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Home My WebLink AboutPR16-2832CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS w� (909} 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov LEE jj JOB SITE ADDRESS °-€ f PLICATION DATE: 3 �pP/C# (' a ISSUE DATE: i PERMIT# : ` II— C�' APINESOT TRACT w TYPE CONST. OCG GROUP: E— OWNER � � �M'��--r�-'._�� % Zi ADD SS a t 1 ,`' Y 8'aa_. 3 =�_' , ...� s� CITY Scope of Work✓ APPLICANT TEL. o CONTRACTOR ADD S m 1. # DWEL. UNITS #STORIES # BEDROOMS CITY L:7 7-1 r Zip t _-9s DLSIGNEF 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 reason(s) indlcated below by the checkmadc(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 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 o exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any apphcantfora permitsuttjectsthe appllcantto a civil penalty of not more than live hundred dollars ($500). U 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (-) portions of the work, and the structure is net 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' er personal effort, bulli or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or Improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). i €, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contractsforthe pre]ects with a licensed Contractor pursuanttothe Contractors' State License Law.). U I am exempt from licensure underthe Contractor's State License law forthe following reasons) Sy my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one ,ear prior to completion of the Improvements covered by this permit,l cannot legally sell a strire that I have built as an mr'r-builder if It has not been constructed in its entirety by licensed contractors. I understand that a copy of the rpplicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or attire following Web site: http/wvvw.lugirfo.C2.90V/Calaw.html. LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) ff Division 3 of the Business and Professions Code, and my license is in full force and effect. -ICENSF LIC. NO ✓'� �� mow, -�' 4- ' EKP. CONTRAsem. . _ 'Ii�` WORKER'S COMPENSATION DECLARATION I Hi AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. `y 1 have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensaill as provided by Section 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 3700 of the Labor Cade, for the performance of the work for wmhthis pennitisissued. MyWork 's ompensationInsurance Carrier and Poll ayNumberare: N CARRIER PDLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS}. I certifythatin the performance of the work -for which this permitis Issued, l shall not employ any person in any manner so asto become subject to the Wodcer's Compensation Laws of Califomla. And agree that if I should become suhjectto the Worker's Compensation provisions of Section 3700 of the Labor Dole, l shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Workers Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,800), r adlilion to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and aRomey'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, ON. C.), LENDEH'S NAME: LENDER'S ADDRESS: 1 certify that I have read this application and state thatthe above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and [sentry authorize representatives of this county to enter uoorrthp above -mart +bed property for 0sppecfM purl G ,� Ef E(PI'll v DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADiD/REM Garage/Carport Patio/i - PoollSpa Re -Roof Commercial Valuation: Adj. Area: CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:° j r SMIP: ',,; p ENERGY PIC: ENERGY PERMIT: RETENTION FEE: Az.c PRE -ALT FEE: BASF: QUANTITY DESCRIPTION FEE PLOT PLAN: U w Li 0 m PIC:320 PAID BY: VALIDATION: ILL _ RECEIPT ff PAID BY: - VALIQATION: rl U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE:° j r SMIP: ',,; p ENERGY PIC: ENERGY PERMIT: RETENTION FEE: Az.c PRE -ALT FEE: BASF: CC PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: Li 0 PIC:320 PAID BY: VALIDATION: ILL _ RECEIPT ff PAID BY: - VALIQATION: WHITE — Department Copy, YELLOW Finance Copy, PINK—Assessor Copy OR COMMENTS: