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Home My WebLink AboutPR17-0556D11�1�1IO�D BAD it CITY OF DIAMOND BAR 11 DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamlondbarea.gov APPLICATION DATE: ISSUE DATE: TYPE CONST. /C# ✓� 1 Pg @y PERMIT# : E Ci OCC GROUP: JOB SITE ADDRESS # STORIES # BEDROOMS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. I APPLICANT TEL. CONTRACTOR ADDRESS/ S CITY IP Th. ARCH/ENG/ DESIGNE DDHE Pool/Spa I ZIP OWN€R-BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable items) [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 issuan ,also requires Bic applicant for the permit to lila a signed statement that he or she Is licensed pursuant to the pro 'lions of the Contractor's Sime License Law (Chapter 9) Commencing with Saation 7000 aE Division 3 of the Busin and Professions Cade] or that he or she is exempt from licensure and the balls ter the alleged exemption. Any violation o ac0on7031.5byany applicantforapermita b(eclsthe applicanttoacivil penalty of not more than five hundred dollars ($ the/ WI,asowaaroltheproperty,ormyemploy with wagesastheirsole mpensaUon,will do{-) all ofor(-)portions of the work, and the structure is not intended lfered for sale on 7044, Rosiness and Professions Code: The Coulracters' Slate License Law does not apply to an or of pro who, through employees' ar personal effort, builds or Improves the property. provided that the Impmvemen o1 intended or pteretl fee sale. If however, the building or Improvement is sold within one year of complefien, the 0 e under will have the burden of preying that it was not built or improved ter the purpose of saie.I. (j I, as owner of the property, am exclusively�0 tracting with lice d Contractors to construct the project (Section 7044, Business and Professions Code: The C,oPRractors' Stale License L does not apply to an owner of property who Cjsfortheprojectswithalicense ntractorpursuant to€haContracturs'State License Law.). builds or improves thereon, andwhXdr,"h L-) I am exempt from flcensure Contractor's State License law for the to ov&g mason(s): Date: sign: By myslgnature below cknowledge that, except for my personal residence in which 1 must have resided for al least one year prior to complej' n of the improvements covered by this permit,] cannot legally sell a structure that i have builtas an owner builder if f has not been constructed in its entirely by licensed contractors, I understand that a copy of the applicable law, Section 7044 ni the Business and Professions Code Is available upon request when this appllcaten Is submitted or at the fallowing Web site: httplvmw.leginio.ca.goylcalaw.html. LICENSED CONTRACTOR'S DECLARATION I herebyaffirm under penalty of perjury that I am licensed under provlslons at Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my lliicee�nss Is In u11 f r e and effect. Cl LICENSE CLASS: LIC. NO,: 1 J E(P.DATE: CONTRACTOR: e WORKER'S COMPENSATLBN DECLARATION I HEREBYAFFIRM UNDER PENALTYOF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a CerGkcale of Consent to SeU-Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, forlhe performance of the work for which this permit is issued. I have and will maintain Workers 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 Compeusaft Insurance Carrier and Policy Number ar : T—. r, CAIRI VVI POLICY NUMBER (IRIS SECRON NEED NOT BE COMPLETED IFTHE PERMTf IS FOR ONE HUNDRED 0 $100 ORLEW. Icertify thatInthe performance ofthe wodrfor which this permit isIssued, Ishall not employ anyp Sunit] any manner soasto become subject to ft Worker's Compensation Lays of Califania. And agree that If I shout ome subject to the Woiker's Compensation prowl of Section 3700 of the Labor Code, I shall fatbvdD comply ase provisions. DATE: APPLICANT: WARNING: Failure to secure rker's Cornpensaton coverage IIs-unl wful, and $hall subject an employer to criminal fines to thousand doU�01'6.000), in to the cost of the compensation, penalties and civil up on adred addition damages as provided for in section 37 he lahor d� Interest, and attemey sfees. CON RUCLIONLENDINGAGENCY I hereby affirm under penalty of perjur�lhat there is a C stcbsU R Lending Agency for the performance of the yank for which this permit is issued (Sec. 3087, Civ. C.I. LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read Oils application and state that the above information is correct. I agree 10 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enterupon the above-menbned props for fnspe 'an purposes. K vyaw PERMTITEE N E SIGNATURE OF POWTHEE DATE APPLICATION DATE: ISSUE DATE: TYPE CONST. /C# ✓� 1 Pg @y PERMIT# : E Ci OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garaga/Carport Patio/Deck tL Pool/Spa Re -Roof n� Commercial m Valuation: Adj. Area: QLIANTITYT DESCRIPTION FEE d U u w a ,r z m61FJ� sl U_ ted' U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:i SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: _ BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: f P/C: PAID BY: VALIDATION: RECEIPT PAID BY: ,--g%(a VALIDATION:, WHITE — Department Copy, YELLOW -- Finance Copy, PINK—Assessor Copy CITY OF DIA-MOAD BAR INSPECTION RECORD COMMENTS: