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Home My WebLink AboutPR17-1044+rr CITY OF DIAMOND BAR DEPARTMENT OF CGS' 1M13NITx & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS f, (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityoidiamondbar.com buihding@diamondbarca.gor�v p APPLICATION DATE: f P/C# ! t ' 0 qT JOB SITE ADDRESS 3r =>G r�,� `"'"'� � t'=`' � `"f `� �°� ISSUE DATE 5 A ( PERMIT# : F�� 1" qq APN LOT TRACT [9a .D. � Ii TYPE CONST. OCC GROUP: OWNERS vr� ADDRESS CITY " , � � sry r �Sz ZIP ] 7 6.S- TEL. '11 ; 6C" 2 S 4" APPLICANT ,. ,_"Ain Sso r —Ti CONTRACTOR f Vim. ADDRESS i CITY ARCH/ENG/ DESIGNER ;•J .�. °�'c•.n v1.lgr i . ADDRESS CITY ZIP'�r�°��TEL� OWNER -BUILDER DECLARATION 7 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason{s) I indicated below by the checkmark(s), I have placed next to the applicable iiem(s) [Section 7031.5, Business and 5 Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any a structure, prior to its issuance, also requires the applicant for the permitto file a signed statement that he or she 5 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] orthat he or she is exempt from licensure and the basis for the alleged exemption. Any violatlon of Section 7031.5 by any applicantfor a permit subjects the applicantte a civil Penalty of not more than five hundred dollars ($5UO). j U I, as ownerof the property, or my employees wHh wages as theirsole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The D Contractors' State License Law dues 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 offered for sale. If however, the building or j improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved forthe purpose of sale.). L f 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 net apply to an owner of property who e builds or improves thereon, and wIrc contractsfor the projects with a licensed Contractor pursuandlo the Contractors' Slide C License Law.). (� t am exemptfrom licensure underlie Contractor's State License law forthe following reason(s): L Date: Signr By my signature below 1 acknoWiedge that, except for my personal residence in which I must have resided for at leastone year prior to completion ofthe improvements covered by this permlt,I cannot legally sell a structure that I have built as an i owner builder if It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Rosiness and Professions Code is available upon request when this application is submitted or atthe following Web site: hapAvww.leginfo.co.gov/ualaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby afflnn under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Rosiness and Professions Code, and my license Is in fill force and effect. n 7� n LICENSE CLASS: �"' � �°" LIC. NO.: 6 C 5� z i DATE '� CONTRACTOR: � WORKER'S COMPENSATION DECLARATION 11 I RER Y AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 3" have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by J Section 3700 of the Labor Cade, for the performance of the work for whirh this permit is issued, I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for Q the performance of the work for which this permit is issued. My Worker's Compensatlon Insurance Canter and Pelicy Number are: G� z CARRIER POLICY NUMRER c� (IBIS SECTION NEED NOT BE C9MPLETEO IFTHE PERMITIS FOA ONE HUNDRED DOLLARS $100 OR LESSj. o i certify that in the performance of tic work for which this pennitis issued, l shall not employ any person In any mannerso roto n become subject to the Worker's Compensation Laws of California, And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. IT DATE: APPLICANT: i WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal w penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, p damages as provided for in section 370E of the labor code, interest, and attorney's fees, d CONSTRUCTION LENDING AGENCY w I hereby affirm under penalty of perjury that there is a Constructor Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, ON. C.). s— LENDER'S NAME: LENDER'S ADDRESS: w � l certify that I have read this application and state that the above information is wmect. I agree to comply with all city and z county ordinances and state laws relating, to building corstmction, and hereby authorize representatives of this county to 5 enter upon the above-mentloned property for inspection purposes. m I,tPv'wil CCID PERMITTEE NAM NTJ -� s 16 yt .� o i l - f 4 2 Sf,GNATURF,.9P" ERMITTEE DATE F— Scope of Worka� a]'" # DWEL. UNITS # STORIES # BEDROOMS. LU LLO C cc DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAfVALUATION SFR/ADD/REM Garage/Carport PatiolDeck Pool/Spa Re -Roof Commercial Valpatian: Adj. Area: CONSTRUCTION: PLAN REVIEW: QUANTITY DESORIPTION FEE J U 2-54 , LAO U w 11! & SMIP: 14 ENERGY PIC: J a PLOT PLAN: z U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: 2-54 , LAO MECHANICAL: INSPECTION FEE: ISSUANCE: & SMIP: ENERGY PIC: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: C.VIVIlVI] I�LClirVllVl�C. TOTAL. FEES ° COMMENTS: PIC: PAID BY, VALIDATION: RECEIPT# IND BY; _ VALIDATION: Lc WHITE — Department Copy, YELLOW — Finance Copy, PINK-- Assessor Copy COMMENTS: