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HomeMy WebLinkAboutPR16-2604�O N CITY OF DIAMOND BAR N �I I DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 r PRESS .: (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY zrs� BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diatnondbarca.gov JOB SITE ADDRESS 35AI APN LOT TRACT 0 OWNER ADDRESS ' CITY ZIP STEL. (4' - APPLICANT '-APPLICANT ' 9 i TEL. ) CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNERA VP144N ADDRESS + 1 CITY ZIP A7 TEL. s OWNER-DUILDER DECLARATION I hereby affirm under penalty of padary that I am exempt from Die Contractor's State Licenso Law for the reason(s) Indicated below by the clieckmadk(s), I have placed next to lire 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 be. or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7060 of Division 3 at the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Anyvioladon of Sec€ion 7031.5 by any appllcantfora permitsubjects the applicant to a civil penalty of not more than five hundred dollars {$500). U 1, as ownerol the property, orhny employees with wagesas their We compensation, will do () 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 Contmctors' State License Law does not applyto an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not Intended orofferod for sale. If however, the building or improvement is sold within one year of completion, the owner Builderwill have the burden of proving that it was not built or improved for the purpose of sale.). U L as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cafe: The Contractors' State License Law does not apply to an owner of property who builds or -improves thereon, and whocontracls forthe projects with a licensed Contractor pursuant tothe Contractors' State License Law.). (� I am exempt from (€censure under the Contractor's State License law forthe 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 ;ear prior to compieliun of the improvements covered by this perm€€,I cannot legally sell a structure that i have built as an owner builder €f it has not been constructed in ifs entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of tie Business and Professions Code Is available upon request when Dts appllcatlon is submitted or atthe fallowing Web site: htplwww.leglnfo.ca.govlcalaw.himl. 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. LICENSECLASS: LIGAO.: EXP. DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFF11M 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 Secton WOO of the Labor Cude, for the performance o1 the work for which this permit Is Issued. I have and wiil maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit Is issued. My Worker's Compensation insurance Canlerand Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPL€7ED IFTHE PERMff IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the porformance of the work for which this permit is issued, I shall not employ any peisah in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that it I should became subject to Die Worker's Compensation provisions of Section 3700 of the Labor Code, I shall foMw€tr comply with those provisions. DATE: APPLICANT: WARNING: hilure 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 3706 of the labor code, Interest, ar;l, atorney'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. 3697, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: i 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 i ereby authorize representatives of this county to i enter upon the above-menticu ed property for Inspection purposes. i e PERMITTEE NAME (PRINT) S€GNATUHE OF PERMITTEE DATE APPLICATION DATE: 0-0/)o LA, PPIC#I � ICj r Alo( L ISSUE DATE: PERMIT# : log /I-, o`D rO y TYPE CONST. OCC GROUP: Scope of Work it # DWEL. UNITS # STORIES / ✓ # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W PatWDeck rwr- Pool/Spa ZRe -Hoof © Commercial m Val'ua! Ion. G Adj. Area: QUANTITY DESCRIPTION FEE v � T r w A7j m lis�,&IeP e} 0. z z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: rR PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: � SMTP: — ENERGY P/C: -- ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: Y.fy r 31 TOTAL FEES 6jo ' 96 COMMENTS: yi PIC: �� �-/�� � PAID BY: RECEIP-r # ' 1 PAID BY: VALIDATION: ` VALIDATION: WHITE—Departmen€ Copy, YELLOW —Finance Copy, PINK --Assessor Copy CITY OF DIAMOND EAR INSPECTION REGORD COMMENTS: WALNUT VALLEY UNIFIED SCHOOL DISTRICT 880 SOUTH LEMON AVENUE, WALNUT CA 91789 CERTIFICATE OF COMPLLANCE With Fee Provisions of Government Code Section 6559996 DEVELOPER/OWNER 9 " ` r ' bL--rs r � ADDRESS CITY/ZIP i TELEPHONE NEW CONSTRUCTION PROJECT Signature of Applicant The person signing represents that he/she is authorized to sign on behalf of the owner/developer and that the Information provided is true and accurate to the best of his/her knowledge. LOT ADDRESS BUILDING USI; " 1` ,-A City Residential/ Commercial/Industrial HOME IMPROVEMENT OR REMODELING PROJECT TOTAL SQ. FT. ADDRESS DESCRIPTION TOTAL SQ. FT. Diamond Bar Walnut (Bedroom, Family Rm., Kitchen, etc.) Other City Signature of Superintendent of Buildings Date S ! 1 I 1 TO BE COMPLETED BY SCHOOL DISTRICT FEE SCBEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE School District under provision of Government Code §65995 $ --- Are (EFF. 1211108) Residential Development $2.97/sq. ft. Receipt # N H Commercial/Industrial $0.47/sq. ft. Data Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet eliminating garage or uncovered patio). 0 This is to certify that all fees are due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. XThis is to certify that the above described development has been determined to be EXEMPT from the development fees of Government Code Section 65995 and a building permit maybe issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET 0 Celia Moynihan an) Director, Fiscal Services 1187 Rev. 2/88; 6/88; 8189; 1190; 8190; 10190; 8/92; 6193; 11193; 8194; 6/96; 1/97; 8/98; 7104; 6/06; 2108; 12/08; 1113; 6/16