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Home My WebLink AboutPR16-1574p"r CITY OF T� DIAMOND BAR nG " DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES co nc � 2)810 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*diamondbarca.gov APPLICATION DATE: PIC# a JOB SITE ADDRESS `—' a ISSUE DATE: PFRMfT# : C:' APN LOT .TRACT o a t TYPE CONST- OCC GROUP: Wu OWNER d G�%rf ;d '�E r _ � acc ADDRESS ^t= CITY z1Pa �"<` --A Scopeoor vre CD APPLICANT TEL. CONTRACTOR f F,.g : > r i :t <� o �. co ADDRESS S "` # DWEL. UNITS # STORIES #BEDROOMS o CITY 71P `' t'">m. TLL_ ` ej` ''. t — i,— DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport PatialDeak Pool/Spa Re -Roof Commercial Valuation: ` dj. Area: DESIGNEE ADDRESS CITY ZIP TEL. "i OWNER -BUILDER DECLARATION C) _ I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the reasen(s) rind€cated below by the checkmark(s), I have placed next to the applicable item{s) ISection 7631.5, 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 permitto file a signed sfatementthat he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7600 of Division 3 of the Business and Professions Code] or that Its or stle is exempt from licensure and the basis for the alleged exemption. Anyv[olafionofSeclion7031-5 by any applicantforapermitsub}ecfst oappficanttoaciviipenally o of not more than five hundred dollars ($500). ®U 1, as cwneroithe property, or my employees with wages as theirsole compensation, will do (-) all of uL) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Lu Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided thatthe improvements are not intended or offered for sale. If however, the building or CD improvement 1s sold within one year of completion, the Owner Builder will have the burden of proving that It was not built c e or improved for the purpose of sale.). ro ;_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 17044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contractsfor the projectswith a licensed Contractor pursuant to the Contractors' State License Law.). C { } I am exempt from licensure under the Contractor's State License law iorthe following reason(s)i By my signature below I acknowledge that, except for my personal residence in which I must have resided for at leastore year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entlrety 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 is submitted or attire following Web site: hftp/www.loginte.ca.gov/calaw.htrnl. - LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provls[ons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license €s in full force and effect LICENSE CLASS: Q+ LIC. NO.: d dC EXP. DATE:' 4 " 9 1.4'_ CONTRACTOR: WORKER'S COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintaln a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section $700 of the Labor Code, for the performance of the work for which this perilt is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthe Labor Cade, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and CARRIER `r liicyNumberare: . BIER ' •' ,.$`..4..r '4` ek d - 8 i..C' c�-"L A - r q. 'aIIs POLICY NUMBER 1. V�, %N,2i Ts-,.� "'�: +°•" y,x (CHIS SECTION NEED NOT BE COMPLETED IF TNEPERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify ttlatin the performance oftbe work for which this permitis issued, Isbell not employ any person in any mannerso as to become suhjectto the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions otSection 3700 of the Labor Code, I shall forthwith comply with 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 thousand dollars {$100,0¢0), 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 this applicafien and state thatthe above information is correct, I agree to comply with all city and county ordinances and state laws relating to holding construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes. PERMITTEE NAME (PRINT) SIGNATURE'& PERMITTEE - DATE CONSTRUCTION: 6 'f , PLAN REVIEW: �• ELECTRIC: l2 PLUMBING: MECHANICAL: INSPECTION FEE: QUANTITY -,"DESCRIPTION FEE J ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: ' U J w ZONING CLEARANCE: cv J rz J4 PIC: �r AID BY: REG[ PT PAID BY: VALIDATION: VALI zd U CONSTRUCTION: 6 'f , PLAN REVIEW: �• ELECTRIC: l2 PLUMBING: MECHANICAL: INSPECTION FEE: WHITE: — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: ' BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: PIC: �r AID BY: REG[ PT PAID BY: VALIDATION: VALI WHITE: — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy NUVIUAW: COMMENTS: