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Home My WebLink AboutPR17-16703 (8)l aLyi CD 0 0 F cn a s 0 0 LO DI 10SID BAR - CITY OF DIAMOND BAR y DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fag: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamon rca.gov JOB SITE ADDRESS� i APN LOT TRACT OWNER CZ L M ADDRESS CITY ZIP TEL. APPLICANT 0-1:11TEL. :1 311 :J f CONTRACTOR E 3. 4- ADDRE, S CITYi€V"?( ZIPTEL�� 6 ARCH/ENC-,! DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penally 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 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 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 the€rsale compensation, will do (-) all of or L) portions of the work, and the structure is not intended or offered for sale (Seetion 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properly who, through employees' er 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-Bul€der 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 contracts forte projects with a licensed Contractor pursuantto the Contractors' State License Law.). (_) I am exempt from licensure underthe Contractor's State License law for the following reason(sjo 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 petal completion ofthe improvements covered by this permitl 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 appllcation is submitted or atthe following Web site: http/www.lcglnfo.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 To Business and Professions Code, and my license is in full force and effect. LICENSE CLASS. b LIC. NO.: EXP. DATE: CONTRACTOR: WORKER'S COMPE SA ION OEGLARATION I HFRFBY 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 prov y 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 Coda for the performance of the work for which this permit is Issued. My Worker's Compensation Insurance Carder and Policy Number are: i ! CARRIER POLICY NJMRFR rM� i (MIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certifythat in the performance ofthe work for which this permit is issued, I shall not employ any person in any mannerso as to become subject be the Worker's Compensation laws of California- And agree that if I should become subject to the Worker's t Compensation provisions of Section 3700 ofthe Labor Code, I shall forthwith comply with those provisions. F 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 cast of the compensation, i damages as provided for in section 3708 blithe labor code, interest, and attorney's fees CONSTRUGTIDN 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, Civ. Q. LENDER'S NAME: LENDER'S ADDRESS: i 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 unthorrze representatives of this county to enter upgp the above-mentioned property for inspection purposes. i PERMITTEE NAME INT) SEGNATJRE OF P E DATE APPLICATION DATE: 1' Q) ` �� P/C# - - — ISSUE DATE: j 3Z 1 PERMIT# : PR € q TYPE CONST- OCC GROUP: 1 (1 Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/RENT Garaga/Carport n Patio/Deck Lu LL PoCI/Spa ZRe -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J a ca wV J w U z OJ 4' z a T U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: /—Clq MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEF: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: Zi ^Tl PIC: PAID BY: g VALIDATION:&& ( RECEIPT# G9 PAIDBY: L.Pc.1' VALIDATION: L"'�^- WHITE —Department Copy, YELLOW Finance Copy, PINK— Assessor Copy COMMENTS: