The URL can be used to link to this page

Home My WebLink AboutPR17-4803Dir01010 BAR S 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 www.cityofdiamondbar.com building@diamondbarea.gov JOB SITE ADDRESS APN 0I -3�01 LOT TRACT OWNER � -2A ADDRESS ✓ ✓l 1 CITY f ZIP P-70�;TEL. M A 5 APPLICANT 0- Iks<Ot4 A"fV'l TEL.0 Z41. 7 - CONTRACTOR g ADDRESS y €X�� "� Sl � �� 47 ARCH/ENG/ �r DESIGNER ADDRESS>��(�� CITY TEL. _ -2 OWNER -BUILDER DECLARATION i k hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasons) indicated below by the checkmark($, I have placed next to the applicahle item(s) [Section 7{31.5, 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 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 is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as theirsole compensation, will do U all of ort) portions of the work, and the structure is not rtmded or offered for sale (Settler 7044, Business and Professions Code: The Contractors' State License Law does net apply to ar 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 of improvement is sold within one year of complotlen, the owner -Builder will have the burden of proving that €t was not built or improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the pro}ect (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 contracts forthe projects with a licensed Contractor pursuant to the Contractors' State License Law.), L) I am exempt from licensure under the Contractor's State License law forthe following reason{s): Date: sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year priorto completion of the Improvements covered by this permit,) cannot legally sell a structure that I have built as an 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 Business and Professions Code is available upon request when this application is submitted or at the following Web site: httplwww.leginfo.ca.gcv/calawhtmL LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (cemmendng with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. LICENSE CLASS: CIO LIC, NO.: IoD,3 ® 1 I DATE: r CONTRACTOR uiv_ fs°4f' L��✓�� T� WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I have and will maintain a Certificate of Consent to Self -Ensure for Worker's Compensation, as provided by Section 3700 of the I ahor 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 Code, for the performance of the work for which this permit Is issued. My Workers Compensation Insurance Carrier and iPolicy Nu75-1-,- POLICY ber CARRIER sT,- POLICY NUMBER / PHIS SECTION NEED NOT OF COMPLETED IF THF PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I conflythat in the performance of the work for which this permitls issued, I shall not employ any person in any manner so a; to become subject to the Worker's Compensation Laws of California. And agree that it I should become subject to the Worker's iCompensation provisions of Section 3700 of Yue Labor Cade, I shall forthwith comply with those provislons. DATE: APPLICANT: i WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal i penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, i damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY i I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: i I certify that I have read this applfcaton and state that the above information Is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to j enter ap Pe above-mentioned pr for in pealien purposes. PFRMI EF E( INT) ---�- SIGNA F fTTEF DATE APPLICATION DATE: tall. 15 tq P/C# P$ \a _14801 ISSUE DATE: l PERMIT# TYPE CONST. OCC GROUP: Scope of Work✓ ��9� # DWEL. UNITS # STORIES h�✓��i� %�Ifdi # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREV GaragelCarport CO Patio/Deck LU LL PooVSpa ZRe -Roof Commercial 03 m Valuation: Adj. Al QUANTITY DESCRIPTION FEE a v w w cv z m ci a y �d x U CONSTRUCTION: e PLAN REVIEW: Oq °� • o' ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: %ZZ SMIP: �7r ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES en COMMENTS: oI / P/C: s�� PAID BY: gg aa RECEIPT # Ill PAID BY: i U VALIDATION: eV6 VALIDATIDN: Y0 WHITE —Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy RMI a=-Lfsl LOU KWU COMMS