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Home My WebLink AboutPR17-842s a —Ad-:� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 3 PRESS " (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839 702:7 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiimondbar.com building*diatriondbarea.gov JOB SITE ADDRESS ✓ y nut W q APN _ LOT TRACT OWNER WS ADDIRiESS � `c CITY'C> APPLIC4_:NT °� Pi�Cr` TEL. CONTRACTOR ADDRESS -per CITY t4a3 e— �i�`! • __Lg } ARCH/EN DESIGNER 1 ` ADDRE CITY ZIP 6 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 [tems) ]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 pursuantto the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Gode] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applleart for a permit subjects the applicantto a elvil penalty of not more than five hundred dollars ($500). (-) I, as owner of the property, or my employees with wages as their sole compensation, will do U all of orU 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 net applyto an owner of property who, through employees' or personal effort, builds or improves 1ha property, provided that the improvements are got 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,), I-) t, 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 forthe projects vAln a licensed Contractor pursuantth the Contractors' State License law.). U I am exempt from licensure under the Contractor's State License law for the following reasen(s): pate: 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 ofthe improvements covered by Phis permit,) cannot legally sell a structure that I have built as an owner-bullder 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.109ilfD.Ca.90V/Calaw,html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I an 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 end effect. LICENSE CLASS: EXP. DATE: CONTRACTOR: - WORKER'S COMPENSATION DECLARATWN I HEREBY AFFI M UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Workers 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 afthe Labor Code, for the performance of tire workfor which this permuad. My WorCompensation Insurance Carrier and ' PalicyNumber are: i � CARRIER POLICY NUMBER (J lit i (THIS SECTION NEED NOT BE ClIMPLEIIIIED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). y I certify that in the performance ofthe workforwhich this permit is issued, I shall not employanyperson in any mannerso a; to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject m 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 7 penaltles and civil fines up to one hundred thousand dollars ($100,OD0}, in addition to the cost of the compensation, j damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY i I hereby affirm under penalty of perjury that there is a Construction tending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C). LENDER'S NAME: 9 LENDER'S ADDRESS: D - I certify that I have read this application and state that the above information is correct.) agree to comply with all cityand county ordinances and state laws relating to building coirstrudon, and hereby authorize representatives of this county to ender upon the above-mentioned property for inspection purposes. r PERMITTEE NA I i 2 4 I "' - SIGNATURE OF PERMITTEE DATE it APPLICATION DATE: ISSUE DATE: TYPE CONST. PERMIT# : P/C# g OCC GROUP: Scope of Work _ # DWEL. UNITS C. # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ, AREA/VALUATION SFR/ADD/REM Garage/Carport CO W Patio/Deck LL Pool/Spa ZRe -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE 13 -- CONSTRUCTION:. CONSTRUCTION:, PLAN REVIEW:. ELECTRIC: ate— - PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: l ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: _ BASF: PLOT PLAN: ZONING CLEARANCE: f�• TOTAL FEES COMMENTS: PIC: PAID BY: VALIDATION: RECEIPTPAID BY: F VALIDATIDN:B WHITE —Department Copy, YELLOW -- Finance Copy, PINK—Assessor Copy CIT'T OF DIAMOND BAR INSPECTION RECORD COMMENTS: