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Home My WebLink AboutPR17-205CITY Or DIAMOND BAR DEPARTMENT OF COMM€JNITY & DEVELOPMENT SERVICES ' 21810 Copley Drive, Diamond Bar, CA 91755 PRESS (909) 839-7020 Tax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY 'aB° BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS APN LOT TRACT OWNER N 1',,tl Q S 4_ TCI 0 e C f ADDRESS 7_961 C ru c� fl C re s CITY J)t &~A I �£-e ZIP 91766 TEL. sAPPLICANT TEL. CONTRACTOR a Ti r ,> `,ctrl 5 f -rk i- t-,;, st ADDRESS Zz F-49 vi do A Le r CITY 0 Al 7£'.ca4-A ZIP `1680 TEL. U X--74 Z-C— ARCH/ENGj DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the mason(s) indicated below by the checkmark(s), I have placed next to the applicable lterm(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 at the Contractor's State License law (Chapler9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or Brat he orshe is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicantfara permitsubjects the applicant too dvil penalty of not more than five hundred dollars ($500). (-)1, as owner of the property, army employees with wages as their sola compensation, will do LI all of or (-) 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 forsale. 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. 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 forthe projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's Slate License lawforthe fallowing reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at leastone year prlarto completion of the improvements covered by this permit,) cannot legally sell a structure that) 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 Code is avaliable upon request when this application is submitted or at the following Web site: httplwww.€egingo.Ga.gov/calBw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurythat 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 farce and effect. LICENSE CLASS: 13 L€C. NO.: <6 <6 6 F%P. DATE- 20 tW CONTRACTOR: P (e!'i 0 CO 4 5 I--ile'LI D ek WORKER'S COMPENSATIO DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a CerUOcate of Consent to Self -Insure for Worker's Comp enation, as provided by Section 3700 of the Labor Code, farthe performance of the work for which this permit Is Issued. X I 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 permitls Issued. My Worker's Compensation Insurance Cartier and Palley Number `art: {` CARRIER t -' W ---- POLICY NUMBER LA tn1 L' G=.3 -77 (WIS SECTION NEED NOT BE COMPLETEO IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I codify that in the performance of the work fnrwhfdr this permit Is issued, i shell not employ any person in any manner so as to become subject 10 the Worker's Campo rsation Lays of Calliornla. And agree that it I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Cade, I shall foiftilh comply wilh those provlslens. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civlt fines up to one hundred thousand dollars ($100,000), In addition to the cast of the compensation, damages as provided for In section 3708 of the labor code, interest, and attorney's lees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that them is a Constroction Lending Agency for the performance of the work for which this parmitis issued (Sec. 3097, Civ. C) - LENDER'S NAME: LENDER'S ADDRESS: I certi€ythat I have read €tris application and stale that the above information is correct. t agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county 10 enter upon the above-mentioned property for Inspection purposes. Meyer- PERMHTEENAME MINT)e. S!IWAAURE OF PERMNTEE DATE APPLICATION DATE: If �^� 1 P/C6 ISSUE DATE: 2L PERMIT# : F'R X—i ^- QO j TYPE CONST- OCC GROUP: `Scope of Work AAA # DWEL. UNITS # STORIES 4 2 J% re ML( e # BEDROOMS DESCRIPTION SQ. FT, FACTOR PSF ADJ. AREANALUATION SFRIAOD/REM GaragOCarport uI Patic/Dack ur rL Pooi/Spa ZRe -Roof Q Commercial 00 on Valuation: '_-3Cyl G C' L7 Adj. Area: QUANTITY DESCRIPTION FEE U' iii e V U w m31'c4tc4 '-S a �a U z a s v CONSTRUCTION: PLAN REVIEW: �(oq• 4i2' ELECTRIC: S cot ' ace PLUMBING: 3 ldo MECHANICAL: INSPECTION FEE: ISSUANCE: Eo $ SMIP: �a ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PR`` -ALT FEE: BASF: W PLOT PLAN: ZONING CLEARANCE: TOTAL. FEES COMMENTS: PIC: PAID BY: VALIDATION:__j RECEIPT # 3 (e3 PAID BY: J VALIDATION: _ WHITE — Department Copy, YELLOW — Finance Copy, PINK --- Assessor Copy CITY OF DIAMOND RAR .. INSPECTI N RECORD COMMENTS: