HomeMy WebLinkAboutPR16-1579CITY OF DIAMOND BAR
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DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 6'�
" 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Ilotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com bnilding@diamondbarca.gov
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OWNER -BUILDER DECLARATION
CD . I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason($)
w indicated below by the checkmark(s), I have placed next to the applicable item(E) [Section 7031.5, Business and
Professions Code: Any city or county that requires a permit to construel, 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 g) 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 applieantto a civil penalty
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of not more than five hundred dollars ($500).
® 11, as owner ofthe property, or my employees with wages astheir sole compensation, will do (-) all of or I portions
€ cD of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The
w Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, Wilds
or improves the property, provided that the Improvements are not intended or offered for sale. If however, the building or
O Improvement is sold within one year of completion, the Owner -Builder will have the burden at proving that it was not built
i! or improved for the purpose of safe),
I z( L-)1, as owner ofthe property, am exclusively contracting with licensed Contractors to construct the project (Section
7044, Business and Professions Code: The Centractors' State License Law does not apply to an owner of property who
builds er improves thereon, and who contracts forthe projects with a licensed Contractor pursuantto the Contractors' State
oYr Llcensc Law.).
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U 1 am exempt from licensure under the Contractor's State License law forthe following reason(s);
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By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one
year prior to completion Df the improvements covered by this Prmft,I cannot legally sell a structure that I have built as an
owner -builder it it has not been constructed in its entirety by licensed contractors. k 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/wwwleginfe.ca.govlcalaw.html.
LICENSED CONTRACTOR'S DECLARATION
t 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 license is in full force and effect.
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LICENSF CLASS: �{ LIC. NO.: Ir'l'-
EXP ,DATE: 31 J CONTRACTOR:
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FGLLOWING 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, forthe performance ofthe work for which this penult Is issued.
1 have and will maintain Worker's CDmpensation Insurance, as required by Section 3700 of the Labor Code, for
the perfurmance of the work for which this permit is issued. My Worker's Compersation insurance Carrier and
Policy Number are: ,
CARRIER ." 4... `t% .:5 "�'✓�• ;rte--,..✓':%".
POLICY NUMBER In L 1. ;Li'l
{THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR CINE HUNDRED DOLLARS $100 OR LESS).
I certlfythat in the performance of the work for which Tle. permit is issued, I shall rot employ any person in any manner so as to
become subject to the Worker's Compensation Laws N California. And agree that if I should become subject to the Worker's
Compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions.
DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal
penalties and civll Lines up to one hundred thousand dollars ($100,000), in addition to the cost at 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 $Lata thatthe above information is correct. I agree to comply with all city and
county ordioances and state laws relating to building construction, and hereby authorize representatives of this county to
enter upon the above-mantioned property for Inspection purposes.
PERMITTEE NAME (PRINT)
SIGNATURE6FPERMITTEE - DATE
APPLICATION DA
ISSUE DATE:_
TYPE CONST
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MECHANICAL:
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OCC GROUP:
Scope of Wor
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSE ADJ. AREANALUATION
SFWADD/RENT
Garage/Carport
Patio/Deck
PcoVSpa
Re -Roof
Commercial
Valuation: di. Area:
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CONSTRUCTION: e7. S
PLAN REVIEW:
CLCD1H :
PLUMBING:
QUANTITY —DESCRIPTION FEE
MECHANICAL:
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ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
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PLOT PLAN:
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CONSTRUCTION: e7. S
PLAN REVIEW:
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MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY PIC:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
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BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
PIC: AID BY: p
RECEIPT # 06 PAID BY: P`
VALIDATION:
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WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy
UUMM NTS:
Cabinet Installation Master
635 E. Whittier Blvd La Habra, CA 90631
Phone: (562) 691-9001/Fax: (562) 691-9088
License number: 989680
Wednesday, May 24, 2017
To City of diamond bar:
I would like to inform you that I would like to take my name off the following permits, or as your
representative described it to me on the phone call today (cancel the permits) , the homeowner have
denied us access work , we worry that she will be hiring another licensed or unlicensed person to
preform work under my permit, I don't want take responsibility for someone else's work.
This is the permits numbers:
PR16-1579
PR17-0054 For windows.
House address is at :
2520 Crooked Creek Dr
Diamond Bar Ca 91765
Sincerely
Salam Mahmoud
Contractor.