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Home My WebLink AboutPR17-0051,�;.. .fit_ - 8B CITY OF DIAMOND BAR 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 tinnv.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS t 1 C1 ouds ResA APN LOT TRACT OWNER -1 2 --- ADDRESS CITY ' . ZIP TEL., I2d V -5* APPLICANT l% TEL. CONTRA C OR ADDRF CITY ZIP1 ARCH/ENG/ ` DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from Via Contractor's State license Law for the reason(s) indicated below by the checkntark(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 Issuance, also requires the applicant for the permit to file a signed statement drat he orsho is licensed pursuant to theprovisfens of the Contractor's State License Law (Chapter 9) Commencingwith Section 7000 of Division 3 of the Business and Professions Code] or that he orshe is exempt from licensure and the basis for the alleged exemption. Any violation of Sect€on 7o31.5 by any applicant fora permit subjects the applicant to a civil penalty of net mare than Iva hundred dollars ($500). 0I, as owner of the property, or my employees with wages as their sole compensation, will do I-) all of ar U 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 uttered for safe. If however, the building or improvement Is sold within one year of completion, the Dwner-Bullifer will have the burden of proving that Itwas 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 7044, Business and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a (housed Contractor pursuant to the Contractors' State License Law.). U 1 am exempt from licensure underthe Centractor's State License law for the fallowing reason(s): Date: . Sign: By my signature below acknowledge that, except for my personal residence ie which I musi have resided fur at least ose year prior to completion of the improvements covered by this pormiLl cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of Ute applicable law, Seeffan 7044 of the Business and Professions Code Is available upon request when this application Is submitted or atthe following Web site: hUp/www.leginio.ca.gov/caiaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7006) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. LICENSE CLASS: LIC. NO.: �I9` EXP. DATE: '7 3 Q CONTRACTOR;� WORKFRISWMPENSATION 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 Workers Compensation, as provided by Section 3700 of the Labor Code, ierthe performance of the work forwhich this permit is issued. I have andwill maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carderand Policy Number are: CAHAIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I ceritythat in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that U I sh wid become subject to the Workers Compensation provisions of Section 3700 of the tabor Code.; shall forthwith comply wigs those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred Btousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for 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 Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.), LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read lhis.application and state tai_ ftghove Information is correct. I agree to comply with all city and county ordinapces'dfilstate laws relatilg [alit€ const on, and hereby aulhpdze.representattves of this county to enter po4a h Y�-meq(IonaQ"" e r sf�RA uses. 1EB ITFE€ NAk OR S16NATURE OF PERMITTEE DATE APPLICATION DATE: ! i! PIC# 17r 0661 ISSUE DATE: PERMIT# : M_+ —0061 TYPE CONST. OCC GROUP: �+ Scope of Work °� • dry/ - # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ: AREA/VALUATION SFR/ADD/BEM Gafage/Carport w PaVoMeck ur rr- PooVSpa ZRe -Roof o Commercial m Valuation: Y�AOz9 Adj. Area: QUANTITY DESCRIPTION FEE J 1 v ` Z C, L cs m J a x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: (o PL.UMBING:. (a l • 2. MECHANICAL:(01.99 INSPECTION FEE: ISSUANCE: _— SMIP: • !-3 ENERGY P/C: ENERGY PERMIT: RETENTION FEE: . PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: 7 _ TOTAL PEES i 0q .9.1 COMMENTS: 5ftP Rib 099 P/C: q PAID BY: �! VALIDATION: RECEIPT) � 4. PAID BY:COLS -VALIDATION:— WHITE— Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITY OF DIAMOND BAR INSPECTION O D COMMENTS: