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Home My WebLink AboutPR16-2832 (7)+� CITY OF DIAMOND BAR I 1'1 = 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.conlf building@riiamondbarca.gov I:= & a JOB SITE ADDRESS CD APN s ,�OT TRACT Wu OWNER = .: ` 3 •�' cn � ADD . S = cf:¢ CITY t� ��ttew� I m� CD APPLICANT TEL. o CONTRACTOR ro ADD E S' �i a CD CITY " ZIP ~✓ r�� t� LL ARCH/ENG/ z DESIGNER CD n ADDRESS m CITY ZIP TEL. rr OWNER -BUILDER DECLARATION CD I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reasoa(s) oindicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and z Professions Code: Any city or county that requires a permitto construct, after, improve, demolish, or repair, any a structure, prior to its issuance, also requires the applicant far the permitto file a signed statement that he or she rn is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 5= 7000 of Division 3 of the Business and Professions Code] orthat he or she is exemptlrom licensure and the basis far �4- the alleged exemption. MyviolatinnofSectien7031.5byanyapp€icantforapermit subjects the applicanitoacivllPenalty 'I- of not more than five hundred dollars ($500). 0 ( j I, as owner of the property, or my employees with wages as theirsole compensation, will do i all of or O portions ® of the work, and the structure 1s 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, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or oimprovement is sold within ane year of completion, the Owner Builder will have the burden of proving that it was not built or improved for Cie purpose of safe.). C1 GJ 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 contractsfortheprojectswithalicensed Contractor pursuant To Contractors'State 0 License Law.). `) I am exempt from ficensure underthe Contractor's State License law fmThe following reason(s): ILL a Date: Sign: o By my signature below I acknowledge that, exceptfar my personal residence In which l must have resided for at least one Q � year prior to completion of the improvements covered by this permit,k cannot legally sell a structure that I have built as an a owner -bonder if h has not been constructed in its entireFy by licensed contractors. I understand that a copy of the ,x1, applicable law, Section 7044 of the Business and Professions Cade is available upon roquest when this application is CD submitted oratthe folio ingWebsite:httplwww.loginto.ca.gav/caiaWhirnl. v LICENSED CONTRACTOR's DECLARATION mI hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Code, and my license is In full force and effect. 0 ate-',,- ✓& LICENSE CLA. LIC NO ,� ,,,, ss FXP. - .. CUNTRA.0 *, o WORKER'S COMPENSATION DECLARATION k H f BY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: o ' I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Cade, 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 Cede, for athe performance of the workfor which this permit is issued. My Work 's Compensation Insurance Carrier and o Policy Number I L " CARRIER ]r CDPOLICY NUMBER 7 d F-: (THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 ORLESS). �CODI cedifythat in the performance of to work for which this permits Issued, I shall not employ any person in any manner so as to p became subject to the Worker's Compensation Laws of Cabfomla And agree that if I should become subject to the Worker's J Compensation provisions of Section 3700 of the Labor Code, I shall forthwith cool those provisions. DATE: APPLICANT'. WARNING'. Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal ED penalties and civic fines up to one hundred thousand dollars ($100,000), In addition to the cost of the compensation, Q damages as provided for in section 370E of the labor code, interest, and attorney's fees. a CONSTRUCTION LENDING AGENCY LU I hereby affirm under penalty at perjury that there is a Construction Lending Agency for the performance of the work for = which this permit is issued (Sec. 3097, ON, C.). F- LENDER'S NAME: LENDER'S ADDRESS: LU I certitythat l have read this application and state that the above information Is correct. I agree to comply with ail city and r� county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to z f' o enter yperttt above- Awed property for spec ion purposes. P EE kAVE(PHI" ' E S NATURED _� s .-•,.. ATE °APPLICATION DATE: I �r 1 to PIC# I ISSUE DATE: C. � PERM IT# TYPE CONST Scope of Work f # DWEL. UNITS # STORIES OCC GROUP: I # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/RFM Garage/Carport Patio/Deck Pool/Spa Re -Roof Commercial Vahlaftili A,11 Area: MI WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy QUANTITY DESCRIPTION FEE J U w w z 0. U_ zd x U MI WHITE — Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy N "' VUIVIMLN 15: