The URL can be used to link to this page

Home My WebLink AboutPR17-100950 z CD 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 ( ) ( ) g p ( ) FIRMLY 'gig BUILDING PERMIT APPLICATION wwwcityofdiamondbar.corn building@diamondbarca.gov JOB SITE ADDRESS - �F Tey APN LOT TRACT OWNER ADD S CITY ��]' �"fmP TEL" r APPLICANT TEL. CONTRACTOR ADDRES fid`°� v V r CIN 7.i �y 71 : EL ARCH/ENG/ C DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury chat I am exempt from the Contractor's State License Law for the reasons) indicated below by the checkmark(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 censil 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 vlolation of Section 7031.5 by any appllcantfor a permit subjects the applicant to a civil penalty of not mare than five hundred dollars ($500). 11, as owner of the property, or my employees with wages astheir sole compensation, will do (_) 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 Contractors' State License Law does rot 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 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.). (,1, 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 contracts forts License Law.). U I am exempt from licensure under the Contractor's State License law for the following reasorl 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 prior 10 completion of the improvements covered by this permit,) cannot legally sell a structure that I have built as an owner-bullder 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.govlcalaw.hlml. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of penury that I am licensed ander provisions of Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business and Professions Code, and my license is in full force and�ct. LICENSE CLASS: LIC. NO.:f EXP. DATE: - CONTRACTOR: WORKER'S COMPENSATION DECLARATIDN I HEREBY AFFIRM UNDER PENALTY OF PER3JRY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the tabor 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 ofthe Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carter and Policy Number are: r _ CARRIER"° POLICY NUMBER (THIS SECTION NEED NOT BE COMP' D IF THE PERMfT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as, to become subject to the Worker's Compensation Laws of California. And agree r�51 ould Rcome subject to thh„4hordcer's Compensation oti 'ons fon 3700 ofthe Labor Code, I shall fo co ar$ro'As' PUCANT: 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 {$100,000), 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 Consbhction 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 application 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 ofthis county to enter upon the above-mentioned prop a 1y for inspection purposes, �..._.- PERMITTEE NAME {PAIN ,_f a., ✓ p SIGNATURE CF`PFRMI r' DATE f APPLICATION DATE: ?'/Z& 17 P/C# PRI -4— if 0095 ISSUE DATE: A 6/1 -4- PERMIT# : P lz i �- -` 16 (39 ] TYPE CONST. OCC GROUP: Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport rn ua Patio/Deck ua Lr- Pool Re -Roof Commercial 00 Valuation: Adj. Area: QUANTITY DESCRIPTION FE E a v r U w z m J J Q U_ x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: BB MECHANICAL: INSPECTION FEE: ISSUANCE: 36 - 12 - SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE ALT FEE: Z. BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL. PEES COMMENTS: 181. 12 PIC: PAID BY: RECEIPTp 35839 PAID BY: L;) 4q VALIDATION: VALIDATION: LC_ WHITE — Department Copy, YELLOW —Finance Copy, PINK—Assessor Copy offRiagot 1:101 LIN N COMMENTS: