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Home My WebLink AboutPR17-1474LU iu Gl 0 6 z Lo i. CITY OF DIAMOND BAR I I ' DEPARTMENT OF COMMUNITY LOPMENT SERVICES _ 21810 Copley Drive, Diamond Bar, CA 917&5 �,, �•,� (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION wwf;v.eityofdiamondbarcom buildinL,6 JOB SITE ADDRESS!� � V v x- i APN L TRACT OWNER (tet "-1' t ADD SS r- V APPLICANT f TEL. S CONTRACTOR — ADDR SS q00 CITY ZIP ')&2JTEL. ARCH/ENG/ 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 reasons) indicated below by the checkmark(s), 1 have placed next to the applicable Itemis) {Section 7031.5, Business and Profess€ons 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 permitto 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 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant Tor a permit subjects €be applicantio a civil penalty of not more khan five hundred dollars JUDO). (_) I, as ewnerof the property, army employees with wages as their sole compensation, will dale 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 for sale. It however, the building or improvement issold within one year of completion, the Owner-Rulider will have the burden of proving that It was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project {Section 1044, Business and Professions Code: The Conkactors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who contracts tar the projects with a licensed Contractor pursuantlothe Contractors' State License Law.). f ] I am exempt from Trcensure under the Contractor's State License law for the following feason(s): Dale: Sign: By my signature below I acknowledge that, except for my personal residence in which t must have resided for at least one year prior to completion of the improvements covered bythls permit,[ cannot legallysell 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 Code is available upon request when this application €s submitted or at the following Moshe: bltplvnvsv.€eglnfo.ca.govlcalaw.himt. 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 andProfessions Carte, and my license is In full force and effect. LICENSECLASS' cz co LIC, NO,: FXP, DATE: CONTRACTOR: ��^J 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 Self -Insure for Worker's Compensation, as provided by ction 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 37004)(the Labor Code, for the performance of Rhe work for which th- permit is rssue . M 7r,scompensaf n Insurance Caoiar and Policy Number o/_ CARRIER �� L�P- POLICY NUMkii (fHISSECTION NEED NOT BECONIKE FU IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $1OO OR LESSI. I cerlify€hat in the performance of the work for which this permit is Issued, I shalt not employ any person In any manner so m to become subject to the Worker's Compensation Laws Cal'omia. And agree that if I should become subject to the Worker's Compensate visions f Con 3700 of the 1641 forlhwill m €lh thos ovis€ons. BATE I PLICANT: WARNING: Fa€lure to secure Worker's Compensation coverage is unlawfu€, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($300,000), In addition to the cost of the compensation, damages as provided for In section 3708 of the labor code, interest, and attomey's fess. 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. 3097, Civ. C.I. LENDER'S NAME: LENDER'S AMES& 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 slate laws relating to building construction, and hereby authorize representatives of this county to act pail va-mentioned property for Inspection purposes- PERMITTEE NAMEIPRI14TI SIGNATURE of P DATE PRESS ondbarea.gov FIRMLY APPLICATION DATE: 2 2G(' P/C# PR i ISSUE DATE: Z _ PERMIT#:PgAa€ TYPE CONST, Scope of Work OCC GROUP: If DWEL. UNITS N STORIES R BEDROOMS QUANTITY DESCRIPTION FEE U U W LD m DESCRIPT€ON 5Q. FT, FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM GaragelCarport w W PatWDeck rc- PooVSpa zHe -Raaf � In CommerciaE 0.l i Valuation; AdL Ar— QUANTITY DESCRIPTION FEE U U W LD m J a v CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: I SMIP: ENERGY P/C: ENERGY PERMIT - RETENTION FEE: PRE -ALT FEE: Z, oo BASF: PLOT PLAN: ZONING CLEARANCE: TOTALFEES COMMENTS: 2-149.8Z PIC' PAID BY: VALIDATION: RECEIPT # PAID BY: c3 VALIDATION: WHITE—Department Copy, YELLOW —Finance Copy, PINK ---Assessor Copy CITY OF Vl'Ak0i ' BAR INSPECTION RECORD COMMENTS: