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Home My WebLink AboutPR16-2604 (12)DWHOND BAR •� may. . 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@diamondbarca.gov JOB SITFADDRESS C_r00k:0 J!J4XeX APN -9r! LOT I dl�- TRACT C / OWNER I 141A�_ _ �� ", ADDRESS r CITY ZIP=TEL - APPLICANT T. ? TEL �s`�ii . °?i CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ I a DESIGNER ADDRESS _' f.' CITY , a" ZIP V� TEL 9tr �i�m ✓ ` OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason{s) Indicated below by the checkmark(s), € 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 statementthat he or she is licensed pursuant to the provisions of the Contractor's State License taw {Chapter 9) Commencing with Sectan 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 or(-) portions of the work, and the structure is not intended or offered for Sala (Section 7044, Business and Professions Cade: The Contractors' State License Law does not 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-Bulider 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 w€ih 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 pursuantto to Contractors' State License Law.). U t am exemptfrom licensure underthe Contractor's State License law forthe following 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 priorte compietiun rf the improvements covered by This permit,) cannot legally sail 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 Buslness and Professions Code Is available upon request when this application is submitted or at the following Web site: httplwww.leglnfo.ca.govlcalaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hemby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of tate Business and Professions Cade, and my license is in full force and effect. LICENSE CLASS. LIC. NO.: EXP. DATE: CONTRACTOR', WORKER'S COMPERSATION 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 Compensator, as provided by Section 3700 of the Labor 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 ofthe work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Panty Number are: CARRIER POLICY NUMBER (MIS SECT10N NEED NOT BE COMPLFTFD IF THE PEPMITiS FOR ONE HUNDRED DOLLARS $100 OR LESS). 1 certifythat in the performance of the workfor which this permit is issued, I shall not employ any person in any manner so Este become subjeetto the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply with those provisions. UATL APPLICANT: 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 ($100,900), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, aryl 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 Irereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. i i PERIA TEENAME(PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION DATE: ft��-F PIC# ISSUE DATE: PERMIT T� 4— TYPE CONST. OCC GROUP: g ��,%% Scope of Work ,Ili X2M fY'..�t�li,?' r # DWEL. UNITS # STORIES y IT BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFFIVADBIREM Garage/Carport W Patio/Deck W r� Pool/Spa - zRe -Roof Commercial m 1/aivatiotr: '' 7 ` � Adj. Area: QUANTITY DESCRIPTION FEE d r U w w m a ec, .� U_ zd x CONSTRUCTION: _ PLAN REVIEW: ELECTRIC: C.1 �F 7 - vPLAN ' PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: " SMIP:a. ENERGY P/C: ENERGY PERMIT: RETENTION FEE:• PRE -ALT FEE: BASF: d PLOT PLAN: ZONING CLEARANCE: e TOTAL FEES ( COMMENTS: [ 3fo 7/ PIG:��+F - _pp:PAID BY: C�- qq VALIDATION: RECEIPT tvPAID EIY: F/ l VALIDATION: r WHITE — Department Copy, YELLOW— Finance Copy, PINK —Assessor Copy COMMENTS: WALNUT VALLEY,UNIFIED SCHOOL DISTRICT 880 SOUTH LEMON AVENUE, WALNUT CA 91789 CERTIFICATE OF COMPLIANCE With Fee Provisions of Government Code Section 6559996 fy� DEVELOPER/OWNER � " i r ' � Q ADDRESS CITY/ZIP qLL TELEPHONE Signature of Applicant The person signing represents that he/she is authorized to sign on behalf of the owner/developer and that the Information provided is true and accurate to the best of his/her knowledge. NEW CONSTRUCTION PROJECT r- r> Lo, LOT ADDRESS BURDINGUSE TOTAL 5Q. FT. City Residential/ Commercial/industrial HOME IMPROVEMENT OR REMODELING PROJECT ADDRESS DESCRIPTION TOTAL SQ. FT. � 5 � � Gino � �� , �r��.�. Adm �-� ��► _ o� Gi � . '� 3 Diamond Bar Walnut (Bedroom, Family Rm., Kitchen, etc.) Other City Signature of Superintendent of Buildings Date (4 TO BE COMPLETED BY SCHOOL DISTRICT FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAI,,,FEES DUE School District under provision of Government Code §65995 $ --� Are (EFF. 12!1108) Residential Development $2.97/sq. ft. Receipt # R1,9 Commercial/Industrial $0.47/sq. ft. Date Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet (eliminating garage or uncovered patio). ❑ This is to certify that all fees are due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. This is to certify that the above described development has been determined to be EXEMPT from the development fees of Government Code Section 65995 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET OTHER Celia Moynihan Director, Fiscal Services 1187 Rev. 2188; 6188; 8/89; 1/90; 8/90,10/90; 8/92; 6193; 11193; 8/94; 6/96; 1/9718/98; 7104; 6106; 2/08; 12108; 1113; 6116