The URL can be used to link to this page

Home My WebLink AboutPR17-11914CITY 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 ofdiaFnondbar.com buildin FIRMLY BUILDING PERMIT APPLICATION www.cityofdiaFnondbar.com g@d iam:anflbarca.gov JOB SITE ADDRESS Z LOX LGy LA C-6 APN LOT TRACT OWNER -F l'i A ADDRESS i b L IsOx Ley i�A( CITYb`"0 A41- ZIP'911 9 01 TEL. 6 VIZ 16575 APPLICANT S-R—W 0►1Xj. TEL. Jed f -1 7Z CONTRACTOR €C O— JT�C k 4 ,SC-TY4 CSL SEAVI C6 IVC. ADDRESS 1,63q -S. toGj;I v(iLr, Af CITY D yLililill A P 116 617 TEL. M t 27 ARCH/ENG/ DESIGNER 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 reasons) indicated below by the checkmark(s), I have placed next to the applicable Item(s) [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 toy the permit to file a signed statement that he or she is licensed pursuantto the provisions of the Contracbor'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 Iicensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penally of not more than ilve hundred dollars {$bawl (_) I, as owner of the property, army employees with wages as their sale compensation, will do Lj all of or U porticos of the work, and the stmcture is not intended or offered for sale (Section 7044, Business and Professions Cade: The Contractors' Stale License Law does not apply to an owner of property who, through employees' ar 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 OwnerBuilderwill have the burden of proving that it was not built or improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors 10 construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properly who builds or improves thereon, and who contracts fortheprojectswithalicensed Contractorpursuar lotheContractors'State License Law,). U I am exempt from licensors under the Contractor's State License law for the fallowing reason(s): Date: Sign: By my signature below I acknowledge that, exceptfor my personal residence in which I must have resided for at least one Year prior to completion of the improvements covered by this permit,) cannot legally sell a structure that I have built as an owner builder if it has riot 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 el the following Weh site: httplwww.leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my licens sels in full force and effect. LICENSE CLASS: C� 1 ® LIC. NO.: 10 0 1 y 0 5- _ EXP. DATE: .1. t .lam coNrRACTOR: SCA-T'EU'd �,�,'.CMI f1�� t/1! 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 -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work forwhich 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 Carrier and Policy Nji are: CARRIER �c�^�D� �T ji%�i Sr POLICY NUMBER (THIS SECTION NEED NOT BE GOMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLMS $100 OF LESS). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so alto become subject 10 the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Comp ens 'on p isiens of Section 3700 of bor Code, I. i m ly with Shaw provisions. DATE:�� APPLICANT: r _ WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($i OC,000), in addition to the cost of the compensation, damages as provided for in section 3708 ofthe 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 permits; issued (Sec. 3087, Civ, C.). LENDER'S NAME: LENDER'S ADDRESS: I 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 hereby authorize representatives of this county to enter upon the above-mentloned property for inspection purposes. S-T8,No1S 0 TO 9.- PEA E PRIN 1 $/A i I '1 SIGNATURE OF PER TT "' DATE f APPLICATION DATE:/ V� �a % P/C# ISSUE DATE: ! I ! PERI — TYPE CONST. MIA—= rT OCC GROUP: Scope of Work Z.N 5-T�' 1.1 A 2,N Q V 0 LT I SO A)%O OUTIAET e o -j 1541111 ab T * VJ N # 0.J F_orgy * T-651./1 E)/5 # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AHEA/VALUATION SFR/ADDlREM Garage/Carport U Patio/lDeck LU La_ Pool/Spa ZRe -Roof 0_ Commercial 7 m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE a v r� r - U w w CD z M a U Z d z ca CONSTRUCTION: PLAN REVIEW: ELECTRIC: S di _ PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: cs SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: L PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTALFEES cks COMMENTS: PX: PAID 13Y: VALIDATION: RECEIPT #.a". PAID 6Y: VALIDATION: WHITE— Department Copy, YELLOW— Finance Copy, PINK — Assessor Copy COMMENTS: