The URL can be used to link to this page

Home My WebLink AboutPR17-6235C7 z 0 J E5 Jul - w (3s -\-e. CI'T'Y OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax- (909) 861-3117 Building Inspection I3otline (909) 839-7027 BUILDI NG PERMIT APPLICATION JOB SITE ADDRESS" 9� eX APN —-� LOT TRACT OWNER ADDR CITY i ZIP TEL. APPLICANT TEL. CONTRACTOR is ADDRE 171 !! CITY ., ZIP TEL. W a ke ARCH/ENG/DESIGNFR ADDRESS CITY ZIP TEL. OWNER-RUILDER DECLARATION I hereby alflrm under penalty of perjury that I am exempt from €he Contractor's State License Law for the reasons) Indicated below by the checkmark(s), I have placed next to the applicable items) [Section 7031.5, Business and Poefesslons 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 siatemerrtthat he orsho Is licensed pursuant to the provisions of the Contractor's state License Law (Chapter9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from Ilcensure and the basis for the alleged exemplion.Any violation of Section 7031.5 by any applicant for a perm t subjects the applicant to a civil penalty of net more than live hundred dollars ($500}. U I, as owner of the property, or my employees With wages as theirsole compensation, will do U all 01 or (-) portions of Ulu we*, and the structure Is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' Slate 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 aro not intended or offered for safe. If however, the building or Improvement is sold within one year of completion, the Owner-Bollderwfll have the burden of proving thatitwas notbullt or improved fur the purpose of sale.). 1-) I, as owner of Ute property, ren exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Cassa: The Contractus' Stale License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for the prolmis with a licensed Contractor pursuant to the Conlraclors' S€ate License Law.). (-) I am exempt from licensure under the Contractor's Stale License law fortho following reason(s): By my signature below I acknowledge that, exceplfof my pemonal residence in which I must have resided for at least one yearpriorto completion of the improvements covered by this permit,i cannot IegaUy sell as€ructure that I have built as an ownar-builder Hit has not been constructed in its enfirotyby licensed contractors.I understand that a wpy of the applicable taw, Section 7044 of the Business and Professions Cade is available upon requestwhen this appfiention is submitted or at the following Website: hOpAvmv.leginfo.ca.govlcalaw.html. BATE: SIGN: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of The Bus€ ess atcd Professions Code, and my license is in full orce and eNecL LICENSE gLAS& s C. .: �✓ �� r DATE: 9 '/ CONTRACTDR: WORKER'S COMPENSATION DEjLdATHON I HERERYAFRRM UNDER P€NALTY Of PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate a1 Consent to SBU -insure fm Worker's Compensation, as pr dud by Section 3700 of the Labor Code, for the performance of the walk forwhich this permit Is issued. I have and will maimin Wprker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work far which this permit Is issued. My Worker's Compensation Insurance Carder and Policy Nom-4ar CARRIER �Zh r__' p POLICYNumER r, z- (THIS SECITON NEED NOT RE COMP(ETFD IFTHE PERMIT IS FOR ONE HUNDRED DOLLARSJ$100) OR Liss). I certify That in the parlormance of Die work for which this permit is issued, I shall not employ any person in any mannef so as to become subject to the Worker's Compensation Laws of Califem a.And agree that if I should became subject to the Worker's Compen lion provisions Section 3700 of 1fio Code, I I Irhvith comply with those pmv€stons. OATS; APPLICANT: 7 WARNING: Failure to secure Worker's Compensation coveragif 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 cast of the compensation, damages as provided far In section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Leading Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ C.). LENDER'S NAME LENDER'S ADDRESS: I cerfify that I have read this application and state thatthe above €nformaVon Iscorrect. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this county to enter upon €€ry above -me tiorinci p rty for inspection purposes. a< ERMITTE M r IGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION DATE: 4 (1/ �/ ISSUE DATE: �—io +�1 PERMIT#, 1PK-",:' VI r �° TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT RW__0 REAR 0 SIDEfSIDE STREET RW ❑ SIDE ❑ PROPOSED USE C 49 # DWEL. UNITS If STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VAWATION SFR/ADD/REM Garage/Carport rn w Patio/Deck LL yooUSRa Z s -Roof Commercial £Y1 M Valuation: Adj. Area: QUANTITY DESCRIPTION FEE JQ v ct w w z m a C=s W 77 CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: 1SSUANCE: a SMIP: Sriia ENERGY P/C: FNERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: f� TOTAL FEES 3 a • 34 COMMENTS: RECEIPT tf PAID RY: 'y 1_I� 4 VALIDATION:-__,_,.__, WHITE---- Department Copy, YELLOW — Finance Copy, PINK--- Assessor Copy, GOLDENROD— File Copy, GREEN —Applicant's Copy 4 COMMENTS: