httplwww.leginfo.ca.govlcalaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing w11h Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: e 6 2_ / �!r EXP. DATE -4 CONTRACTOR:k & /�ib�'`� �i"-:8d� :�: i:v, "._dr'r_' lw; _ 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 Seif-Insure for Worker's Compensation, as provided by Section 3700 otthe Labor Code, forthe 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 werkfor which this permit is issued. My Worker's Compensation Insurance Carrier and Policy Number ar CARRIER �. x r , POLICY NUMBER 4. (RIES SECTION NEED NOTSE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the performance ofthe wodcfor which this permit Is issued, I shall not employ any person In any manner so ES 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 cf the Labor Code, I shall forlhwilh 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 1$100,000), in addition to the cost of the compensation damages as provided for in section 3709 of the labor coda, 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 (See. 3097, Civ. C.). LENDER'S NAME. LENDER'S ADDRESS: I certify Ynat 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 ofthis county to enter upon the above-mentioned property for inspection purposes. _'4L,_ L t PEIIMITTE AME ( Ir _ ,A Sl NATURE OF PERMITTEE DATE APPLICATION DATE:� P/C# pp 1 ISSUE DATE: L5 2 li PERMIT# : PP TYPE CONST. OCC GROUP: ��,;,�/�� / Scope of Work _n /Fz 6 # DWEL. UNITS # STORIES yam, 11, # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage)Carport Patio/Deck U- Pool/Spa ZRe -Roof O Commercial D !i m valuatictl Adj. Area: QUANTITY DESCHIPTION FEE .y�e.10 y rv,.r§ L9 50.x- � s q•"'+.� `p. s sli 9 f e::} P, �]' l.4✓ 8 B Y i,'" i.' ..1�'[ w ' � 3 � s Bi� �: e z: .• z in Z z U W CONSTRUCTION: PLAN REVIEW: 0 i 2-8 , ELECTRIC: (} _ PLUMBING: MECHANICAL: -� INSPECTION FEE: ISSUANCE: SMTP: Cm. ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE TOTAL FEES (id COMMENTS: P/C: C l LP PAID BY: RECEIPT11 PAID BY: VALIDATION: VALIDATION: a " WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy COMME°` TS: