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Home My WebLink AboutPR17-890CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-70.20 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION wwwcityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS APN LOT TRACT OWNER TJG$ S► 1 ��l� j�� ADDRESS `, Cf i e, P, -K r1 LT4, Sk CITY 1CItA6fl ZIPqiii_ TEL. C1 0`i APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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 items) [Section 7031.5, Business and Professions Code; Any city or county that requires a permit to construct, atter, 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 7000of Division 3 of the Business and Professions Code] or that he or she is exempt from licensors 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). %0 1, as owner of the properly, or my employees with wages as their sale compensation, will doUall oforvportions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: The Contractors' State License Law does not app€yte 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,), (-) 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 forthe projects with a licensed Contractor pursuant to the Contractors' State License Law.). �) I am exemfrom licerpsure under the Contractors Stat License law forthe following reason(s): Date 5 // .5 By my slgna(ure below I acknowledge that, except for 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 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: http/www.leginfe.ca.govlcalaw.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 Cade, and my license is in full force and effect. LICENSE CLASS: LIC. NO.; EAP, DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBYAFFIAM UNDER PENAL FY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensator, as provided by Section 3700 of the Labor Code, forthe performance of the work forwhich this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Palley Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that In the performance of the workforwhich 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 that if I should become subject to the Workers Compensation provisions of Section 3700 ofthe Labor Code, 1 shall foilhwith comply with those provisions. DATE: APPLICANT; WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminai 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 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 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 of this county to enterr[u�pon t`rhe above-ruentioned property for I¢nyspodonn $purposes. 6 �q PERMITL"PETWITTEE SIGNATDATE APPLICATION DATE: 11/ 2 e 1 "7 P/C# P R 8200 ISSUEDATE: aS)\--'k PERMIT#: Vil \-1^ g C..) TYPE CONST. OCC GROUP: g g Scope of Work _C`jI P! i1 dT,FI OE C1 # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD EM,J—ill 4sIn Garage/Carport &.".AYb u Patio/Deck Lu LL Pool/Spa zRe -Roof Commercial Valuation: 8 C' ' V Ad}. Area: QUANTITY DESCRIPTION FEE V it w w z rL Q t V€''Ah c} z a 2 V CONSTRUCTION: {S 1-2� PLAN REVIEW: ELECTRIC: PLUMBING: • &2 MECHANICAL: i o INSPECTION FEE: ISSUANCE: �� '4440 SMTP: "so ENERGY P/C: ENERGY PERMIT: RETENTION FEE: 1Q C]� PRE -ALT FEE: BASF: I . �@ PLOT PLAN: ZONING CLEARANCE: TOTAL FEES . 5Q COMMENTS: P/C: a 14 0 8 PAID BY: VALIDATION: L C RECEIPT # 3 -- 1O PAID EIY: q VALIDATION: WHITE Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITY OF DIAMOND AR INSPECTION Y:: RECORD COMMENTS: